Tooth Extraction in Children
In pediatric dentistry, taking out a child's tooth is a last resort.
Baby teeth matter for more than chewing and speech: they hold space for the permanent teeth and guide them into place. That's why pediatric dentist Dr. Dt. Esra Yeşilöz Gökçen at KidsDent Istanbul looks at every way to save a tooth first. An extraction is only recommended once options such as a filling, root canal treatment or a pulpotomy have been ruled out.
In short
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A last resort: we don't extract until the options to save the tooth (a filling, pulpotomy or root canal treatment) have been ruled out.
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Numbing comes first: the gum is numbed with a gel, then local anesthetic is given slowly. Most children feel light pressure rather than pain.
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Space maintainers can help prevent crowding: if a baby tooth comes out early, a space maintainer keeps room for the permanent tooth.
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Children usually heal quickly: after a simple extraction, most children can go back to school the next day.
Last updated: 2 October 2026 · Dr. Dt. Esra Yeşilöz Gökçen
When Does a Child Need a Tooth Extraction?
We never decide on an extraction without an examination. After a clinical exam and an X-ray, a tooth may need to come out in these situations:
Advanced Tooth Decay
When tooth decay reaches the nerve (the pulp) and root canal treatment is no longer possible, the tooth may need to come out. Untreated decay can lead to infection.
Dental Injury
A tooth that has broken or moved after a fall or a knock may need to come out if the damage can't be repaired. KidsDent doesn't provide emergency injury care, so after a fresh injury, go to an emergency dental service first.
A Baby Tooth That Won't Fall Out
If the permanent tooth has started to come in but the baby tooth is still in place, the baby tooth is taken out so the permanent tooth doesn't come in at the wrong angle. This can lower the risk of crowding and of needing orthodontic treatment later.
Preparing for Orthodontic Treatment
When there isn't enough room for the teeth, some may need to come out before orthodontic treatment.
Dental Abscess
An abscess forms when decay reaches the tip of the root. If it doesn't respond to antibiotics and the tooth can't be saved, extraction is unavoidable. Left untreated, the infection can spread.
Damaged or Malformed Tooth
A tooth that has lost too much structure, or has a developmental defect, and can't be restored with a filling or a crown may be better taken out.
🦷 A study of 567 extracted baby teeth, published in the journal of the American Academy of Pediatric Dentistry (AAPD), found decay and the pulp damage it causes to be the most common reason for extraction (53%). In children aged 3 to 5, almost half of the extracted teeth were front teeth; in 6- to 9-year-olds, first baby molars came first. In our practice in Ataşehir, Istanbul, the most common reasons are advanced decay and baby teeth that don't fall out on time.
BY AGE 1
Recommended time for a child's first dental visit (AAPD)
AGE 6
When the first permanent teeth start to come in and baby teeth begin to be replaced
10–20 Min
How long most simple extractions take
How Is a Tooth Extraction Done?
At KidsDent Istanbul, extractions follow a protocol designed to keep a child's anxiety and discomfort as low as possible. Our pediatric dentist first explains each step in words the child can understand. Here are the seven steps:
1. Examination and X-ray
We check the roots, the surrounding tissue and the permanent tooth developing underneath on an X-ray. This is when we decide for certain whether the tooth needs to come out.
2. Explaining It to Your Child
We don't rush this step, and we don't start until your child trusts us. In the long run, it's what helps a child see dental visits as a positive experience.
3. Numbing Gel
Before the injection, a numbing gel or spray is put on the gum, so the injection itself is felt as little as possible.
4. Local Anesthetic
The area is fully numbed with a slow, controlled injection. During the extraction, children typically feel light pressure rather than pain.
5. Removing the Tooth
Using instruments made for children, the tooth is gently loosened and removed. A simple baby tooth extraction takes 10 to 20 minutes on average. If a root is trapped or the case is complex, a surgical technique may be needed.
6. Stopping the Bleeding
We place sterile gauze over the socket and your child bites on it for 20 minutes, so a blood clot forms and the bleeding stops.
7. Aftercare Instructions
We give you the aftercare instructions verbally and in writing. If your child needs a space maintainer, we book an appointment to take the impression.
Treatment under general anesthesia: For children with severe dental anxiety, or who can't be treated in the chair even with behavior guidance, Dr. Yeşilöz Gökçen can carry out dental treatment under general anesthesia at a partner hospital, where an anesthesiologist manages the anesthesia. Contact us to find out more.
When Should a Pediatric Dentist Check a Loose Tooth?
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A permanent tooth is showing behind it: if the permanent tooth is coming in while the baby tooth is still there, you get "two rows" of teeth. The baby tooth may need to come out, because waiting can make the permanent tooth come in crooked.
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It has been loose for 3–4 weeks but hasn't fallen out: this usually means the root hasn't fully dissolved. We recommend an examination.
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Chewing hurts or is difficult: if your child avoids chewing on one side, have it checked.
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The gum is swollen or red: this can be a sign of infection; see a dentist.
How does a loose baby tooth come out?
Most loose baby teeth don't need to be pulled: once the root has fully dissolved, the tooth falls out on its own. Your child gently wiggling it with clean fingers during the day helps it along.
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If the tooth moves easily in every direction, doesn't hurt when touched and the gum isn't red, expect it to fall out on its own, usually within a few days to two weeks.
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A little bleeding from the socket is normal when the tooth comes out. Pressing clean gauze on it for 5–10 minutes stops it. For the first two hours, your child should leave the area alone with their tongue and avoid hot drinks.
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If the tooth moves in only one direction, hurts when wiggled or has decay, don't force it. Its root hasn't dissolved yet, and a dentist should look at it.
Can a baby tooth be pulled out at home?
A baby tooth that's about to fall out needs nothing special: wiggled gently with a clean finger, it comes away on its own. Pulling it with string, thread or a door isn't recommended.
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A sudden pull can break the root tip off under the gum. A fragment left behind can cause infection and delay the permanent tooth.
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If the tooth comes away faster than expected, your child could swallow it or breathe it in.
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An open socket is an entry point for infection if hands or the mouth aren't clean. Wash hands first, and rinse the mouth with warm salt water afterwards.
What if a loose baby tooth isn't pulled?
A baby tooth whose root has dissolved will fall out on its own, so waiting is usually harmless. The problem comes when the permanent tooth starts to come in behind the loose one.
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If the permanent tooth comes in behind a baby tooth that hasn't fallen out (the "shark teeth" look), it can settle in the wrong position. The baby tooth then needs to be taken out by a dentist.
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A tooth that stays loose for a long time can stop your child chewing on that side, and chewing on one side out of habit can affect jaw development.
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If the gum around the loose tooth is red, smells bad or is inflamed, don't wait; see a dentist.
Can a Baby Tooth Be Taken Out Before It Falls Out on Its Own?
A baby tooth is taken out early only if it's blocking the permanent tooth coming in underneath.
If the baby tooth is loose but the permanent tooth isn't visible yet, there's no need to hurry. Taking a baby tooth out before its natural time counts as early loss and may mean a space maintainer is needed. Your child's pediatric dentist decides this after an X-ray.
Can a loose tooth with decay be pulled?
A decayed baby tooth being loose doesn't mean it can be pulled at home. Its root may not have dissolved, and it's more likely to break during removal.
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If decay has caused an abscess or swollen gum, the infection needs to be brought under control before the tooth comes out.
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If a decayed baby tooth is lost long before its time, the teeth behind it can drift into the gap. A space maintainer then keeps room for the permanent tooth.
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Extraction isn't the only option. If the roots allow it, a pulpotomy (a partial root canal treatment) and a crown can keep the tooth in place until it's time for it to fall out.
At what age can a child have a tooth taken out?
There's no minimum age for removing a baby tooth: what decides it is the state of the tooth, not the child's age. Baby teeth normally start falling out on their own around age 6.
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If a baby tooth comes out early and no space maintainer is fitted, the neighboring teeth can drift into the gap and leave no room for the permanent tooth.
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The "six-year molar" isn't a baby tooth: it's the first permanent molar and won't be replaced. If it has decay, treatment options are considered before extraction.
Tooth extraction at age 5
A five-year-old can have a tooth taken out when needed, but age alone is never the reason. After an exam and X-ray, extraction may be recommended for advanced decay, an abscess, a fracture that can't be repaired, or a baby tooth blocking a permanent one.
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Because baby teeth usually start to change around age six, an extraction at five can count as early loss for some teeth.
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If the tooth can be saved with a filling, root canal treatment or a crown, those options come first.
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If the permanent tooth is still a long way off, a space maintainer may be needed to stop the neighboring teeth drifting into the gap.
When does the new tooth come in?
If the baby tooth came out at its natural time, the permanent tooth usually comes in within 1–3 months. If it was taken out early, this can take months, sometimes years.
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What decides it isn't the time that has passed but how far the permanent tooth underneath has developed, which only an X-ray shows.
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When a baby tooth is lost early, the gap can close and leave no room for the permanent tooth. A space maintainer keeps the gap open.
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If no tooth has appeared 6 months after the extraction, the permanent tooth's position and development should be checked.
Aftercare
How well your child heals depends largely on aftercare. The table below shows what to do and what to avoid after an extraction.
How Long Does Mild Pain Last After an Extraction?
Once the anesthetic wears off, mild pain or aching for 24–48 hours is normal. Pain relief can be given at the dose your dentist recommends for your child's weight. If the pain lasts more than 3 days, gets worse or comes with swelling, call your dentist: it can be a sign of infection.
Why Is My Child's Cheek Swollen After an Extraction?
Mild swelling around the extraction site is the body's normal response to the procedure; it's common in the first 24–48 hours. To reduce it, soak a clean cloth in cold water and hold it gently against the cheek for 15 minutes. Don't put ice directly on the skin.
If the swelling lasts more than 3 days, gets bigger or comes with a fever, it can be a sign of an abscess or infection. Call your dentist.
How Can I Support My Child Emotionally?
Your attitude shapes how your child experiences an extraction. That's why I recommend avoiding words like "hurt", "scary" or "needle" and using calm, reassuring language instead. Children pick up on a parent's anxiety, so staying calm and confident is the most effective support you can give.
Before the visit, ask your child, "Is there anything you'd like to ask?" Feeling some control noticeably reduces anxiety. Afterwards, you can reward their courage with a small surprise: a book, a toy or a little outing. All of this helps your child look forward to dental visits rather than dread them.
If several teeth need treatment, the extraction can be done in a single session under general anesthesia at a partner hospital.
Managing the Gap After a Baby Tooth Comes Out Early
When a baby tooth comes out before its natural time, the neighboring teeth can drift into the gap and narrow the space for the permanent tooth. The result can be crowded teeth and, later, the need for orthodontic treatment. This isn't inevitable.
If the permanent tooth is about to come in, the check-up may show that no space maintainer is needed. When a tooth comes out at a young age, a space maintainer helps prevent this.
Frequently Asked Questions
Does tooth extraction hurt?
We do everything we can to keep it comfortable. The gum is numbed with a gel first, then local anesthetic is given slowly. During the extraction, most children feel light pressure rather than pain.
How long does it take to heal?
The gum surface usually heals within 7–10 days, and children heal faster than adults. Mild swelling and aching in the first 2–3 days is normal. If severe pain or swelling lasts more than 3 days, call us.
Is a space maintainer always needed after a baby tooth is taken out?
No. It depends on how early the tooth was lost and how far the permanent tooth underneath has developed.
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If the permanent tooth is about to come in, a space maintainer may not be needed. If the baby tooth was lost early, the neighboring teeth can drift into the gap.
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The decision is made after an exam and X-ray.
See our space maintainers page for more.
When can my child go back to school after an extraction?
After a simple baby tooth extraction, usually the same day or the next morning. Once the anesthetic has worn off and your child has eaten a first meal without trouble, they can get back to most normal activities.
After a surgical extraction, 1–2 days of rest may be advised.
Call us for information or to book an appointment.