San Diego, CA – Children should see an orthodontist by the age of seven so that an orthodontist can monitor the child’s mouth and begin treatment at precisely the right time to have the most impact. For some children, this will mean two phases of treatment, making the second phase of treatment less complicated than if the patient had simply waited until the teen years for treatment. But, for those who have begun treatment, or even waited a bit, should an orthodontist place braces on the teeth before the child has lost all the baby teeth?
“The answer to that question, at least for me, is that it all depends,” says San Diego orthodontist Dr. Santiago Surillo. “For some patients who have severe crowding, leaving little room for permanent teeth to erupt close to their ideal locations, we may recommend braces while there are still some baby teeth present. The braces may actually work to help that baby tooth become loose and fall out on its own, freeing us up to ensure permanent teeth have the proper space to erupt.”
For other children, Dr. Surillo may take a different approach, however. If a patient has entered the teen years and still has a baby tooth or two present, it is important to look at the factors that may be causing that. For some children, dental development may just be delayed. If the teeth are falling out in the proper sequence, just a bit later than peers may be losing theirs, it may just be a sign that the child’s dental development is slightly delayed, and not cause for serious concern.
If, however, the child has lost all of the primary teeth, but one or two still haven’t fallen out, it may be a sign that something isn’t quite right, and Dr. Surillo may recommend investigating further.
“In this instance, we would recommend additional X-rays to ensure that there is in fact a permanent tooth waiting below the surface,” says Dr. Surillo. “In a small percentage of the population, there may be congenital missing permanent teeth, so an X-ray would tell us if that was the case. We usually want to leave these baby teeth in place for as long as possible, as the situation dictates, to allow for the preservation of the supporting bone, for as an implant replacement may be needed when they are in the adult years.”
If a child has a dental delay that may impact how the permanent teeth are able to come in, Dr. Surillo may recommend having the remaining primary teeth pulled so that the permanent teeth can erupt and the final phase of orthodontic treatment can begin. This is largely determined by the child’s age – for a later adolescent, Dr. Surillo may suggest pulling the teeth so that orthodontic treatment can be completed during the teen years and not extended past high school. However, pulling teeth is always a last resort and reserved only for extreme situations.
“Luckily for my patients, I am also a pediatric dentist, so I can make fully informed decisions about how a patient’s smile is shaping up, and marry my dentistry expertise to my orthodontic knowledge,” says Dr. Surillo. “Parents know that when I make a recommendation, I am doing it with the combined knowledge of both pediatric dentistry and orthodontics. A decision to pull baby teeth before they fall out on their own is not one to be taken lightly, but my patients and their families know that when I make a recommendation, it is with the end result in mind.”
Typically, beginning treatment once the baby teeth have all fallen out can make treatment as efficient and short as possible, but Dr. Surillo always makes the best decision for each individual patient.