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.

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

  1. MimiLee says:

    I am a thirty-nine year old female with an upper right primary cuspid in place, and an adult canine tooth impacted above the roots of my two front teeth. I was hoping by some miracle that if I extracted the baby tooth, the adult cuspid would come into place without the need for additional surgery or braces (seems very painful to me and I just assume cap the baby tooth before I go through with something like that). Have you ever heard of the adult tooth coming into place after the primary tooth has been removed, even in adults?

  2. Donald Delgado says:

    My daughter chipped her front tooth on the floor due to a fall. The children’s dentist said that she could see a little red dot, and therefore the tooth chipped all the way to the root. She said it will eventually become absessed and would have to be pulled. She gave me three options. 1. preserve the tooth via a sort of root-canal procedure which would entail an anestisiologist because she is only 2. 2,100 dollars, or seal the tooth for 450 dollars which will not last and will still have to be pulled eventually, or just wait until it starts bothering her and pull it. She never mentioned anything about preserving the space if we elected to pull it. What do you think about the options and should I be concerned that she did not mention anything about preserving the space? Thanks. Donald.

  3. Noor Beidas says:

    Is it normal to have only lost 13 teeth by age 11?

  4. Princy says:

    My 7 1/2 year old son just had one of his biannual appointment with his dentist this week. He has no cavities but she suggests that his 2 bottom canine teeth be removed because they are one of the last teeth to be lost naturally. He has lost the primary tooth beside one of the canines and it is has not erupted because there is not enough space. She also suggest that he have a retainer to keep space for permanent canine teeth. I am wondering if this is really necessary.

    • Actually, a 7 1/2 year old should still have 12 baby teeth left. The lower canines don’t usually fall out until about age 10. I think that pulling the canines at this age is premature unless there is something else I don’t know about in your son’s case.

  5. Curious says:

    My 8 year old son’s adult lateral incisor is coming in behind his baby cuspid it is a tad into the upper palate. The baby cuspid is loose but the orthodontist is recommended getting it extracted along with his other top cuspid (that lateral incisor has already come in straight his bite is great) He blatantly told me he had no knowledge of palate expansion and that my son’s palate measures fine. However it is obvious there must be crowding If he wants to remove teeth, right? Is it normal to have a perfectly good cuspid extracted when that adult cuspid isn’t ready to come down on either side? I am falling on the side of palate expansion at this point rather than braces and am wondering if extracting that solid baby cuspid is a good Idea? Last thing to mention is that his front incisors are off the midline by a tad and removing that solid incisor will give them a bit more room to shift his midline. With palate expansion would removing that solid baby incisor be necessary? The adult incisor is still pretty far up in the X-ray.

    • I am a big believer in expansion rather than extraction in 8-year-olds. When you remove teeth at that age, you are merely “robbing Peter to pay Paul.” Someday you’ll have to deal with the crowding. Removing teeth at age 8 and only expanding if there is a crossbite is how some orthodontist were trained, but I have 25 years of amazing results expanding to alleviate crowding in the absence of a crossbite.

  6. Cha says:

    My 6 y/o has 2 permanent teeth growing at the back of 2 lower incisors. One of the baby teeth has loosened quite a bit since this pediatric shark tooth was discovered 3 weeks ago. Should we wait for it to drop off, or should this be pulled out? Thank you.

    • This is a call for your local pedodontist (child’s dentist) or orthodontist. In most cases, the baby teeth associated with the permanent teeth that come into the wrong place must be removed. Your local orthodontist will make the call, but it is likely you’ll need to have that done.

  7. Help please says:

    My 4 year old (Will be 5yrs in 2.5mths), knocked out most of one of her bottom middle teeth and it has had an absess underneath it about a year. The Dentist has X-rayed and monitored it and now says it has to be removed so the infection doesn’t damage the adult tooth below.
    I am worried that this will cause the big tooth to come up prematurely and could cause over crowding. I mentioned to the dentist about a space maintainer, but they said that at this age it would have to be changed so frequently and the NHS (I’m in England) may not have the funds to do this. I am worried this is going to cause lots of problems for the teeth later in life.
    Could you please tell me any advice that you have in this situation and what the procedure is of putting in a space maintainer.
    Many thanks

  8. Melissa says:

    My son is 9 1/2 years old. He has a large cavity in his lower 2nd molar. His dentist has given the option of extraction or a root canal. If I opt to have it pulled would he need a space maintainer. I know root canals can be costly but I want to make the best decision.

    • It would depend upon the longevity of the baby molar. If it is going to be in place more than a year, I’d have the root canal. The space maintainer would also work if it is substantially cheaper, but it just adds complexity to your son’s mouth.

  9. Miyelani says:

    My son had his baby teeth removed in 2012 due to decay, still today nothing has come out? what could be the problem? his gums are swollen but nothing is coming out. “worried mom”

    • The early removal of baby teeth can sometimes delay the eruption of the underlying permanent ones. The only way to “see” what is going on is to have your dentist or orthodontist take an x-ray.

  10. Sara says:

    My daughter is 7-1/2. She has only lost her two front teeth at this point and her perm teeth have since come in. Her dentist wants to remove her two front baby teeth because she says she has an underbite and as a result the top babyteeth are pushing into the new bottom perm teeth and going to cause them to push out/crooked as the roots will push forward in the gumline. Not sure what to do? Should we extract them? Is she right, will this cause her two bottom teeth to grow crooked and or damage the roots?

    • If your 7 1/2 year old has only lost 2 teeth, it may be appropriate to have others removed, especially if she is in the care of a dentist who is on top of the situation. Baby teeth, left in too long, can cause the permanent ones to come in crooked.

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