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Dentistry/Too young for serial extraction for future braces


QUESTION: My son is 10, and has a his adult teeth are double or more his baby teeth.  He's been seeing an orthodontist since he was 8 for the crowding issue.  Our dentist has been pulling his baby teeth in order for the adult teeth to bread through.  According to the new teethes, his molars are coming and needs space.  His baby teeth are not loose yet.  The orthodontist strongly suggest pulling 6 baby teeth and 4 adult teeth (1st bicuspids) to make space for the molars.

My concern is his tender age to have all these teeth removed, as it could be a long time before the adult teeth come in.

Will his jaw not continue to grow and reduce some crowding?  
Will his jaw not grow more to accommodate the teeth?  
Will the jaw growth slow down because less space is required, after the extraction?  
Will this change his facial features?
When is the best time to do it, and why?
What will happen if I wait?

ANSWER: Serial extraction is designed to be accomplished over a several year time span, typically from age 8-12.  While it is not appropriate for all types of bite problems, in certain cases it can greatly simplify orthodontic treatment a allow for a better result.  The timing of the extractions is very important and must be done before the baby teeth actually become loose.

To answer some of your other questions...
The jaws will certainly grow more after age 10, however this will not reduce the crowding to accommodate the permanent teeth.  When properly done the serial extraction plan should not adversely affect facial appearance.
In most cases if serial extraction is necessary and it is not done it can result in impacted teeth, the need for surgery, and prolonged orthodontic treatment.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your time and response.

You mentioned that serial extraction is designed to be accomplished over a time period.  The orthodontist is recommending the extraction all at one shot.  Will it be more trauma to extract 10 teeth at once, or over time (thus reopening the gums)?  Is this too aggressive for a 10 year old?

I can't answer your question since I don't have any of the important details that go into making the specific treatment recommendations.  The timing of extractions for each case needs to be determined after careful consideration of all the diagnostic information.  If you wish to have a second opinion you should obtain copies of all the diagnostic records and take your son for an evaluation.


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Dr. Randolph Myerson


Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.


I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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