Dr. Greg Jorgensen
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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.

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

  1. Mom says:

    Long story short. My son had severe tooth decay in his four upper front teeth. It was bad enough that dentist had to extract before he turned 3. He just turned six and started to lose his lower front baby teeth-his permanent teeth are coming in-but there is no sign of his front teeth coming in. On his Xrays taken for his routine cleanings, the dentist pointed out that his permanent teeth are in there in his gums. Should I do something? What should I do? When should I do it? Or should I continue to wait it out?

    • There is really nothing you can do except wait. The reason they are delayed is because the baby teeth were removed before the underlying permanent ones were ready to come in. Consequently, the bone and gums had a chance to heal delaying the eruption of the permanent incisors.

    • Kendall says:

      Hi! My daughter is having her upper teeth extracted. Was wondering how long it took for your sons adult teeth to come in after they extracted the baby teeth? Thank you!

      • There are a lot of variables Kendall. Just removing the baby teeth doesn’t always clear the way. If the underlying teeth are crooked or headed in the wrong direction, it may be a while and may even require additional treatment (braces, expander, additional oral surgery, etc.). I’m sure your dentist will follow up with you and let you know how things are progressing. Good luck!

  2. Um mariyam says:

    My daughter is 3years old. she had very bad decay on her front upper tooth and causing frequent swelling on her gum. The dentist said it is better to remove them. Yesterday the dentist remove all the three decayed tooth(upper front). Is this correct solution and what will happen to her permenant teeth in the future?

    • This in not my area of expertise (I’m not a children’s specialist), and I’ve never examined your daughter, but I can say this. Sometimes there is no option except removing decayed primary teeth. What you can expect is that the underlying permanent teeth may be delayed in their eruption because the bone and gum will heal over the permanent ones won’t be ready to come in for another 3 or 4 years.

  3. Jay Alcantara says:

    When we visit our Dentist, he decide to extract my childs fang teeth. After a few months my child told me that his fang is not growing anymore. Is it true that the fang Will not be replaced anymore coz I’m afraid that my child will grow with his tooth missing

    • You need to ask the dentist who removed the tooth what you can expect. He probably took an x-ray that shows what is underneath the baby tooth that was removed. My guess is that the underlying canine doesn’t have enough room to come in and therefore its eruption is being delayed.

  4. Pheba says:

    My almost 6 year old has lost his upper and lower central incisors all while he was 5 years old. His dentist looked at his X-rays and feels he should have his upper and lower canines removed to create space. Does this make sense? I always thought that once you remove the baby teeth that the corresponding permanent teeth will come down so how is that creating space. Thanks so much!

    • Merely removing baby teeth is just “robbing Peter to pay Paul.” You’ll never get ahead. That is why I prefer to expand the arches to make room rather than just stealing it from other teeth.

  5. Hari says:

    My son,age of 4.5years have decayed tooth in lower jaw and was removed by dentist.is it correct?may I know at what age he will get permanent teeth

    • I can’t tell you if removing the tooth was right for your son, but there are times when there is no other option. Permanent teeth erupt between the ages of 6 and 13, depending upon which one was removed.

  6. Ellou says:

    Hello , i just got back from the dentist who told me that my 4 years old tooth is dead and they need to remove it as it got infected… Is there any way to avoid remove his tooth? I feel desperate

  7. Gemma says:

    Hi my son is 2/3 in February the dental hospital have told me he has to have at least 6 upper teeth removed as they are decayed. When he was teething I noticed they were off coloured greyish/pale coloured then as they started to come down they got more and more decayed when i realised this I stopped his bottle very early he only drinks water no diluted squash of any kind and sugary food is very limited as his teeth are so Sentive anyway he’s not really intested in that type of food. I was given antibiotics for and infected tooth at 36 weeks pregnant so they said that these antibiotics have caused my sons front teeth to grow this way anyway he has to have those 6 teeth removed now as they cause his pain he drags food off his bottom teeth to chew it up and it’s a real struggle to brush his teeth as he cries every time I odviously still brush them twice a day but it’s not without a lot of tears! im very worried that having these teeth removed is going to effect his speech the way he eats his food etc after the surgery infection setting in the list goes on? and odviously the time period on when his adult teeth are going to come in as having these teeth removed so early on his his life.
    Thankyou for any advice you can give me.

    • This issues is not my area of expertise Gemma. As an orthodontist, I specialize in straightening teeth and improving bites. The best specialist for you to consult would be a pedodontist (a children’s dentist). Good luck!

  8. Cheryl Daves says:

    My granddaughter’s orthodontist has recommended removing 5 baby teeth. Teeth A, C, H, I & J. Upper canines have already protruded through. Diagnosis includes: Normal jaw relationship. Normal overbite. Mild overjet. Mostly permanent and some primary teeth. Teeth #6, #11 are ectopic. Tooth #12 is possibly impacted. Moderate upper crowding. mild lower crowding. Carries risk is low. My question is: Is it best to start ortho treatment (cementing brackets) before removal or after removal? What is best and why? Thank you for your expertise and comments. Your site is most helpful and your recommendations appreciated!

    • I have no problem removing primary teeth to facilitate the eruption of the permanent teeth underneath. I would follow the recommendations of your local doctor who is closest to the situation. Most often I’ll wait until after the underlying teeth have come in the best they can before I’ll actually begin treatment. Good luck!

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