Should milk teeth be treated? Fillings, root canal treatment, extraction and space maintainers

Should milk teeth be treated if they are going to fall out anyway?

Milk teeth are treated because they do not fall out quickly: according to the chart of the American Dental Association (ADA), milk molars are lost only between the ages of 9 and 12. A four-year-old’s molar with a cavity therefore still has 5 to 8 years of chewing ahead of it.

The American Academy of Pediatric Dentistry (AAPD) lists the consequences of untreated early childhood caries: a higher risk of new cavities in milk and permanent teeth, emergency visits and hospital stays, missed school days, difficulties with learning, nutritional deficiencies and poorer quality of life. So it is not only about a tooth that will one day fall out.

Milk teeth also hold the space for the permanent teeth. The AAPD recommends restoring decayed milk teeth wherever possible, because losing them early can shorten the dental arch and encourage bite problems.

How long does a milk tooth stay in the mouth?

A milk tooth stays in the mouth for anywhere from a few years to more than ten, depending on which tooth it is: the incisors are replaced first, and the canines and molars last. The table gives the typical ranges from the ADA chart for upper and lower teeth together; in an individual child the timing may be earlier or later.

The table suggests a simple rule: the further back in the arch a milk tooth sits, the longer it still has to serve. That is why the decision to treat an incisor in a six-year-old looks different from the decision to treat a molar in a four-year-old.

What happens when a milk tooth with a cavity is left untreated?

A milk tooth with a cavity that does not hurt still needs a plan: in the British FiCTION trial (1 144 children aged 3 to 7 with decay in their molars and no pain at the start of the study), roughly 4 in 10 children had at least one episode of toothache or infection within about 3 years. This applied to each of the three strategies compared.

The trial compared conventional fillings, biological methods (sealing in the decay and preformed metal crowns fitted without drilling) and intensive prevention alone. Pain or infection occurred in 42%, 40% and 45% of children, with no evidence of a difference between the strategies.

The conclusion of this trial is not that milk teeth can be left alone. A child with active decay needs a plan: prevention, regular check-ups and treatment chosen together with the parent, and drilling is not the only sensible route.

An infection in a milk tooth can also harm the permanent tooth developing beneath it, although studies do not give a reliable figure for how often such complications occur. The decision therefore depends on the depth of the cavity, the symptoms, the child’s age and how long the tooth still has to stay in the arch.

How are milk teeth treated? The methods in a table

Treatment of milk teeth is matched to the depth of the decay and to how long the tooth still has to remain in the mouth. The table sets out the methods from the least to the most invasive, together with what reviews of studies say about them.

Root canal treatment of a milk tooth: when does it make sense?

Root canal treatment of a milk tooth makes sense when decay has reached the pulp and the tooth still has to stay in the arch for a long time. Two kinds of pulp treatment are used: amputation (pulpotomy), that is, removal of the inflamed pulp from the crown of the tooth, and pulpectomy, that is, root canal treatment of the whole milk tooth.

A 2018 Cochrane review (87 studies, 7 140 teeth) concludes that pulp treatment for extensive decay in milk teeth is generally successful, and the failure rate was low in all the studies. MTA produced fewer clinical and radiological failures than older materials. The dentist assesses the state of the pulp on the basis of symptoms, examination and an X-ray.

For extensive cavities in molars, a 2015 Cochrane review (5 studies) found that preformed metal crowns, including those fitted with the Hall technique without drilling or anaesthesia, lead to major failure and pain less often than fillings over longer follow-up. The relative risk of major failure was 0.18, with moderate quality evidence.

Extraction of a milk tooth: when is a space maintainer needed?

Extraction of a milk tooth is the solution when the tooth cannot be saved. After a tooth is lost early, the neighbouring teeth can drift into the gap, and the AAPD writes that shortening of the arch can cause or worsen crowding, crossbite and other bite problems.

A space maintainer is a simple appliance, fixed or removable, that holds the space for the permanent tooth. A 2026 meta-analysis (El-Motayam et al.) found that after early loss of the first milk molar between the ages of 6 and 9, the gap narrows by an average of 1.78 mm in the lower jaw and only 0.52 mm in the upper jaw. The authors considered a space maintainer indicated after extraction of a lower tooth, but not necessarily as routine after extraction of an upper one.

The AAPD notes that there is no consensus or evidence on whether space maintainers prevent bite problems, and lists their possible drawbacks: the appliance coming loose or being lost, plaque build-up, decay and obstructed eruption of the permanent tooth. That is why a space maintainer is decided on individually, often together with an orthodontist.

What does the NFZ fund in the treatment of milk teeth?

For children and young people up to the age of 18, the NFZ funds treatment of milk teeth, including fillings, dentine impregnation, therapeutic dressings, pulp amputation and extraction. The list comes from the Minister of Health’s regulation on dental treatment funded by the NFZ (consolidated text, Dz.U. 2025 item 615), with the law as at 12 October 2026.

• Filling a cavity in the crown of a milk tooth.
• Dentine impregnation in milk teeth.
• Therapeutic dressing in a milk tooth.
• Vital pulp amputation in documented cases and amputation of devitalised pulp in a milk tooth.
• Extraction of a milk tooth.
• A space maintainer up to the age of 12, as part of orthodontic services.

When are milk teeth treated under general anaesthesia?

Milk teeth are treated under general anaesthesia when the child cannot cooperate in the dental chair and treatment is necessary and extensive. It is a medical decision made after joint dental and anaesthetic qualification, not a more convenient version of an ordinary visit.

Since 1 January 2026, the NFZ has funded general anaesthesia for, among others, children under 3 who do not cooperate despite adaptation visits and pharmacological sedation, and who have at least 8 carious cavities or need root canal treatment or extraction of at least 4 teeth, a surgical procedure or treatment of an injury. The other criteria are described in the article on dental treatment under general anaesthesia on the NFZ.

How milk teeth are treated at DentalBlue

DentalBlue in Białystok provides paediatric dentistry, from an adaptation visit (250 zł) to treatment of milk teeth. In the clinic’s price list a filling in a milk tooth costs 250 zł (the item “Wypełnienie w zębie mlecznym Kromoglass”, a glass ionomer filling in a milk tooth) or 270 zł (composite), root canal treatment of a milk tooth 320 zł, extraction of a milk tooth 250 zł (resorbed) or 300 zł (not resorbed), silver nitrate treatment of 1 arch 250 zł, and a space maintainer 400 zł. The final scope and cost are set at the visit, and prices may change.

When a child cannot cooperate, treatment can take place under general anaesthesia in the clinic’s own anaesthesiology department, after a joint qualification consultation. Eligibility for NFZ funding is checked at that qualification.