GreatSmiles

Should Baby Teeth Be Filled? The Evidence

Reviewed 2 September 2026. Numbers come from a systematic review and meta-analysis of 28 to 29 studies per outcome on pulp therapy in baby teeth, two further reviews of pulpectomy outcomes and materials, a meta-analysis of space loss after early extraction, two population studies on what untreated decay does to children, and two syntheses of minimally invasive options — each listed at the end with its PMID. Written for parents told “they fall out anyway” and for clinicians who have to answer for it. Not medical advice.

The short answers

Why a baby molar is worth treating: the four mechanisms

The argument for treating primary teeth is not sentimental, and it is not “cleanliness”. It is four concrete jobs the tooth does, each with a literature behind it.

Pain and infection. Untreated caries produces pulpitis, abscess and, in the population data above, a PUFA prevalence of 41.1% in a national sample of children, with measurably worse quality of life (Silva RCDD et al., Rev Bras Epidemiol 2026-01-01, PMID 42385016). Toothache is not a rite of passage: 70.6% of 8-to-11-year-olds in one Brazilian population study had already had it (Souza et al., Braz Oral Res 2025-01-01, PMID 41259575).

Space. The first primary molar holds arch length for the first permanent molar. Lose it early and the loss is not zero: in the meta-analysis above, −0.52 mm in the maxilla and −1.78 mm in the mandible, and the mandibular figure is more than three times larger, which is exactly why the same authors recommend space maintainers after lower extractions and not routinely in the upper arch (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934).

The permanent tooth developing under it. A chronically infected primary molar sits on top of a permanent tooth that is still calcifying. This is the part parents are least often told and the part the neglect data indirectly capture: dental neglect was associated with the advanced consequences in first permanent molars (rho = 0.174; p = 0.008), not with early decay — i.e. with what happens when problems are left (Gümüşboğa et al., BMC Oral Health 2026-03-01, PMID 41888825).

Function and development. Chewing efficiency and speech both depend on an intact primary dentition, which is part of why space maintainers are supported beyond pure orthodontic logic (Casaña-Ruiz et al., Dent J (Basel) 2025-01-01, PMID 39851607).

None of this means treating every white spot. It means the default of “wait until it falls out” is not the neutral option — it is an option with a price, and the numbers above are that price.

What the options actually score

Option Best verified result Evidence base and its limits
Pulpotomy + crown (nerve partly involved) 92.32% clinical success (88.99–95.00); 85.35% radiographic (80.94–89.26) (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222) 28–29 studies, 874–1,410 teeth, ≥24 months; high heterogeneity, moderate risk of bias
Pulpectomy (whole nerve removed) 79.96% clinical (71.86–86.98); 74.07% radiographic (67.84–79.84) (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222) 21 studies, 2,007 teeth; success varies 38.5%–96.2% by case selection (Kendre et al., Int J Clin Pediatr Dent 2025-12-01, PMID 41552027)
Pulpotomy vs pulpectomy in irreversible pulpitis No significant difference to 12 months (Chawla et al., J Dent 2026-03-01, PMID 41485532) Very low certainty for both outcomes
Hall technique (preformed metal crown, no drilling) Among the approaches with significant benefit in an umbrella review of 49 reviews (Padilla-Cáceres et al., Front Dent Med 2025-01-01, PMID 41602568) High-confidence reviews only; 93.8% vs 60.8% two-year success in the trial cited there
Silver diamine fluoride Significant benefit in the same umbrella review (Padilla-Cáceres et al., Front Dent Med 2025-01-01, PMID 41602568); 80–90% arrest in a narrative synthesis (Al-Kaff et al., Cureus 2025-07-01, PMID 40772222) Arrests, does not restore shape; staining is the trade-off
Microinvasive treatment of non-cavitated proximal lesions OR 0.29 (0.19–0.38) versus non-invasive (Tasleem et al., BMC Oral Health 2025-01-01, PMID 39780151) Moderate GRADE certainty; low heterogeneity; durability and cost still unproven
Extraction and nothing else Space loss −0.52 mm upper, −1.78 mm lower (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934) 7 studies, 141–171 children; the outcome measured is space, not the child
Extraction + space maintainer Limits migration and later need for invasive orthodontics; supports chewing and speech (Casaña-Ruiz et al., Dent J (Basel) 2025-01-01, PMID 39851607) Meta-analysis of effectiveness
LSTR (“three-mix” antibiotic paste) No significant difference from conventional pulpotomy/pulpectomy at 12 months (Baghlaf et al., Saudi Dent J 2025-10-01, PMID 41091393) 14 studies; only two compared it with MTA pulpotomy; positioned for children where conventional treatment is not feasible

Two things this table should not be made to say. First, “pulpotomy beats pulpectomy” is not established for the harder cases: the head-to-head review found no significant difference and graded its evidence very low (Chawla et al., J Dent 2026-03-01, PMID 41485532). Second, the 92% success figure is a pooled average over 28 studies that disagree substantially (I² high enough to force a random-effects model) — the honest sentence is “usually works, sometimes does not, and the tooth has to be reviewed”.

Five-year-class success of invasive pulp therapy in baby teethPooled percentage of teeth that stayed successful, follow-up of 24 months or morePulpotomy, clinical success92.32%Pulpotomy, radiographic success85.35%Pulpectomy, clinical success79.96%Pulpectomy, radiographic success74.07%0100% of teeth successful
Vaiude A, Jawdekar A, Mistry LN, Int J Clin Pediatr Dent 2026;19(3):389-402, PMID 42328222 — a systematic review and meta-analysis of long-term outcomes of invasive pulp therapies in primary teeth. Clinical pulpotomy pooled over 28 studies and 1,410 teeth, radiographic over 29 studies and 874 teeth; pulpectomy both pooled over 21 studies and 2,007 teeth. Random-effects model was used because heterogeneity was high and the risk of bias was rated moderate, so these are averages across dissimilar studies, not a promise about one child’s tooth. The review’s own conclusion is comparative: pulpotomy scored higher than pulpectomy after 24 months.

How to read this like a clinician

What the evidence does not support

Cost, coverage, and what to ask for

Utah’s public children’s dental benefit already contains a treatment ladder that matches the evidence, and it is worth reading before you decide to skip care: pulpotomy covered without prior authorisation for infected baby teeth, once per tooth, excluded on a tooth about to exfoliate; stainless steel crowns allowed once every two years per tooth specifically “to protect teeth with large cavities or after a nerve treatment”; silver diamine fluoride covered every six months per tooth as a non-invasive alternative to fillings; sealants every two years per sound permanent molar or premolar; simple and surgical extractions without prior authorisation when the tooth cannot be saved; and orthodontics only once per lifetime with prior authorisation via the state IOTN sheet (data as of 04 February 2026; see Additional documents). That last line closes the loop with the space data: if a lower first primary molar is lost early and space is not held, the correction may land in a category the plan will not fund twice.

For a family paying cash, the same structure gives you a script: ask which option the plan will pay for on this tooth, and ask for the one with pooled success numbers attached rather than the one sold as painless. The cheapest covered item that also has trial support here is the crown after a pulpotomy — because it is what makes the 92% figure hold (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222).

A plan, if you want one

Frequently asked questions

Is it worth filling baby teeth? On the verified evidence, for a lesion that has progressed: yes — either with a microinvasive approach for non-cavitated proximal lesions (OR 0.29) (Tasleem et al., BMC Oral Health 2025-01-01, PMID 39780151) or with pulp therapy and a crown where the nerve is involved, at 92% clinical success (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222). For a tooth that is already loose and due to fall out, no — and Utah’s own benefit rules say the same (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934).

My child is afraid of the drill. Is there a non-drilling option? Two: silver diamine fluoride (arrests in 80–90% in the narrative synthesis, at the cost of a dark stain) and the Hall technique, which is a crown cemented without caries removal or anaesthesia; both were among the approaches with significant benefit in an umbrella review of 49 systematic reviews (Al-Kaff et al., Cureus 2025-07-01, PMID 40772222) (Padilla-Cáceres et al., Front Dent Med 2025-01-01, PMID 41602568).

The dentist wants to pull it rather than treat it. Is that reasonable? It is, if the tooth cannot be restored, if there is a vertical root fracture or pathology affecting the developing permanent tooth, or if it is close to natural exfoliation. Ask what the plan is for the space, because in the lower arch the measured consequence of doing nothing is roughly 1.8 mm (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934).

Do baby tooth infections damage the adult tooth? The chronic-infection mechanism is exactly why this question exists, and the population data show what being left does: neglect tracked with advanced consequences in first permanent molars rather than with early decay (Gümüşboğa et al., BMC Oral Health 2026-03-01, PMID 41888825). Direct evidence on enamel damage in the successor was not part of what we verified, so ask the clinician to look at the tooth underneath rather than accept a general reassurance.

Will a space maintainer be needed forever? Not forever — its job is to hold length until the permanent tooth is ready. The evidence supports its use specifically after lower first primary molar loss (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934) (Casaña-Ruiz et al., Dent J (Basel) 2025-01-01, PMID 39851607).

Does it matter which filling material is used? For the final restoration on a pulpotomy-treated primary molar, yes — crowns outperform direct restorations in this literature, and a stainless steel crown is what the payer documents are built around (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222).

Glossary: kitchen-table words ↔ chart words

What you say at home What is in the notes How it is measured
“The nerve is gone” Irreversible pulpitis; pulp necrosis Clinical and radiographic signs; pulpal diagnosis criteria (Chawla et al., J Dent 2026-03-01, PMID 41485532)
“Half the nerve” Pulpotomy (coronal pulpectomy) Clinical and radiographic success at 12–24+ months (Vaiude et al., Int J Clin Pediatr Dent 2026-03-01, PMID 42328222)
“Root canal on a baby tooth” Pulpectomy of primary tooth Success 38.5%–96.2% by case selection (Kendre et al., Int J Clin Pediatr Dent 2025-12-01, PMID 41552027)
“The silver paint” 38% silver diamine fluoride; chemical arrest Arrest rate; lesion activity at review (Al-Kaff et al., Cureus 2025-07-01, PMID 40772222)
“The metal cap without drilling” Hall technique / preformed metal crown cemented over unremoved caries Two-year clinical success in RCT and network meta-analysis (Padilla-Cáceres et al., Front Dent Med 2025-01-01, PMID 41602568)
“A hole that hasn’t broken through” Non-cavitated (initial) lesion, ICDAS 1–2 or proximal equivalent Progression/regression odds in microinvasive trials (Tasleem et al., BMC Oral Health 2025-01-01, PMID 39780151)
“Abscess, swelling, a pimple on the gum” PUFA lesion (pulp involvement, ulceration, fistula, abscess) PUFA/code prevalence in population studies (Silva RCDD et al., Rev Bras Epidemiol 2026-01-01, PMID 42385016)
“The space keeper” Space maintainer (band-and-loop, distal shoe, etc.) Arch-length and space change in millimetres (El-Motayam et al., BMC Oral Health 2026-03-01, PMID 41820934) (Casaña-Ruiz et al., Dent J (Basel) 2025-01-01, PMID 39851607)

Related reading on this site: what to do about a toothache at night, what to eat and drink in the first days, how long to wait before smoking or vaping again and which swelling signs mean the emergency department.

How this page was built, and what it cannot tell you

We searched Europe PMC for systematic reviews, meta-analyses and randomised trials on treatment of caries in primary teeth, retrieved each record programmatically (authors, journal, volume, issue, pages, DOI, open-access status and citation count) and quoted only numbers printed in the fetched abstracts, together with the certainty ratings the authors themselves published. Where pooled heterogeneity forced a random-effects model, we say so, because it is the reason the confidence intervals are as wide as they are. Where a review’s certainty is “very low”, that adjective travels with the finding.

What this page cannot tell you: whether your child’s specific tooth is restorable (that needs a clinical and radiographic assessment of root resorption and periapical status — the two variables that separate success from failure in the pulpectomy data (Kendre et al., Int J Clin Pediatr Dent 2025-12-01, PMID 41552027)); what your plan will pay for; how long a particular restoration will last in a particular mouth; and whether extraction plus a maintainer or pulp therapy plus a crown is better for one specific child, which no pooled number in this review can settle. What it can settle is that “baby teeth don’t matter” is a claim with no support in the material we checked — and that both directions of treatment are measured.

Sources

Peer-reviewed evidence

Additional documents

Bibliographic records above were retrieved and verified programmatically from Europe PMC (authors, journal, volume, pages, DOI, PMID, citation count). Coverage, guideline and regulatory statements are quoted from the cited public documents with their dates; verify against the current version before relying on them. This article is not medical or dental advice.

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