Help! They want to extract all my first molars: sunken face?

[indecisive and scared]

I am 29 years old and have had wonky teeth for as long as I can remember. They aren't extremely bad, and my teeth are mostly healthy and strong otherwise, but there are a few which are really wonky due to overcrowding, especially on the top arch.

Now, one of my first molars (i.e.: the bigest tooth) has had a root canal and a huge filling and because of this, the ortho says he wants to remove this one and to preserve symmetry, he will remove all my other first molars too.

Now that seems very excessive to me, as the other three are healthy teeth, and very big - bigger than the space needed.

Worse still, I have been reading about people who got sunken face from this operation as these teeth are the ones which hold your whole face up. I love my face (apart from my teeth) and don't want it to go all haggard like an old woman.

Would LOVE to hear from anyone please who had this operation done (extraction of first molars) and whether you got sunken face from it, especiallya s an adult. Horror stories welcome, you may be saving me. I am paying nothing for my brace as it is getting done on the NHS.

I have two weeks before the extractions! arghhh so not much time to decide!!

[indecisive and scared]

p.s. if someone can tell me how to add images, i have a few pics of my teeth on the computer if this would be helpful![/img]

[VA5]

Resounding NO... do not do it. I have my first molars gone on both uppers. You do not need to get all of them removed for symmetry and you will have a sunken face. Unless you have an unusually round and large face, you will regret it.

What I would do if I were you is to get an implant as soon as you extract that one bad molar. Well, not as soon, but as soon as it heals and you are able. If you wait too long, your bone will start to disappear on you in that area and THEN you will have an assymetrical face, with one side more sunken in than the other. The key is, don't wait, get it done as soon as you can (the implant)!

[indecisive and scared]

Hey VA5,

Thank you SO MUCH for your advice. I kind of suspected this might be the case..... it's odd - I was all ready to go through with it when I had a dream which scared me a bit... and made me do a little research.

Thing is, the root canal on that bottom molar was a success (so far) and I actually don't see why I need to have it extracted at all.... except that I would rather have that extracted than a healthy tooth of course.

However, do you think there is any solution to my overcrowding other than to have teeth removed? And if not, which are generally the teeth which when removed, have the smallest effect on the face?

And if you don't mind, I know this is quite a personal question but what happened to your face after you had your upper first molars removed please? And what age did you get it done at?

I can't seem to find a definitive answer to my question online as I do not think it is common to remove first molars! thanks again!

[itsabouttime22]

I agree- do not get extractions if you can help it. I had two baby molars removed (the second ones) on the bottom. First of all, my ortho never recommended having the top ones removed too for symmetry, so that doesn't sound right at all.
I have a round face- and I still got the sunken look- its probably not that noticable to most people, but I don't like it.

[indecisive and scared]

Thanks so much for your advice It'sabout time, and for sharing your story!
The thing that really scares me is the bottom extractions is that my bottom teeth are pretty well aligned in my opinion, well it is my top ones which I am bothered about. So getting two big molars removed, one of which is perfectly healthy (the other one isn't though) seems very very drastic!! I already have quite a long face and I am just at the age when you start to fear ageing with avengeance......!

[alimommy1]

I had 4 premolars removed.. I think they were the 1st ones, right next to your canines. I have never heard an ortho suggest removing molars, since most people end up with 8 molars total, wisdom teeth either are removed before or after treatment or in some people they are missing. I am actually missing one lower molar due to a fractured root. The tooth had had a root canal and a large filling, and when a part of the filling broke, it broke the root too. I had been intending to see if I could just get a crown put on it, but my dentist said if you fracture the root, even with RCT and a non vital tooth, you can still get infection in your gums, which I did. It's fine now but I'm thinking about an implant - which I won't do till I finish treatment because I can use a bit of the space if necessary.

In answer to your question, I have not noticed any 'sunken face' concerns, not sure if that only happens if you have symmetrical extractions of molars, or if it has more to do with how protrusive your teeth are or were, mine are not. I have a small mouth and relatively large teeth, so creating space and making good use of what was there was probably a nightmare for my first ortho.

With all the information i have read here as well as my own research, if I had known about the possibility of using expansion instead of extraction, I think I would have gone that route. My original ortho never said anything about it, maybe it wasn't used as much 15 years ago as opposed to now. I thought the only way to gain space to align teeth was extracting, so that's what I did.

[VA5]

I too wish I had considered expanding first too but I have mentioned it several times to my ortho and i'm always told that it doesn't work so well on adults... and you have to expand the bottom too and all that really happens is your teeth tip outwards more and then it's harder to have good alignment on bottom/top teeth b/c of the tipping.

[VA5]

Hey VA5,

Thank you SO MUCH for your advice. I kind of suspected this might be the case..... it's odd - I was all ready to go through with it when I had a dream which scared me a bit... and made me do a little research.

Thing is, the root canal on that bottom molar was a success (so far) and I actually don't see why I need to have it extracted at all.... except that I would rather have that extracted than a healthy tooth of course.

However, do you think there is any solution to my overcrowding other than to have teeth removed? And if not, which are generally the teeth which when removed, have the smallest effect on the face?

And if you don't mind, I know this is quite a personal question but what happened to your face after you had your upper first molars removed please? And what age did you get it done at?

I can't seem to find a definitive answer to my question online as I do not think it is common to remove first molars! thanks again!

Wait, so your tooth is actually fine.. but they want to extract?? That doesn't makme sense at all. I would try the braces first and if that tooth fails than you'll have ot make some decisions but that would not include removing other teeth. The implant route is the way to go.

As for making room in your mouth.. if there is a lot of protrusion, or a lot of crowding, than many times you have to extract. Some people here do just the tooth filing and that has a little bit of effect but nothing drastic, and some people do the expansion route, and others get surgery to expand too. Most people will extract and if you have crowding, protrusion, it's the way to go. I have a friend who got braces to straighten, with no extracting, and what happened.. she has total horse teeth now. way too much stuff going on in her mouth. she really should have extracted.

The extractions of premolars shouldn't really change your face so much especially if you have a lot of crowding. if you have only minor crowding, it might be too much to extract and you'll have facial changes that you might now like. if you have protrusions, then you'll appreciate having your teeth extracted.

I had both my molars removed at different times in my adulthood... both for the same reason.. just failed root canals. The 2nd one happened very recently and for some reason that side really got affected... the bone really shrunk in that area and my cheek is hollowed out now. it's definitely not the braces, it was my lost tooth. It stinks. I should have gotten an implant in right away but i didn't.. so the bone shrunk and affected my face.

[alimommy1]

That's terrible, V5! When I had the molar extracted because of the fractured root, I had intended to get an implant, so they did a bone graft of some sort... not sure exactly how that works but they added something into the extraction site. Although I do not have a tooth there (or an implant yet), it does not make my face look sunken or any different than my other side where i still have a tooth. I do notice that the gum itself looks odd, since there is no tooth AND no root, the gum area there is a little sunken but it doesn't affect my cheek or my face.

I guess it's kind of because losing that molar, I thought about how it would be nice to have my extracted premolars back, or perhaps the wisdom tooth on that side, but those were all impacted and laying sideways toward the roots of my second molars, and they caused excruciating pain right before I had them removed lol. I had extreme crowding, which may have been why expansion wasn't even an option. My back teeth all had to be moved backwards and part of the space from the premolars closed up before the ortho could even start straightening out my front teeth, it was that bad. Can you still get an implant... or would the site have to get a bone graft and be re-prepared for it? With all of the dentists telling me to get an implant, it sounds like they can be effective at any time, even if it's been awhile since you lost the tooth. I just don't want to pay the high cost for one until I've been able to put it aside, plus I want the space there in case IPR by itself isn't enough for the movement I need on the lowers.

I think if I were asked to make a choice with extraction, I would say yes to premolars but not molars, those should be kept unless they really are diseased or something.

[VA5]

Hi Ali,
I did get an implant however by then over a year (1 1/2 years?) had passed and that is just too long to wait b/c the bone starts to shrink. It helped a little bit but I still have a hollowed look on that side. This sounds weird but I think it's b/c I wasn't chewing my food that much on that side that accounts for some of it... it's the same side where my teeth tend to hurt more and my last molar on that side (next to the implant) sometimes feels sensitive and moves quite a bit compared to other teeth. It's much better now, but I got into the habit of chewing on the other side... I'm trying to consciously chew more on the hollowed side, to see if I can "build up" the muscles and face structure there.. and I think it will help some b/c I see diagrams on the net with the muscles right where the hollowed out area is.

I agree w/you that if you're going to get extractions anywhere, premolars are much preferred to other places.

[indecisive and scared]

Wow, thanks for all this wonderful advice everyone. You are really mirroring my concerns. If someone can tell me how to post up pictures that would be amazing, as I don't even know how serious my crowding is compared to others' and it would be great to know!

Alimommy - it sounds like you definitely did the right thing. The way I think of it, extractions could actually help teeth in the long run as they will be easier to clean and to keep healthy - at the moment there are a couple which are practically behind each other! However the sunken face problem does scare me a LOT as I like the shape of my face and don't want to start ageing before I even hit 30.

VA5 - yes the tooth is causing me no problems. It has had multiple fillings in the past, and has caused me pain like nothing I've ever known, but since the root canal it's been fine, except for the fact it doesn't look very nice as it has a big black filling and the tooth is so thin it shows through! But it's still going strong. I don't want to lose it, and I certainly don't want to lose any more molars, especially now you have made me aware of the implant option if it doesn't stay ok. Is this costly? Thanks so much for the warning.... I wish dentists would explain the possibility of bone loss to patients before extracting.

Looking at my teeth from a layman's point of view, it really does seem to me like some will have to come out to make room for them to all sit straight! Every ortho I have ever been to has told me four extractions will be necessary. My mum had four premolars removed in her teens and my sister had all her wisdom teeth removed so it is clearly genetic.

[indecisive and scared]

I have made my decision - am going to say no to having molars extracted. It's just, how on earth do I explain this to my orthodontist without appearing like I am dissing his expertise? Or sounding like I don't trust him? (I do trust him!!)
Since it is free and all being done in the name of research, I don't know how much choice I really get in the matter.........

[sammywantstraightteeth]

You have plenty of choice in the matter, they are your teeth!!!

Explain your concerns to him and see what he has to say. Remember that you get the final decision on this, and if they refuse to treat you if you don't have the extractions, then maybe they aren't the right people to treat you anyway.

I have invisalign for overcrowding and an overbite. My dentist (yes, dentist not ortho) told me I could have extractions to make room for the overcrowded ones, but that he avoids that as much as he can because of changing your face and because they often create too much room. His prefered option was to shave spaces between some of my back teeth, and this is what I went for.

[drrick]

First I would not recomeend an implant immediately after an extraction if you are going to undergo braces. The timming of the implant placement is critical when performing ortho. The implant will not move and you do not want it to hinder movement of the surrounding teeth or otherwise compromise your result.

In regards to the molar ext. THere are times when that is indicated (albeit not as frequent as bicuspid ext). Closing down open bites, helping with long face syndrome in addition to crowding correction. More often 2nd molars are removed but it isnt unheard of to remove the first molars. Again it isnt common but it is done.