very common question on our Metal Mouth Forum involves
extraction. Often, adults may need teeth extracted to make
room so their other teeth can move into their proper
so easy for someone else to tell you that you need teeth
removed. After all, the teeth are not coming from their
mouth! And as you know, after teeth are removed, you can't put
them back. It's the permanence of the procedure that makes
this a very difficult decision for adults.
me tell you my story. My teeth were never perfectly straight,
and they got more crooked as I got older (despite 4 impacted
wisdom teeth being removed in my early 20s). By my early 30s I
wanted braces, but every orthodontist that I saw (and I saw
plenty) told me that I needed 4 teeth extracted. Well, I
didn't like that one bit. In fact, I was totally against it.
So I just resolved to live with crooked teeth.
forward 10 years. Here I am, at age 43 in braces, with a near-perfect
smile, which was only achieved by -- you guessed it --
extracting 4 second bicuspids. Boy, do I wish I'd had this
done 10 years ago. Now I feel really silly for being so scared
and waiting so long.
orthodontist who finally treated me tried very hard to fix my
teeth without extracting, but it just didn't work. (I applaud
his earnest efforts on my behalf). Six months into treatment,
it was evident to me (and to him), that the extractions were
necessary. At this point I felt better about it because at
least we had TRIED the other way.
Was I remorseful about
losing those perfectly healthy teeth for the sake of beauty?
Yes, of course I was! I felt sick about it! After the
extraction, I kept thinking, "Oh God, have I done the
right thing?" But soon I got
over it. Now that the extraction gaps have closed and my smile
looks great, I know I made the right decision. I was worried
that extracting teeth would negatively impact my facial
aesthetics (which, IMO, didn't need any changing). But you know what? The change is very subtle, and in fact, it
is actually good.
But that is my
experience and it may not be the same as your
experience. Sometimes if the mouth and smile are already
"small," depending on your facial bone structure,
extractions may result in your face looking "sunken in" over
time because the underlying structure has been changed.
Before you decide on extractions, you should get several
opinions, ask how your facial aesthetics may change, and
think about it carefully. In some cases, other methods can
be used to make space, such as "shaving" the teeth or using
Damon-type brackets (whose manufacturer claims that they
eliminate the need for extraction in some patients).
This orthodontist's web page talks a little bit about
why he feels Damon brackets help eliminate some extractions.
As time goes on, there may be other methods developed which
also help to reduce the need for extractions.
you want to read a detailed account of what my extractions
If you are hanging on the
fence, not sure what to do, then this article will give you
information to help you decide the best course of action.
are Extractions Necessary?
the time we are adults, our jaws have stopped growing.
Sometimes our palate can be expanded, but other than that,
there is limited room for improvement. If your teeth are
crowded, you may need to have some of them taken out to make
room for the other teeth to move into better positions.
Usually an orthodontist will start with the wisdom teeth. If
there still isn't enough room, the back bicuspids are usually
chosen next. Because your smile must be symmetrical, the same
teeth usually must be taken from the top and the bottom. If
two teeth are taken from one side, your midline (the place
where your front top and bottom teeth meet) may be thrown off,
and you may be stuck with a crooked smile. This is why teeth
are often extracted in either 2s or (more commonly) 4s.
and Children: Be Careful!
about children? Personally I do not advocate tooth extraction
in children because they are still growing. Years ago,
extraction for children was common, but this is not the case
today. Some orthodontists still routinely extract children's
teeth. If you encounter this, please seek several additional
opinions before making your decision.
many other methods that can be used to meld children's
jaws to make room (palate expansion, headgear, or guided
growth methodology). Extracting teeth from children can result in
less than optimal facial aesthetics. In other words, you
child's face may not wind up looking as good as it could have,
because it will grow longer and flatter instead of fuller.
exception involves a Class III malocclusion. Class III
cases are technically much more difficult and often involve
jaw surgery. If you need more information about Class III
malocclusion, read about it in our FAQ.
Performs the Extraction?
an oral surgeon extracts teeth. Other types of dental
professionals with training in tooth extraction may also
perform the procedure.
of wisdom teeth is quite involved, with sedation,
stitches, pain, possible bruising, and inconvenience.
of bicuspids and other teeth is a piece of cake
compared to wisdom teeth. There is virtually no pain
afterwards (yes, I know that's hard to believe, but it's true). You can either get local anesthetic or get
"put out" for the procedure. It takes only about 20
minutes total to extract four bicuspids! There is usually no
stitches, very little bleeding, and usually no bruising.
[Please do not take any anti-inflammatory or pain medicines
beforehand -- they prevent clotting, which could result in
more bleeding. So, take no Advil (ibuprofen), no Tylenol (acetaminophen),
and no aspirin beforehand! If you take a regular dose of an
anti-inflammatory medication for arthritis or other chronic
condition, tell your dentist!]
the oral surgeon will give you some strong prescription pain
pills such as Vicodin. In my case, I had so little pain
that I took only one when I got home (as a precaution), but
didn't need any more than that! By the way, I have a
relatively low pain threshold -- so you see, it barely hurt at
all! You will be told to eat soft food and not to suck on
straws for several days. After that, you can do whatever you
There be Complications?
is rare, but sometimes complications can result from tooth
extractions. If the hole doesn't heal properly, you may
develop what is known as a dry socket, which may get
infected. The following information comes from the website Ask
an Oral & Maxillofacial Surgeon.
dry socket occurs when the blood clot is lost from an
extraction site prematurely. Basically, the blood clot in the
socket serves the same two functions as a "scab" on
a skin surface cut. First, it assists in the cessation of
bleeding and second, it protects underlying structures during
the healing process. Like the child who "picks at a
scab" the area heals in time but is painful for far
longer than if the "scab" had been left alone.
the blood clot is lost before the underlying structures have
had time to heal, bone is exposed to the oral environment
along with fine nerve endings. This is an exquisitely painful
but otherwise relatively harmless situation. There are packing
materials which the oral surgeon can place to help ease the
discomfort both by physically blocking the wound and by the
action of the chemicals in the pack on local nerve endings.
Generally, patients return to have the pack changed every day
or two and most patients do not require more than 2 or three
dressing changes. Some patients require no dressing while
others may require 4 or 5 changes of packing. Tincture of time
and good oral hygiene usually resolve the situation.
are some activities which may increase the propensity for dry
socket formation...smoking, drinking carbonated beverages in
the first 24 hours after surgery, spitting or drinking through
a straw in that same time period...but often "dry
sockets" occur for no particular reason at all."
Are The Braces Put On?
an extraction, braces can be put on almost immediately. (I
already had braces, so my arch wires were taken off first.
After the extractions, the arch wires were replaced the
About Eating and Talking?
eating with several gaps in your mouth is very strange. Be
sure to take small bites and chew slowly and carefully. You
will need to change the way you chew for a while, until the
gaps begin to close. Food may get stuck in gaps, which is
time passes and the gaps close, this will become less of a
problem. Just hang in there and deal with it. Also remember
that your bite will change as time passes, so your teeth will
meet differently, and you will chew differently as you go
through the stages of gap closure and teeth straightening.
frontal teeth have been extracted, you will have to deal with
other people noticing your gaps. Yes, this can be a bit
embarrassing, but remember that it is only temporary. In a few
months, the gaps will be gone (particularly the top gaps,
which tend to close more quickly).
Long Does It Take to Close The Gaps?
length of time to close extraction gaps depends on your unique
case. But the short answer is: between 4 months and one
The gaps on top often close
faster than those on the bottom. My orthodontist said that typically the teeth move
about one millimeter per month. Your orthodontist may use power
chains or other methods of linking the teeth together to
close the gaps.
took 21 months to completely close all of my extraction gaps (I
needed closing loops, as shown in the next section), but I
am an exception -- I had a couple of stubborn lower teeth! In
fact, the top gaps closed within 9 months.
month, your orthodontist can measure the gaps between your
teeth with a special ruler. By doing this, you can see solid
results from month to month. This is a good idea,
because at first it will seem like your teeth aren't moving at
all -- when in fact, they are!
a photo of my teeth after the gaps on both top and bottom were
completely closed. You'd never know that I had two teeth
extracted on the bottom, and two on the top!
Do They Close The Gaps?
gaps are usually closed with power chains or other special
methods of linking teeth together. White power chain is shown linking my teeth in
the photo on the left. Notice the extraction gap between the
molar and the bicuspid. The power chain is attached to the
hooks on some brackets, and also put directly on the brackets
in place of ligatures. (I don't recommend white color
power chains, because they show a lot of stains. I've had
great success with "smoke" grey color, which is
almost invisible. Smoke-colored chains are on the top teeth in
the large photo below. Notice that you can barely see them!
They "resist" curry stains quite well.)
In some cases, the orthodontist makes a
in the arch wire to close the gaps. This is sometimes called a
"finishing loop" or "closing loop" because it is usually done near the
end of treatment to help close stubborn gaps that are not
helped by other methods.
Wire Displacement (otherwise know as "a poking
extraction gaps are closing, the arch wire will often be
displaced and the "extra" bit will poke into the end
at your cheek. This is very common, and it hurts like hell! If
this happens to you, do not wait -- call your orthodontist
immediately to get the wire trimmed! You can temporarily
remedy the situation by globbing some wax or chewing gum at
the end of the wire (but this frankly doesn't work very well).
Sometimes, teeth move "all of a sudden" and you find
yourself making an emergency trip to your orthodontist to have
the wire trimmed. You can purchase a pair of orthodontic
pliers for emergency clippings -- but personally my husband
was afraid to even try to clip the end of my wires (and you can't
really do it on yourself).
arch wire displacement is literally a big pain, it is
positive. It means that your teeth are moving and the gaps are
Do Others Say?
are some comments from readers of our Metal Mouth Forum regarding
December 2003, I had 2 upper bicuspids extracted. I went to my
appointment directly from work late in the morning. The
extractions themselves were quick and painless and I had very
little bleeding. I was back at work after my half hour drive
home. Later that day after the numbing medication wore off, I
did not have any pain or bleeding.
The worst part for me was the time I wasted worrying about the
whole procedure. For three weeks, I was in a total panic about
the extractions. I was afraid and expected the worst. But it
was really no big deal. Hope your extractions go as well as
mine did. Good luck."
note: Unless you absolutely positively need to go right back
to work or school, it would be better to take the rest of the
day off. Go home and take it easy!]
had to have 2 back teeth extracted 2 months ago. I went in at
7:30 in the morning and went to work after it was done. And
these teeth were difficult to pull--not as bad as impacted
wisdom teeth, but not as easy as other teeth. The main problem
was feeling this gap where my teeth once were.
I took one Vicodin tablet that night, but managed on OTC pain
meds during the day. The next day it was fine.
Hang in there!"
second the opinion that worrying about the extractions (&
braces) was worse than the actual event. Relatively painless,
however, be prepared for a liquid diet for at least a few
had braces put on on the Monday and 4 teeth extracted on the
Thursday and was not back to work until the following Tuesday.
I somehow developed dry socket in two of my four gaps!!! It
was extremely painful. I followed Dr orders to a T, but I
guess I wasn't so lucky! Sounds like this is pretty rare
though, so I wouldn't worry."