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Orthodontics/8 year old... Palette Expansion or Baby Tooth Removal


Hello and thank you for your time. I have a question that I bet a lot of parents have. My [almost] 8 year old daughter has a very crowded mouth. She has lost her front 8 teeth, 4 top and 4 bottom. Her permanent teeth are coming in crooked on the top, the bottom are more crowded than anything.

We visited an orthodontist a few months ago who suggested a treatment plan of an expander, braces (for 6 months or so to straighten her fron teeth) then a retainer for a series of years before she would likely need full mouth braces.

We received another opinion the other week from a very well respected orthodontist in the area who said that more times than not, removing the baby teet (canine - all 4) will allow her permanent teeth that are in to straighten up and for those that are yet to come in, to come in better positioned. He was not in favor of a paletter expander. He did say that it was likely that as a young adult - similar to the first ortho - my daughter would need "full mouth braces"; but perhaps she may not.

I know that an expander can not only be painful but cumbersome and obtrusive. Not trying to take the easy way out; but one of the most respected orthos suggests pulling 4 canine teeth and the other suggests the 12+ month treatment route.

Any suggestions?

With baited breath, thank you...

Hi David. I'm not an orthodontist - I provide resource information on various aspects of the field - but I had both teen and adult braces and my three daughters have had braces (including one with an expander). My stream of thought is: these days, most orthodontists say never remove a tooth if you don't have to, and therefore use the expander. However, you say they're talking about taking out four baby (canine) teeth. To me, that's fine because they're going to come out anyway. I personally would want to wait until the adult canine teeth start to come in, to see how they're all sorting themselves out.

My daughter's expander worked out fine - she was quite cool with it at about age 9 1/2 to 10. One word of warning that I WISH they had told me: they had me use the "tool" (very easy, really) to give it one crank at the office, to learn how. Then they said give it one turn a night. Well, that's true but in my humble opinion, I should never have turned it that same night as when I turned it at the office!! I knew I put her in pain and felt terrible. But, the one-crank-a-day did not seem to bother her.

Okay, one more thought which might only confuse you - sorry. After going through all this with my daughter, and again it worked out fine, I've since talked to people who say the palate expansion visually changed the shape of their child's jaw/cheek/profile/face shape and they weren't happy. I have not delved into this to see if this can be predicted, but perhaps with today's computer-visualization programs, it could be predicted and shown to you ahead of time.

I myself had a terribly crowded mouth with a small arch. I don't think there were expanders in the 70s, so they took out four adult teeth. All went well and my mouth turned out perfectly. Personally I would think wait maybe even six months, and possibly go with extracting the four baby teeth. After that, see how the adult canines are behaving and *maybe* extract them, too. A 3D image should show a lot, if you can have that done. My own orthodontist always does the expander, not extractions (of adult teeth).

Best wishes, and feel free to keep me posted.


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Pamela Waterman


I can supply tips, hints, recipes and resources about a braces-friendly lifestyle, for parents of children and teens in braces as well as for adults in braces. Although I am not a medical/dental professional, I have colleagues in the field and will do my best to point you to additional resources.


I am the author of two specialty award-winning cookbooks of soft-food recipes and tips targeted to all ages of braces-wearers (including adults) and give workshops to dental hygienists to help them help their patients with this type of information. I have worn braces both as a teen and as an adult, and am from a family of three generations of braces patients. I regularly contribute information to the public website of the American Association of Orthodontists and Orthotown magazine.

Women in Orthodontics, American Academy for Oral Systemic Health, Independent Book Publishers Association, Society of Women Engineers, Society of Manufacturing Engineers

Orthotown, Cricket, Family Fun, Highlights, Better Homes and Gardens Kids' Rooms, Chicago Tribune, East Valley Tribune (Phoenix AZ), Healthy Alternatives, Organic & Natural, Desktop Engineering, Machine Design

BS Astrophysics, MS Radio Astronomy/Electrical Engineering

Awards and Honors
Good Parenting Award from Glyph Award - Best Cookbook, Arizona Book Publishing Association Finalist Glyph Award - Best Cookbook, Arizona Book Publishing Association Finalist - Next Generation Indie Books, Independent Book Publishing Professionals Group

Past/Present Clients
American Association of Orthodontists, Smile for a Lifetime

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