The goal of any orthodontic treatment is to make someone’s smile better. If given the choice no patient would want to have teeth removed in order to get this. Let’s be honest we have all heard horror stories about the dentist kneeling on the chest to get a stubborn tooth out! (that never happened when I took teeth out!). So why is it some patients are told they need to have teeth out whilst others not?
In reality we judge each case individually, and sometimes the only way to make enough room to straighten them or to get the best aesthetic result is to lose some teeth. Let me explain why in the following examples:
Too many teeth
Our modern diets and genetics has meant that we are developing smaller jaws, but our evolution is too slow to keep up so in some cases a patient can have too many teeth to fit into their jaws. They have the same number as everyone else but the lack of room in their mouths mean that the teeth are crowded together (rather like the tube at rush hour!).
In these cases the only way to straighten teeth is to remove some (get them off the train!). We can then straighten the remaining teeth – problem solved!
Teeth have drifted forwards with age
As with many other things that start to change we age so, do our teeth. Our teeth naturally drift forwards. If our front teeth begin to overlap they take up less space at the front and the back ones shuffle forwards to close up the gaps (like a queue at the supermarket checkout!). Unlike a queue though, it’s not that easy to push the teeth backwards, especially if the wisdom teeth have now decided to come through and fill the space. There is less room at the front than before so just lining the front teeth isn’t possible if we want them to look their best and stay in that position long term. Too make room to line up the tooth we can sometimes recommend removing teeth to help us make room to tidy up the rest.
Straightening the teeth will just make them stick out too much
In some patients lining up their teeth will make them lean forwards more so whilst they may look straight they can make it difficult to bite the teeth together at the front, and closing the lips over them a bit of a strain. It tends to give the lower part of the face a fuller appearance as well which can affect the profile of their face.
In these cases taking 4 teeth out means we can tuck their front teeth in helping the lip profile as well as the smile.
In what situations can extractions be avoided and if they have to come out how can we diminish the look of that gappy smile?
Avoiding extractions is always great for us. If we can gain space by widening the jaws or shaping the teeth then that’s wonderful – happy orthodontist and happy patient! We can sometime see benefit from treating a child at the age of 9-10 years with a removable braces to help the jaw to develop as the new adult teeth come through but this is not a cure all for everyone.
We can also make room by shaping teeth to gain space between them – this gives us valuable gaps to help us straighten the teeth without having to take other teeth out. This can work well when there is only a small amount of space needed.
However there are always cases where having teeth out cannot be avoided. In this situations, if a patient if worried about having the gaps at the start we can place a “shell” tooth to disguise the space which we can gradually reduce in size until the gap is gone or less visible. We also have this feature built into Invisalign so when the patient is wearing their aligner the gap is gone!