Does having braces always mean getting teeth pulled?

Treating an orthodontic patient with extractions (having teeth pulled) as opposed to non-extraction has been a hotly debated topic amongst orthodontists and researchers since the early days of the specialty. Though there is evidence of orthodontics as far back as 400 BC, “modern” orthodontics started in the 1700’s, so in either case, that is a very long time indeed! Over all these years, orthodontists have gone through various cycles where extraction or non-extraction was the preferred method of the day.

Today, through research, we know a lot more about good and bad consequences of both removing teeth and not removing teeth when extractions may be indicated. As such, making that simple decision becomes critical in the overall success and long-term stability of each case. A certified orthodontic specialist will have the diagnostic skills and experience to make that decision for you or your child. Of course, each orthodontist will have his/her own preference and some orthodontists definitely like to pull teeth more often than others.

Personally, my preference is to keep as many teeth as possible. That is what I would want for my own children. But does that mean I never suggest extractions? Absolutely not! There are many factors that come into the extraction decision. The most obvious one, and the one that is easiest for patients to understand, is crowding. But in addition to crowding, orthodontists typically assess the age of the patient, the presence of primary (baby) teeth, which can help in space control, the health of the surrounding gum tissues and bone, the relative position of the upper and lower teeth (or the bite), the position of the lips compared to the rest of the face, etc. Once all these factors are evaluated, the orthodontist will make a decision as to whether or not teeth should be removed. This can also affect the mode of treatment.

Though, in most cases where extractions are needed either braces or clear aligners like Invisalign can be used to correct the position of the teeth.

One thing is certain: if, like me, you would like to avoid extractions, an early visit to the orthodontist will most definitely maximize the likelihood that your child can be treated without having teeth pulled. This is because while a child is still growing (even in the presence of baby teeth), we can manipulate the jaws to help create the needed space for all the teeth to erupt.

I invite you to call our office for a complimentary consultation for you or your child so we can best assess your needs.

Happy Smiles,
Dr. Pourang Rahimi, Palermo Orthodontics

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