Frequently, early loss of the lower baby cuspids is a diagnostic sign of (and is caused by) crowded lower permanent incisors (front teeth), The permanent cuspids will not be able to grow in if their space has already been used by the permanent incisors, which grow in first. If not corrected by an orthodontist, this early crowding may lead to severe permanent teeth crowding, impacted cuspids (unable to grow in), gum recession (lowering), and increase in overbite (vertical overlap of the upper front teeth over the lower front teeth0 and increase in overjet (protrusion of the upper front teeth beyond the lower front teeth), and may cause the need for extraction of permanent teeth later on.
This type of crowding should be reviewed by an orthodontist once the four lower permanent incisors have erupted. Unless the lip profile (fullness) or gum recession require that teeth be extracted (which is somewhat unusual), early jaw expansion with braces will salvage this crowded condition and avoid later extractions.
Expansion is usually done by widening the dental arch laterally and pushing the incisors forward and the molars backward using braces. After the treatment, retention is important to prevent collapse of the expansion from cheeck and lip pressure, and it is best done with a semi-permanent wire behind the teeth.
The benefits of early expansion treatment are that extractions of permanent teeth are avoided and more growing time occurs after the expansion, to help stabilize it. The dental arch and smile have more lateral width, which looks better.
Crowding involving significant loss of the lower baby cuspid space is a condition that worsens with time. It is not advisable to "wait and see." This space needs to be regained early with active therapy.
