Narrowing of the dental arches: As space is closed after extractions, the arch becomes smaller, which can reduce the amount of space available for the tongue and airway. A smaller airway can contribute to issues like obstructive sleep apnea, poor breathing habits, and even long-term breathing problems, particularly during sleep.
Increased risk of TMJ disorders: Changes in jaw alignment can lead to problems with the temporomandibular joint (TMJ), causing discomfort and pain.
Potential for sleep-disordered breathing: As mentioned, a smaller airway can lead to conditions such as sleep apnea, which may affect overall health and quality of life. The connection between airway health and orthodontics is increasingly being recognized as critical to your overall well-being. That’s why avoiding unnecessary extractions is a priority in our practice, especially when considering the potential lifelong impacts on the patient’s airway and breathing.
When permanent teeth are extracted to make space for alignment, the removal of teeth often leads to a retraction of the remaining teeth. As these teeth move backward to close the spaces left by the extractions, the entire dental arch can become smaller. This can result in a phenomenon where the jaws, particularly the upper jaw (maxilla), appear set back or too small. This type of retraction can significantly alter facial aesthetics and function in the following ways:
1. Sunken Facial Appearance
As the dental arches narrow, it can create the appearance of a more sunken or “collapsed” midface. When the upper teeth and jaw are positioned too far back, it diminishes the natural support provided to the lips and cheeks. This can cause the face to look flatter, with less fullness in the middle third of the face, leading to an older or less vibrant appearance. The prominence of the cheekbones may also appear reduced, contributing to a less defined facial profile.
2. Flat or Retruded Profile
Extractions and subsequent retraction can have a noticeable effect on the profile of the face. With teeth being moved backward, the lips often lose their natural support and may appear to be set back. This can result in a flatter profile, with the chin or nose appearing more prominent in comparison. The face may lack the natural forward projection that contributes to a balanced and aesthetically pleasing facial appearance.
3. Narrow Smile
A narrower dental arch following extractions may result in a smile that shows fewer teeth. Instead of a wide, broad smile, patients may exhibit a narrower smile with less of their teeth visible when they smile naturally. This can make the smile look less full and, in some cases, less attractive, as broad, even smiles are generally seen as more aesthetically appealing.
4. Functional Changes
In addition to aesthetic concerns, altering the facial structure through extractions can also impact the function of the jaw and teeth. A retracted jaw position can affect how the upper and lower teeth come together, leading to a less ideal bite. In severe cases, this can contribute to problems with chewing, speaking, and overall jaw function. Over time, patients may experience discomfort or pain in the jaw joints, leading to issues such as temporomandibular joint (TMJ) disorders.
5. Posture and Airway Effects
The position of the jaws plays a crucial role in overall head posture and airway health. A retruded jaw position may contribute to a forward head posture as the body compensates for the altered structure, potentially leading to neck and back strain. More critically, a reduced jaw size and retraction of the teeth can narrow the airway, increasing the risk of sleep-disordered breathing conditions such as obstructive sleep apnea (OSA). When the airway is compromised, it can have wide-ranging effects on sleep quality, energy levels, and overall health.
The choice to extract teeth as part of orthodontic treatment is a major decision with lasting consequences. At Face Focused Orthodontics, we recognize the profound long-term effects that extractions can have on both facial aesthetics and jaw function. That’s why we prioritize preserving or expanding the dental arches rather than reducing their size. By maintaining the natural width and forward position of the jaws, our goal is to create a balanced, harmonious facial structure that not only enhances appearance but also supports optimal long-term health. Whenever possible, we offer alternative treatment options to avoid extractions, including:
Arch Development: For younger patients, early intervention can help guide the growth of the jaw and teeth, reducing the need for extractions later on. By monitoring growth from an early age, we can utilize appliances to encourage proper development and avoid crowding.
Space Management and Coordination: Our philosophy includes maintaining or creating space for the permanent teeth without resorting to extractions. Through precision space management, we ensure proper alignment while keeping the airway open.
Bone-Anchored Expansion (MSE or MARPE): This technique is designed to expand the upper jaw without moving teeth unnecessarily, maintaining a wide dental arch and healthy airway. We use this approach in conjunction with Invisalign to minimize the movement of teeth and focus on skeletal changes.
Impacted Teeth or Severe Trauma: Teeth that are unable to erupt into the proper position, or those severely damaged beyond repair due to injury, may need to be extracted to restore function and aesthetics.
Periodontal disease: If teeth are severely compromised by gum disease and cannot be saved, extraction might be the only option.
Orthognathic Surgery Preparation: Sometimes, extractions are required as part of a pre-surgical plan for patients undergoing jaw surgery (such as for correcting bite misalignments or severe skeletal discrepancies).
Non-Restorable Decay: When a tooth is too decayed or damaged to be restored with treatments like fillings or crowns, extraction may be the best course of action to prevent further complications.
Understand alternative treatment options: There may be non-extraction alternatives that are more suited to your needs.
Evaluate the long-term effects: Make sure the treatment plan considers not just the immediate goal of straightening teeth but also how it impacts your facial structure, airway, and overall health.
Ensure you’re making an informed decision: The decision to extract teeth is permanent, and it’s important to feel confident that you’ve explored every avenue before proceeding..
