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When (Not) to Get Your Permanent Teeth Pulled

September 21, 2017

This may be the most important warning I give you: think twice before having permanent teeth removed.

Before you read any further, know that extractions are no longer needed in over 99 percent of orthodontic patients. As a prospective patient, you need to advocate for yourself in your own treatment. If you are recommended to have permanent teeth extracted, be sure to get a second opinion.

Orthodontics has changed dramatically in the past twenty years. Most orthodontic cases throughout the seventies and eighties required the extraction of permanent teeth. Unfortunately, extracting teeth can result in long-term detrimental effects on many patients’ facial structures and compromise the health of their gums and bones as well as contribute to the potential for sleep apnea.

Nobody wants to go through having teeth pulled if it can be avoided. A full complement of teeth often results in a fuller, more beautiful smile.

So what has changed to allow orthodontists to avoid the extraction of so many teeth?

  •      The test of time. As more and more people were treated with braces over the years, orthodontists were able to see what happened to these patients as they became adults and aged. What they saw was not encouraging. Orthodontists realized that as people age, their lips tend to flatten out naturally. In patients who had permanent teeth extracted, this flattening was magnified significantly due to reduced support for the lips. As orthodontists began seeing this negative aging process caused by extractions, they began seeking other ways to treat.
  •      Controlled research. In the eighties, the University of Michigan began researching what caused people to have crowded teeth. Many times, orthodontists told people that their teeth were just too big to fit. Were people’s teeth too big? Interestingly enough, research has shown that this was not the case at all. In fact, virtually everyone had the same sizes of teeth, but those who had crowding had much smaller dental arches than those who had no crowding. The conclusion was that orthodontic treatment options should focus more on creating additional room for crowded teeth instead of removing teeth.
  •      Bonds instead of bands. Do you remember those rings around teeth with braces? Until the late seventies, braces included rings around the teeth, called bands. They were the only way to connect braces to the teeth. Bands around each tooth added about five millimeters of material between the teeth. Because of this, even in mildly crowded cases, there just was not enough room to fit all the teeth in the mouth and teeth needed to be pulled. Now, orthodontists use bonding. Bonding is a thin layer of adhesive that connects a brace to the front surface of a tooth.
  •      Better wires. Today’s wires deliver a force on the teeth that is much lighter and gentler on the teeth than that of the stainless steel wires used with traditional braces. Due to this gentleness, teeth are now able to move in a way that allows the bone to adapt and change with the movement, and orthodontists are able to treat more cases without tooth extractions.
  •      Better braces. The final piece to the puzzle arrived on the scene in the new millennium. Braces traditionally have required something to hold the wire in place (also referred to as “tightening” the braces). This was done with either small wire ties or those fun little colored elastics. Although these ties kept the wires in place, they caused friction and kept the teeth from sliding freely. Around the year 2000, a new type of brace was invented that does not require ties to hold the wire in place. Instead, a door or clip opens and closes to hold the wire in place. There is no friction against the wire, so the teeth are free to slide, and the orthodontist does not need to push as hard to get the teeth to move (which means less pain!).

Having permanent teeth extracted is not a pleasant experience, and long-term results have shown that permanent-tooth extractions can result in unwanted aging changes if performed on the wrong patient. The current recommendation is to make more room to accommodate the teeth rather than remove them. The perfect combination of technology has arrived, allowing orthodontists to accomplish the desired nonextraction treatment.

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