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.

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

  1. Paige Tractenberg says:

    My 7.5 yr old daughter has tons of crowding. I am sure she will need permanent teeth removed. Her new dentist said she needs some baby teeth pulled. They already pulled one lateral incisor and a canine, and they were supposed to pull the other lateral incisor (all lower), but she was screaming bloody murder when they did the first two. One still had the very long root. I am now questioning if we should go through this again for the other side. The dentist assured me it was just pressure, but that was crazy. They also wanted to pull the two upper lateral incisors, but those have fallen out in the last few weeks since she was there. In addition, they believe they might need to pull one or two of the molars based on how the permanent ones are coming in. How do I know if they are right? Should I just leave them be since she will then have to have permanent teeth removed as well? Thanks!

    • I would recommend that you have your daughter examined by an orthodontist who will help create space by moving the teeth rather than just pulling out the baby ones. All he is doing is “robbing Peter to pay Paul.” Eventually he’ll have to pull permanent teeth unless extra room is created somehow

  2. Monalisa pablo says:

    My son is six years old. His baby tooth didn’t fall out yet but the permanent tooth started to grow. I should ask the dentist tohave tooth extraction but some other says he is too young to have tooth extraction. Is it possible dor him to have toothextraction at his age? Thank you

  3. Tanya says:

    Is it at all positions lê to email you my son’s Xray for your opinion please? The dentist wants to extract about 10 of my son’s baby teeth. He’s only 7.

    • Sorry Tanya. I cannot diagnose patients who are not physically in New Mexico where I am licensed to practice. Please have your son seen by someone in your locale for the best results.

  4. Jaime says:

    My 14 year old daughter still has both her upper canine baby teeth. Should they be extracted immediately and will the adult canines erupt?

    • There are many reasons that the eruption of a canine might be delayed. Some are crowding, impaction, or a missing canine. My best guess is that just removing the baby tooth will not solve the problem. I would recommend a formal evaluation with an x-ray so you’ll know what is actually going on with your doctor.

  5. Evelyn says:

    I have a nine year old who may need to have two teeth pulled. If so should I have his Dentist do so or an Orthodontist? Reading your blog I realize he may need spacers as they are his molars and I believe they shouldn’t naturally come out for a year or two. He already has a dentist appointment but wondering if I should be looking for an Orthodontist.


    • Orthodontists don’t remove teeth although they may be the best ones to decide how many, which ones, and when the teeth need to be removed. General dentists and oral surgery are the dentists who typically remove teeth for our patients.

  6. Kendra Higgins says:

    My daughter is 10 and both of her upper canine baby teeth are still in place. Her permanent teeth are coming in above them as you can see a bulge on each side above the baby teeth. The permanent tooth on the left side appears to be coming through the gum. The baby teeth are slightly loose. Should we have her evaluated now or wait to see if the baby teeth will loosen and fall out?

  7. Kristina says:

    My daughter is 3 years old and her gums were swollen but she doesnt want to take any anti biotics. I just want to ask if is it ok for a 3 year old kid that all her teeth will be extracted?

    • I’m not an expert on swollen gums in 3-year-olds, but I think antibiotics at that age are uncommon (unless she has an abscess). Please take her to a children’s dentist (pedodontist) and follow their instructions.

  8. Barbara says:

    My son will be 12 in two wks. Nearly 3 months ago in 2 sessions he had 4 canines upper & lower removed as the roots were not absorbing (remarked dentist) and they showed no sign of getting loose (there are many more but orthodontist wanted these four outcfirst to start braces. The adult teeth were there but unable to come in. Now 3 mo. later it doesn’t appear as if any of the adult teeth are ever going to come in. He’s lost very very few teeth st all….His twin sister lost all hers though already. My question is- will the adult teeth ever come in? Is it weird they are not breaking through yet?

    • Everyone is different Barbara, but in most cases they do eventually come in. If there is crowding, braces may be needed to create space for them to come in. In some rare cases the braces must be used to pull the teeth in, one-by-one, into the arch. These cases require the help of an oral surgeon to uncover and bracket the delayed teeth. Don’t jump to any conclusions yet however. Your son is young and should be given some more time to let nature take its course.

  9. Deanne says:

    It has been suggested for my daughter,16years, have baby canine teeth removed then surgery to have adult teeth pulled down and braces to follow on with. If we don’t go ahead with this what are the possible outcomes? Her grandfather still has a baby tooth at 70years with no ill effects.

    • There are a couple of possible problems with not rescuing the permanent lateral. 1) it may move near the roots of the nearby teeth and damage them, and 2) the baby tooth may fail later in life when moving the permanent tooth may be harder or impossible to move. I would recommend rescuing the tooth when she is younger.

  10. Thabelo says:

    My 4 year daughter had her baby tooth removed due to an infection, the tooth was also moving around as if it wanted to come out. I am worried if the normal tooth is going to grow. Is there anything you recommend we should do?

    • I would have your daughter examined and followed by a pedodontist (a children’s dentist) who will not only help you with this problem, but help prevent problems like it in the future.

Leave a Comment

Back to Top

Your account login
Your rewards
Schedule an appointment with our talented orthodontist online