The shedding of baby teeth and the eruption of permanent teeth is an important phenomena for the normal growth and development of the orofacial structures. There are 20 milk teeth that are replaced by permanent successors. Additionally, there are 12 molars that are accessional and present in the permanent dentition.

Many times a milk tooth does not completely exfoliate. There are many reasons behind this. Firstly, a primary tooth that has caries or has been impacted by trauma may become weaker. This can lead to only the coronal or crown portion of the tooth getting detached, leaving the roots behind.

Another reason can be attributed to a faulty extraction procedure carried out by the dental surgeon. In case a primary tooth with poor prognosis is supposed to be removed, then during the removal of the tooth, only the coronal portion may get separated and removed. Negligent dentists may not inspect the socket after extraction, leading to the radicular portion of the tooth left behind.

In some cases, the left out root pieces within the gums are too small to be seen clearly clinically. They might also get covered by fibrous tissue over a period of time while also bothering the patient with a dull pain. In such cases a dentist take a radiograph to confirm the presence of root piece and its position within the gums.

If the roots of the tooth are left behind, then it can be managed in the following ways:

• If the portion of the tooth left behind becomes infected and a swelling develops around the roots, then the left behind roots needs to be removed.
• Many times neither the parents nor the patients realize that a portion of the tooth is left under the gums. It is because of the eruptive force of the underlying successor, that the primary tooth's roots are pushed outwards and eventually removed.
• There might be instances when an uncooperative child may not allow the dental surgeon to perform the procedure for extraction of the retained roots. In such cases, if the tooth does not have any carious lesion or is not surrounded by inflammatory swelling and is not excessively mobile, then it can be left till the child reaches an age of compliance. However, the parents should be strictly instructed to constantly supervise the space of the retained root. If the child complains of pain or if a pathology becomes visible in that area, then the roots need to be removed. The uncooperative patient then needs to be guided by a pediatric dentist through certain behavioir guidance techniques in order to get the treatment done.

If the roots of a primary tooth are left within the oral cavity then the following things might take place:

• The root might become infected and be painful upon chewing or biting for the patient. Moreover, the infection can progress to the underlying bony tissues and result in swelling.
• The spreading infection might reach the underlying permanent tooth's crown and harm it. When this permanent tooth erupts, there is a good chance that it is already weak, prone to infection and is highly sensitive.
• In some cases the permanent tooth's path of eruption might get completely deviated due to the retained roots. This is more commonly seen in anterior teeth, especially the canines. The resulting malocclusion is unaesthetic and can also result in crowding of teeth.

Left out milk tooth toots that are visible in the oral cavity can be easily removed by numbing the area with a local anesthetic. In cases where a fibrous tissue has covered the root piece, the dentist may have to put a small incision to expose the underlying root piece before removing it. Since every procedure is done under an anesthetic effect, the patient does not have to worry much in terms of pain during the procedure.

Following the extraction of the retained root piece, the patient is prescribed analgesics as there might be pain once the anesthetic effect wears off. The patient is advised not to eat any oily, hot or spicy foods for two days and is asked not to expectorate for the next 24 hours.

Left out tooth roots thus need to be extracted upon diagnosis and should not be avoided.