Dr. Greg Jorgensen
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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.

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

  1. Katy says:

    Hello, I turned 14 a month ago, and I have braces. I have two baby teeth that my dentist wants to remove next week, but I wanted them to fall out on their own. They are a little loose, but I feel like they can maybe fall out in another month. Plus, to take them out I need to get 3~4 shots in my mouth which hurt really bad. My gums are still swollen from the inside of my mouth from a shot my dentist gave me about 5 months ago to remove 2 teeth, I asked him why they were swollen and the response he gave me was that they were not swollen.Please help, should I talk to him and tell him I don’t want them removed?

  2. emma says:

    Hi my son is 10yrs old and his upper lateral incisors have not come through yet and we were sent to an orthodontist who said that his teeth are growing a couple of years behind and that he will just keep an eye on it and see him again in 2yrs time. Yet our regular dentist seems to think the gap he has is not big enough for the tooth to come through. Should i be worried that my son’s teeth aren’t growing as quickly as they should be?

  3. Shafi says:

    Hi. My daughter who is 3.8 yrs complains of tooth ache. She has cavity in her tooth. Since she isn’t too cooperative, Doc suggested that we can wait until she grows a bit older to have her tooth removed. Since the complaints are not too frequent, we decided to wait. But when she is in pain, it’s very painful. I look forward for your suggestion in this case. Thanks.

    • If your dentist will not help because of your daughter’s age, I would recommend seeing a children’s dentist (a pedodontist). They specialize in treating kids.

  4. Mel says:

    You are very generous to answer everyone’s questions. My 9.5 yr old son has 8 adult teeth (4 upper and 4 lower incisors). His upper lateral incisors are flared – likely due to his adult canines (only visible via X-ray) tipping the root of the lateral incisors. The 1st orthodontist suggested we remove the baby canines and see if the adults move into proper position and take the pressure off of the lateral incisors roots, thereby reducing the flare. Six months after removal we would discuss a palate expander as well. Brace are unknown and a future decision. The 2nd orthodontist identified the same root tipping issue but instead suggested we not remove any teeth, put on a palate expander and braces to fix the flared lateral incisors. This would likely be “phase 1″ braces. Does one plan seem more sound than the other? It’s amazing to me that their approaches differ so much. Thanks for your time.

  5. Robin Biggs says:

    I have to stop my x from having 8 of my six year old’s back teeth out under general anesthetic. I say let nature take it’s course. Why put him through the trauma and the danger . I have seven days before the operation to stop this madness, this is a woman who takes him to the hospital for every cold he gets — please , I could use some advice !

    • I understand your concerns Robin. 8 teeth does seem like a lot, especially at one time. I don’t know all of the circumstances, but I’m guessing that there must be something wrong (i.e. decay, abscesses, etc.) that the dentist is worried about and it may be that if your son is going to be “out” for the treatment of a few teeth, they are just going to take care of a bunch while they are at it. I’m sure that if they are submitting a six-year-old to general anesthesia, there must be something really wrong with those teeth.

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