Extractions as part of orthodontic treatment are required somewhat less frequently than in the past on account of advances in orthodontic techniques. There has been widespread adoption of braces which take advantage of the growth of the patient’s jaw to correct the bite, possibly also creating small amounts of additional space in the dental arch. These braces, known as functional appliances, are routinely used now by most orthodontists and can often avoid the need for extractions. Other advances have likewise reduced the proportion of cases where extrctions are recommended.
It is sometimes asserted that these techniques are appropriate in all cases and that narrow jaws can always be widened to bring overcrowded teeth into line without extractions. But the evidence is that this approach, applied uncritically, can lead to excessive prominence of the teeth greatly increasing the risk of subsequent relapse.
There is little doubt that well-planned orthodontic treatment can both improve the bite and enhance a patient’s overall appearance. Every course of treatment needs to be tailored to the needs of the individual patient. For many patients, in order to get the best appearance and long-term result, extractions will still be part of the process.
In reaching a decision on extractions, a full assessment of the patient’s face, teeth and state of development is essential. A meaningful opinion cannot be given on whether extractions will be required in the absence of such an assessment. Any offer to treat without extractions made before such an assessment should be regarded with considerable caution.
It is important that the recommendations of your orthodontist command your confidence. If you are unsure about the advice you are receiving, you should discuss your concerns with your own dentist. You might wish to seek a second opinion from another specialist, to which everyone is entitled under the terms of the NHS.
