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  • To remove teeth or to not remove teeth…The Irvine Orthodontist’s take
  • The thought of removing permanent teeth in your child or even yourself can be frightening for almost anyone. I have a lot of patients reject orthodontic treatment or some even say, “My dentist said I don’t have to get teeth taken out” or “Another doctor said if I get Damon braces or Fast Braces then teeth don’t need to be removed.”   Sometimes when I hear these statements it makes me upset.  As an orthodontist, there is no reason why I would want to put a patient through teeth removal if they absolutely do not have to.  If there is the slightest chance that I can straighten your teeth without having to extract teeth then I will always choose that option.   It comes down to a matter of trust and that is what Simply Orthodontics is based upon.   There are often cases where there can be a compromise, but there are also cases where extraction is a necessity. Taking teeth out often times improve how your face looks and even makes the treatment progress faster because there is room for the teeth.  Extractions is still a proven effective method of treatment and if anyone tells you they don’t take teeth out anymore, you should get a second opinion.   PLEASE be wary of all the marketing videos and media of “new technology” where you don’t need to have teeth removed, i.e. DAMON Braces or FAST braces.  I just saw a video of a general dentist, not a specialist,  telling the media, “You really don’t have to take teeth out anymore to get your teeth straight.”  I thought this was a completely ludicrous statement which inspired me to write the blog.   There are four main reasons why most orthodontists recommend the extraction of teeth: 1) Severe Crowding 2) To reduce teeth sticking forward in a non growing patient 3) To reduce an underbite in a non growing patient 4) Protruded teeth   1) Severe Crowding   Teeth crowd for a vast array of reasons and some are unexplainable. There is a mix of genes in your body and you may have a small mouth but the genes for large teeth.  Perhaps you may be born with tight cheeks and a wide jaw.  The explanations are limitless, but the fact is your teeth are crowded.   Imagine your jaw as a garage.  You have a two car garage, but you have four cars. There is no way you are going to be able to cram four cars into a two car garage. It’s just not going to happen no matter what you do unless you widen your garage or you sell your cars.  Just like your mouth, you can’t fit all your teeth into your jaw unless you remove some teeth or make your jaws bigger.   Below are photos of before and afters of an extraction case.   before   Before after After   In a nutshell, extraction for crowding is very common practice in orthodontic treatment. Sometimes, it’s the most healthy and best treatment for your teeth.  Many people are scared that people will know they have missing teeth. You can see in the picture that unless your friend is a dentist, it is extremely difficult to notice. No spaces are left after treatment.   Common risks for not extracting teeth when indicated include gum recession and lip and teeth protruding forward.  extractions-adult   2) To reduce teeth sticking out in an adult   There are certain patients where their lower jaw didn’t grow as much as their upper jaw or the upper jaw grew too much or their upper jaw has crowded teeth because it is too small.   There are two options for these patients who aren’t growing anymore (ie adults)
    1. Surgery
    2. Extraction of two top teeth
      If there is enough room for the top teeth then a combination of orthodontics and a surgical procedure to move your lower jaw to match your upper jaw position can be performed.  This is an invasive and costly procedure that many people do not want to undertake, especially if it is not absolutely necessary. There are patients where the skeletal discpreancy is so big that it is warranted. Talk to your orthodontist and they should give you the best options and limitations.   On the borderline cases, the optimal treatment usually involves the extraction of two upper teeth, especially if your teeth are protruded. Below are pictures of a patient before and after extractions and orthodontic treatment. buck-teeth Buck teeth after1After   3) To reduce an underbite in a non growing patient   The reverse of teeth sticking out on the top is an underbite.  The lower jaw sticks forward.  The best option for full correction of an underbite is through surgery. However, most often, the patient does not want to undergo surgery and we can instead extract teeth in the lower arch to mask the underbite.   4) Protrusion   When your your teeth don’t crowd and they try to fit in a smaller jaw, they have the tendency to stick forward. This is what orthodontists call "protrusion."  Your teeth look like they lean out and make your lips stick forward.  This is very common in the Asian population called ("Bao Ya" in Mandarin). It’s a feeling whereyour lips don’t fit over your teeth and you can’t close your mouth completely.  The only way to fix this is with extractions.   In a nutshell, extractions should not be seen as a negative in your orthodontic treatment if prescribed or recommended by a professional.  Orthodontists recommend it for your health and to give you the best results.  I have treated many extraction cases and the results are dramatic and spectacular. I have never had a patient regret taking out their teeth.  Taking out teeth does not affect your eating or speech.   If you are still uncertain, come to us! We’ll steer you in the right direction…that is our goal.