After the question “Can I have a brace?”, the next one to be asked by people at their first visit to the orthodontist is usually “Do I need to have teeth out?”.
Orthodontists prefer to say “No you don’t!” whenever possible. Brace treatment tends to get started quicker and finished quicker if we avoid dental extractions…which is great for us and for our patients.
But it is not always the right way to go. Probably around one third of our patients have extractions at the start of treatment, another third don’t need extractions at all and the final third we will decide about later on once brace treatment has started.
When having teeth out is a good idea
Baby teeth outstaying their welcome
We usually start treatment for teenagers with train track fixed braces when the baby teeth have fallen out. People lose their baby teeth at wildly different times. Some have lost all of them by the age of nine…others have baby teeth hanging on up to the ages of fifteen and beyond.
If baby teeth are still hanging around past the age of 14 years, we may ask your dentist to give them a helping hand so that we can get your brace treatment started.
Teeth with nowhere to go!
Many people have too many teeth in their mouth. Or rather, there is not enough room in the jaw bone for all the teeth to be lined up nicely side-by–side.
Orthodontists call this “crowding”. If crowding is fairly minimal, we can often get the crooked teeth aligned with braces without teeth being taken out.
But there comes a point where teeth are so crowded, extractions are needed to give some space to line up into.
The braces work by moving the front teeth back into the gaps and while simultaneously moving the back teeth forwards. That way we aim to get all the gaps closed up at the end of treatment where possible.
Sometimes teeth can be “impacted” under the gum. This is really another sort of crowding, where teeth are so short of space that they cannot even break through the gum.
Orthodontists are good at spotting impacting teeth. When we do the “chart up” at your first visit (you’ll hear us muttering to our orthodontic nurse “upper left seven, six, five, four…”) we will notice straight away if there is a tooth not there when it should be. An x-ray will then usually confirm our suspicions.
Sometimes the impacted tooth itself may need to be taken out. Other times we may advise an extraction of a nearby tooth to give room for the impacted tooth to come up through the gum.
Sticking out teeth
Teeth that stick forwards are one of the commonest reasons for people to visit us for help.
There are a number of ways to correct this problem with braces. One way which is used especially for older teenagers and adults is to consider the extraction of teeth towards the back of the mouth so that braces can be used to pull the teeth backwards.
How are teeth taken out?
Most orthodontists will write to your own general dentist if extractions are needed, telling him or her which teeth and why the decision has been made.
Often extractions are suitable to be carried out in the chair at the dentist under local anaesthetic. However you will be able to discuss with your dentist if it is more appropriate for extractions to be done under sedation.
Decisions take by specialists in orthodontics
Whether or not teeth are taken out as a part of treatment is a big deal for our patients. And we do not take the decision lightly.
Specialist orthodontists have completed not only a full five year dental degree but also three years of additional orthodontic training. A large part of that training involves being able to make sound clinical judgements on when teeth should be taken out as part of brace treatment.
At Cleveland Orthodontics all of our patients’ treatments are planned by specialists in orthodontics.
About Cleveland Orthodontics
Our specialist-led practice has been established since 1996 and provides brace treatment to people of all ages from across the North East, including Middlesbrough, Yarm, Stockton-on-Tees, Billingham and Redcar.
We offer NHS orthodontic treatment for children and a range of modern white and “invisible” braces for adults of all ages such as Invisalign. FREE consultations are available… you can either telephone for an appointment on 01642 243 020 or book through our website.