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.

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

  1. Collins says:

    Hi. My 4yrs old daughter’s teeth (four top front teeth- looked cracked and discoloured, one lower molar and one upper pre-molar had a kind of decay). My 2yrs old son’s teeth( the two upper front teeth) had same signs of crack and discoloration.
    The dentist says he got to extract all the teeth as the decay may affect the permanent teeth. I ain’t comfortable with the extraction.
    Isn’t there a better option?

  2. Shae says:

    Hello, I’m fourteen years old and have an issue. My upper right canine is growing in on top of my baby canine, and has been like this for a while. The baby canine is wiggling, but not enough for it to fall out on its own, nor does it get any more loose as the days go on. The adult tooth is a bit higher up on the gumline than the rest.

    I can’t get to a dentist, because my parents won’t make me an appointment at the moment. I’m getting increasingly concerned about the prospect of needing braces to set the tooth back into place, or the adult tooth even falling out once the baby tooth is no longer ‘supporting it’ after being pulled. What do I do?

    • The fact that the adult tooth is coming in but not pushing out the baby tooth usually means there is a crowing problem. Even if you were able to wiggle it out, the permanent one would probably not move into the right place on its own. It sounds like you’re a candidate for orthodontic treatment.

  3. Debbie Gibbons says:

    My son is 14 and the dentist is saying that his top two 2nd from the middle teeth are still baby teeth and that I should see an orthodontist to have them taken out. On the x-ray you can see his adult teeth. Will they eventually fall out or is pulling necessary? I am concerned about the cost of taking them out and what will need to be down after they are pulled to the adult teeth. I do not have insurance.

    • Merely removing baby teeth in a 14-year-old does not guarantee that the underlying permanent ones will come in on their own. They are usually delayed due to crowding and just removing the baby teeth does not fix that. I would have your son evaluated by an orthodontist who can evaluate if there is a crowding issue.

  4. Charlotte says:

    My granddaughter had to have medicine for double pneumonia while she was pregnant for my 3 year old grandson. The medicine she had to take has affected his 4 upper-front baby teeth, they’re not growing like they should, just partly out, discolored. Should we wait until his permanent teeth push them out? He’s too little to have the teeth extracted, & his Mom is afraid to have him do it. Any suggestions? Thank you.

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