This is not an uncommon occurrence. Sometimes the permanent teeth begin to come in before the baby teeth are lost. When this happens, unless the child can work the baby teeth out by himself within a few weeks, the pediatric dentist may have to remove them. Once the baby tooth is out, the tongue usually moves the permanent tooth forward into its proper position, if space permits. If this crowded condition should occur in the upper jaw, the baby teeth should be removed immediately. Sometimes it is necessary for the pediatric dentist to move the permanent tooth forward with an orthodontic appliance.