Cavities in Baby Teeth: To Fill or Pull?

By Premier Dental of Ohio

Learn why pediatric dentist appointments are important

This is a common question we hear from parents when they discover their children have cavities.  Because baby teeth do fall out and permanent teeth replace them, it is a valid question.  The answer to that question will actually vary depending on multiple factors.  However, in general, it is safe to say that it is usually better to fill a baby tooth than to pull it.  Here’s why.

Importance of Baby Teeth

Baby teeth, also called primary teeth, come through the gums between ages six months to two years, on average.  They serve many important functions.


As babies grow, they need nutrition outside of what they get in milk or formula, so parents begin to add food into the diet.  In order to properly digest the food and receive these vital nutrients, they must be able to chew the food.  Chewing breaks down large food particles to reduce the risk of choking, and salivary enzymes begin breaking down certain compounds in the food molecules.

Baby teeth are a necessity for good nutrition as your child grows.


As a baby learns to speak, the presence and position of the baby teeth is important.  Missing or improperly placed teeth will affect speech patterns and cause a noticeable speech impediment.  Healthy baby teeth are necessary for the normal development of speech.

Development of Jaws

The way the baby teeth come together in the bite affects the way the upper and lower jaws develop and grow..  Again, missing or improperly placed baby teeth can adversely affect the growth and development of the jaws.  This can lead to severe orthodontic problems in the future, requiring long courses of treatment and possibly even jaw surgery to correct them.

Development of Facial Appearance

Much of the appearance of the face is determined by the development of the upper and lower jaws.  As a child grows, the teeth help to position the jaws, lips and chin into a natural facial appearance.

Maintenance of Space for Permanent Teeth

All permanent teeth but the molars form beneath the roots of the baby teeth.  When they have fully formed, they begin to push through the gums, dissolving the baby teeth roots and taking the position held by the baby teeth.  The baby teeth work to hold that position, like saving a spot, for the permanent teeth.  When a baby tooth is naturally missing, often the permanent tooth is also absent.

Consequences of Pulling Baby Teeth Early

Baby teeth are meant to fall out on their own when the permanent teeth underneath are ready to push into the mouth.  There are consequences to removing a baby tooth before the permanent tooth is ready to emerge.

In cases of a single baby tooth, the most common problem to develop after early removal is orthodontic in nature.  Without the baby tooth to hold the space for the permanent tooth, surrounding teeth collapse into the empty space.  This can cause the submerged permanent tooth to come into the mouth only partially, in the wrong position, or at an awkward angle.  In rare cases, the permanent tooth is unable to come into the mouth at all, which is a situation called “impacted”.

When multiple baby teeth are missing from early removal, the entire dental arch can collapse, making it smaller and narrower.  The small size leads to severe crowding of the permanent teeth.  A narrow arch can affect the child’s ability to breath, leading to snoring and airway problems.

Why Cavities are More Concerning in Baby Teeth

Children are more susceptible to tooth decay than adults are.  There are two reasons for this:

  1. Thinner Enamel

The layer of enamel covering baby teeth is significantly thinner than that covering permanent teeth.  All cavities begin with a process called demineralization. This is a softening or weakening of the hard outer shell of enamel.  At this stage, the process can still be reversed, meaning no treatment is necessary on the tooth.  Because the enamel on baby teeth is so thin, when demineralization starts, you have a much shorter time period in which you can intervene and stop the decay process.

Cavities simply grow much faster in baby teeth than they do in permanent teeth.  This means that, as a parent, you will need to work quickly to stop cavities in your child’s teeth.  It also means that doing nothing is not a good treatment option for your child.  Without intervention, cavities in baby teeth rapidly progress into dangerous dental infections.

  1. Impaired Oral Hygiene

Children are more likely to get cavities due to their lack of ability to perform great oral hygiene.  Unfortunately, kids just cannot clean their teeth by themselves.  Unless your child can tie his shoes and write his name in cursive, he shouldn’t be brushing and flossing without supervision.

This impaired oral hygiene means that dental plaque remains on the teeth after brushing, and the bacteria within that plaque continue to produce dangerous, demineralizing acids.

This means that your child remains at risk for cavities even when he or she brushes twice a day.

And, yes, baby teeth do need to be flossed, just like permanent teeth do.  If you need help flossing your child’s teeth, ask us to give you some pointers at your next visit.  We have a few tricks that make flossing a toddler’s teeth much easier.

When is it Safe to Pull a Baby Tooth?

There are times when it is okay to pull a baby tooth.  Your dentist will typically use an x-ray of the tooth, which shows the underlying permanent tooth, to help you make this decision.  It is perfectly safe to pull a baby tooth with a cavity when the permanent tooth is properly positioned and near its normal time for emergence into the mouth.  The opposite is also true.  The further away the permanent is from the eruption, the riskier it is to pull a baby tooth.

There are also cases where the cavity on a baby tooth is small enough that it will not reach a dangerous point before the baby tooth falls out.  The risk in this situation is that the bacteria and decay on the baby tooth could transfer to an adjacent permanent tooth, which you would obviously want to prevent.

Sometimes, an orthodontist will request the removal of baby teeth so that they can guide poorly positioned permanent teeth into the correct position.  So there are times that we even remove relatively healthy baby teeth to produce a better long-term result.

If your child has cavities on baby teeth, just ask the dentist about the developing permanent tooth and how the various treatment options will affect it.  The overall goal is ensuring healthy, properly-positioned permanent teeth for your child’s long-term health.

More Questions about Baby Teeth?

Call your nearest Premier Dental of Ohio location today to schedule a consultation with one of our dentists.  We can assess your child’s specific situation and advise you of all of your treatment options.

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