Should You Extract Baby Teeth or Start Orthodontics First?

Should tooth extraction be done before orthodontic treatment or vice versa?

Hello, my child is in the fourth grade this year (she is relatively small for her age), but the teeth next to her upper front teeth have not yet fallen out (they are a bit loose).
I initially wanted to extract the baby teeth (after confirming with an X-ray that there are permanent teeth behind them), but the doctor advised against extraction, fearing that it might cause the adjacent teeth to shift and create a smaller gap.
The doctor also mentioned that her upper front teeth are misaligned and are making contact with her lower front teeth, which could lead to wear.
Therefore, they suggested starting with localized orthodontic treatment to maintain space for the lateral incisors, facilitating the future eruption of teeth.
Should we proceed with the orthodontic treatment first? Thank you.

Zhenzhen, 30~39 year old female. Ask Date: 2016/09/19

Dr. Zeng Guanghui reply Dentistry

The teeth next to the upper front teeth should be primary molars.
If the erupted permanent first and second premolars have already pushed forward, localized orthodontic treatment can be performed first, followed by the extraction of the primary canine to minimize the risk of space loss and the potential for the permanent canine not to erupt.
It is still recommended to seek further evaluation from a dentist.

Reply Date: 2016/09/19

More Info

When it comes to deciding whether to extract baby teeth or start orthodontic treatment first, there are several factors to consider. The situation you described involves a child in the fourth grade who has not yet lost certain baby teeth, and there are concerns about the alignment and spacing of the teeth. Here’s a comprehensive look at the considerations involved in this decision.

Understanding the Situation
In pediatric dentistry, the timing of tooth eruption and the transition from primary (baby) teeth to permanent (adult) teeth is crucial. Typically, children begin losing their baby teeth around the age of six, but this can vary. If a child has a baby tooth that is loose but has not yet fallen out, it may indicate that the permanent tooth is ready to erupt. However, if the baby tooth is not lost in a timely manner, it can lead to complications such as crowding or misalignment of the permanent teeth.

The Role of Extraction
Extraction of baby teeth is sometimes necessary, especially if they are not falling out on their own and are causing issues with the eruption of permanent teeth. However, as your dentist pointed out, premature extraction can lead to other problems, such as the adjacent teeth shifting into the space left by the extracted tooth. This can create a situation where there is insufficient space for the permanent tooth to erupt properly, potentially leading to misalignment or crowding.

Orthodontic Intervention
Orthodontic treatment can be beneficial in managing the alignment and spacing of teeth. In your case, the recommendation to start with localized orthodontic treatment makes sense. This approach can help maintain the space needed for the permanent teeth to erupt properly while also addressing any immediate alignment issues. Orthodontic appliances, such as space maintainers or partial braces, can be used to guide the growth of the teeth and ensure that there is adequate space for the permanent teeth.

Timing and Monitoring
It’s essential to monitor the situation closely. Regular dental check-ups will allow the dentist to assess the progress of the baby teeth and the eruption of the permanent teeth. If the baby teeth remain in place longer than expected, or if there are signs of crowding or misalignment, further intervention may be necessary.

Conclusion
In summary, the decision to extract baby teeth or start orthodontic treatment should be made based on a thorough evaluation by a pediatric dentist or orthodontist. Given the concerns about potential crowding and the alignment of the teeth, starting with orthodontic treatment to maintain space and guide the eruption of the permanent teeth seems to be a prudent approach. It is also important to keep an open line of communication with your dental care provider to ensure that any changes in your child's dental health are addressed promptly.
Ultimately, every child's dental situation is unique, and a tailored approach that considers the specific needs and developmental stage of the child will yield the best outcomes. Regular dental visits and proactive management will help ensure that your child's transition from baby teeth to permanent teeth is as smooth and healthy as possible.

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