Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 12/12/2009

Question
My 11 yr old daughter has her baby eye teeth still in, and shown by an xray, the secondary canine teeth are heading on an angle. They are not impacted on the roof of her mouth, they seem to have the whites showing through the gum at the front of her gums. Our dentist said she could remove the baby teeth then expose the gums and attach brackets onto the canines to help them come into place, though I wasn't sure whether we should be going to a surgeon instead. I was concerned about the costs too, are surgeons usually more expensive than normal dentists if done in dental surgery?

Answer
Wendy -  First of all, surgeons and all dental specialists usually charge a higher fee for similar procedures.  Saying that, the quality of procedures, whether surgical, by an oral and maxillofacial surgeon, or periodontal, by a periodontist, a usually significantly different, but the fees are also higher.  In removing the baby eye teeth, the procedure is not difficult unless a portion of the root of the baby tooth has been resorbed by the adult tooth as it attempted to erupt.  A careful exposure of the adult tooth without damaging the attachment of the tooth to the gum tissue can be challenging and it is important for whoever performs the procedure is skilled and knowledgeable with surgery.  

So a dentist can do the extraction and exposure for a lesser fee, but that dentist needs to have extensive experience.  Due to the nature of their practice, a general dentist sees fewer patients for this procedure and probably does not have the overall skills.  So you need to weigh the skills of your daughter's dentist vs the money you might save.  Not an easy answer, but the healthiest approach should be the ultimate goal.  If you have any additional questions, feel free to contact me again.