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.

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

  1. Stacey H says:

    HI My daughter is eight and had 4 baby teeth removed due to not having room for the adult teeth to drop down, now they are saying that the k-9 teeth are not dropping down they are going sideways and pushing on the front teeth, now he is talking about removal of adult teeth what do we do, I fee that she is way to young to go that way what are your thoughts

    • There are times when adult teeth must be removed to allow other teeth to come in correctly (known as serial extraction). In my own practice I might consider expansion before extraction, but I don’t have all the facts in your case.

  2. Vanessa says:

    My daughter is just shy of her 7th birthday. She has her 4 lower incisor adult teeth (our dentist recommended pulling both lateral lower incisors so we did, pretty traumatic for my daughter though)… She also has lost her upper incisors and the 2 centrals are in. The upper right lateral incisor is breaking through the gum line but her canine is going to definitely be in the way and she has complained of “it” the new tooth- hurting. I had overcrowding and had 4 adult teeth pulled around age 10 before braces—our dentist has mentioned that we may have to keep pulling teeth on the top and bottom to make rooms for the big ones coming. I cannot imagine her having to go through this. Her central upper right incisor is a little bit turned inward – will that lateral incisor come in over the central one or over the canine? Any chance it will loosen the canine? …or are we being realistic with having to pull all of her baby teeth as the big ones come down? She does have somewhat of a gap in her front teeth- at one time I was told she had a maxillary frenum, she would look into snipping this for the centrals to close up to allow for more room? Any input is appreciated. Thank you for a very informative site!

    • Some kids just don’t lose their baby teeth very well on their own. I’m happy to hear that your daughter’s development is being monitored by a professional. If you don’t trust what he is doing, seek a second opinion. In cases of crowding, you can either expand or extract. It sounds like your doctor leans more in the direction of extraction. If you’re not comfortable with that, you may want to see if there is a practice that does more expanders.

  3. Susu says:

    Hi my daughter is about to turn 7 in July ,and we just pulled out her central incisors( top),one of them was moving ,and one wasn’t but the docter Said they have to be pulled out,was this necessary?,when should her teeth start coming out

    • Your doctor may be trying to help the underlying teeth come in correctly. Sometimes you have to remove the matching one on the other side to keep things symmetrical.

  4. Deb says:

    My daughter is 10 turning 11 and was just found to have an impacted lower left canine on a pan xray… I was told to pull the first molar and canine on left side to bond chain to tooth and with braces it may be pulled into place. The part that I am disturbed with is they said I should have the first molar and canine on the right pulled as well so that there is no shifting of lower teeth. Is this wise even though only baby teeth? Would they really shift if I didn’t have the right side done? I know you didn’t see films but won’t that delay them coming in?

    • These are questions only your local orthodontist can answer. I’m guessing they want to remove teeth on both sides for symmetry, but I can’t see why that is an issue here. Press your doctor for a better explanation.

  5. Laura says:

    The Orhtodontist recommended pulling 4 and 3 primary teeth from the upper and lower jaw respectively for our almost 10 year old daughter. Her teeth are crowded and she feels pain due to the pressure between them. I am concern about having all 7 teeth come out at once. Would it be better to pull these gradually over a couple of months, instead?

    • I can’t comment on your daughter’s particular case, but having 7 baby teeth removed at one time in a 9-year-old seems a little agressive to me. I would probably go for three and then four about six months later. I would ask “What’s the hurry?”

  6. LeeAnn Brooks says:

    My daughter is 5 and starting kindergarten. Her pediatric dentist wants to pull her front top teeth and 2 on each side of the front teeth for a total of 6 teeth. They are beginning to decay as they haven’t held up well through early childhood. There is no pain to my daughter but they don’t look the best. I know she is starting into the age range for front teeth to fall out and I really don’t want her to have oral sedation or be strapped down to have 6 teeth removed. Is it common to allow a longer waiting period for these to fall out naturally and avoid the trauma to her? I am concerned it is bad parenting to go against the dentist orders and people may not understand my reasoning.

    • It is impossible to diagnose your daughter’s case from here. Some questions to ask however are 1) Why do the teeth need to be removed now? Are they abscessed? Are they preventing eruption of the other teeth? Etc., 2) How long will will your daughter be without her front teeth?, and 3) What happens if we wait?

  7. Mona says:

    My daughter is 5yrs and 10mo old. A few weeks ago we noticed one permanent tooth coming out behind the front bottom tooth. Her dentist recommended waiting 4 weeks and if the baby tooth did not fall out by then, she will pull them out. She said they would use some gas (nitrogen?). Is this procedure required? What is the risk to not extracting this tooth? I feel it will traumatize my daughter to go through this level of dental procedure at young age. Thanks a ton!!

    • If a permanent tooth comes out behind a baby tooth and the baby tooth is not loose at all, it will usually need to be removed. It sounds like your dentist is on top of this for you. As for traumatizing your daughter, our children usually do better at the dentist than their parents do. If you are nervous, your daughter may be better off with you in the waiting room. She can “smell fear.”

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