Sometimes baby teeth just hang around for too long. They become loose then tighten again as the emerging adult tooth becomes increasingly deflected from an ideal position in the dental arch. Some baby teeth just seem to be hanging by a thread making eating and brushing very difficult and painful. Plaque can build up around the gum line of both the baby tooth and the emerging adult tooth placing it at risk of early decay or at least mineral loss. The gums may bleed excessively on brushing causing distress.
Patience is the first course of action as many of these baby teeth will eventually be lost naturally. If pain and gum infection become a problem so that eating and brushing are an ordeal then removal of the tooth may be necessary. If the baby tooth has become quite tight again and the adult tooth is deflected from an ideal position then it may be necessary to remove the baby tooth. Some children suffer from this problem repeatedly while others will have an isolated problem with only one or two teeth affected. The most common position is in the lower two central incisors. The next most common is the upper two central incisors.
The loose baby tooth can sometimes be removed by applying some topical anaesthetic gel to the gum line around the tooth. The gel is flavored and after three to five minutes causes the gum to become ‘numb’ or ‘frozen’. It is then possible to pinch the tooth away with some light pressure and a piece of gauze. Parents may be able to do this for their child by using a preparation like ‘bonjela’ to ‘numb’ the gum first. If the tooth does not come away easily it may be quite painful for the child if you persist. Dentists are generally quite experienced at determining whether or not local anaesthetic will be necessary.
A firm baby tooth may require the use of local anaesthetic. Topical anaesthetic is first applied for three to five minutes and then an injection of local anaesthetic is used to totally ‘numb’ or ‘freeze’ the area. The injection can be quite painful for a second or two and it is best to warn the child that it may be a little painful or uncomfortable similar to a ‘mozzie’ bite or pinch. Some children may not feel anything at all.
Children respond well to a kind approach and firm instructions such as remaining very still and opening wide. They understand the importance of being safe and minimizing the discomfort. Your dentist has developed a sensitive and positive approach to the use of local anaesthetic and is very experienced in safe and reliable injection techniques. It is best to keep the answers to your child’s questions brief and simple. If you are unsure about the precise nature of the procedure then it is best to tell your child to ask their dentist for information on the day of the procedure.
It is not usually necessary to use any other form of sedation or pain relief for this type of simple procedure. Post operative pain management is usually unnecessary. Although the gums bleed profusely with the loss of a tooth it is usually short lived and settles best with some pressure by biting on a pad of clean gauze as supplied by your dentist.