"Trapped" Permanent Tooth

My 11 year-old was just referred for an orthodontic evaluation due to a "trapped" permanent tooth on the bottom. My son still has 12 baby teeth (I was 14 and still had baby teeth) and the orthodontist is suggesting that the dentist pull eight of the teeth now to let the permanent ones come in to see if that will allow for room for the trapped tooth to come up. What is your opinion on this multiple tooth extractions?


A process of serial extractions can be done in some cases in an attempt to control eruption of the permanent teeth and to gain space. Careful consideration must be taken before this treatment is done. First, extraction of a primary tooth will result in faster eruption of the permanent tooth if the root of the permanent tooth is at least half developed. Otherwise, early extraction of the primary tooth may delay eruption of the permanent successor. If proper space maintenance is not retained after the extractions, more arch length may be lost, causing more difficulty with crowding and eruption of permanent teeth.

Since it sounds as if your son has only lost his primary incisors, perhaps other options might be available. Treatment will vary if this is a bilateral condition or present on only one side of the arch. Your son's occlusion (relationship of upper and lower teeth) should also be evaluated. Perhaps an arch expander or increase in space with some other type of appliance may be more helpful or prudent than multiple tooth extractions. My main concern is that more arch space may be lost if proper follow-up is not taken. In addition, if multiple extractions are not necessary, it may be a little less traumatic for your son.

I suggest you ask for a second opinion. Perhaps you could ask your general dentist to refer you to a different orthodontist, or ask other parents which orthodontist they are working with for treatment of their children.

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