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.

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

  1. Mary says:

    My son is 7 1/2 years. His bottom right front incisor erupted about 2 1/2 months ago behind his baby teeth, which have not fallen out and are not loose at all. It looks like his permanent tooth is not even half way out. And his left incisor has not yet erupted, but it looks like it will soon because his gum looks swollen. His dentist wants to pull out his 4 bottom front baby teeth. I would rather give my son’s body about 2 more months to see if his baby teeth fall off naturally. Is there anything wrong by me choosing this? Because after all I heard that a permanent tooth’s root plants itself completely in the jaw bone between 2 to 3 years. So I don’t see why the dentist wants to rush the baby teeth extractions which have no cavities by the way.

    • If the teeth came in behind the baby ones and did not make them lose, I would recommend having them taken out. Rarely will anything change on its own and the teeth coming in behind will just get more crooked.

  2. Linda says:

    My 12 year old son has had 3 upper baby teeth removed today. When will the adult teeth begin to come in?

    Thanks

    • This depends upon a lot of factors. 1) how much crowding in the area, 2) how far below the gums the permanent teeth are, 3) the position those underlying teeth are, and 4) your child’s natural variation. Your dentist is the best one to estimate since he has an x-ray

  3. Brandi says:

    My 6 year old is scheduled to have his back upper molars removed to allow his 6 year molars to come in. The dentist said the 6 year molar is dissolving the root on the baby molar. I was wondering if it is necessary to have the baby molars extracted?

    • In general, if the permanent tooth is stuck too far under the primary tooth, the primary molar will need to be extracted and the lost space regained. Make sure that you ask how this is going to be done so there are no surprises (it generally means orthodontic movement to push the permanent molar back where it should have been in the first place).

  4. Sandra says:

    My grandson had a accident when he was 3 and his dentist removed his 2 front baby teeth. He is now 7 and he has this space in his mouth. I’m concern that it’s taking so long for his permanent teeth in the front to grow in. His dentist keep saying his permanent teeth are there, so why aren’t they trying to push through the gum.

    • Great question Sandra. Normally when a baby tooth falls out it is because the tooth underneath it is pushing it out. It is right there ready to come in. When a tooth is lost prematurely, the bone and gums actually heal over the underlying tooth and its eruption is delayed.

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