Who needs extractions?

[vincent168]

I hear some people require extracting 4 teeth before putting braces on, what cases are these and why is it needed?

Thanks

[Labguy]

Some doctors feel that extractions are a way to make room in the mouth. A while back, it was the standard first step to orthodontic treatment. Other orthodontists feel that extractions are never necessary, and that extractions can lead to changes in the way that the face looks and dental problems down the road. My periodontist says that orthodontic extraction cases will be funding his retirement 25-30 years from now. The trend now is towards not extracting, but can still be a "knee-jerk" response for some orthodontists, depending on where and how they were trained, their personal philosophy, etc. Do your research and get multiple opinions from various orthodontists. Most of the orthodontists I do work for prefer to work with all of the teeth except when absolutely necessary. Where once I saw about 85% of the finished cases extractions, now I'd guess it is closer to 10-15%. There is a lot of good material on the web about both sides of the argument.

[crooked rory]

I had an upper bicuspid and a lower canine removed, both on the same side. The canine had weak bone around it, and my ortho decided it was risky to my other teeth to try to save it. The upper bicuspid needed to come out to make room. No other extractions are planned. He hoped to not have to remove any, but my case is unusually complicated I guess.

[Bracer215]

25 years ago I went for an orthodontic consult and they said they needed to pull 4 perfectly good molars so I declined treatment. Last year I went for a consult and the ortho did not recommend pulling any teeth even two wisdom teeth that I still have on my left side.

[Amanda6]

Some doctors feel that extractions are a way to make room in the mouth. A while back, it was the standard first step to orthodontic treatment. Other orthodontists feel that extractions are never necessary, and that extractions can lead to changes in the way that the face looks and dental problems down the road. My periodontist says that orthodontic extraction cases will be funding his retirement 25-30 years from now. The trend now is towards not extracting, but can still be a "knee-jerk" response for some orthodontists, depending on where and how they were trained, their personal philosophy, etc. Do your research and get multiple opinions from various orthodontists. Most of the orthodontists I do work for prefer to work with all of the teeth except when absolutely necessary. Where once I saw about 85% of the finished cases extractions, now I'd guess it is closer to 10-15%. There is a lot of good material on the web about both sides of the argument.

Hi Labguy,

You wrote "My periodontist says that orthodontic extraction cases will be funding his retirement 25-30 years from now."

What is the reason your periodontist says this? What is meant by it?

I had orthodontics as a child in the 1980s with extraction of 4 premolars. I am now having orthodontics again, not for the purpose of straightening teeth, but to treat my TMJ dysfunction which has been causing me constant face, neck pain and headaches for years. In my opinion, whatever an orthodontist does, whether they extract teeth or not, it's important that the condyle position within the TMJ is considered for good jaw and muscle function. So many orthodontists are not considering this within the orthodontic plan and when deciding to extract teeth, they are just making teeth look straight.

[Labguy]

Hi Amanda,

My periodontist sees a lot of problems with extracting healthy teeth, including bone loss, root problems, etc. that will not show for years. If you search on You Tube for extractions in orthodontics, you'll find a doctor from Acutech(?) explaining some of the things in a presentation about why extractions should NEVER be done. Then, there is the other side of the argument.

A good orthodontist will consider many variables when considering a case. If you check through my other posts, you'll find common themes: never use a dentist for orthodontics, always get a second and third opinion, and make yourself an informed buyer. My soap box issues you might say. As in any profession, including my own, there are good ones and bad ones.

Good luck!

[sharp]

DO NOT GET EXTRACTIONS

If I can stop just one person from having the same 6 year long nightmare (and counting) that I'm having, it will be worth it.

Reda my threads.

Don't extract.

I was once good looking. Now I am not.

Enough said.

[ArchWired28]

My sister had significant crowding and has declined extractions and decided to proceed with an ortho who did non-extraction. So, after five (!) years of wearing expanders, braces, bite plates and elastics her teeth are straight, however she has 100% overbite, 6mm overjet and a crossbite on premolars. Looking at her teeth, one realizes that there is just no way to fix her bite without taking at least two upper premolars out as her upper arch is just too big to fit the lower.
Extractions may be detrimental to the TMJ health in some cases, but so is overbite and crossbite. Sure extractions can lead to bone loss and all kinds of problems in a long run, but crowded, badly position teeth can and will have the same effect. One never knows which one is worse.

I think, extractions should almost never be used in growing children; however, once people resume growth, little can be done to fix the jaw/bite discrepancy besides extractions or surgery. There are established cases that are commonly treated with extractions, like significant overbite/class II or bimaxillary protrusion. My opinion is that in many cases, the benefits of well conducted extractions, followed by proper orthodontic aligning, outweigh the risks of TMJ damage.

P.S. I personally did not have extractions done, but that is what I advice to my sister as well.

[ArchWired28]

sharp

I have read your story earlier, and I understand you completely! After paying 11K and being braced for over 5 years you would expect nothing shy of perfect teeth, and not a huge overbite and overjet. However, I don't think extractions or lingual braces are to blame in your case. I am not a professional, but seems to me that you were a surgical case to begin with, and your ortho failed to notice or acknowledge it. I don't think you were ever suitable for extractions, that is why you got little or no benefit of it and perhaps, they only made things worse. This is your unique case that unfortunately, has not turned out right just yet. However, there are still many people who can benefit of extractions, the problem is to correctly recognize them, and here's when the ortho's skills come into play. That is why it is important to choose your ortho carefully and perhaps, get several opinions before starting treatment - especially in the case when extractions or other invasive interventions are involved.

[frankiecgsw]

i had 4 removed because if i didn't my teeth would be sticking out and what not. its not that bad actually.hurted a little for few days, but that was it.

[kennyandrew85]

I had extractions 8 months ago.
Face looks the same, possibly a slight improvement to my side-angle (profile?), I looked thin for a bit because I lost so much weight from having braces initially.
But soon as I could eat normally I look fine.

Was pain free for me when getting the teeth pulled, the only pain was about 4 hours after when the painkillers wore off, but went away pretty quick.

[sirwired]

I don't think extractions, in and of themselves, are a problem. Where you have perio issues is if the final bite means the teeth are tilted. If the roots of the teeth are not properly aligned after the extractions are finished, or if the final result isn't stable and the teeth tilt on their own, eventual perio problems are nearly inevitable.

Extractions, when done properly, are sometimes the only way to get a good result. Extractions, done poorly, or merely as a way to speed treatment, can indeed cause lasting damage.

It simply isn't correct to say "never get extractions", nor is it correct to say "extractions always work."

Speaking for myself (whose parents sent to a "no extractions, ever" ortho as a kid) I wonder what would have happened if I did have extractions. I have a crowded crossbite, a too-narrow upper jaw, and a crooked lower one... all causing gingival recession in the absence of actual gum disease (four grafts so far, and I'm only 34.)

Could extractions have headed those off at the pass by allowing better arch and jaw development? Because I'm now in line for $3700 in braces and $15,000 of jaw surgery to keep my gums from eroding further.

As a side note, my current ortho won't be doing extractions for round 2. My jaw and upper arch are simply hopelessly compromised by this point, and just relieving the crowding won't fix it; the time for that was about 25 years ago.

[survenant]

I have had braces for 6 months and will undergo surgery in about a year. In my case, at first my ortho said that he was not sure If my premolars needed to be removed but now, he said it looks likely.

[joanne88]

When I first got my consultation, my orthodontist told me that I may have to do the same thing. He said that he had to make room for everything to fit (I have an overbite so that may have contributed to the issue). But during my last visit, he told me its not necessary anymore. So, if you're worried about the extraction, don't feel too discouraged! Maybe you'll not end up needing them at all.

[sea54change]

When I was 23, I had all my wisdom teeth removed. They were all impacted. Days before my bottom braces went on last year, I had 1 lower tooth on the right side extracted. I thought for sure the ortho would want one from the top because of the way my 2 front teeth were overlapped. But no, he said no extractions were required on top! After 15 months I am AMAZED at how straight and aligned my teeth are! And after 20+ years of not being able to floss my teeth easily due to crowding, I can floss again!