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.

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

  1. Susan Stone says:

    My 10 year old has a cavity in his upper first baby molar on both sides of his mouth. They cause him no pain but can be visually seen as a small hole on the back edge of each tooth. They were noticed by the dentist 6 months ago who told me to leave them alone and that they would fall out. They have still not fallen out and the dentist is now recommending that they be extracted. He said no space maintainer would be necessary. I am concerned about the space closing up because his teeth are beautiful and not look perfect right now. He is kind of slow with losing his teeth as he has only lost 8 teeth so far which are the front top 4 and lower 4. Does an extraction of both teeth sound reasonable with no space maintainer if the permanent molars could still take a while to come in?

  2. kamran says:

    my age is 18 years..one of my milk teeth did not came out because there is no permanent tooth under it….but now it is decaying and moving…. and it is almost coming off…why it happens that there is no permanent tooth behind the milky one??? and what is the solution of this problem please???

    • After the primary tooth is lost, you have three options with the space: 1) leave it, 2) close it with braces, or 3) replace it (implant, bridge, etc.). Determining which is best for you is what an orthodontic specialist is trained to do.

  3. Angela says:

    Hello Dr., first of all thank you for your answers to our questions and the information contained in your blog. It has been extremely helpful. I have a situation; my daughter has a permanent tooth coming in behind her permanent ones. She has crowding in the area and is being followed by an orthodontist. The orthodontist recommended that 4 primary teeth need to be removed. Is there a reason why we need to wait until the tip of the permanent tooth shows behind to remove the front primary tooth? I feel very confused and trapped between what my orthodontist recommends and what the dentist says. I think that waiting until the tip of the permanent tooth shows up behind will get my daughter (9 year old) the shark teeth appearance. I really do not understand why we need to wait. If the problem has been detected early wouldn’t it be better to proceed with the extraction? If yes, would it be ok to remove 2 teeth first and then the other 2? Which interval? Would you recommend removing the 4 at the same time? Would a “space maintainer” be needed immediately?
    She has big permanent teeth and I see that 2 of them will soon erupt (behind the bottom lateral incisor and canine – both sides) because her gum looks swollen. I am confused. Thank you, Dr. for your advice.

    • I usually have all four baby teeth taken out at the same time since the new teeth are much bigger and just removing two usually doesn’t get the job done. Space maintenance is not needed in the lower anterior at this age.

  4. Angela says:

    Hello Dr., first of all thank you for your answers to our questions and the information contained in your blog. It has been extremely helpful. I have a situation; my daughter has a permanent tooth coming in behind her primary ones. She has crowding in the area and is being followed by an orthodontist. The orthodontist recommended that 4 primary teeth need to be removed. Is there a reason why we need to wait until the tip of the permanent tooth shows behind to remove the front primary tooth? I feel very confused and trapped between what my orthodontist recommends and what the dentist says. I think that waiting until the tip of the permanent tooth shows up behind will get my daughter (9 year old) the shark teeth appearance. I really do not understand why we need to wait. If the problem has been detected early wouldn’t it be better to proceed with the extraction? If yes, would it be ok to remove 2 teeth first and then the other 2? Which interval? Would you recommend removing the 4 at the same time? Would a “space maintainer” be needed immediately?
    She has big permanent teeth and I see that 2 of them will soon erupt (behind the bottom lateral incisor and canine – both sides) because her gum looks swollen. I am confused. Thank you, Dr. for your advice.

    • I usually have all four baby teeth taken out at the same time since the new teeth are much bigger and just removing two usually doesn’t get the job done. Space maintenance is not needed in the lower anterior at this age.

  5. Damipe says:

    My baby milk teeth has remove for the past 9 months now, and Another one refuse to grow.

    • You probably have one of three things, 1) the tooth is trapped by crowding, 2) the tooth is growing in the wrong place, or 3) the permanent tooth is missing. Only a doctor with an x-ray can tell you for sure.

  6. florence erro says:

    Hello Dr., my 4 year old child already suffering pain because of her damaged teeth. Can her teeth be removed by dentist even in her younger age.Thank you.

    • I would recommend that your child be seen by a pedodontist before you do anything. A pedodontist is a specialist who is trained to work with children. He or she will be able to help you with your very young child.

  7. Mary says:

    My daughter (15 yrs old) has a baby canine that hasn’t fallen out. We had an orthodontist 3D xray to see if the permanent tooth is viable which now sits in the gum over the next permanent tooth. He confirms its viability and recommends the following:
    - extract the baby tooth
    - inserting a space maintainer
    - surgically attaching to the permanent to slowly pulling it over and down

    Is this something frequently seen?
    My husband and I are worried about the outcome.
    Are her other teeth really at risk? Is this really necessary?

  8. hunter says:

    My name is hunter and I can’t tell weather I am loseing a grown up tooth or a baby tooth what does a baby tooth look like compared to a grown tooth I am 12

  9. Jennifer says:

    My 10 year old daughter is getting 15 baby teeth removed at the dentist. Her teeth are in good condition but she is having difficulty with her primary teeth falling out. Because a lot of her primary teeth are loose she has not been brushing properly and this has caused her gums to become very inflamed. The dentist has recommended these be removed and to save the same problem arising again he is just going to remove all baby teeth. I have agreed to this as I understand the logic but I am worried she will be left gummy for too long and she becomes self conscious about it. Can you tell me how long it will take for her second back teeth to come through once the primary teeth are removed.

    Thanks

    • Having 15 teeth removed at once sounds excessive to me. The average 10-year-old girl has 12 baby teeth remaining and loses them over the next three years. I think your dentist is being too aggressive. I would never have 15 teeth removed from my daughter all at once.

  10. Kuldeep says:

    Hi doctor my daughter she is 4 year old she damage her all front teeth because of milk. Nor dentist told to pull her front to top baby the etch and back one should be crowned. It’s is ok to pull her teeth to save a permanent teeth.

Leave a Comment

Back to Top

meet orthodontist Greg Jorgensen of Albuquerque NM
why choose our Rio Rancho NM orthodontic office
Schedule an appointment with our talented orthodontist online