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Orthodontist • Grass Valley, CA

Orthodontics Blog

The Ultimate Orthodontic Dilemma: To extract teeth or not

For more than 75 years, doctors have debated the issue of extracting permanent teeth in orthodontic treatment.  Today, the profession is still somewhat divided.  There are those who believe teeth should never be removed and those who extract in a majority of cases.  Most orthodontists, however, fall somewhere in between these two extremes.

In our opinion, the question of utmost diagnostic importance is this:

Can the goals of excellent function, esthetics and stability be achieved without removing permanent teeth?

In the majority of cases, the answer is yes.  This is primarily achieved through early orthodontic treatment.

Age, among other factors, must be taken into consideration when establishing criteria for extraction.  For the most part, growth of the jaws from canine to canine (where crowding is most critical) is complete with the eruption of those teeth around age 10. Because of this, if we are going to use expansion appliances, we need to begin treatment during the growing years (ages 7 to 11).

Another very important consideration for extraction is future lip posture. With age, loss of lip support can lead to unflattering facial changes. Computerized diagnostics have enhanced our ability to predict future growth. We prefer to maximize lip support wherever possible.

Extractions can be of great benefit where lip strain or thin gums are present.  With attention to providing a functional and stable bite, removal of teeth can be a benefit without any negative effects.

In the majority of cases however, we can achieve ideal results without the need for extraction. With early treatment of crowding problems (as early as age 7), we have the best chance to provide patients with minimal discomfort as they are growing rapidly during this time. Most of the changes that occur at this stage of a child’s development are orthopedic in nature and occur quite readily and quickly. We make a permanent change in the overall shape and structure of the developing jaws. This change provides the needed room for all the future adult teeth.

With expansion, there is also increased nasal airway capacity and many of our patients report better nasal breathing, improved sleeping, less allergies and overall improvement in their daytime awakeness.

If you have any question about extractions, early treatment and expansion, please call our offices at (916) 435-8000 to schedule a complimentary consultation.

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