Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Does My Child Need To Have Baby Teeth Removed?

Posted by Dr. Jorgensen on December 15th, 2013

Pulling Baby TeethOne of the most common questions I get from parents in my office and on this blog is whether or not their child should have baby teeth removed. Most baby teeth (primary or “milk” teeth) fall out on their own. There are times however when having them removed by your dentist is not only necessary, but beneficial. Conversely, there are times when you should not have baby teeth removed. While I cannot diagnose your child’s problems online, here are some general guidelines to help you understand when removing primary teeth is appropriate.
For a detailed explanation of when baby teeth normally fall out on their own, please refer to my article http://www.gregjorgensen.com/blog/2012/06/at-what-age-do-baby-teeth-normally-fall-out/. That article explains that although there can be variations from normal, there are certain patterns that most children follow in the loss of their primary teeth. The first step in any examination of children in my office is to take inventory of how many primary and permanent teeth they have. If they have more than they should for their age, my list of possible causes includes the following: an overall developmental delay, crowding, and impacted or missing permanent teeth. Before I offer an opinion however, I always look at a radiograph.

If the loss of primary teeth is slow but in the right sequence, I generally don’t worry until a child is two years behind. If the primary teeth “hang around” too long they can adversely affect the eruption path of the underlying permanent ones. For example, if a lower primary canine is still in place at age 10 or 11 (normally lost at 9), I’m not too concerned. I will probably recommend that it be removed at age 12 however. Another milestone that I consider is the eruption of the permanent second molars. Once they are in, any remaining primary teeth need to go.

There are other orthodontic reasons for removing primary teeth besides falling behind schedule. An obvious one is when a permanent tooth starts to come in adjacent to a primary one that isn’t loose. This commonly happens in the lower anterior when a permanent incisor erupts behind a primary one or in the upper canine area when a permanent canine erupts in front of the baby one (a “fang”). Removing the primary teeth in these instances is necessary but it does NOT correct the crowding that created the problem. It is important to realize that pulling BABY teeth never corrects crowding. It only “kicks the can down the road.” Eventually there will have to be expansion or extraction of permanent teeth if the final result is to be uncrowded.

Another time when primary teeth need to be removed is when doing so will change the eruption path of the associated permanent teeth. This is commonly done in the area of the upper canines and all second bicuspids. CBCT scans (3D x–rays) are excellent for helping me determine when removing primary teeth will help permanent ones come in better. Removing primary teeth at the right time can possibly save patients from more complicated treatment or even prevent surgery down the road.

Sometimes primary teeth must be removed by your dentist for other reasons (infection, trauma, etc.). When this happens, it is important that the space be maintained until the underlying permanent teeth are in place. If a “space maintainer” is not placed immediately and the adjacent teeth shift into the vacated area, the eruption of the corresponding permanent teeth may be affected or prevented.

Lastly, there are times when it is better to not remove primary teeth. Primary teeth should be restored and maintained if possible until the underlying permanent ones are ready to come in since they preserve the needed space. If the corresponding permanent teeth are missing however, you and your orthodontist will need to determine how to deal with the situation. If he or she decides that the space will eventually be closed, early removal of the primary tooth might be helpful. If you are going to eventually replace the missing permanent tooth with an implant, it may be best to preserve the primary one as long as possible to preserve the space and keep the surrounding gums and bone healthy.

As you can see, primary teeth serve an important function in the development of the permanent smile. Every child is unique and the decision whether or not to have primary teeth removed is one that you and your local orthodontist will have to make together.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

312 comments so far in response to “Does My Child Need To Have Baby Teeth Removed?”

  1. Adrian Mak says:

    Hi, I’m 10 years old and my permanent upper 3rd tooth to the right is growing in front of the baby tooth. The permanent tooth has only started growing and the baby tooth is a bit wiggly. Should I have the baby tooth removed?

    This message was sent from the child in case you haven’t noticed. :)

    • You probably will need to have the tooth removed, but the first step is to be evaluated by and orthodontist to make sure that the removal of the tooth is the right thing for you.

  2. MARI says:

    My daugther is 5 years old. the baby teeth in the back of her mouth is rotten. is it adviceble to remove them at this age.

  3. Brandi says:

    My son is about to be 13 and we have started the process of braces and an expander. His K9 teeth are impacted and the 1 Ortho said we would have to have the teeth surgically pulled down and an other one is saying since he will need perm teeth removed anyways we could probably just take out his K9’s but I worried his smile would be off with no K9’s. What is your opinion?

    • I cannot make recommendations about specific cases. In general, it is my goal to expand the arches and rescue the teeth. I’ve only seen a few canines that needed to be removed in my 25 years of practice.

  4. amie says:

    I had my kids into the orthodontist yesterday. They are wanting my 9 year old to have 6 teeth removed next week and then place space maintainers! Top canines because the permanent teeth are pushing on the front permanent teeth, and the back two baby molars on both sides because the permanent back tooth has a severe step down to them. I am having a hard time understanding how necessary this is at this time. That us a lot of teeth to loose at one time. He is pretty nervous…and I can’t hide my lack of understanding from him. Please enlighten me. Thanks!

    • Without examining your son and seeing the x-rays, I can only speak in general terms. We sometimes need to remove baby canines to help the underlying permanent ones come in to the right place. We also must remove ankylosed baby teeth (the ones that are stepped down) to allow the ones underneath to erupt. Space maintainers hold the space until the permanent teeth come into place. I would guess your son has some of these issues, but asking his doctor for specifics is the only way to know for sure.

  5. Kelly says:

    Question: My eight year old son had 8 baby teeth pulled at once back in April The dentist said his adult teeth will not come down unless they are out. Was this excessive? After it happened he passed out at home in the bathroom and was sent to the ER. He was released later that night. It’s now November and not 1 adult tooth has come down. Wondering if I made the wrong decision having him pull them all at once. He is VERY traumatized since this happened.

    • This is very common when a child’s permanent teeth are not coming in, their baby teeth are still hanging on, and they are falling behind in their development. Your son’s permanent teeth will eventually come in, but they may take a while if they are crowded. Many times expansion of the arches (to make more room) is necessary to provide the necessary room. As for how many teeth to remove at one time, that is a matter of opinion. I have had as many as four removed at the same time. Personally, eight seems like a lot. Don’t second guess following your orthodontist’s recommendation if you know and trust him. If you don’t, find a doctor you do trust. Trust is critical.

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