Baby teeth (primary teeth) are meant to come out on their own. So then why would an orthodontist recommend extracting baby teeth?
There are a variety of reasons why it might be recommended to extract a baby tooth. I generally leave it up to the patient’s pediatric dentist or family dentist to extract a tooth based upon decay. But, if there is a space issue, or if the adult tooth underneath is not developing straight and appears to be at an angle, it can be highly recommended to extract the baby tooth.
One common scenario centers around the development of canine teeth. Especially on the upper arch, adult canine teeth can sometimes develop and grow at an angle underneath the bone. This is discovered usually on a Panoramic x-ray. If left alone with no intervention, the canine or canines may continue to angle and become impacted. This means that they are stuck in the bone and cannot erupt properly on their own. Once impacted, the tooth needs to have a canine exposure procedure (performed by an oral surgeon) to expose enough tooth to place a bracket and move orthodontically. If angled, a canine can also damage the root of the neighboring lateral incisor.
For these reasons, when this scenario is discovered in an x-ray, the recommendation often is to remove the baby canine. Teeth tend to follow the path of least resistance like water. Therefore, opening up a pathway by removing a baby tooth can encourage the angled canine to start to straighten and follow a new, straighter path.
The American Association of Orthodontists recommends children see an orthodontist starting at the age of 7. Most of the time, children aren’t ready for treatment at this age, but monitoring growth or catching improper dental development or angulation of teeth and prescribing relatively small interventions such as baby tooth extractions can make a big difference.