Parents often assume that their child cannot receive orthodontic treatment if they still have primary/baby teeth. The American Association of Orthodontists actually recommends having your child first seen at age 7 and younger patients can benefit from treatment called “two-phase treatment.” Two-phase treatment can provide early intervention that may help prevent difficult dental problems in the near future. If a parent chooses to wait to have their child seen, the future corrections can require more aggressive treatment. In addition, a young child may have bite problems that not only make them more susceptible to serious injury, but also negatively impact their self-esteem.
While a full set of braces do necessitate all of a child’s permanent teeth to have erupted, additional orthodontic treatment may be necessary, even if a child is older. By age 12 all permanent teeth save for wisdom teeth have typically erupted in a person’s mouth, replacing all baby teeth. It is possible for a child to have delayed eruption of permanent teeth, and often the order in which the teeth are lost can help determine if the delay is normal. If teeth are lost prematurely or unevenly, there could be a dental issue.
All new child and teenage orthodontic patients are examined to determine their dental developmental status using a panoramic radiograph (commonly called x-ray.) If a patient is 13 years or older and does not have all of their permanent teeth yet, determining why and how can help us determine if the delay is normal or if there is an underlying issue. If a patient still has baby teeth, there are a few factors that influence a recommendation to remove them. Factors include the patient’s age, the root formation of the baby teeth, if the patient has their 12-year molars already, crowding in the mouth, and the concern of impacted permanent teeth.
If a patient is already 14 or 15, removing baby teeth can help move orthodontic treatment along so they can be done before high school graduation. If the root formation of a permanent tooth that has yet to erupt is nearly complete but the baby teeth are not lose, it is advisable to remove the baby teeth. If other dentition like the patient’s 12 year molars are erupting but they still have baby teeth, removing the baby teeth will allow treatment to begin. Crowding is another reason to remove baby teeth. A main concern is impaction of permanent teeth. A impaction is when a permanent tooth is displaced and therefore unable to erupt without orthodontic treatment. These can be difficult to correct, so any actions taken to prevent them is worth looking into, including removing baby teeth.
The recommendation to remove baby teeth depends on all of these factors and will not be recommended unnecessarily if there are other methods to prevent dental problems. Removing baby teeth will generally reduce treatment time meaning less appointments and less missed school. There are situations where orthodontic treatment may begin before all baby teeth have been lost. This includes when an unerupted permanent tooth does not have room to come in and therefore the baby tooth is still present. Orthodontic treatment can provide room for that unerupted tooth to come in, helping the baby tooth to be lost of its own accord. If a permanent tooth is completely missing, a baby tooth will have no bearing on treatment start time. Another situation that warrants initiating treatment could include a patient’s self-esteem. It is important that patients look and feel their best and anything that can be done to facilitate that will be done!