This is a tricky question. I am very conservative when it comes to extracting teeth, but sometimes it’s necessary. I have made the comparison before to plastic surgery (see post on Damon system). Just like surgeons can push the limits in terms of size or tightness, I can always fit and straighten all of the teeth in a patient’s mouth. The question comes down to what is aesthetically pleasing as well as the health and longevity of the teeth.
To understand this dilemma better, I’d like to give you a quick biology and math lesson. Hang with me, it won’t be painful. The lower jaw is one solid piece of bone, so for all intents and purposes, we have to work around the lower jaw. If teeth are overcrowded, we have to make room for them in the arch of the mouth. That is done by either expanding the palate laterally or flaring out the front teeth. For every 3-4 mm of lateral (outward) expansion I gain 1 mm of arch perimeter. Put another way, for one tooth that is 6-7 mm wide I need to expand more than one centimeter to create space while making sure the upper teeth still fit properly with the lower teeth. I hear chewing is important! The other option I have is to flare the teeth forward. Again, I can only do that so much before the health of the teeth is jeopardized and the optimal aesthetic result is compromised.
It seems scary to pull teeth, and it is. You don’t get them back! But sometimes it is the right decision. If I recommend extraction, I talk to patients or parents in depth and never do anything patients aren’t comfortable with. Can you guess which of these patients had extractions and which ones didn’t? If you guessed that all of them had teeth extracted you guessed correctly. I’m kind of biased, but I think their smiles are beautiful!
Thanks for stopping by! And remember,
Smile, Life is good.