What factors are important to consider when determining whether to remove the remaining primary teeth? If a patient’s overall development is delayed, the decision to remove the remaining baby teeth is determined by several factors.
1. I consider the patient’s age. If they are 14 or 15 years of age, I have no hesitation in recommending the remaining baby teeth be removed so that their orthodontic treatment is completed before they graduate from high school.
2. I examine the development of the roots of the unerupted adult teeth. If the root formation of these unerupted teeth is nearing completion but the associated baby teeth are not loose, extractions are advisable.
3. If the 12-year molars are partially or fully erupted but the baby teeth remain, I will usually recommend having the remaining primary teeth removed so that treatment can begin.
Avoiding Impaction of Permanent Teeth
Although my preference is to wait until all of the primary teeth have been lost, there are times when it is appropriate to begin treatment early. One of our greatest concerns when evaluating our patients is to avoid the possibility of a tooth becoming impacted. An impacted tooth is one of the scourges of orthodontics and can be very challenging to resolve. An impacted tooth is one that is displaced from its normal eruptive position and unable to erupt without orthodontic assistance.
When a tooth or teeth are blocked out or crowded, removal of a primary tooth may be necessary as well. The timing of removal will depend on the patient’s age and the particular circumstance. I attempt to delay removal of primary teeth as long as possible if there are other methods to prevent problems from developing. However, I have no hesitation to remove baby teeth when it is in our patient’s best interest.
There are occasions when the baby tooth has not been lost because the underlying tooth does not have enough room to come in. In this situation we will usually begin treatment with the associated baby tooth in place. Sometimes making room for the underlying tooth will help the baby tooth become loose on its own. If not, we may have the baby tooth removed by the family dentist.
If the patient’s smile is causing an issue with self-esteem I will typically initiate treatment even though the primary teeth have not been lost. This situation may require the extraction of selected primary teeth to make room for the adult teeth to line up.
Finally, if we’re planning on keeping a baby tooth because the underlying permanent tooth is missing, the presence of the baby tooth will have no influence on the starting time.
When and only when it is advisable, starting treatment after all of the primary teeth have been lost generally reduces treatment time. It also minimizes the amount of school and work that patients and their families miss. It also reduces the probability of undesirable consequences that can accompany extended orthodontic treatment (white spot lesions, puffy gums, root resorption, etc.)
My Early Treatment Philosophy
Generally speaking I have observed that there are many young patients who are the recipients of early braces without justification. My philosophy of early treatment is measured and conservative. It is based on the latest scientific literature, and in the wealth of experience that I have benefited from over the years successfully treating thousands of young patients. I do not believe in placing braces on a young child’s teeth just for the sake of braces and to increase the practice’s financial fortunes. We never exploit our patients for financial gain so when we hear stories of children in 2nd grade with sets of braces it makes us question the specialist’s motives and diagnostic skill sets. We encourage you to visit Mark Feinberg Orthodontics if you believe that your child is a candidate for braces or request our special pamphlet on early treatment via email version or regular mail.
If you have any questions about early treatment, don’t hesitate to contact our office, Mark Feinberg Orthodontics. Also please feel free to request a copy of our resource guide on early orthodontic care.