What is the reason for removing baby teeth before they’re ready to fall out on their own? This is an excellent question and one that I often get throughout the day. There are many situations where the patient would benefit from early removal of baby teeth and each case must be evaluated on an individual basis. Baby teeth fall out at a specific age range and in a specific sequence. This allows for the permanent teeth to come in properly. Sometimes, baby teeth don’t fall out when they’re supposed to which can result in an orthodontic problem. An example of an orthodontic problem is when the upper baby canine teeth do not fall out resulting in the permanent canines that will replace them to erupt behind the root of the adjacent tooth. This situation can result in a more complicated orthodontic problem where the permanent canine is impacted and won’t erupt on its own. Orthodontics and surgical intervention is often necessary to resolve this problem. A panoramic x-ray is an excellent diagnostic tool to evaluate if potential tooth impaction will be a future problem for the patient. If the permanent canines appear to be erupting at an unfavorable angle based on the panoramic x-ray, the upper baby canine teeth are removed early to allow for the unimpeded eruption of the permanent canines.

Sometimes baby teeth need to be removed early to begin orthodontic treatment. If it is determined that the time to start braces is soon and the baby teeth are not close to falling out, the orthodontist will request that the general dentist remove some or all of the remaining baby teeth so that movement of the permanent teeth can occur and at the same time, encourage the eruption of the rest of the permanent teeth. There are many scenarios where this would be beneficial, but not enough room in this article to discuss here. There are times where baby teeth have no permanent teeth to replace them. This most often occurs with the lower baby molars. When that situation exist, sometimes the baby molar tooth becomes ankylosed, meaning that the roots become fused to the surrounding bone and don’t erupt with the adjacent permanent teeth. The tooth actually looks like it is sinking into the gum tissues. This situation often calls for the removal of the baby molar to prevent a large difference in the heights of the adjacent teeth and other periodontal problems. There is a situation that sometimes occurs when the 6 year molars erupt. For unknown reasons the upper first molar will erupt under the baby molar in front of it. If it is identified early by the dentist or orthodontist, the erupting molar can be redirected with minimal intervention. If the eruption of the molar results in the resorption of the root of the baby molar, extraction of the baby molar is required to allow the permanent molar to erupt and this usually results in a lack of space for the future premolar. This will require orthodontic intervention to regain space.

These examples are some of the more common examples where baby teeth need to be removed early. Like I said, there are many variables that impact the decision on whether to extract baby teeth early or let them fall out on their own. The ultimate goal is to minimize potential complications that can result in a more difficult orthodontic problem. And yes, the tooth fairy can still deliver! Orthodontists watch for possible tooth eruption problems. In some cases the child may need a space retainer to prevent future problems. Having a child see an orthodontist before the age of 7 can easily help manage this.”