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Those considering braces are glad to hear that one of those mostly outmoded approaches is pulling teeth. At one time, 75 percent of orthodontic cases included the removal of at least one permanent tooth, usually to give the other teeth more room, but in the vast majority of today’s cases, extraction isn’t done.
“These days, most orthodontists consider this a last resort rather than a first option,” says Dr. Jamie Reynolds, an orthodontist, national and international lecturer and author of World Class Smiles Made in Detroit (www.AskDrReynolds.com). “In my practice, I’d say that less than 1 percent of patients need to have a permanent tooth removed.
“Fortunately, the number of cases best treated by extractions has drastically reduced due to early orthodontic intervention and advanced treatment options.”
There are times when a patient might require an extraction of a permanent tooth before getting braces. But Reynolds says if that’s the first recommendation, it’s prudent to get a second opinion.
“While baby teeth are meant to come out in due time, permanent teeth are supposed to be, as the name applies, permanent,” Reynolds says. “Removing a permanent tooth is a big deal.”
Reynolds points out some important considerations to keep in mind about having a permanent tooth pulled for orthodontic treatment:
The consequences. Two of the long-term benefits of braces – enhanced oral health and smile – can be somewhat lessened. “Pulling permanent teeth can compromise the health of gum and bones,” Reynolds says. “It can also result in long-term negative effects on facial structures, such as seen in the aging process. That’s a huge deterrent to extraction. As people age, their lips naturally flatten out, and for patients who had permanent teeth extracted, this flattening is significantly magnified because support for the lips was reduced.”
Modern research. “In the past, orthodontists believed that teeth crowding was due to teeth that were just too big to fit in your mouth,” Reynolds says. “Research has shown that this is not the case at all. Crowding is a result of smaller dental arches. Instead of pulling permanent teeth, treatment should focus on creating additional room for crowded teeth.”
Gentler wires. “Today’s wires provide a much lighter and gentler force on the teeth than traditional, stainless steel wires,” Reynolds says. “This gentleness allows the bone to adapt and change with the movement of teeth, increasing the ability to treat more cases without pulling teeth.”
Better braces. Traditionally, braces were tightened with small wire tires or colored elastics. They kept the wires in place but caused friction and prevented the teeth from sliding freely. “Nowadays, braces have a door or clip that opens and closes to hold the wire in place,” Reynolds says. “This new type of brace does not require ties or elastics, so teeth are free to slide and don’t need to be pushed as hard to move. That’s largely eliminated the need for permanent tooth extraction.”
“These advanced technologies and discoveries allow orthodontists to make room for teeth, rather to remove them,” Reynolds says. “If a doctor recommends the extraction of permanent teeth, be sure to advocate for yourself or your child and consider getting a second opinion.”
About Dr. Jamie Reynolds
Dr. Jamie Reynolds (www.AskDrReynolds.com) is recognized on an annual basis as one of the top orthodontists in metro Detroit. His book, World Class Smiles Made in Detroit, puts an emphasis on the many benefits of having a great smile. Reynolds – who is a national and international lecturer on high-tech digital orthodontics and practice management – attended the University of Michigan for both his undergraduate education and dental studies, and did his orthodontic residency at the University of Detroit-Mercy.