Does overcrowding require teeth extraction?

I get this question asked a lot in my practice, and there is no clear answer for every patient. It really depends on a case by case basis. How slim or fat your face looks really depends on a few common factors: 1. size and dimensions of your upper and lower jawbones 2. Amount of skin, muscle and fatty tissue covering your upper and lower jaws. 3. Alignment of your teeth in your jaws and whether or not your teeth are protruding and/or crowded. 4. Whether or not you suffer from clenching and grinding which may lead to having over-developed jaw muscles resulting in a square jaw look.

Thank you for your question. I suppose the dentist who is attending to your child recommended the extractions based on the fact that the breakdown on the teeth is severe (as you have also described), which may cause more problems for your child in the long run. They probably timed the extraction of the 1st molar with the growth sequence of the 2nd molar in the hope that the 2nd molar would be able to drift into and occupy the space left behind after extraction. Is it a must to extract all the 4 at the same time since the 2nd molar is ready under GA? Any painless way to extract one at a time?