Patient Information
A young patient reported to the dental clinic with a complaint of pain and food lodgment in the lower left back tooth region. On clinical examination, tooth 75 (primary mandibular second molar) was found to be grossly carious with significant crown destruction. Interestingly, a broken pen nib was lodged inside the cavity, further complicating the case.
Treatment Plan
- Removal of the carious crown portion of tooth 75.
- Careful assessment of the root condition.
- Preservation of roots wherever necessary.
Procedure Performed
- After administering local anesthesia, atraumatic extraction of the grossly destroyed coronal portion was carried out.
- During the procedure, it was noticed that the roots were still firm and intact within the alveolar bone.
- Considering the proximity of the roots to the underlying developing permanent successor (tooth 35 - permanent mandibular second premolar), complete removal of roots was not attempted to prevent accidental damage to the permanent tooth bud.
- The area was thoroughly irrigated to remove debris and the lodged pen nib.
- The patient was given post-operative instructions and recalled for follow-up.
Why Were the Roots of Tooth 75 Retained?
In pediatric dentistry, the management of grossly carious primary teeth requires careful consideration of the developing permanent tooth. Extraction of roots is not always necessary, and in some cases, retention is the safer option.
Reasons for Retaining Roots:
- Protection of the Permanent Tooth Bud: The permanent premolar is situated directly below the roots of primary molars. Attempting to remove deep or fragile roots may traumatize or damage the developing successor.
- Natural Root Resorption: Primary roots are programmed to resorb naturally as the permanent tooth erupts. Retained roots without pathology usually resorb on their own over time.
- Avoidance of Surgical Trauma: Excessive force or surgical intervention for root removal can cause unnecessary bone loss, delayed healing, or disturbance in eruption of the permanent tooth.
- No Signs of Infection: If the retained roots are free from infection, swelling, or abscess formation, they can be left in situ safely until the natural exfoliation process occurs.
Post-Treatment Care and Advice for Parents
- Maintain good oral hygiene to prevent infection of the retained roots.
- Regular clinical and radiographic follow-ups are essential to monitor natural root resorption and eruption of the permanent tooth.
- Educate the child and parents about avoiding habits like inserting foreign objects (e.g., pen nibs, matchsticks) into carious teeth.
Conclusion
The case of tooth 75 extraction with retained roots highlights the importance of conservative pediatric dental management. While parents often assume that complete removal is mandatory, the preservation of roots is sometimes the best choice to safeguard the developing permanent teeth. With proper monitoring, the roots will resorb naturally, ensuring smooth eruption of the permanent premolar without complications.
Takeaway for Parents: If your child has a badly decayed tooth, never ignore it or try home remedies. Timely dental intervention ensures safe treatment while protecting the permanent