Is removing teeth for braces really necessary? How common is it to have to have teeth removed for braces? What the things you should be aware of if you are considering braces but would need extractions before you can get them fitted? In this article, you will find answers to all of these questions and more.
Any licensed orthodontist can do incredible things to your teeth, from straightening your teeth, fixing your bite, to improving your smile. Time-tested orthodontic treatments like braces and Invisalign are designed to do just that. While orthodontists prefer to save as many teeth as possible, certain types of tooth and bite problems are better treated by having some teeth removed. There are lots of reasons why orthodontists may recommend removing teeth for braces.
If you are having second thoughts on pushing through your plans of getting braces because your dentist recommended tooth extraction, then this entry will help you understand why removing teeth for braces may be better for you.
Why and when are extractions necessary?
The most common reason for extractions is to make room for the braces treatment to move, spread out, and align the teeth correctly in the gum line. Serious overcrowding makes it impossible for the braces or Invisalign to work. Common reasons for overcrowding of teeth include:
- Jaw too small to properly support all the teeth
- Too many teeth
- Teeth too big (or one tooth is too big or abnormally shaped)
To eliminate overcrowding
In many extraction cases, the jaw is simply not big enough to accommodate the size and number of permanent teeth. Overcrowding is when the teeth erupt into an unusual direction and wrong position in the first place. Dentists perform strategic extractions to allow the braces (or Invisalign) to work and move the teeth into the right places.
To get rid of unusual teeth
Some people have extra teeth. These oddly shaped, overly large, or tiny teeth apply pressure to other teeth, moving them out to odd angles. These teeth can be removed, and the space they leave can be used to make way for the shifting of other teeth.
To correct protruding teeth
In some cases, the front teeth protrude all the way out causing the lips to stick out. This doesn’t only affect speech, but it can also affect one’s profile. Removing the overcrowding teeth can help the sticking front teeth to move backward for a straighter line.
To improve jaw stability
Some people have abnormally developed jaws. By removing some teeth, the braces can help adjust the jaw normally and ultimately improve jaw stability.
To remove damaged or decayed teeth
Plaque build-up and bacterial growth cause tooth decay. If the decay is too advanced and impossible to save, it would be wise to remove it and allow the other teeth to align properly by filling the vacant space.
To solve severe malocclusions
Severe cases of underbite, open bite, and deep overbite may only be fixed by extracting a tooth or two.
To remove impacted teeth
When there is not enough space, some teeth are forced to grow on top or behind their neighboring teeth. Some remain on the gums, while some come out next to another tooth. This can easily lead to infection. Dentists and orthodontists will usually request an x-ray of this tooth to find out if it needs to be extracted.
More about impacted tooth
When a tooth becomes impacted, it may stay and hide inside the gums and may not emerge at all. This hidden tooth puts pressure on other teeth, moving them in different strange positions. Once infected, it can also cause decay.
Impacted teeth may not be easily seen by the naked eye. This is why dentists often request an x-ray to see everything that is going on inside one’s mouth.
Correcting impacted teeth requires surgery, and it is incredibly important to extract them to avoid infection and maintain good oral health.
Impacted teeth symptoms include:
- Swollen gums
- Pain and discomfort
- Unexplained headaches
- Teeth moving out of positions
Overcrowding teeth is a common problem, but why?
For decades, scientists have wondered why overcrowded teeth are such a common dental problem. Research from Stanford shows modern human jaw sizes have been shrinking, while the teeth remain full size, and this is the culprit behind many orthodontic and health issues.
The study suggests humans used to do a lot of chewing on unprocessed or stone-ground grains, resulting in the bigger and stronger jaw and worn-down teeth. Subsequently, modern humans have been taking better care of their teeth and eating softer cooked foods.
Signs you may need extraction for braces
Your dentist or orthodontist will inspect your teeth thoroughly, including comprehensive x-rays, to determine the proper placement for each tooth, and what will need to be done to achieve straighter teeth and proper bite. Some of the signs you may need extraction include:
- Extremely large tooth that don’t fit in its position
- Tooth growing in wrong direction
- Painful or sore tooth
- Discolored tooth (sign of decay)
- Sensitive tooth
- Chipped, cracked, or damaged tooth
- Loose tooth due to decay or periodontal disease
- Biting or chewing issue
Note that it still entirely depends on the specifics of the case. Having these symptoms doesn’t automatically mean your teeth must be extracted.
Not all patients require tooth extraction to proceed with the braces treatment. As a matter of fact, it is often not needed. If the orthodontist determines the teeth can be aligned into a healthy bite and correct position, then there will be no need for extractions.
For cases that require extractions to accommodate the braces, however, the orthodontist may extract one to four teeth, depending on the diagnosis. While some people have an abnormal eruption of wisdom teeth, it is generally considered separate from orthodontic extraction cases, since there are other reasons for removing molars. Also, dentists may remove an odd number of teeth (1 or 3) when treating bite asymmetry or traumatic biting.
Which teeth are usually extracted?
Choosing which teeth to remove depends on the case of the patient. In most cases, however, it is the premolars (4th and 5th teeth from the front). In some cases, the back molars are removed as well.
When choosing which teeth to remove, the dentist, of course, considers the health of the teeth, their positions, and how their absence may affect its neighboring teeth or affect the tongue position and shape of the face of the patient. Thus, the dentist may require 3D-modeling scans to help pinpoint the right teeth to extract.
Extraction of teeth for braces, what to expect
Thanks to advancements in dental technology, tooth extractions today are quick and generally painless. To manage the pain, dentists use numbing substance and rub it against the gums near the tooth that is being extracted.
They will then use local anesthesia near the area of extraction. The anesthesia will eliminate any sensation. You may feel some pressure or movement, but it wouldn’t be too painful. You will be awake and aware during the tooth extraction.
In some cases, dentists may be required to perform sedation dentistry methods using Nitrous Oxide (laughing gas). This substance provides minimal sedation to help you relax during the procedure. The dentist will provide you with a pill or tablet to get you sedated. You will still be conscious during the extraction process, but you will feel drowsy.
For more moderate or deeper sedation, dentists administer sedation through an IV and inject it into your arm. This is often used for complex and multiple teeth extractions, but can also be used to calm anxious patients during the procedure. While awake, your consciousness will be suppressed. When the effect of the sedation wears off, you will not remember anything from the procedure.
General anesthesia is rarely used for dentistry, as it is reserved for special cases. It can be administered via IV through the arm or via inhalation. In some patients, both are used simultaneously.
This type of anesthesia renders the patient fully unconscious throughout the extraction. Thus, vital signs such as breathing, blood pressure, oxygen level, and temperature will be constantly monitored throughout the procedure. Like sedation, patients will not recall anything about the procedure.
Extracting the tooth
Your dentist will use a forceps-like tool to loosen the tooth from its socket and eventually dislodge and eventually remove it from its foundation. Then, your dentist will use gauze and apply pressure to the empty socket to help stop the bleeding.
For broken, damaged, or impacted teeth, especially those that are trapped or erupted under the gum line, your dentists may perform a surgical extraction. This involves opening the gums by making incisions to remove tooth pieces. Recovery for this type of extraction, of course, takes longer than simple extractions.
Tooth extraction aftercare
Before the numbing effect of the anesthesia wears off, you will be prescribed to take over-the-counter pain medications (usually Ibuprofen or Tylenol) to help manage discomfort. For complex and multiple teeth extractions, you may be prescribed more potent pain medication.
You will have to change the gauze every few hours following the procedure.
Also, make sure you rinse your mouth frequently and gently after the extraction. Rinse your mouth with a mild saltwater solution for the first week.
You may notice a blood clot in the socket where the tooth was extracted. Make sure you don’t touch or remove that clot, as that clot is the first step for healing.
You need to avoid hard food and must stick to soft foods and liquids for the next 48 hours.
Here are more tips to help alleviate pain:
- Warm compress on your cheek – warm temperature can help promote better blood flow to the area and help speed up the healing process.
- Ice pack on your cheek – cold temperature can help mitigate pain by numbing the area
- Get enough rest – help your body heal itself by getting enough rest and avoid straining activities or exercise for 2 to 3 days.
- When lying down, use a pillow under your head
Healing time of the extraction depends on the patient. Many people feel better faster, while some may experience tenderness in the area for a few days.
While swelling and soreness is common, you have to notify your doctor if you notice any of the following symptoms:
- Fever or chills
- Sever swelling and bleeding
- Shortness of breath and/or chest pain
These are signs of infection and must be addressed as soon as possible.
Tooth extraction alternatives
There are alternatives to tooth extraction when it comes to preparing for braces. One involves surgical insertion of bone into the palate. This will expand the palate to make more room and accommodate all the teeth.
Another alternative is aligning teeth further back into the mouth. This will enable the molars to extend further back and make room for all the teeth. Ask your orthodontist if you have questions about these treatments.