TO PULL TEETH OR NOT?
At Gorton & Schmohl Orthodontics, we are passionate about our work and our commitment to non -extraction techniques have always been an important part of our practice. Our extensive experience treating adults as well as children has only reinforced this, since we can see the long term effects of different orthodontic treatments on not only the teeth, but the surrounding gums, bone and overall health.
There are 2 approaches to resolving significant crowding- make room so that the teeth can fit or remove permanent teeth so that the teeth don’t need to fit because they are not there anymore. Both approaches will result in the teeth looking straight and fitting together well, yet there are many other esthetic, health and patient experience issues that should also be taken into consideration…
A few points to consider:
1) Q: WHAT IF THEY ARE JUST BABY TEETH?
What about removing some baby canine teeth so that the front permanent teeth have room to line up better?
A: Removing the baby canine teeth is officially the path to a process called “serial extraction”. Sometimes doctors are not clear in communicating that after the baby canines get extracted, then next comes removal of the baby first molars (x4) so that the permanent canines can come in. Lastly, the PERMANENT first premolars (x4) need to be removed, since at some point the severe lack of space still needs to be addressed. The parents are always very happy with the “easy” solution to have great esthetic improvement in the straightness of the front teeth once those first baby teeth are removed, but they don’t realize that the path ends in removal of permanent teeth
2) FACIAL APPEARANCE LONG TERM
The normal pattern of aging is for the face to flatten and sag. The position of the front teeth and thickness of the lips influence the extent to which this will happen. Removing permanent teeth can lead to less support of the lips, creating a more flat profile. The effects of this are less obvious at the end of treatment in a young teenager, only becoming more apparent in the adult years.
3) OVERALL HEALTH LONG TERM
Yes, your mouth can affect your overall health!
Research studies are showing that the collapse of the dental arches can contribute to sleep apnea /snoring later in life, as the tongue has less space and gets pushed back towards the throat. This appears to be more prevalent for people who were treated with removal of permanent teeth or with headgear, as these both maintain or even further reduce the space available inside the mouth. While snoring can be viewed as a lifestyle concern, it can also be indicative of a more serious health concern such as sleep apnea. The pauses in breathing that happen with sleep apnea are correlated with heart failure/higher mortality rates after age 50.
4) THERE ARE DIFFERENT KINDS OF EXPANDERS
There are 2 different approaches expansion for young children (usually 2nd/3rd grade). One approach is to widen the middle part of the face (upper jaw, nose) and the other is to widen only the teeth and the bone immediately above the teeth that holds the permanent teeth.
In our office, we have a low dose CBCT 3D x-ray to determine which kind of expander would be best for each patient. For patients with a narrow airway on the x-ray and/or a history of relatively consistent snoring, we recommend the more comprehensive approach of expanding as much as possible. Otherwise, have the alternative of a slower, more customizable expander or we can use Phase 1 Invisalign for the expansion (no difference in fee and more patient-friendly). For patients needing a lot of upper expansions, we also provide a lower expander to make sure the teeth don’t get too far away from each other in a side-to-side direction. We have photos of our expanders on our website https://marinortho.com/making-space/
5) Q: WHAT IS THE PATIENT EXPERIENCE LIKE WITH EXPANSION?
a) FIRST APPOINTMENT (RECORDS): In our office, parents need not be concerned about our triggering a gag reflex- we no longer take impressions/molds for anyone, only scans (no radiation exposure with those). https://marinortho.com/itero-invisalign/
We also take photographs with a regular camera and a low dose digital 3D CBCT xray. With the xray, nothing goes inside the mouth, it just spins around, similar to a panoramic 2D digital xray that some dentists have.
Unless Invisalign will be used for the expansion, 2 little rubber bands called “separators” are flossed into the area between the last 2 upper teeth on each side. These can make the teeth feel a little bit sore for a couple of days and this can be soothed with either Tylenol or gentle vibration. https://marinortho.com/acceledent/
b) SECOND APPOINTMENT (EXPANDER): Unless Invisalign will be used for the expansion, the separators are removed and the upper expander is fit, adjusted, then “glued in” for the duration of treatment (usually 6-12 months). Since it can feel strange to talk/swallow for the first couple of days with the new expander, we do not do any activation that first appointment in order to minimize any soreness from tooth movement initially.
7) They can see exactly what the expanders look like on our website..
8) We do not charge for our consults – they can book online https://marinortho.appointlet.com/ or by phone 415-459-8006