| My son began complaining a few weeks ago that his loose tooth was hurting so much he couldn't eat. So I brought him to the dentist, thinking that since his baby tooth was hanging by a thread the dentist might be able to pull it and put him out of his misery. Instead, after a quick look and an X-ray, the dentist said the best course of action is just to wait it out. In fact, that's the guidance from the American Dental Association and the American Academy of Pediatric Dentistry — it's best to let loose baby teeth fall out naturally. Premature extraction can create adverse effects, like teeth shifting into the empty space and later requiring straightening. Teeth are also critical for speech and self-esteem, and extractions can cause unnecessary pain. Amr Moursi, professor and chairman of pediatric dentistry at New York University's College of Dentistry, says children are normally encouraged to wriggle away with their tongue, lip or a clean finger as soon as they feel a loose tooth. "That usually does the trick," he says. Still, "some children do have trouble losing their teeth on their own, and benefit from a dentist's intervention," says Mirissa Price, a pediatric dentist in Tennessee and ADA consumer adviser spokesperson. These could include cases in which permanent teeth are coming in before primary teeth fall out. Sometimes a baby tooth fractures, making it more difficult to wriggle the pieces out. Extractions might be needed for children with autism spectrum disorder, who can be upset by sensory changes, and children who have seizures or a feeding tube, who run the risk of aspirating a tooth when it falls out. In cases where a baby tooth does need to be pulled, dentists should provide space maintainers to keep the teeth properly aligned. Weeks later, we are still waiting on that front tooth to come out. But at least we've nailed down the Tooth Fairy rates. My son reports back from his first grade classroom that it ranges from 25 cents to $20 depending on the quality of the tooth and how well the kid has been brushing. — Shelly Banjo and Truth Headlam | 
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