A decayed baby tooth: treat it or take it out?
Usually it is treated, not left because it is “on its way out”. A baby tooth holds the space for the permanent tooth beneath it, and decay in it can hurt and get infected just as in an adult. Extraction becomes the choice when the tooth can no longer be saved or the permanent tooth is ready to come through, and the examination and x-ray decide that, not age alone.
Hours: Sat–Wed 10–6 · Thu 10–4 · Fri closed
Why treat it, if it is going to fall out anyway?
Because it is not falling out tomorrow. A baby tooth has a job to do until the permanent tooth arrives, and some of the back baby molars stay in your child’s mouth until they are around ten or older. So a molar that decays at four still has years ahead of it in the mouth, not weeks.
First reason: it holds the space
A baby tooth keeps the room for the permanent tooth forming beneath it. If it is lost early, the teeth beside it can tip into the gap and take some of that room, especially when it is a back molar, so the permanent tooth may come through into a tighter space. That can show up later as crowding, or as a tooth coming in out of line.
Second reason: it can hurt and get infected like an adult tooth
A baby tooth has roots and a nerve, just like a permanent one. The layer protecting the nerve is thinner, and the nerve itself is larger for the size of the tooth, so decay reaches it faster than in an adult. Once it does, it usually hurts, and your child struggles to eat and sleep.
And the permanent tooth underneath?
Under a baby tooth there is usually a permanent tooth forming, and an infection sitting above it for a long time can affect it. And decay in a baby tooth means whatever caused it may still be at work in the mouth, so the visit is a chance to find what is causing it and stop it (sugar and brushing) before the permanent tooth comes through into the same mouth.
And note: the molar that comes in behind the baby molars at around six is permanent, not a baby tooth, so decay in it should not wait.
What happens if we leave it?
A cavity does not close up on its own, and it usually grows if left untreated, faster in a baby tooth. There is no fixed time before it reaches the nerve: it varies from tooth to tooth and from child to child, depending on sugar, brushing and how deep the cavity was to begin with. This is what can happen if we wait:
- Pain. It starts with cold and sweet things, then it may come on by itself, at night, and wake your child up.
- Abscess and swelling. If the nerve becomes inflamed and dies, the infection spreads below the root: a bump on the gum, a swollen cheek, or a fever.
- Bigger treatment. What a small filling could have fixed now needs nerve treatment and a crown, or an extraction.
- Lost space. If the tooth has to come out early because of the infection, the space it was holding for the permanent tooth can be lost.
- An effect on the permanent tooth. A long-standing infection above the permanent tooth can affect it while it is still forming.
And if they are not complaining?
That does not mean the tooth is fine. Sometimes the nerve dies quietly and the infection sits under the root without obvious pain. A young child cannot always describe pain, or remember when it started, so they say “it doesn’t hurt” while chewing on the other side. That is why the examination and the x-ray tell you more than they can.
The options, depending on how far the decay has gone
Treatment follows how deep the decay is, not your child’s age alone. The depth shows at the examination, and on an x-ray too, because decay between the teeth often cannot be seen by eye. The good news: the earlier it’s caught, the smaller and easier the treatment usually is for your child.
| How far the decay has gone | The usual option | What it means for your child |
|---|---|---|
| A dull white spot that has not become a cavity yet | Care that aims to strengthen the surface again: fluoride at the clinic, brushing, and less sugar | No drilling, no needle, and follow-up |
| A small or medium cavity | A tooth-coloured filling | Local anaesthetic when needed, usually one visit |
| Large decay that has taken a big part of the tooth | A small crown for the baby tooth that covers it on every side | It protects what is left of the tooth, aiming to keep it until it falls out on its own |
| It has reached the nerve, and the tooth can still be saved | Nerve treatment for the baby tooth, usually followed by a crown | The aim is to keep the tooth in place, doing its job as a space holder |
| It can no longer be saved, or the permanent tooth is ready to come through | Extraction, with a small appliance to hold the space if needed | The doctor tells you whether the space needs protecting until the permanent tooth arrives |
The white spot: there is still a chance to stop it here
Decay starts as a dull white spot, often along the gum line. At this stage the surface has not broken yet, and it can harden again: fluoride works its way into the surface of the tooth and helps it resist acid. The clinic can paint on a fluoride varnish, repeated every few months depending on how prone your child is to decay. Add brushing with fluoride toothpaste and fewer sugary snacks between meals, and the spot may stop there and never become a cavity. Fluoride for your child’s teeth: helpful or harmful?
Filling or crown?
A small cavity is treated with a tooth-coloured filling, as for an adult. Tooth decay and fillings: what it is, and how it is treated.
But when decay has eaten a large part of the tooth, or has spread over three or more of its surfaces, a large filling is weaker and may crack or come out. Here a small crown covers the whole tooth and protects it better, with the aim of keeping it until it falls out on its own. Crowns for baby teeth are a different thing from adult crowns, with different materials and a different method, and the doctor chooses the type by where the tooth is and how much of it is left. And if the tooth is about to fall out anyway, a crown is not needed.
When it gets close to the nerve, or reaches it
Sometimes the decay is deep but the nerve is still healthy. Here the doctor cleans out the decay, tries not to uncover the nerve, and seals the tooth well. If it turns out deeper than expected, you’ll be told then, before any further step.
If the nerve is inflamed, there is a nerve treatment for baby teeth that removes the inflamed part, aiming to keep the tooth in place, usually followed by a crown because the tooth is weakened. If there are signs the nerve is more affected, such as pain that wakes your child at night, or swelling, the doctor then weighs nerve treatment against extraction, with the examination and the x-ray.
When is taking it out the right call?
An extraction is not a failure or a punishment; sometimes it is the right treatment. It becomes the choice in cases like these:
- The tooth can no longer be saved. Decay has gone down below the gum and below the level of the bone too, and nothing is left to hold a filling or a crown.
- The infection has gone too far to treat. An abscess that has spread far enough to affect the permanent tooth beneath, or an infection that does not respond to nerve treatment.
- The permanent tooth is ready. The baby tooth is loose, its root is almost gone, and the permanent tooth beneath is about to come through, so the baby tooth has no job left.
- Your child’s general health changes the picture. Some heart conditions make the doctor unwilling to leave an infected tooth in the mouth, and some bleeding problems make him try to keep the tooth before taking it out. So tell us about your child’s full health from the first visit.
If it comes out early: what holds the space?
When a baby molar comes out before its time, especially a back one, the teeth behind it can drift forward and take the space kept for the permanent tooth. So the doctor tells you whether a small appliance is needed to hold the space until the permanent tooth arrives, and when it comes off. My child's teeth have gaps, or they overlap. Is that normal?
And before any extraction, you’ll be told why extraction rather than another treatment, and what happens afterwards. The decision is made with you, not for you.
What you can do starting today
- 1
Lift their lip and lookIn good light, look at the front teeth along the gum line, and at the tops of the back teeth. A dull white, brown or black spot, or a hole: take a photo to show the doctor at the appointment, and mention it when you book. Not every dark spot is decay; the examination tells them apart.
- 2
If it hurtsA suitable painkiller, chosen by the pharmacist or doctor for your child’s weight, and do not put a tablet or anything else on the tooth or gum. A painkiller calms the pain; it does not treat the cause. Is your child crying with toothache? Here's what to give, and what not to.
- 3
Cut down sugar between mealsSweets, juice and biscuits between meals are what feed decay, and how often matters more than how much. Make water, not juice, the drink between meals and at night, and give the last bottle of milk before they fall asleep, not while they are asleep.
- 4
Brush twice a day, and you do the brushingWith a fluoride toothpaste: a smear the size of a grain of rice under three, and a pea-sized amount from three to six. A young child needs your hand on the brush, not just your eyes on them. The most important brush is after the last feed, last thing before bed; after that, only water.
- 5
Book the examination before it growsDon’t wait for pain. A spot caught today usually needs smaller treatment than a cavity caught months later. And prepare your child with a few calm words, without mentioning needles or pain.
When not to wait
Go to the nearest hospital emergency department now, not an appointment:
- Difficulty breathing, swallowing or speaking. If they’re struggling to breathe, call an ambulance on 911 rather than driving them yourself.
- Swelling that has reached the eye or below it, or the neck.
- Swelling or a fever, and they’re unusually drowsy or floppy, or won’t drink.
- A knock to the head, with dizziness, vomiting or any loss of consciousness, even for a moment.
And let us know afterwards.
Call now:
- Swelling in the cheek.
- Swelling under the jaw.
- Fever with the pain.
- Difficulty opening the mouth.
If the clinic is closed or you can’t reach us: go to the nearest hospital emergency department. Don’t wait.
Call today:
- Pain that wakes them up, or stops them eating.
- A swelling on the gum without a fever, or a bump or blister on the gum next to the tooth.
If we are closed, call as soon as we open. We will tell you the earliest available slot, and what to do until you arrive.
A knock to a tooth, or a tooth broken or knocked out? Call right away. If it broke, keep the piece in milk if you find it. If a tooth has come out completely and it’s a permanent one, or you’re not sure: hold it by the white part, not the root, don’t scrub or dry it, and put it in a cup of milk; if the clinic is closed, take it with you to the nearest hospital emergency department.
Questions people ask
What happens if you leave a decayed baby tooth?
The cavity does not close on its own; it usually grows. In a baby tooth it reaches the nerve faster, and the treatment it needs grows with it. Sometimes this happens without obvious pain, so silence is not a sign the tooth is fine. What happens if we leave it.
When is tooth decay in children serious?
When it reaches the nerve or causes infection: swelling, a fever, or pain that wakes them up. These don’t wait, and what to do for each one is here: When not to wait.
Can tooth decay be removed without a filling?
Early on, sometimes. While it is still a white spot and not yet a cavity, the surface can harden again with fluoride at the clinic, good brushing and less sugar, and stop there. Once it becomes a cavity, it does not close on its own, and it usually needs treatment at the clinic depending on its depth; the doctor talks you through the options.
How do I know if decay has reached the nerve?
Some signs point to it: pain that comes on by itself without eating, pain that wakes your child at night, swelling, or a bump on the gum next to the tooth. But there are not always signs, so the sure answer comes from the examination and the x-ray, not from the pain alone.
Can you get rid of a cavity at home?
Not the cavity itself. Decay is damage done by the acid that bacteria make from sugar, and the hole it leaves can only be dealt with at the clinic. What is in your hands at home is stopping it from growing: brushing twice a day with a fluoride toothpaste, and less sugar between meals. If there is pain, a suitable painkiller chosen by the pharmacist or doctor for your child’s weight, and nothing put on the tooth. Then the examination.
Your next step
An examination for your child, with an x-ray if needed. If they’re happy to be examined, you leave knowing how far the decay has gone, what the options are for that particular tooth, and what happens if we wait. Any treatment is discussed before it is done.
Pages that go with this one
This is general information, not a diagnosis of your child’s case. The decision is made at the examination.