One of the most common reasons why we like to see children for their first orthodontic exam at age 7 is to evaluate the position of the developing upper permanent canines. We normally want and expect them to be developing straight up and down. This means there is generally enough space for them and they are “growing” in the correct position. With time we would expect them to “push out” the baby canines.
However, many times when we take the initial panoramic x-ray we observe that the upper canines are growing on an angle. This generally means there is not enough space for them and/or they are developing in the wrong area. Often they are overlapping the adjacent tooth (upper lateral incisor).
This is an unfavourable situation for two main reasons: 1) The canine can cause damage to the root of the adjacent tooth (called root resorption), and 2) The canine can get stuck on the palate (become impacted). Teeth with resorbed roots have a worse long term prognosis. Impacted canines require a special surgery called an exposure and extensive and prolonged orthodontic treatment.
Luckily, impacted canines can be preventable if caught early enough. There are a number of approaches but usually the simplest one involves early removal of the upper baby canine. By doing this, it allows the permanent canine to redirect and change its position. Research has shown that extracting the baby canine results in successful eruption of the permanent canine approximately 80% of the time. Being slightly more aggressive and removing the baby canine AND first molar results in successful eruption of the permanent canine nearly 100% of the time.
The example below demonstrates this. Notice how the upper left canine is completely overlapping the root of the lateral incisor but after the extractions completely uprights.
You may ask – what if we do nothing and just monitor? The same research study showed that doing nothing resulted in spontaneous improvement about 35% of the time. So it’s possible that it may improve and self-correct but it’s risky.
Another related question we get is: “If we just wait won’t the adult tooth just push out the baby tooth?” The answer to this question is that the natural mechanism of an adult tooth pushing out a baby tooth isn’t happening in this situation. That is why we are trying to restore normal by taking out the baby canines early. Usually extractions are done bilaterally. If done on one side, everything shifts over to the one side which can make the problem worse.
Further, there are other ways to make space for the canines – this involves doing an early round of orthodontic treatment including a palatal expander. This is usually the second line of defense or done from the outset if the upper canine is in a really bad position.
If you have questions about your child’s oral development, we are here to help! Contact the Walt Orthodontics office for a personalized consultation. We work with children, teens and adults in Vaughan, Maple and Thornhill!