Ask the Dentist: The orthodontic conundrum – to extract or not to extract teeth if you need braces?

MY favourite part of dental conferences is at the very end when all the speakers huddle together for a Q&A session.

When the dental planets are aligned often an excellent scientific argument gets going, where the lecturers sling research papers and statistics back and forth.

One area of dentistry laden controversy is the field of orthodontics, or what everyone knows as braces. To extract the teeth or not to extract the teeth before brace treatment has been riding the wave of orthodontic fashion for hundreds of years.

The debate reached a blustering pinnacle in 1911, when two heavyweight American dentists, Angle and Case, went head-to-head defending their ideologies. At that time, non-extraction-believing Angle won, arguing that removing teeth and then retracting the other teeth backwards left a “weak face” where the lips aren’t well supported, the cheeks flatten, and the lower jaw sits backwards encroaching the airway.

Angle reasoned that the jaws should be made to fit the teeth, believing that orthodontics should, “Help Nature in overcoming her blunder of fashioning a small jaw for the reception of the full complement of well-developed teeth”.

He didn’t agree with the common misconception that people still hold today, that they are born with “too many teeth”; rather he felt that the jaws failed to reach their potential maximum size.

It wasn’t until after the Second World War that the pro-extractionists made a revival as they countered in the discussion, that the long-term results of not taking teeth out before braces were not stable, the attractiveness of the face was subject to the eye of the beholder and the jawbone could not be grown to the size that the teeth really needed.

Right up to today, the debate rages with all the twists and turns of an Agatha Christie mystery and this makes it very difficult for patients who are caught up in the melee to make good decisions for themselves.

Everyone has individual needs and there’s rarely a one size fits all treatment plan. Generally, if healthy teeth can be kept and jaw growth encouraged it’s more like how nature intended us to be.

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