I workded for a pediatric dentist for 5 years and I couldn\'t tell you how many of patients like this we saw in a days time. If there is infection present he could take antibiotics for it but the infection will just continue to come back and back and back,each time getting a little worse. If the tooth has abcessed then the child could possibly be in some pain not from the tooth itself but from the infection that has settled around the root. If the tooth is dark as you say from trauma then more than likely it is \"dead\". If you are worried about the space that will be left after the extraction you would be amazed but there is a kiddie partial for missing teeth. If the child is 4 1/2 I probably wouldn\'t do this because it won\'t be that long before they would shed this tooth anyway . Be sure to find a good pediatric dentist that doesn\'t use a papoose board - when we had \"scared children\" we used a form of premedication for this. good luck!