What should I do about my 6 year old's baby teeth that is causing crooked adult teeth?
Adult teeth can develop in abnormal positions within the bone even if the baby teeth have exfoliated (dropped out) in time. There is NO WAY for this to be controlled.
A panoramic xray that can visualize the developing adult teeth and their positions within the jawbone. All of the adult teeth (except the wisdom teeth) should be visible on a panoramic xray by the age of 6.
Another common cause of crooked adult teeth is insufficient space in the jaw for the teeth to erupt into.
Insufficient space can be a consequence of:
1) Untreated space loss from early loss of baby teeth
Baby teeth may be lost due to severe decay or premature exfoliation (from root resorption). If this happens before the adult tooth is ready to erupt, the adjacent teeth (baby or adult teeth) will drift into the empty space and "use up" the space that should have been reserved for the permanent successor of the lost baby tooth.
2) Undersized jaw
Some children have adult teeth that are too large to fit neatly into the jaw. This can be predicted by taking measurements of the teeth present in the mouth and comparing that with the measurements from the panoramic xray. A lateral cephalogram (a special type of xray showing the skull in profile) can allow for assessment of the developing jaws and allow certain growth pattern predictions to be made.
If the child has not yet reached puberty, there may be scope to improve the space available in the jaws by using growth modification appliances (palatal expanders, lip bumpers etc).
Some children require treatment early. This is essential for conditions like:
1) Retroclined (backward tipping) upper incisors, since these may prevent the lower jaw from developing normally.
2) Underbites, to prevent a permanent skeletal underbite from developing later on.
The exact timing of treatment also depends on other factors such as the child's mental maturity, ability to cooperate for treatment, good level of oral hygiene, minimal decay rate or decay that has been successfully controlled and the ability to commit to multiple dental visits (that may interfere with extra-curricular activities).