Why shouldn’t I have teeth taken out if they are all crowded?

A beautiful smile without removing premolars is possible!

Most dentists and orthodontists were trained in school to remove premolars when a patient has crowded teeth.  Space is then created, and that space can be used to relieve the crowding of the other teeth.  Makes sense, right?

For every action, there is a reaction, and many of the negative outcomes from removing permanent teeth are poorly understood and/or explained to patients (and their parents).  On the plus side FOR removing teeth…it makes orthodontic treatment faster and sometimes even easier than if teeth are kept.  This means the patient may be out of braces sooner, which everyone always likes.  However, the following are the CONS outlining why we should always strive to keep teeth:

1) Usually these teeth are healthy and free of decay or filling material.

Why should something our body created in a healthy way be removed? These teeth are there for a reason, and the function they serve is chewing smaller bits of food that have already been pre-chewed by the molars.  Without premolars, the canine (eye) teeth may be used for this function, and show very fast signs of wear.

2) Patients who have had premolars removed often have less attractive facial features and profile, especially as they age.

Believe me, I am saying this as objectively as I can! Removing teeth and then pulling the others backwards into the face makes for a flat face, flat cheekbones, thinner lips, and a retruded chin.  If the patient is a man, he will most likely end up growing facial hair in adulthood to make his face look fuller and more proportionate.  Women don’t have such “luck” and instead can look older than they really are.  Most women I know prefer to look younger, not older.

3) Retracting (pulling back) the teeth make a smaller “container” for the tongue.

The tongue is then forced backward and can block the throat, making the person a mouth breather; in this case, the tongue sits on top of the bottom teeth, allowing them to re-crowd even years after the braces come off.  Everyone blames the orthodontist, or the retainer wire…but it’s actually then the tongue’s fault for not doing its job.

4) Retracting (pulling back) the teeth increase the chances of snoring.

Snoring may be cute in commercials, but if you live with and/or sleep in the same bed as a snorer, you will know it is anything but cute. The snoring happens because the tongue falls back into the throat, restricting air flow.

5) People who snore are more likely to develop sleep disorders like sleep apnea later in life.

And sleep apnea can kill you…sometimes quickly, but most often slowly so you won’t notice the changes.  In fact, most people with sleep apnea go undiagnosed…and blame their continuing decline in health on age or heredity.  While age and heredity are factors, a poor airway, poor oxygen exchange, poor rest at night have slow, long-term effects on overall health.

So…what can I do if my dentist or orthodontist says I should have teeth removed to make space?

Honestly?  Get a second opinion.  Your dentist or orthodontist is absolutely recommending the best treatment he/she knows to provide. That doesn’t always mean it’s the best treatment option available! Be open to choosing the best treatment based on the best possible care, rather than how near it is to work, school, the local grocery store or Starbucks!  That may sound harsh, but I hear so often that this is how people choose which orthodontist will provide care.

Many orthodontists now will treat children at a younger age to help improve the way the jaws grow so there is enough room for all the teeth.  Sometimes just by growing the jaws properly, the patient can avoid the need for braces, or make the treatment faster and easier.  For more information about why to keep premolars, please look through the website of a colleague, www.facefocused.com or contact us for more information.