Primary teeth with pulpal exposure or pathology must always be treated, either by root canal treatment or by extraction. The maintenance of arch length is important for good masticatory function and the future eruption of the permanent dentition with optimal development of the occlusion. Whilst it is preferable to conserve a tooth rather than carry out an extraction, if this does become necessary, balanced extractions should always be kept in mind. A balanced extraction is the removal of a tooth from the opposite side of the same arch. A compensating extraction, removing a tooth from the opposing arch to the enforced extraction is more difficult to justify.
Balanced extractions are rarely justified for primary incisors. The loss of a primary canine, however, may have a significant effect on the arch and balanced extractions should always be considered. When a primary molar has to be extracted it may be preferable to prevent drifting with a space maintainer than carry out balanced extractions.
Balanced extractions are rarely justified for primary incisors. The loss of a primary canine, however, may have a significant effect on the arch and balanced extractions should always be considered. When a primary molar has to be extracted it may be preferable to prevent drifting with a space maintainer than carry out balanced extractions.
Extractions should be avoided wherever possible in certain groups of children; ie those with bleeding disorders, or medical conditions such as diabetes where general anaesthesia is contraindicated. Primary teeth should also be retained where a radiograph reveals the lack of a permanent successor, as in Figure 3, where the patient may find pulp therapy less stressful than extraction, and in an already crowded dentition where tooth loss would lead to even further crowding of the permanent teeth.