Teeth may be aligned poorly because the dental arch is small and/or the teeth are large. The bone and gums over the roots of extremely crowded teeth may become thin and recede as a result of severe crowding. Impacted teeth, poor biting relationships and undesirable appearance may all result from crowding.

INTERCEPTIVE ORTHODONTIC TREATMENT: CORRECTION OF CROWDING IN YOUNG PATIENTS

Our office philosophy is avoidance of extraction of the permanent teeth when possible. To attain that goal, it is sometimes necessary to remove a few baby teeth to avoid distortion of the jaw, damage to the teeth, improve the cleaning ability, and gain alignment of the erupting permanent teeth. The following discussion will help you understand the interceptive steps necessary to help your child attain a normal development:

• Quite often we see young children (age 6-9 ) with moderate to severe crowding of the lower or upper front teeth. As the permanent teeth begin to erupt in the front part of the mouth, there will sometimes be two rows of teeth present at the same time. Usually it is the permanent teeth erupting to the tongue side of the baby teeth which gives the "double row" appearance.

• The space available for alignment of the teeth is at a maximum in the front part of the mouth at age 8-9. The mouth gets bigger to allow the molars to erupt through growth in the back part of the jaw. At age nine, the jaw width across the front is as wide as it will be in the adult and any crowding present at that time will not self-correct due to growth. Sometimes, parents think if they wait, the mouth will grow to accommodate the permanent teeth. Not true! What you see at age eight is what you get later unless the space is managed by orthodontics.

• If there is moderate to severe crowding in the front, then sometimes we will recommend removing two to four baby teeth to make room for the permanent teeth to erupt. Unless one of the erupting teeth is way out of line, the tongue pressure will usually align the four permanent incisors within a period of 3-6 months. Since we usually recommend removing the baby cuspids, there is no harm in doing this procedure to eliminate crowding.

• Having to remove these baby teeth tells you something though! There may not be enough room for all the permanent teeth in the future. Early removal will allow most of the permanent teeth to align, so the bone will not be damaged by severely crowded permanent teeth. When the permanent bicuspids begin to erupt around age eleven, it may be necessary to begin treatment with braces or other orthodontic appliances to make more room, and try to avoid having to remove permanent teeth. We don't need to make those decisions until we see how much room is needed later, but it is best if we see your child on a regular basis to evaluate the growth and development.