Tween orthodontia WWYD - pulling 3 impacted teeth before braces?

[MommyAllison]

DD1 (13.5) and DS (just turned 11) have been going to the orthodontist for growth checks for several years. The first orthodontist said they would plan to pull multiple adult teeth on each of them, because their mouths were too small. Both kids were pre-puberty at that point, so I asked if their jaws would continue to grow/widen as they grew, ortho said no. I wasn't thrilled with that answer, and our dentist gave us a different ortho referral. DD1 has since had her braces put on at the second ortho, who does not plan to pull any teeth from DD1's mouth, as there is space for all of her adult teeth (all but one are already in).

DS is a little more complicated - he has a congenital missing adult tooth (DH has one as well), and has lost his teeth out of order so teeth are impacted/blocked out because adult teeth have moved into the wrong spaces. At first, the second ortho wasn't planning to pull any adult teeth, but after looking at his chart again, he thought that having an oral surgeon pull 3 adult impacted teeth (one from each quadrant, except the quadrant with the missing tooth) would create lots of space and simplify treatment. However, DS hasn't entered puberty yet and DH and I are concerned about the permanence of pulling so many adult teeth when his jaw still has a lot of growing to do - and possibly ending up with too much space. I've read posts here that say they had adult teeth pulled on ortho recommendation, and ended up with too much space in their mouth as an adult, and shifted teeth. Obviously we can't put those adult teeth back in once they're gone! It seems like a pretty involved surgery and recovery, and we know DS will be very nervous about it (he doesn't know this is a possibility yet). Additionally, seeing how DD's jaw ended up with enough space for her teeth (as did mine, my mouth is also small and was crowded, but didn't need any teeth pulled), makes me think that I'd rather stick with the first plan, of using braces to straighten and move the teeth, allowing the impacted teeth to come in and then see where we're at, and if we need to pull any teeth. I think the ortho prefers his new plan of pulling teeth to simplify treatment, though.

So, WWYD? Any input is much appreciated!

[Kindra178]

DD1 (13.5) and DS (just turned 11) have been going to the orthodontist for growth checks for several years. The first orthodontist said they would plan to pull multiple adult teeth on each of them, because their mouths were too small. Both kids were pre-puberty at that point, so I asked if their jaws would continue to grow/widen as they grew, ortho said no. I wasn't thrilled with that answer, and our dentist gave us a different ortho referral. DD1 has since had her braces put on at the second ortho, who does not plan to pull any teeth from DD1's mouth, as there is space for all of her adult teeth (all but one are already in).

DS is a little more complicated - he has a congenital missing adult tooth (DH has one as well), and has lost his teeth out of order so teeth are impacted/blocked out because adult teeth have moved into the wrong spaces. At first, the second ortho wasn't planning to pull any adult teeth, but after looking at his chart again, he thought that having an oral surgeon pull 3 adult impacted teeth (one from each quadrant, except the quadrant with the missing tooth) would create lots of space and simplify treatment. However, DS hasn't entered puberty yet and DH and I are concerned about the permanence of pulling so many adult teeth when his jaw still has a lot of growing to do - and possibly ending up with too much space. I've read posts here that say they had adult teeth pulled on ortho recommendation, and ended up with too much space in their mouth as an adult, and shifted teeth. Obviously we can't put those adult teeth back in once they're gone! It seems like a pretty involved surgery and recovery, and we know DS will be very nervous about it (he doesn't know this is a possibility yet). Additionally, seeing how DD's jaw ended up with enough space for her teeth (as did mine, my mouth is also small and was crowded, but didn't need any teeth pulled), makes me think that I'd rather stick with the first plan, of using braces to straighten and move the teeth, allowing the impacted teeth to come in and then see where we're at, and if we need to pull any teeth. I think the ortho prefers his new plan of pulling teeth to simplify treatment, though.

So, WWYD? Any input is much appreciated!

Baffled as why no expander? DS1 had two expanders. I really thought that pulling adult teeth was the last resort these days, unlike when we were little, when it was the thing to do.

To backtrack - DS1 super small mouth, no space between teeth. At age 8ish, he got an expander and phase 1 braces. At age 12, he got phase 2 braces and a second expander. He lost his last few teeth at age 12.5, so then he got bottom braces. No teeth need to be pulled.

[scrooks]

I agree with Kindra! Most kids I know with crowding get expanders. Ds1 just got braces put on after a year of an expanded. His teeth are straightening out beautifully.

[KrisM]

I'd also ask about the expander. DS1 had a lot of crowding and teeth came out really early. Many times 2 baby teeth came out for each adult tooth coming in, so some spaces had holes for a year until that adult tooth was actually ready to grow in. But, by 11 or so, his mouth had grown enough to hold all the teeth and he just needed braces. Now they are nice and straight and he didn't have any crowding issues.

DD ended up needing an expander, as her upper jaw was super narrow. She got it and braces on at Thanksgiving last year and just got out of the expander a few weeks ago. Her teeth were much more crowded and I could see her jaw was much more narrow than DS1's. Her teeth look great already, after just these few months!

[MommyAllison]

Thank you all! I know this ortho does expanders, but he didn't suggest them for either of our kids. I will ask about it. Currently, DS' top teeth have more open spaces than teeth! There are a lot missing. His mouth has never seemed as crowded as DD1's, and honestly I think if not for the congenital missing tooth on bottom, the treatment plan would have been very similar to DD1's. It seems like the ortho thinks this will even things out on all 4 quadrants, and make braces go faster. I'd rather keep the teeth though! His mouth seems very similar to DH's, who never had braces and has a small gap between his front top teeth (DS has the same gap). DH has an empty space currently where his adult tooth is missing and hasn't had any crowding issues, which really makes me want to hold off on pulling teeth on DS.

[JBaxter]

It could be how the teeth are impacted coupled with the fact he has one missing. Each case is patient specific. Its easy to say do an expander but there are a lot of factors involved. If you do ask about the expander then also ask how you are going to address the missing tooth.

[SuenosDelMar]

Nope, wouldn't have teeth pulled unless there was no other option. Both my kids have super-crowded mouths and the first ortho we had for my older daughter was wanting to pull to make things easier for him. Went elsewhere as I know too many people who wish they had their pulled teeth back as adults. The Damon ortho said no pulling of any teeth for my daughter and he was right. She has a beautiful wide smile now. I wish we had the $1200 we wasted on the expander at the first ortho that did absolutely nothing.

My younger daughter who is 9 has several impacted teeth and thinning gums because of too much tooth in her gums. She has been in treatment for a year and the Damon ortho is going slow because of the gum issues, but it making huge progress in getting the impacted teeth out of the gums (a few were pointing sideways) and into correct position. it truly is an art. She will likely need a 2nd short phase in her teens.

I highly recommend Damon orthos!

[anonomom]

Has your DS already lost the baby tooth where the corresponding adult tooth is missing? Because, if not, the baby tooth may hang out indefinitely. I’m 43 and still have two baby teeth where adult teeth were missing.

[MommyAllison]

Has your DS already lost the baby tooth where the corresponding adult tooth is missing? Because, if not, the baby tooth may hang out indefinitely. I’m 43 and still have two baby teeth where adult teeth were missing.

He hasn’t lost that baby tooth, no. Dh’s Dentist pulled his baby tooth in his mid-twenties because they thought it would cause problems. After the fact though, the dentist said the root was still very strong and would likely have lasted many more years, and that he probably shouldn’t have pulled it. Oops. I’m hoping DS’ baby tooth will be healthy and strong enough to leave it in for a good long while! The ortho would like that baby tooth pulled now, along with the 3 other impacted teeth.

[California]

I’d get more opinions. DS had something similar and his ortho did partial braces with the expander to create room for the impacted adult tooth to emerge. It worked. Would that be a possibility? This same ortho is managing to get my DD’s seriously wonky overcrowded teeth looking beautiful, with no pulling.

DD’s school has an ortho office next door. Kids are allowed to go straight from school to their appointments- which sounded awesome so we decided to check them out too. The ortho insisted DD needed four adult teeth pulled. We stuck to DS’s ortho and it’s worked out great. Just amazes me how different orthos are!!

[ray7694]

I think the issue is that the teeth aren’t coming down in the correct place. An expander wouldn’t help that. My dad had x rays to make sure the teeth were in the right place.

I know not a lot of kids need teeth pulled but some do. I had 2 pulled and have had no issues.

You could always wait and see.

[megv]

The congenital baby tooth complicates it long term. I have 2, as do 3 of my kids. The long term solution varies for each of us, but I’d be very hesitant to pull it. I’d get another opinion

[smilequeen]

You need another opinion from an expert if you are worried about the extractions. No one on here can tell you this, not even me, and I actually have the degree. This takes knowing the exact specifics of your son’s case.

[KpbS]

I would get at least 2 more ortho opinions, preferably from folks who have been practicing more than 10-15 years.

[gamma]

Each case is different. Two of my DSs had 12 year molars extracted, which allowed their wisdom teeth to move right into position when they came in. I was very relieved that they didn't need palate expanders, since a DN and DN had palate expanders and the finished result changed their whole appearance and facial structure. I think expanders are beneficial in a case by case situation.

[MommyAllison]

Thank you all! As a quick update, we are meeting with the ortho again to discuss treatment. There is a second dr in the practice that he said could give us a second opinion as well. We have an appointment next week with a Damon ortho that I am hoping will help us make a decision. The Damon ortho is in the nearest big city (4 hours away) so definitely not convenient for treatment, but we are limited in our small city - only 3 orthos and we’ve seen two of them already. I will update again when we make a decision. I really appreciate all of the input!!