Premature Loss of Baby Teeth Can Lead to Crowded Permanent Teeth

Posted by: Jason Hui, DDS, on June 25, 2013

Recently updated on March 3rd, 2014 at 02:18 pm

There is often a misconception about baby teeth, as many believe that since they are not permanent and eventually fall out, they are not important and can be electively pulled (as opposed to saved) should any problems arise.  The truth is, not only are baby teeth important for nutrition, they are also crucial in maintaining space for the permanent teeth to come out, or erupt.

As we discussed in a previous post, permanent teeth have a tendency to drift toward the midline when teeth are extracted and not restored in a timely manner; the same phenomenon applies to baby teeth.  Baby teeth serve as placeholders for the developing permanent teeth.  The natural progression of tooth development is for the permanent teeth under the gums to develop, and when they are ready to erupt into the mouth, they resorb the roots of the baby teeth, which makes these baby teeth loose and ready to fall out (Figures 1 and 2).  If a baby tooth is prematurely pulled, the teeth behind it are free to drift forward to close the space where the extracted tooth once occupied, leading to space loss (Figure 3).  When space loss occurs, there is insufficient room for the permanent tooth to erupt into alignment; this is a frequent cause of tooth crowding.

Baby teeth above adult teeth in x-ray

Figure 1. This image is a panoramic x-ray of a child. There are numerous baby teeth present in the mouth with long roots, and directly under the baby teeth are the developing adult teeth.

Loose baby teeth ready to fall out on x-ray

Figure 2. This x-ray image depicts a permanent tooth ready to erupt into the mouth. As the permanent tooth pushes its way into the mouth, it resorbs the root of the baby tooth, which causes the baby tooth to become mobile and ready to fall out.

Losing baby teeth too early and prematurely

Figure 3. This image displays the consequence of early loss of baby canines. The loss of space as delineated by the arrows is evident, and it will be impossible for the permanent canines erupt into alignment.

The important take-home message is to leave baby teeth in the mouth until they fall out on their own!  If there are cavities on baby teeth, then fillings should be rendered immediately to preserve the integrity of the baby teeth.  If there are large cavities leading to toothache, then a baby root canal and stainless steel crown should be rendered, even if the tooth will eventually fall out.  Only in cases where the baby tooth is non-restorable (i.e., the tooth cannot be salvaged and repaired) should an extraction be considered.  Even so, when premature extraction due to non-restorability occurs, it is important to maintain that space following tooth loss with a space maintainer (Figure 4).  Space maintainers serve to hold the space that the extracted tooth once occupied to prevent the drifting of other teeth until the permanent tooth is ready to erupt.

space maintainer for early loss of baby teeth

Figure 4. This image reveals a band-and-loop space maintainer. The band is attached to the permanent molar, while the loop extends across the entire space the missing tooth once occupied and contacts its adjacent tooth. This space maintainer prevents the permanent molar from drifting forward into the space of the missing tooth.

We hope this entry has been helpful in conveying the importance of retaining baby teeth until they naturally fall out.  Preventing space loss is crucial for allowing sufficient room for the permanent teeth to erupt.  When teeth erupt properly into alignment, orthodontics (braces) may not be necessary, and this converts to thousands of dollars in savings!  Please feel free to contact us at Paragon Dentistry if you feel your child has lost space and we will be happy to evaluate for placement of a space maintainer to prevent further loss of space!


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