Patterns of balancing and compensating primary tooth extractions among paediatric dentists (2025)

  • Research
  • Published:
  • Eser Rengin Nalbantoglu1 &
  • Parmjit Singh2

British Dental Journal volume238,pages 122–128 (2025)Cite this article

  • Metrics details

Abstract

Introduction Balancing and compensating extractions (BCEs) of primary teeth aims to minimise the development of more severe malocclusions and reduce the need for subsequent complex orthodontics.

Purpose To assess the demographics, practice characteristics and clinical preferences of United Kingdom paediatric dentists for BCEs of primary teeth.

Methods All members of the British Society of Paediatric Dentistry were sent an electronic questionnaire. Questions offered frequency options (always/frequently, often/sometimes and rarely/never) for a range of clinical scenarios in patients up to five years and between 6-9 years.

Results Of the 288 specialists invited, 67 (23.3%) completed the questionnaire. Respondents were mostly female (n = 55; 82.1%), with most working in secondary care (n = 51; 77.3%). The majority (n = 54; 81.8%) supported the application of guidelines. A total of 39 paediatric dentists (58.2%) always/frequently encountered BCEs, with 31 (46.2%) performing BCEs in over 40 patients in the past year. Additionally, 40 respondents (59.7%) reported always/frequently complying with guidelines. Data from 65 respondents indicates that 83.6% (n = 56) rarely/never made referrals to an orthodontist, while 65.7% (n = 44) rarely/never consulted an orthodontist (p <0.001).

Conclusions There was variation across clinical scenarios, with good adherence to guidelines in BCEs of primary teeth among paediatric dentists. However, there was limited interdisciplinary collaboration with orthodontists.

Key points

  • Balancing and compensating extractions of primary teeth can reduce the need for later complex orthodontic treatment.

  • Paediatric dentists follow guidelines for balancing and compensating extractions of primary teeth.

  • Orthodontic input is not routinely sought before decisions are made to extract primary teeth.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Change institution

Buy or subscribe

Subscribe to this journal

Receive 24 print issues and online access

We are sorry, but there is no personal subscription option available for your country.

More Information

Prices may be subject to local taxes which are calculated during checkout

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (1)
Patterns of balancing and compensating primary tooth extractions among paediatric dentists (2)

Similar content being viewed by others

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (3)

Management of molar-incisor hypomineralisation by general dental practitioners - part two: treatment

Article 23 April 2021

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (4)

A questionnaire-based study of Paediatric Dentists’ knowledge of teething signs, symptoms and management

Article Open access 12 March 2022

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (5)

Perspectives of general dental practitioners on restoring endodontically treated molars: a UK-based vignette study

Article 08 November 2024

Data availability

The authors confirm that the raw data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Kumar D, Gurunathan D. Primary canine and molar relationships in centric occlusion in 3- to 6-year-old children: a cross-sectional survey. Int J Clin Pediatr Dent 2019; 12: 201-204.

  2. Nadelman P, Magno M B, Pithon M M, Castro A C R, Maia L C. Does the premature loss of primary anterior teeth cause morphological, functional and psychosocial consequences? Braz Oral Res 2021; DOI: 10.1590/1807-3107bor-2021.vol35.0092.

  3. Spodzieja K, Olczak-Kowalczyk D. Premature loss of deciduous teeth as a symptom of systemic disease: a narrative literature review. Int J Environ Res Public Health 2022; 19: 3386.

  4. Bansal M, Gupta N, Gupta P, Arora V, Thakar S. Reasons for extraction in primary teeth among 5-12 years school children in Haryana, India - a cross-sectional study. J Clin Exp Dent 2017; 9: 545-549.

  5. Health and Social Care Information Centre. Children's Dental Health Survey 2013. Country Specific Report: England. 2015. Available at https://files.digital.nhs.uk/publicationimport/pub17xxx/pub17137/cdhs2013-england-report.pdf (accessed 20 May 2024).

  6. Alsheneifi T, Hughes C V. Reasons for dental extractions in children. Pediatr Dent 2001; 23: 109-112.

  7. Bhujel N, Duggal M S, Saini P, Day P F. The effect of premature extraction of primary teeth on the subsequent need for orthodontic treatment. Eur Arch Paediatr Dent 2016; 17: 423-434.

  8. Rock W P, British Society of Paediatric Dentistry. UK national clinical guidelines in paediatric dentistry: Extraction of primary teeth - balance and compensation. Int J Paediatr Dent 2002; 12: 151-153.

  9. Demiriz L, Bodrumlu E H. Reasons for the extraction of primary teeth in primary school-age children in Zonguldak, Turkey: a retrospective study. Meandros Med Dent J 2017; DOI: 10.4274/meandros.21939.

  10. Haralabakis N B, Yiagtzis S C, Toutountzakis N M. Premature or delayed exfoliation of deciduous teeth and root resorption and formation. Angle Orthod 1994; 64: 151-157.

  11. Ngan P, Alkire R G, Fields H Jr. Management of space problems in the primary, mixed dentitions. J Am Dent Assoc 1999; 130: 1330-1339.

  12. Murshid S A, Al-Labani M A, Aldhorae K A, Rodis O M M. Prevalence of prematurely lost primary teeth in 5-10-year-old children in Thamar city, Yemen: a cross-sectional study. J Int Soc Prev Community Dent 2016; 6: 126-130.

  13. Gibas-Stanek M, Loster B W. The effect of premature extraction of primary molars on spatial conditions and formation of malocclusion: a systematic review. J Stomatol 2018; 71: 420-431.

  14. Royal College of Surgeons of England. Extraction of primary teeth - balance and compensation. 2006. Available at https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines/ (accessed May 2024).

  15. Tsang S, Royse C F, Terkawi A S. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017; 11: 80-89.

  16. Flesch R. A new readability yardstick. J Appl Psychol 1948; 32: 221-233.

  17. Funkhouser E, Vellala K, Baltuck C et al. Survey methods to optimize response rate in the national dental practice-based research network. Eval Health Prof 2017; 40: 332-358.

  18. Alkadhimi A, Cunningham S J, Parekh S, Noar J H, Travess H C. Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: a comparison of orthodontists and paediatric dentists. J Orthod 2022; 49: 7-16.

  19. Sebo P, Maisonneuve H, Cerutti B, Fournier J P, Senn N, Haller D M. Rates, delays, and completeness of general practitioners' responses to a postal versus web-based survey: a randomized trial. J Med Internet Res 2017; 19: 83.

  20. Edwards P J, Roberts I, Clarke M J, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2023; DOI: 10.1002/14651858.MR000008.pub5.

  21. Watt E, Ahmad A, Adamji R, Katsimpali A, Ashley P, Noar J. Space maintainers in the primary and mixed dentition - a clinical guide. Br Dent J 2018; 225: 293-298.

  22. Jones H, Nichol R, Spencer R J. Paediatric dentistry and orthodontics interface: when should we consider balancing and compensating extractions? Prim Dent J 2021; 10: 83-87.

  23. American Academy of Pediatric Dentistry. Management of the developing dentition and occlusion in pediatric dentistry: the reference manual of pediatric dentistry. 2024. Available at https://www.aapd.org/globalassets/media/policies_guidelines/bp_developdentition.pdf (accessed December 2024).

  24. Nedeljkovic A, Petrovic M, Andjelic B. Space maintenance of premature primary tooth loss - an overview. Exp Appl Biomed Res 2023; DOI: 10.2478/sjecr-2022-0009.

  25. Kirschneck C, Proff P. Extraction of MIH-affected molars and orthodontic space closure. In Bekes K (ed) Molar Incisor Hypomineralization. New York: Springer, 2020.

  26. Lee J, Johnson J, Bister D, Chaudhary M, Khoshkhounejad G. Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: to compensate or not to compensate? J Orthod 2021; 48: 305-312.

Download references

Acknowledgements

The authors are grateful to the British Society of Paediatric Dentistry, with special thanks to Urshla Devalia, Honorary Secretary for providing access to member lists and Neil Sutcliffe for distributing the survey.

Author information

Authors and Affiliations

  1. Assistant Professor Doctor, Biruni University, Faculty of Dentistry, Department of Paediatric Dentistry, Merkezefendi Mahallesi, G/75.Sokak No:13B, Zeytinburnu, 34015 Istanbul, Turkey

    Eser Rengin Nalbantoglu

  2. Professor in Orthodontics, University of Ulster, Faculty of Life and Health Sciences, College of Medicine and Dentistry, 32‑34 Colmore Circus, Birmingham, B4 6BN, UK

    Parmjit Singh

Authors

  1. Eser Rengin Nalbantoglu

    View author publications

    You can also search for this author in PubMedGoogle Scholar

  2. Parmjit Singh

    View author publications

    You can also search for this author in PubMedGoogle Scholar

Contributions

Eser Rengin Nalbantoglu contributed to study conceptualisation, methodology formulation and data collection, formal data analysis and manuscript writing. Parmjit Singh contributed to study supervision and manuscript editing.

Corresponding author

Correspondence to Eser Rengin Nalbantoglu.

Ethics declarations

The authors declare no conflicts of interests.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (6)

Cite this article

Nalbantoglu, E., Singh, P. Patterns of balancing and compensating primary tooth extractions among paediatric dentists. Br Dent J 238, 122–128 (2025). https://doi.org/10.1038/s41415-024-7783-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-024-7783-z

Patterns of balancing and compensating primary tooth extractions among paediatric dentists (2025)
Top Articles
Latest Posts
Recommended Articles
Article information

Author: Kimberely Baumbach CPA

Last Updated:

Views: 6278

Rating: 4 / 5 (61 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Kimberely Baumbach CPA

Birthday: 1996-01-14

Address: 8381 Boyce Course, Imeldachester, ND 74681

Phone: +3571286597580

Job: Product Banking Analyst

Hobby: Cosplaying, Inline skating, Amateur radio, Baton twirling, Mountaineering, Flying, Archery

Introduction: My name is Kimberely Baumbach CPA, I am a gorgeous, bright, charming, encouraging, zealous, lively, good person who loves writing and wants to share my knowledge and understanding with you.