Skip to content 
Have you or your child been advised to have teeth removed as part of an orthodontic treatment plan? While many orthodontists prefer to avoid extractions as their first option, there are times when tooth removal is necessary. At Orthodontic Specialists, we understand that the prospect of having teeth taken out can be unsettling. With the vast amount of information available today, it can be overwhelming, especially when faced with conflicting data. We aim to clarify some common myths about extractions in orthodontics:
Expanders and/or Other Appliances Can Avoid Extractions
This is mostly true! There was a time in orthodontic history when it was common for patients to have four premolars removed as part of their treatment. The thinking was that larger teeth in smaller jaws necessitated tooth removal to position the teeth aesthetically. Today, we recognize that often the jaws are underdeveloped and can be guided into a better position using expanders, which utilize growth to create more space in the upper jaw. However, there are still limitations to how much expansion is possible, and extractions may still be required.
Modern Braces Eliminate the Need for Extractions or Expanders
This is a myth. Currently, there is no evidence to support the idea that any bracket system can completely avoid the need for extractions. Brackets serve merely as handles or “steering wheels” to align teeth. Ultimately, it is up to the orthodontist, the “driver,” to guide the teeth into their proper positions. Treatment plans focus on achieving the most ideal positions for both aesthetics and function. Any bracket system can be utilized to accomplish this.
Removing Premolar Teeth Can Cause Jaw Problems and Sleep Apnea Later in Life
There is currently no evidence to support this claim. Systematic reviews have shown that orthodontic treatment, even with extractions, does not increase the risk of developing jaw issues (TMJ or TMD) later on. Moreover, the notion that removing premolars constricts jaw size pushes the tongue backward and causes sleep apnea lacks verification. As advanced 3D diagnostic imaging develops, we will gain a better understanding of how jaw size affects airway volume and the impact of tooth movement. There is indeed a connection between airway development, jaw development, and tooth development. At OSIV, we screen all our children for sleep disturbances (such as enlarged tonsils/adenoids and nighttime snoring) along with other factors that can influence the function of a developing mouth.
The success of your orthodontic treatment plan relies on trust—trust between you, your child, and the orthodontist. As specialists, we continually pursue an education focused on orthodontics and take diagnosis and treatment planning very seriously. The ultimate goal is to position the teeth in the most aesthetically pleasing and functional alignment, with functionality including both chewing and breathing. Each case is unique and requires thorough examination. To learn how to request a complimentary virtual consultation, call us at 215-799-4602 today.
