Removing Teeth for Braces May be Harmful for Overall Health
It is almost never a good idea to extract teeth for orthodontic braces. Long story-short, taking such an action will likely do the following things:
- Poor reverse profile and shrunken facial bone structure. Watch your jaws fall backwards when they should grow outward in childhood.
- A decrease in the size of your mouth and upper airway
- Poor speech
- Poor tongue function
- Obstructed night time breathing
- Poor nasal breathing
- TMJ pain
- Bad Bite
- Sleep Apnea
Some of these problems may not happen right away, but they eventually occur. The main cause is a decrease in the size, volume and position of the jaws. Teeth extractions and braces shrink the mouth. The teeth come backwards and bring bone with them. The tongue space is reduced and the tongue is drawn closer to the airway and the lower jaw is retruded. And all this happens in childhood when the face and the entire body are supposed to be “growing.” After braces comes retainers that retain and prevent the jaw structure from growing after the orthodontic treatment is complete. Better wear that retainer forever or your teeth may not stay straight! Then what happens is forever later is you have the same underdeveloped small face and airway for the rest of your life. Sleep apnea and TMJ here we come.
When Children Should get Braces or Invisalign?
Braces are in style, right? All kids want braces until they get them and they get their first adjustment, right? Most kids will need some growth and orthodontic treatment between the ages of 4 and 11 years old. But some children may never need their teeth straightened. It depends on growth, development and cosmetic expectations.
Your child should be evaluated by a qualified dental professional no later than ages of 4- 6. Some kids may be a little small and others may be very small and need a lot of help at a younger age. For one child, orthodontic growth treatment may need to be started at age 3-4 and for others starting at 9 or 10 years old may be fine. 80% of facial growth is done by age 12 and by then the problem will already have happened. Timing is everything. It is best to promote growth prior to getting crowding, crooked teeth and bite problems. At this point, there are already problems. There is not a best or one magical appliance. There are really three issues:
- creating enough space for teeth and the tongue
- getting the upper and lower jaws to be a compatible size and shape
- getting the jaws to grow forward into the correct 3 dimensional position. Having the jaws too far back leaves the tongue on top of the airway. That is bad for sleep and breathing while asleep.
Evaluating the child. Identifying individual needs. Matching specific treatment to the specific needs of the child. Many people are concerned about when kids should get braces. The real question is what needs to be done to prevent the conditions where braces need to be done to begin with.
Dos and Don’ts about When to Get Braces
- Get Braces after all the baby teeth have fallen out. And only if the adult teeth do not come in straight. Wrong. If the baby teeth are crowded there will never be enough room for the adult teeth to be straight. By the time the baby teeth have fallen out, it is too late to take advantage of any of the child’s natural growth during treatment.
- Getting palatal expanders will guarantee my child does not need braces. Expanders create more space, but crooked teeth will not be corrected by expansion. Only crowding will be corrected.
- If teeth look straight and nice, they do not need treatment. The goal is to have room for all the teeth to fit and for there to be enough room for all the functions that happen in the mouth. Most importantly breathing. We are equally concerned about form and function. Proper treatment prevents tmj pain and sleep apnea in the future.
Do Not Blame Orthodontists
Poor growth and under development is the cause of crowded teeth and small facial profiles. Do not wait to go to the dentist until teeth are crooked and crowded. By this time, the problem has already happened. Facial and jaw development is behind and the dentist is playing catch up. When teeth become crowded it is best to use expanders to stimulate the jaws to grow larger, so all the teeth can fit. Sometimes getting the necessary expansion can be difficult especially with children who are not compliant with treatment. It is best to be patient and only use extractions as a last resort or not at all due to the consequences above.
Stimulate Growth in the mouth for straight teeth and tongue space?
First, we need to determine why things are not growing properly. No biological dentist in their right mind would start by removing natural teeth. Second-let’s get your smile straight, so your smile looks right and everything in your mouth works properly and is healthy. Bottom line, use anterior growth appliances that will create more space in the mouth and jaws and straighten the teeth and balance the bite. The goal should be to promote growth (at an early enough age) so the conditions where braces become necessary never happen.
Dr. Adams uses a variety of expanders and forward growth in children including the Schwarz, Twin Block, ALF and Crozat appliances. There are also appliances for Adults including the DNA appliance, AGGA forward growth device and the Homeoblock. The DNA in particular is a great treatment to reverse the effects of extraction and retraction orthodontics.
ALF Appliance Video by Dr. Adams
Anterior Growth Treatment vs Removing Teeth and Straightening
If there is tooth crowding, signs of poor sleep, mouth breathing or teeth clenching, something needs to be done to create more space in the mouth. Another troubling condition is a tied tongue or frenum. Proper growth of the mouth and face is dependent on proper tongue space and function. It is actually proper tongue function that stimulates the facial bones to grow properly in the first place. Conditions such as tongue tie needs to be treated at a young age for normal anterior growth to occur.
Dr. Adams’ favorite kids anterior growth appliances:
Schwarz Appliance is a versatile Expander and Functional Orthodontic Device for Kids
The Schwarz can grow the jaws wider, taller and more forward. It can also reposition the lower jaw more forward.
ALF Appliance for crowded teeth and jaw balance
Twin Block Appliance appliance for functional orthodontics
In many cases the best appliance for moving the lower jaw more forward. For severe cases of retrognathia, this may be the best appliance. This appliance requires a very compliant child and a very experienced functional dentist.
Crozat Appliance is like ALF but expands the palate better
DNA Appliance works the best for older children 12 and older
This DNA appliance is basically a Schwarz appliance with special springs capable of causing bone cells to start growing bone again. The best appliance for older kids and adults.