Dentist Says Wait on Crowded Teeth

We have an old fashioned dentist, which is fine with me, but I wonder about something. My sever-year-old daughter is very small for her age. She is losing teeth, and they are being replaced by much larger teeth of course. This means crowding, and some teeth are coming in behind others. He says leave them alone for now, eventually some will have to be pulled, and she will prob. need braces. Does that sound right? No pulling yet? No retainer, spacers, etc.?


Ask your dentist for a referral to an orthodontist for a consult. Many orthodontists will not charge you for an initial consultation. The orthodontist should examine your daughter's teeth, spacing, arch length, and growth potential. With this information, the orthodontist will tell you if treatment should begin now or if it is best to wait. (Please note that it is not uncommon for the lower permanent incisors to erupt slightly behind the primary incisors.)

If your daughter has developed a crossbite (lower teeth overlap upper teeth) due to a lack of arch space, an arch expansion appliance may be needed. If a lack of arch space without a crossbite is detected, other possible treatments may be devised either to maintain existing arch space or to help permanent teeth erupt in proper sequence, which may alleviate spacing problems.

The permanent premolars, which replace the primary molars, occupy less space in the dental arch than their predecessors. This space is called "leeway space." The leeway space is closed as the primary teeth are lost and the permanent teeth erupt. If this movement is prevented, more space would be available for alignment of the teeth. This space can be preserved by placement of an appliance called a lingual holding arch.

A plan which calls for "serial extraction" of the primary teeth may also be beneficial. Serial extraction is a strategic plan that targets specific primary teeth for extraction and sets dates when this should be completed. This will aid in the eruption pattern of the permanent teeth and prevent or minimize crowding. Primary tooth extraction promotes faster eruption of the permanent tooth if at least half the root of the permanent tooth is already formed. Otherwise, early extraction of the primary tooth will delay eruption of the permanent successor. If slightly more space is necessary for eruption of the permanent teeth, some stripping of the enamel in between the teeth may be beneficial.

Early intervention can be quite beneficial because it can produce more stable long-term results and possibly prevent extraction of permanent teeth. While early treatment may not be possible or necessary for your daughter, an evaluation of her situation should be accomplished. Armed with the necessary information, you and the orthodontist can then make that decision.

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