By Joseph M. McManus, Jr. D.M.D., M.S., M.H.A
Columbia University College of Dental Medicine

It's a conversation that your child's dentist has had many times.

Dentist: "Your son, John, has a very large cavity in his second primary molar. In order for us to save the tooth, I will have to do a root canal and place a crown."

Parent: "Doc, it's a just baby tooth. Why don't you pull it?"

Unfortunately, this parent, like most people, does not understand the importance and the role that primary (baby) teeth play in a child's life.

By the time most children are 3 years old, they will have 20 baby teeth. These teeth are very important and they serve several functions. They help the child chew and speak, they play a role in the child's physical appearance, and they maintain the spaces for the permanent teeth.

Permanent teeth grow and develop under the baby teeth. If the baby tooth becomes infected, this can harm the permanent tooth as well. Damage to one can lead to damage to the other. This is why the dentist wants to treat John's diseased primary tooth.

If a child loses a back tooth too soon, there can be negative results. Let's look more closely at John's case.

If he loses that second baby molar, it can no longer maintain the space for the permanent tooth that is growing between its roots. It is a fact that back teeth want to touch one another. If John loses the baby molar, the tooth behind it will start to drift forward into the space. If this occurs, the permanent tooth may not have enough room to be able to come into the mouth in a normal position.

In addition, John will not be able to chew as well without this molar. Therefore, it is very wise for the parent to let John's dentist make every effort to save this baby molar.

Sometimes a baby tooth may be so diseased that it cannot be saved. If this is the case, the dentist has no alternative but to extract (pull) the tooth.

In a situation like this, the dentist may recommend a space maintainer. A space maintainer is a device that is designed to preserve the space of the missing primary tooth until the permanent tooth is ready to come into the child's mouth. Space maintainers are not always needed when a child loses a baby tooth too early. Your dentist will explain what clinical situations require this type of treatment.

Primary teeth are very important, and every effort should be made to keep them in a child's mouth. Although it is true that dentistry can treat badly diseased teeth, this treatment is costly and time-consuming.

The proper approach to maintaining baby teeth is to practice prevention. With proper brushing, flossing and regular visits to the dentist, a child can preserve his or her baby teeth until it is time for them to be replaced by the permanent successors.

Joseph M. McManus, Jr., D.M.D., M.S., M.H.A., is an associate professor of pediatric dentistry, director of professional affairs for extramural programs, assistant dean for admissions and director of student affairs at the Columbia University College of Dental Medicine. Dr. McManus is a fellow of the American College of Dentists. He is the co-author of many papers, articles and monographs on various dental topics.