Do I Really Need Teeth Extractions?

Do I Really Need to Extract Teeth to Straighten My Smile?
Posted on 01/19/2023
This is the image for the news article titled Do I Really Need to Extract Teeth to Straighten My Smile?Have you been told you need to extract a tooth in order to straighten your teeth? Tooth extraction for orthodontic purposes is widely debated among orthodontic specialists. If you or your child have an overbite smile, most likely an issue of overjet, a visit to an orthodontic specialist is crucial. The need for extractions in conjunction with orthodontic treatment is a very individualized decision. That decision should be made in conjunction with a qualified orthodontic professional after a thorough clinical examination and careful analysis. To be clear, we are referring to the removal of permanent teeth, not baby teeth. So, this decision is important as it has long term consequences. 

In general, Dr. Eves aims to avoid extraction wherever possible. That is not to say that it is never appropriate to recommend extractions. Given that information, let’s examine the pros and cons of extraction.

Why would tooth extraction be necessary?


•Severe crowding may influence an orthodontist to recommend removal before placing braces or clear aligners. Some of the patient’s teeth may even be out of the dental arch due to lack of space in the mouth. Extraction becomes necessary in such an instance because aligners cannot function as intended until all teeth are in the dental arch. However, utilizing new braces instead of aligners could help with this issue as well. See our info on the difference between Damon braces vs. Invisalign.

•In other cases, there could be a discrepancy between the positioning of the upper and lower jaw. Mismatching of the jaws causes overbite and underbite. The difference in jaw size in most patients is small enough that braces and aligners move teeth into position without a problem. With an extreme discrepancy, extraction or even corrective jaw surgery may be recommended to fix the overbite/underbite. 

•Extremely protruded front teeth can distort the appearance of the lip. Removing teeth allows the doctor to reposition protruded front teeth by moving them backward, which improves lip posture.

•Extra, missing or ankylosed (tooth fused to the jaw bone) teeth are other justifications for recommending extractions. Many other variables determine the appropriateness of pulling teeth when fitting braces. For example, a patient whose teeth are fused, or ankylosed, to the bone may have more satisfactory results with teeth straightening if the affected ones are removed first. 

Why Should a Patient Think Twice Before Extractions?


•Pulling teeth is a permanent situation. Once gone, they cannot be replaced. Should the patient ever need an extraction in the future for an unexpected situation like trauma, they would have even fewer teeth to support the structure.
•Removing teeth can alter the facial profile. The teeth support the lips, the facial profile, the smile. Pulling teeth can alter the profile, causing the face to flatten or narrow too much.
•Extraction could also extend the time it takes for realignment as the teeth have to move a greater distance to close the space where the tooth was removed.

Are there alternatives to tooth extraction?

As mentioned above, for an overbite smile, Dr. Eves would not recommend extraction in the vast majority of cases. Here are some alternatives:

The Damon System. Tollgate Orthodontics uses a bracket system that has been proven to offer patients amazing results without the need to have any teeth removed prior to treatment. Dr. Eves is an expert in this more advanced bracket technology.
•An option commonly used in aligner cases is to slenderize teeth by very conservatively removing a small fraction of the enamel to make the teeth more narrow and therefore more likely to fit into the crowded space. 
•For younger patients (aged 16 or younger), a palate expander can often provide a smooth path to avoid tooth extraction.
•Finally, the TAD is yet another option to potentially bypass tooth extraction. This treatment secures one or more critical teeth in place using a small implant. With the help of these implants, it becomes easier to control jaw alignment and ease overcrowding issues.

RI Orthodontist Dr. Daniel Eves Can Help

The consultations at Tollgate Orthodontics are complimentary and comprehensive. We are happy to provide you with all our findings and recommendations at no cost and with no obligation. Before making a big decision like teeth extraction, get the opinion of our board-certified specialist, Dr. Daniel Eves. 

Book an appointment today to learn how to get the smile you have always wanted. Call us at 401-739-3900 and we’ll be happy to help you.

Dr. Daniel Eves, orthodontist rhode island, 401-739-3900