Your teenager has just completed her initial orthodontic evaluation and the treatment plan calls for several of her adult teeth to bebefore extraction 1 removed.

Why should your daughter have perfectly healthy teeth pulled as part of orthodontic treatment? This is a great question, and there are several reasons for it that I will address in today’s article.

First, it is important to keep in mind that my goal as an orthodontist is to create beautiful smiles that my patients are proud of. I will never recommend a treatment approach that would do anything to detract from your smile.

Before I recommend tooth extraction, I conduct a thorough examination that includes after extraction 1taking impressions of the teeth, a full set of X-rays, and photographs that show how the teeth in the upper and lower jaws fit together. I use all of this information to create a treatment plan.

If tooth is extraction is recommended by me, it is because I believe this is the best option to achieve the desired result, or that it is the next best option if a patient wishes to avoid surgical correction. Extraction often is recommended for patients who have front teeth that protrude, they have significant overjet or underbite, or they have tooth crowding.

I just wrote about protruding teeth last week, and briefly explained that one method of addressing this type of malocclusion is to remove some of the adult teeth in the upper arch. One cause for protruding teeth is crowding. By removing some of the adult teeth (usually two), space is created so the protruding teeth can be shifted inward and brought into their ideal position. Doing this helps reduce the likelihood of suffering an oral injury to the front teeth that protrude too far. If left untreated, people- particularly younger children- are prone to chipped, cracked and broken teeth because their lips don’t provide enough coverage to protect the teeth from blows to the mouth.

Overjet/Underbite Correction
These types of malocclusion involve an improper relationship between the upper and lower jaws. In the case of overjet, the upper jaw is too far forward in relation to the lower jaw. Underbite is the condition in which the lower jaw juts outward and causes the lower front teeth to rest in front up the upper front teeth.

Correcting these types of malocclusion may require the use of a variety of orthodontic appliances in addition to tooth extraction. But in these situations, tooth extraction can eliminate the need for jaw surgery by creating the space needed to correct the relationship between the jaws.

Severe cases of overjet and underbite may require orthognathic (jaw) surgery to correct.

before extraction 2Crowding
Sometimes the jaws are not large enough to comfortably fit all of the teeth. Other times, the teeth are too large for the jaws to properly accommodate them. In these cases, removing some of the permanent teeth creates space so the remaining teeth can be aligned properly.

Orthodontic Treatment for Adults
More adults seek improvements to their smiles than ever before. Because they no longer are growing, orthodontists are slightly more limited in treatment options when

after extraction 2it comes to tooth crowding, or jaws that are too small to properly accommodate all of the teeth. In these cases, tooth
extraction creates the space needed to achieve the desire teeth movements necessary to create an aligned smile.

Facial Changes Caused by Permanent Tooth Removal
It seems that no matter what stance you take on an issue, you can find a study that supports it. There has been great debate in orthodontic circles about whether removing permanent teeth can significantly alter the patient’s face.

Some studies have said that removing permanent teeth can lessen the support the teeth provide to the lips and cheeks, and even cause a person to appear to age prematurely.

The truth is that removing teeth can alter facial appearance positively or negatively. In the vast majority of cases, however, neither you nor anyone you come into contact with will ever notice that you’ve had teeth removed as part of orthodontic treatment.

Preventing the Need for Tooth Extractions
I frequently mention in these articles that the American Association of Orthodontists recommends that all children be evaluated by an orthodontist by age 7. If you want to lessen the likelihood that your child will require teeth extractions when it’s time for orthodontic treatment, this is a guideline you will want to follow.

A child’s growth can be one of the most powerful tools for an orthodontist during orthodontic treatment. Orthodontists have a wide range of appliances at our disposal that help guide growth to correct various malocclusions, to create or maintain space, and to help break unhealthy oral habits that can adversely affect a child’s bite and teeth alignment.

Evaluating a child at age 7 gives me an opportunity to determine whether crowding or other problems exist that might require tooth extraction in the future if left untreated now. Then I can determine a course of treatment to create the necessary space and prevent the need for extraction.

Methods of creating more space in children to lessen the likelihood of extracting teeth later in life include:

• Rapid palatal expander- This appliance is used to widen the upper jaw so the upper and lower jaws fit together better. It addresses crowding by creating space for adult teeth that haven’t yet erupted.
• Lingual arch- Also known as a transpalatal bar, this appliance is used in the upper and lower arches to maintain the space created through other methods until the permanent teeth erupt.
• Forsus springs- Orthodontists may use this appliance on children with crowded and protruding front teeth, particularly those who aren’t compliant with wearing elastics and/or headgear.

Please call the office today if your child is 7 years old and hasn’t had an orthodontic evaluation yet. This initial evaluation is complimentary, and many parents tell us the evaluation is good for peace of mind, even if their children don’t need treatment at that point.

And remember: adults can achieve significant improvements to their smiles, too, so never believe that you’re too old for treatment. We help patients of all ages achieve the beautiful smiles they’ve always dreamed of.