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Tooth extraction has been the standard answer to crowding for decades, but it is not the only answer. Dr. Courtney Lavigne explains how developing the jaws can create space while protecting your child's face, profile, and airway, and why a second opinion is always worth it.
If your child's orthodontist has recommended pulling permanent teeth to make room, I want you to do one thing before you say yes: get a second opinion.
Not because the first orthodontist is wrong. Ten orthodontists can look at the same child and come up with ten different treatment plans. But extractions are permanent, and your child only gets one chance to grow. You should know what all of your options are before anything comes out.
For decades, tooth extraction has been the standard approach to crowding. The logic is simple: not enough room, so remove teeth and straighten what's left. It works, in the sense that the teeth end up straight.
But crowding is almost never a tooth problem. It's a space problem. The lack of room comes from the way the jaws are growing. If the upper jaw is narrow or underdeveloped, the teeth don't have anywhere to go. Pulling teeth treats the symptom while leaving the cause exactly where it was.
When you remove permanent teeth to create space, you can straighten the teeth that remain. But you can also narrow the face, flatten the profile, and reduce the size of the airway. Those are changes that matter for the rest of your child's life, long after anyone remembers what the braces looked like.
This one is personal for me. I had eight teeth extracted as a kid. I also grew up with an undiagnosed sleep disorder that nobody connected to how my jaws and airway had developed. It's a big part of why I practice the way I do, and why I look at every child's airway and growth pattern before I ever talk about treatment.
At Anchor Orthodontics, our first question is never which teeth to remove. It's whether we can create the space your child needs by guiding how the jaws grow. Expanders, growth guidance, and early intervention can often make room for all of the teeth while supporting the face and protecting the airway at the same time.
This works best while your child is still growing. The upper jaw stops developing around age 9 or 10, and once that window closes, our options narrow. That's why the American Association of Orthodontists recommends every child be seen by age 7. Not because every 7 year old needs treatment. Most don't. But the kids who would benefit from early intervention shouldn't be missed.
I want to be honest with you: no orthodontist can promise that, and you should be careful with anyone who does. There are cases where extraction is genuinely the right call. But it should be the last resort after growth modification has been considered, not the starting point. In our experience, when we see kids early enough, the majority of extraction recommendations have an alternative.
You don't need a referral to see an orthodontist, and you don't need anyone's permission to ask a second set of eyes to look at your child's plan. Consultations for kids at Anchor Orthodontics are complimentary. Bring the records you have, or we'll take our own look, including a 3D evaluation of how the jaws and airway are developing.
If extraction really is the best path for your child, we'll tell you that too. But you deserve to make this decision with the full picture in front of you.
Anchor Orthodontics has offices in Providence and Wakefield, Rhode Island. Dr. Courtney Lavigne is a board-certified orthodontist and an Accredited Member of the American Academy of Cosmetic Dentistry (AAACD). Call (401) 782-1221 or request a consultation. No referral needed.
