Are Extractions Necessary Before Orthodontic Treatment?

extractions before orthodontic treatment
Peter, the patient
Dear Dr. Stosich,
My child’s dentist said that he is too old to still have baby teeth, and recommends that we have them all pulled now. He’s only 11, and I’m worried about what pulling teeth too early will do for future orthodontic work. The dentist claims that we should pull the teeth now to make the orthodontist’s job easier. But are teeth always pulled before beginning orthodontic work?
Caitlyn G.
Dr. Michael Stosich
Dear Caitlyn,
It is important to note here that baby teeth fall out in a certain order, and while most children lose their teeth in the early elementary years, every child is different. Losing baby teeth too early or too late can cause orthodontic issues, so it’s great that you are checking into it before simply agreeing to your dentist’s plan.

Most children will lose their first tooth around age six or seven, and the last teeth will typically fall out between the ages of nine and 12. So, your son is probably still in the ideal range for losing teeth.

baby teeth falling timeline

It is not always necessary to extract teeth to begin orthodontic treatment. In younger children, we have the advantage of a growing jaw that can be manipulated through orthodontic devices, such as palatal expanders, to ensure adequate room for all of the permanent teeth.

If your dentist pulls your son’s teeth before they are ready, and the permanent teeth aren’t ready to erupt yet, he or she could be creating an orthodontic headache. Surrounding teeth could drift into the open spots, creating a bad bite and misalignment that might otherwise not have been there an issue if the teeth hadn’t been pulled. We can, however, use spacers to ensure this doesn’t happen.

On the other hand, though, if your son’s teeth fall out too late, it can highlight an existing orthodontic problem or trigger one altogether. Pulling a baby tooth can allow for crowded permanent teeth to come in at their normal time, and at their normal locations.

My best advice to you would be to consult an orthodontist before agreeing to your dentist’s plans. An orthodontist will have the knowledge needed to understand the relationship between what the mouth looks like today, what it will look like when the permanent teeth erupt, and what it could look like through orthodontic treatment.

Your orthodontist may agree with your dentist, and recommend spacers to keep the locations of the primary teeth open so the permanent teeth will be able to erupt in their proper locations. Or, your orthodontist may propose a wait and be monitored solution.

No matter what, an orthodontist will have the expertise in dentofacial orthopedics to understand how to ensure the most ideal bite for your son, both now and in the future.

Sincerely,
Dr. S.

AUTHOR: Michael Stosich

Michael S. Stosich, DMD, MS, MS, is a specialist orthodontist for children and adults with subspecialty expertise in robotically assisted orthodontics. Dr. Stosich serves as the orthodontic director at the University of Chicago's cleft lip and palate clinic and craniofacial anomalies clinic, which treats complex pediatric craniofacial anomalies.