. As with most fields, there are different camps regarding the preferred methodology based upon the pioneering predecessors under whom they studied in orthodontics school. In the United States, in particular, there are two philosophies.
Extraction vs Non-Extraction
Traditionally, the Non-Extraction philosophy leans away from extracting teeth during orthodontics treatment, while the Extraction philosophy tends to be more likely to extract teeth as part of the treatment. These extractions do not include wisdom teeth, usually, as that is a different situation altogether. Typically, if a tooth is going to be extracted, it will be the premolars, since they are in closest proximity to the typical trouble area of the anterior (front) teeth.
Keep the Teeth or Take Them Out?
Both schools of thought have rationales to support their philosophies. For the clearest understanding, it’s necessary to view both opinions in more depth. First, consider where the two camps overlap in thinking. Both the Extraction and Non-Extraction philosophies would recommend extracting teeth under certain circumstances. When a patient shows major dental crowding, both philosophies will agree to extraction. There are appliances that can be used to open space and move the jaw in cases of minor crowding.
Reasons some Orthodontists Recommend Extracting Teeth
Sometimes, orthodontists recommend extracting primary (baby) teeth in favor of straightening permanent dentition. This could be because the primary teeth are interfering with treatment, or it could be because the permanent teeth erupted without pushing the primary teeth out.
Perhaps the most common argument orthodontists of this philosophy use with patients is that it makes the orthodontics treatment faster. Patients in a hurry to complete the treatment, for vanity’s sake or for budgetary reasons, are often willing to take this step.
Finally, those of the Extraction philosophy believe extractions are the best means of resolving overcrowded teeth. Some patients experience overcrowding because their jaws are too small to hold the number of teeth they have or because those teeth are too big for the size of the jaw. This often creates a malocclusion. Malocclusion occurs when top (maxillary) teeth are not seated properly together with the bottom (mandibular) teeth. This creates a problem with the bite and how the teeth work in collaboration to bite and chew. From an Extraction perspective, extracting teeth frees up room to shift teeth into a more proper position and align the bite.
Alternative Treatments for Overcrowding
From a Non-Extraction perspective, on the other hand, there are other ways to create room. Distalization is a process by which the orthodontist shifts the teeth further back into the mouth (distally) using orthodontics appliances. This is a more time-consuming process, but it preserves all the healthy teeth while also resolving the malocclusion. Distalization is the more conservative of the options for creating additional room.
The second option is to widen the dental arch. This may be done with appliances designed for the process, and, in severe cases, it may be done surgically to add bone to the palate. Orthodontics practitioners who favor the Non-Extraction philosophy cite the fact that extractions may negatively impact your appearance as you age, specifically around the jawline where teeth are removed.
At the end of the day, both philosophies deliver results patients love. But knowing which mindset your orthodontist has will help you better understand what to expect.
