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.

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

  1. Gaelle says:

    My daughter is 9 and I am now discovering all these issues. First she began teething late, and then started loosing her baby teeth late as well…apparently she also had a few baby teeth that never came in…such as one of her bottom canines. On our last visit the orthodontist said she had a lot of overcrowding and recommends that the only bottom baby canine and two baby premolars be extracted in order to clear the way for the permanent teeth. The permanent teeth are already pushing their way out and the baby teeth non longer have roots as he put it. I simply wonder if I really must make my daughter go through this or should we just let the teeth come out normally?!?!

    • From what you’ve described Gaelle, your daughter’s teeth already have problems and they cannot come in “normally.” I would recommend that you have her examined by an orthodontic specialist who can coach you and your dentist on what needs to be done to get her back to normal. It won’t happen on its own.

  2. Grace says:

    Hey my daughter is 12 and she has lost all her theta but her 2 molar so is that ok

  3. Tracy says:

    My non verbal 8 year old autistic daughter is due to go to hospital to have 5 baby teeth removed, 1 that has some noticeable decay but the other 4 are very early decay. Is it not possible for the dentists there to fill those 4 instead of removing them? So worried for her ☹️

  4. Shaun says:

    Hello Dr,
    My child is 7.5years had a swollen cheek due to an infection which amoxicillin was prescribed for a few days then later that week the molar tooth was opened and 2 days later dentist took her tooth out.
    Should i be worried for my daughter?Is she the size of her teeth going to be affected by the gap left by the molar or are their any other effect I’m not aware of that may happen

    • I’m sorry, but this is not my specialty. Because of the age of your daughter, I would put her in the care of a pedodontist (a specialist in children’s dentistry). Good luck!

  5. Francinah says:

    My son is six his upper teeth are so badly decayed should I take him to the dentist for it to be removed?

    • Yes, yes, yes. If you know your son has decay, he needs to be seen by a dentist who can help you determine the best approach to treatment. That might mean removing the teeth, but it also may mean restoring them. Good luck!

  6. Kathryn says:

    We are considering a rapid palatal expander on top (using a key over time) followed by a lip bumper on the bottom to expand the lower jaw, instead of pulling any teeth. My only concern is, how do you make certain the jaw wil not look too big with the other elements of the face? since we would be speeding up jaw growth or possibly expanding the jaw too large for the rest of her face I am concerned. All her teeth will fit nicely in the end, but is it better to pull some permanent teeth and have a smaller jaw?

    • You cannot change the genetically programmed size of your child’s jaws. If the arches are constricted, they can be widened with expanders and lip bumpers. If they are already normal, expanding them further can actually be unhealthy for the bone and gums around the teeth. Sometimes there is no healthy alternative to removing teeth in very crowded cases.

  7. Saba says:

    Thanks for the informative blog. My son is 11 turning 12 in 3 months. He still has his baby pre molars in and he started growing permanrt ones. Should we go for extraction of his primary teeth or wait a few months to shed off on its own?

    • It is common for the permanent bicuspids to emerge above (or below on the lower arch) the primary molars. By this age, your son should be seeing a dentist for his other dental needs. Just ask him or her if everything looks normal with your son at his next visit.

  8. Sandy says:

    My 6.5year old son. Has lost the bottom2 middle teeth and now has the permanent ones. Theyou are saying we need to remove 4 primary teeth – 2 on either side of the permanent ones on the bottom due to crowding already. I’m nervous and really on board with that. What should I do?

  9. jackie says:

    My son is 6 – he has had no teeth fall out yet.. he has his 2 front bottom teeth starting to come through – well they are out of the gums not all the way but they are absolutely visible and had to be cleaned but his baby teeth are not budging – do I remove them or wait?

    • I would recommend that your son be examined by an orthodontist who can determine if the baby teeth need to be removed to allow normal eruption of the permanent ones you’re seeing

  10. Yamilet says:


    Generally speaking, if a child has a baby tooth with an infection, is it practical to just wait until it falls out or have it extracted with a dentist?

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