Extractions in Orthodontics
Whether teeth need to be taken out to make space is becoming an increasingly controversial issue in orthodontics.
With today’s modern braces technology virtually any case, no matter how crowded the teeth may seem, can be treated without pulling any teeth out. The question is “Is the patient going to get a better result if they do have some teeth taken out?” Dr Tiang’s philosophy is to only recommend having extractions as part of braces treatment if there is a significant benefit to the patient. Having crowded teeth does not automatically mean needing extractions as there are many cases treated by Dr Tiang where crowding of the teeth was resolved by the braces creating more space for the teeth to move into (not technically exactly what happens but close enough in layman’s terms).
The most common situation where extractions are recommended are in cases where the teeth stick out too far forwards due to excessive forward growth of either the upper or lower (or both) jaw bones. People in this situation often appear like their whole mouth protrudes. The ideal solution for this is usually jaw surgery to make the jaw bones the ideal length and the teeth stick out the ideal amount. However, surgery is a major undertaking and usually one which people prefer to avoid. In some situations, by extracting some teeth and moving the other teeth in the right way, the protrusiveness of the mouth and therefore their entire facial profile can be altered – an acceptable alternative to surgery. Achieving this kind of result where the face changes as the teeth straighten is very difficult if not impossible without removing some teeth.
Certain sectors of the population such as people of Asian and African descent tend to be more prone to developing a protrusive mouth appearance. Orthodontics for people with this genetic background often involves removing some teeth to try and improve the overall facial appearance as well as make the teeth straighter. People of caucasian descent do not have this protrusive mouth problem as often so Dr Tiang finds he rarely removes teeth in people of this genetic background. There is more potential, unless careful orthodontic mechanics are used, for people in this genetic category to go from a nice mouth profile of having a dished in profile. If the front teeth move backwards to help close the gaps created by having teeth pulled out, the lips sink inwards and look less full (meaning botox in the future to compensate) and the nose and chin begin to look more prominent.
There is also research showng the links in children between orthodontic problems, grinding teeth and bed-wetting even. If your child snores loudly, breathes mainly through their mouth, grinds their teeth in their sleep or has a persistent bed wetting issue then you should consider bringing them in for a consultation. The potential links between these things and orthodontic problems could mean Dr Tiang is able to help much more than simply providing straighter teeth.
The other most common reason for having teeth removed is if there is a size discrepancy between the upper teeth and the lower teeth. If a patient has really big lower teeth and normal upper teeth then maybe taking out a bottom tooth or two is needed in order the balance out the teeth in both jaws and allow them to fit together better when biting.
Dr Tiang assesses each case individually to see if extracting teeth is recommended. We are in the business of making our patients look better (not worse) so we carefully plan whether extractions are the best thing and which directions we will move the teeth. We do not have a rule which says we will never pull out teeth nor do we always pull out teeth. We try to avoid it if we can though and if we do recommend extractions it is for a very good reason. However’, the choice is ultimately the patients.