Second opinion for extraction?

My 7 yr old daughter has been diagnosed with a cross bite. In addition, the dentist wants to extract 4 baby teeth 2 on top and 2 on the bottom because the permanent teeth are coming in sideways. He also wants to do 'Panaromic xray.' Should I get a second opinion before any xray or extraction?


Dear Karen,

A second opinion would be helpful, especially since your daughter may need orthodontics. A panoramic radiograph (x-ray) will also be beneficial because it will show several important things regarding your daughter's dental development. It will show if all of her permanent teeth are developing, their positions, how they relate to the primary teeth and other permanent teeth, and how they relate to other vital structures in the jaw. In order to determine if any skeletal discrepancies exist between the upper and lower jaw, other types of radiographs may be necessary. These will help to ensure proper diagnosis and treatment for your daughter.

You did not state if your daughter was diagnosed with a crossbite of the anterior teeth or the posterior teeth. A crossbite can be caused by a simple ectopic eruption of the teeth, by a skeletal discrepancy, or by a muscular adaptation. It is important to determine the cause of the crossbite to ensure proper overall treatment. For example, insufficient arch length and prolonged retention of the primary teeth can cause a crossbite in the posterior region. In addition, it should be determined if the crossbite is unilateral or bilateral. Treatment may vary according to this diagnosis. Posterior crossbites should be treated as early as possible to aid in proper development of the arches.

It does sound as if your daughter might have insufficient space for eruption of her permanent teeth. There are several ways to treat this condition including a procedure known as "serial extraction". Don't worry. This procedure sounds alot worse than it really is! This procedure calls for "premature" extraction of certain primary teeth to better control the eruption of the permanent teeth. In some cases, extraction of some permanent teeth may be necessary later. In cases of slight crowding, missing permanent teeth, or skeletal discrepancies between the upper and lower arches, serial extraction may not be indicated. A patient undergoing serial extraction will need to be supervised and followed closely for several years to ensure proper care. If permanent teeth appear to be impacted or are erupting ectopically (out of proper position), extraction of primary teeth may be necessary. Then an orthodontic appliance can be used to regain some lost space.

Discuss treatment with your dentist to determine plan that is acceptable. Again, panoramic and cephalometric radiographs may be necessary and helpful to determine tooth and skeletal relationships. After determining a diagnosis, you can then determine who you would prefer to complete the treatment.

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