Extracting Baby Teeth

I have a seven-year-old daughter who has a crossbite and an abscessed tooth. Her orthodontist is going to place a quad helix in her mouth to alleviate the crossbite. My concern is that her dentist wants to extract three of her baby teeth because of the abscessed tooth. This will necessitate using a retainer to hold tooth placement until her adult teeth appear. Is this really a necessary procedure or are there less invasive alternatives?

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It is possible that there is another orthodontic condition, e.g. inadequate space, in addition to the crossbite. Sometimes, in an attempt to gain a space advantage for the permanent teeth, a process termed serial extraction can be done. Serial extraction of the primary teeth can help control the eruption pattern of the permanent teeth, possibly eliminating or reducing the need for further orthodontic intervention. Your daughter's dentist and orthodontist should be working together to determine whether or not a specific orthodontic advantage will be gained from extracting more than just the abscessed tooth.

If there is no orthodontic reason for extracting all three primary teeth, you should ask your daughter's dentist why he or she recommends extractions. Depending upon the circumstances involving the abscessed tooth, it may be possible to do a pulpotomy or pulpectomy (remove the nerve tissue in the tooth) and restore the tooth. This option would, of course, depend on the extent of the abscess, the restorability of the tooth, the health of the periodontium (gum and bone surrounding the tooth), and its relationship to adjacent and opposing teeth. The other two teeth may not require extraction unless they have deep decay or have been traumatized.

Ask your dentist to explain exactly why all three teeth need to be extracted. You may also want to discuss this issue with the orthodontist to ensure this will not change his or her treatment plans. If you do not receive an adequate explanation or are still unsure of the treatment, you might want to seek a second opinion. If you do opt for the extractions, and one or more of the extracted teeth are posterior primary teeth, a space maintainer will be necessary to prevent loss of space for the permanent teeth.

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