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My recommendation is to have your child follow a two-phase treatment. Sometimes waiting until the teenage years to have appliances placed could make the treatment last longer or become more difficult to achieve. Some teens will still have baby teeth at the age of 13, which leaves parents wondering if they should wait until all the baby teeth have fallen out? Another frequently asked question is if all the baby teeth need to fall out before the orthodontist can begin the comprehensive phase of the treatment.

Baby teeth are usually gone by age 13

At first glance, I will inspect for any baby teeth during an adolescent consultation. If there are baby teeth remaining, it could simply mean that the patient has a delayed dental development. An orthodontist can spot this usually from examining the 12-year-molars. The signs of a delayed overall dental development is if the molars have not yet erupted or if the teeth are being lost in the appropriate sequence. There is however a difference between having all four primary second molars remaining in the mouth of a 13-year-old patient and having just one molar remaining while the other three replacements have already come in. If this is the case and the patient has one primary second molar remaining, it could mean that there is something amiss with it. The orthodontic specialist will also examine the patterns of tooth loss and symmetry, this plays a key role in their diagnosis.

Sometimes the remaining baby teeth need to be removed

There are times when the orthodontist will write a prescription to have teeth removed, this is dependent on several factors. Firstly, if the patient is 14 or 15 years old, I recommend having the remaining baby teeth extracted so orthodontic treatment can start sooner and the patient can be out of treatment by the time they graduate high school. The recommendation for extractions to be done will also depend on the formation of the roots of those baby teeth, if they are about completed but the tooth is not loose, they will need to be extracted. Starting orthodontic treatment sooner than later is preferable which is why if the 12-year-old molars have come in but there are still primary teeth in place, those will need to be extracted.

There are times when treatment needs to begin early

In many cases, the orthodontist will prefer to wait to commence treatment until all the primary teeth have fallen out but, there are cases that indicate starting treatment early will allow for a better treatment process and time. An indicator of this could be a blocked out or impacted tooth caused by severe crowding. This means that if a primary tooth is unable to come in from lack of space, because of crowding, it is important to begin treatment early. Many times, placing braces on early to make room for the underlying teeth will help those baby teeth loosen on its own to avoid having them extracted by the family dentist. If the patient’s smile is socially handicapping, the orthodontist will also begin treatment early. Lastly, the start time of treatment is not affected by any remaining primary teeth that are being kept because the underlying permanent teeth are missing.

To keep the length of the treatment as short as possible, orthodontists will typically begin treatment once all primary teeth are gone. Starting orthodontic treatment comes with several probable consequences such as puffy gums, difficulty with daily brushing/flossing, root resorption, white spot lesions, etc. Treatment also requires maintenance which means frequent doctor visits and missed school and work for the patient and family members, so beginning treatment once all primary teeth are gone will minimize the number of visits.

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