This patient, a 12-week-old Goldendoodle presented with a narrow mandible and minor brachygnathism. The mandibular canine teeth were striking the gingiva, causing trauma. The mandibular deciduous incisors were also striking the hard palate.
These deciduous teeth are smaller and sharper than the corresponding adult teeth. Therefore, they have the potential to cause pain and trauma when there is a malocclusion. What would you recommend for treatment of this patient?
This patient should have the deciduous canines and incisors extracted ASAP. This will accomplish multiple objectives. Each time this patient closes his mouth, sharp needle teeth poke into his soft tissue, causing pain. The patient will not communicate this pain to the owner, but it hurts. Whenever the mouth is closed, the mandibular canines and incisors sit in a groove or hole, minimizing the ability for the jaw to grow. When an overbite is already present, if the mandible is unable to grow forward to its optimal capacity, the malocclusion will likely worsen. By extracting the teeth, the patient’s pain and dental interlock will be eliminated. Sometimes this “interceptive orthodontics” will eliminate or minimize the need for future dental work once the permanent teeth emerge.
Extracting deciduous teeth prior to eruption of the permanent teeth is a delicate feat requiring patience and gentle technique. Below are dental x-rays of this patient showing how close the tips of the developing permanent teeth are on the lingual surfaces of the deciduous tooth.
I like to create a small incision in the gingiva vertically then use a #2 luxator avoiding the lingual surface. Overzealous elevation can be damage the thin enamel walls of the permanent teeth.
Keep in mind the length and fragility of deciduous roots as you continue to move the luxator apically to loosen the teeth.
Post extraction, the incisions are closed with 5-0 Monocryl simple interrupted suture using a small p3 needle and dental x-rays are taken to confirm complete removal.
I like to clean the teeth with peroxide and provide them to the clients. Below are some of the teeth removed from this patient.