Often there are indications that the jaw size of a child will not be large enough to accommodate the permanent teeth that are developing. Dental crowding and irregularities with regard to the positioning of the newly erupted teeth are the major indicators of a discrepancy in the relationship between the size of the jaws and the size of the teeth. The tendency for crowded teeth will usually become increasingly more apparent as the larger permanent front teeth erupt and replace the deciduous "baby" teeth.
Developing crowding and irregularly aligned teeth can often be handled by an interceptive early procedure called serial extraction. This is the progressive removal of selected teeth as the child matures both dentally and skeletally. By removing deciduous teeth and, more rarely, permanent teeth at the appropriate time, "extra" space will aid in the natural alignment of the remaining teeth. Since the remaining teeth are somewhat likely to straighten or align naturally on their own as the child is maturing, these changes are often more stable and future orthodontic therapy is often facilitated. The removal of permanent teeth (usually the first bicuspids) is elected when the crowding is so severe that treating via expansion would compromise dental health, cosmetics, and stability. If permanent teeth are removed, months or years may pass until comprehensive orthodontic treatment is initiated.
Before removing any teeth, it is often advised that we obtain orthodontic records (photographs, models, dental x-rays, cephalometric analysis) to evaluate and diagnose the necessary treatment. We may wish to discuss our findings with you at a second consultation appointment.
In order to attain the maximum benefit from the serial extraction program, it will be necessary for us to monitor your child at regular intervals to assess the developmental changes in order to assess the appropriate time for future extractions. We will either schedule the next visit while you are in the office or send a reminder in the mail. Failure to maintain the periodic recall visits as scheduled may nullify the program and result in longer and more difficult treatment in the future.