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.

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

  1. Sara says:

    My dentist said we needed to pull my 6 year old daughter’s top 4 teeth as to make room for the new, adult teeth. We saw in the X-ray that they are close behind. After the fact, my husband questioned if I made the right choice and now I’m worried I somehow messed up her teeth. They were beautiful and straight. Is it possible to cause damage by pulling baby teeth if it wasn’t necessary?

  2. carleen lucas says:

    My son still has one baby tooth in and he is 15yrs old the xray showed the adult tooth is in there but crooked the reason why the baby tooth never fell out. Now they want to extract the baby tooth but mt concern is that ho can a crooked adult tooth come down bu itself if its crooked . should i let them extract the baby tooth

    • I have not seen your son’s x-ray, but it sounds like the permanent tooth will not come in unless the baby tooth is removed. All primary teeth are usually gone by age 13, so that is another clue that there is a problem

  3. Shoizzaib says:

    Hi Doc.

    My question is about my 10 years old daughter, she developed a cavity in her right upper 1st molar (or probably the 2nd molar). The dentist offered the only treatment option to have it extracted as the cavity is deep, and not only this one, but also the same upper molar on the other side as that is also decaying, as he said. My worries are, is this normal at this age to extract 2 teeth while the procedure might need general anaesthesia? Is it common in this age? and if these are milk-teeth, probably fall in a year or 2, could there be a filling solution until then? Thanks

  4. Penny C says:

    My almost 7 year old just had his 4 front teeth pulled a few days ago. Orthodontist recommended extraction because of severe crowding. X-ray is showing the permanent teeth ready to come down. My friend is now saying I shouldn’t have done it, 4 teeth extracted is too much. I’m thinking now I made a horrible decision. Any advice? How long until permanent teeth start to come in?

    • Sorry but your friend is wrong. I would trust and orthodontist who has training and experience rather than a friend who is just giving an uneducated opinion. You either trust your doctor or you don’t.

  5. Sara t says:

    Hi, my son is 12 and we recently had him seen by an orthodontist . Braces was placed on his second visit and we was told on the third visit that all four baby teeth need to be removed before she can go any further with the braces, which seem very weird. If that was the case, I’m not sure why the braces was placed in the first place. I’m a little concerned with pulling four baby teeth. We had three taken out already and the molar was fully attached to the root and seem a very uncomfortable while he was having it removed. The other molar is the still attached to the root as well. Should I have that one pulled to or wait? Will it effect spacing for the permanent teeth?

    • The last baby teeth are usually lost at about age 12, so your son’s age is not that far off. I don’t usually begin treatment in 12 -year-olds until the baby teeth are gone, so I would probably had them removed first. I think the orthodontist should have discussed this with you ahead of time so that there were no surprises.

Leave a Comment

Back to Top

Your account login
Your rewards
Schedule an appointment with our talented orthodontist online