Metal Mouth Message Board

Hi all, thank you for your answers so far. Please keep them coming! The pictures have been especially helpful.

I've seen three orthodontists and all have recommended two upper bicuspid extractions. None have advised the "four on the floor" method or anything like that.

I have been told that my front central incisors tip inwards because my lower lip presses against the bottom of them. If these were to be tipped outwards so that their placement was accurate, I would be left with a 6mm overjet. At the moment I don't really have an overjet because my upper incisors touch my lower incisors. In my case I hope that the tipping outwards of the upper incisors would counterbalance the moving back of the rest of my teeth, leaving me with my profile intact.

Jumptheditch - believe me, I'm not disregarding anyone's experiences!! I'm proceeding with an extreme amount of caution, which is why I'm here: to seek opinions from people who are undergoing or who have undergone braces treatment. I will not have healthy teeth removed unless I am sure in myself that it would be the best thing to do in my case.

As for functional braces - I had one as a child. Unfortunately my jaw continued to grow after I finished treatment at the age of 15 and the overjet issue has returned somewhat. I have had a look online but can't see a dentist who practises functional braces on adults in the UK. Certainly not in the London area.

That's what this board is for Undecided, I'm happy to share my experiences if it helps anyone in their decision making (especially if it helps anyone not make the mistakes I did). I was about to post my two-upper-bicuspid-extraction experience but I was a little put off by the comments that posting my extraction experience would be 'moaning' as it turned out to be less than positive. I don't believe all extractions are bad. I just think they were very bad in my particular case. Having had two healthy teeth extracted and discarded, I believe teeth should only be extracted if there is no alternative. In my uneducated opinion, I suspect crowding cases would be those that justify extractions, but as I never suffered crowding I don't feel qualified to judge. As to whether anyone else's case is similar to mine or not, I don't know. But I do know that I very much regret my extractions. I wish I'd been informed enough to consult an ortho who would consider my jaw-to-jaw function when deciding on the extraction-and-retraction-to-reduce-overjet treatment. In my opinion people generally post their experiences in response to a question posed by someone considering a similar path. I suspect negative experiences may be commonly shared, as people who've had a negative experience genuinely want to be able to warn others considering the same option. I don't think the majority bother to sit down and type out their experiences so that they can moan. I suspect much detail is included so that others can compare to their own situation. I can't go back and warn my younger self, but I can post my experience for others to read and digest or disregard as they like. If sharing my naivety prompts anyone to be more thorough in advocating for their own jaw health then it's worth the effort.

Having said that, I'm quoting my post from another thread, there's only so many times you can type the same thing. It's in response to a post about op feeling that the upper jaw was too far back at the end of treatment. I'd felt exactly the same way at the end of mine...

Towards the end of my treatment I felt like I really had to tuck my lower jaw right back and bite down to engage the molars to 'hold' the bite as it felt like a really uncomfortable stretch to bring my molars together. I stupidly didn't speak to my ortho about it, as I assumed (in my ignorance) that as he was so experienced and so highly qualified, this must be how my jaws were supposed to be, and that my pre-braces, comfortable bite must have been 'wrong'. I assumed it would become comfortable as I got used to it. I had already mentioned to the ortho about my jaw clicking and starting to cause me grief just after I started wearing elastics to help retract my overjet (allegedly) but he carried on regardless. He was quite brusque and busy so I didn't want to be a nuisance (OMG, how dumb).

Fast forward about five years (this is my second stint on Archwired ), and I was finally independently diagnosed by a Craniofacial Chiro and two Neuromuscular dentists with TMJD. In my case I had had my upper second bicuspids extracted and the other upper teeth retracted to treat overjet. In no way am I saying that all extractions are bad or cause issues, but it would seem for me that they did (presumably because they were never really warranted, which makes me want to cry). I've seen the iCAT images of my TMJ with the 'ball' of the mandible clearly pushed too far back into the socket, with the protective disc squished out of it's intended space between the two. Apparently this now misplaced disc is what causes the 'click' or 'pop' that you can hear and feel during jaw movement, as the jaw (as it was described to me) "gets stuck" and then moves past the disc with a judder like a speed bump (or judder bar, if you're a kiwi ). My chiro and NM dentist told me that your teeth placement along the jaw determine the functional position the upper and lower jaws must adopt in order to achieve occlusion. Apparently my ortho-provided bite forces my lower jaw too far back into the socket to achieve occlusion, which in my case has caused a whole host of TMJ problems (narrowed airway, reduced tongue space, reflux, sleep apnea, headaches, migraines, balance and spatial interference, the list goes on and on).

Before the pro-extraction party jump down my throat, I'm not saying that extractions are always bad, or that some people's overjet can't be successfully treated with extractions. I can only speak to my own experience. All three professionals I consulted each independently commented that my lower jaw was underdeveloped, and had my 'overjet' been treated by bringing my lower jaw forward, rather than removing teeth to make room to retract the uppers, I may well have never had any issues with my TMJs.

I'm currently in the early stages of TMJ therapy, which involves 3 months jaw splint, follow by expansion and braces (again) over approximately 3 years I wish I had known when my braces were removed what I know now. I wish I'd had the confidence in my feeling that my bite wasn't right to mention it to my ortho. Mostly I wish I'd had more than one consult initially.

It took me a long time after my original ortho work to discover that a whole host of seemingly unconnected minor issues were related, and were actually caused by the same issue. I didn't decide I had TMJ because of all my symptoms. I was diagnosed with TMJD and slowly realised I had it's symptoms. Since being diagnosed, I am constantly realising that almost all of my TMJ symptoms began during or immediately following ortho treatment. Eg: the increase in the torus of my lower palate occurred after the (debanded) retainer impressions were taken, as they grew into areas covered by the lower 'flanges' of the retainer.

Both my NM dentist and CF chiro said not all cases of extraction and retraction for overjet 'cause' TMJ. Possibly I was susceptible to TMJ issues as one side of my jaw always had a 'click'. This is the only one of my TMJ symtoms that existed prior to orthodontics, but who's to say exactly what 'caused' my TMJ. Dentists and orthos are never going to say outright that an ortho was wrong. My dentist and chiro as well as a second NM dentist have all strongly suggested that had I not had my teeth moved into their new position, I may never have had an issue with my TMJs. My dentist said I'm not the first patient she's treated from this particular ortho. My chiro says about half his patients are previous ortho patients. The other NM dentist I consulted said one of his patients' TMJD got so severe he used to sometimes sit at night with a gun in his mouth, waiting for the courage to pull the trigger. Fortunately the bloke found the NM dentist to relieve is pain. My chiro says mine is a classic case of TMJ, and that he's sure reversing the extraction position will alleviate my symptoms. I frigging hope so!

My tips:
a) get as many consults as you can, and
b) only use a functional ortho or neuromuscular dentist.

Functional orthos are not big in Australia, I wish I'd known to look for one prior to my treatment.

All the best for your treatment

Er, sorry that got so long... !

Count me as one who doesn't regret extractions. Had four of them and profile is better, as is breathing (not sure why on the breathing, but much improved). So, no downside here.

My sister and fiance both had 4 extractions for braces as teens and both are doing great with fantastic smiles. (So good I couldn't stand not having such a nice smile!) I think I'm probably still a let's see case with extractions but my progress means hopefully I wont need them. Extractions don't necessarily cause problems but in the past they have been used in cases where they weren't needed and that CAN cause problems for some. I think thats when getting a 2nd opinion or taking the 'let's see' approach works well - you find out if its really needed or not! Aso in some cases extractions aren't the best choice but when someone doesn't want to undergo surgery (me!) they might be needed as a compromise. Might not be ideal but its all about weighing up the options.

I am reading some of the bad extraction stories in horror. How could an ortho not see extractions could create jaw problems? Isn't ortho supposed to take potential jaw problems into consideration when he treats a patient? I mean, doesn't orthodontics involve study on jaws?

JillD wrote:I am reading some of the bad extraction stories in horror. How could an ortho not see extractions could create jaw problems? Isn't ortho supposed to take potential jaw problems into consideration when he treats a patient? I mean, doesn't orthodontics involve study on jaws?

I had orthodontics as a child in the 1980s with the extraction of 4 premolars. While it was done I started getting ear pain, and chronic tiredness, and within 2-3 years after I started getting stiff necks and jaw clicking on one side, and about 3 years after the jaw clicking began, I then started getting jaw cracking on biting on my opposite side and also constant and debilitating pain in my face, head and ears. I have more recently been having orthodontics and splint treatment with a dentist who treats TMJ dysfunction, which has been to help rectify the problems caused due to the extraction orthodontics, and improve my TMJ function.

Orthodontists do not have to take jaw problems into consideration, or have any good understanding of the jaw joints. Some have consent forms which you have to sign before treatment, which says there is a risk the orthodontics will cause TMJ dysfunction. They also often do not consider what the affect the extraction orthodontics will have on tongue space or tongue position.

I didn't have crowding or over lapping teeth when my dentist as a child decided to do the extraction orthodontics. My upper front incisors angled forwards slightly, so he explained it would help pull them back, and also it would help create space for my wisdom teeth when they started to grow through. Maybe in a few cases the extractions are necessary in order to treat crowding of teeth, but I certainly don't think it was necessary or helpful in my case.

If orthodontics doesn't involve studies on jaws, it seems that it certainly should.

I totally agree JillD, that's why I've provided detailed info in my posts; I'm appalled any health professional can advocate and undertake a course of action that can be (and often is) so detrimental to their patients' long term health.

In my naivety I assumed that someone highly trained like an orthodontist would look after my health as well as the appearance of my teeth; I wouldn't want anyone else to make the same mistake. Sadly the majority of people seeking orthodontic treatment trust the title of Orthodontist without realising the ortho may make their teeth look good but sacrifice the integrity of their jaws in doing so. It's frightening to think people trust professionals on a daily basis who do not look after their patients' jaw health, and for some even cause damage.

There are some fantastic Orthodontists out there, and the field of Orthodontics has developed considerably over the past few decades. As a result we have a good understanding of Functional Orthodontics as opposed to Traditional Orthodontics, I think Functional Orthodontics should be the standard, rather than an option. It should just be Orthodontics, which should encompass a Functional approach. Who doesn't want their jaw function maintained?

Whilst I agree that orthdontosts should consider jaw placement etc you have to understand you are in a very small minority here, when you say this happens often... can you back this up with numbers?

I have lots of friends who had extractions who are in good health and im sure thousands and thousands have extractions every day yet on this worldwide forum there are few people with complaints.

Please dont make assumptions about how many people get jaw problems when you don't have any facts you may just be putting people off improving their smiles which is sad.

I've had 4 extractions total, 2 just prior to braces and 2 others a few years ago that would also have been done now if they hadn't been pulled already. I've had no issues at all aside from the normal initial discomfort and a very mild infection. No jaw issues whatsoever. As others have said, it's the ones with bad experiences that you'll hear all about

I had jaw clicking before i got extractions/braces. but now that I'm almost done with my treatment, the jaw clicking is gone. My profile actually looks better. I think the people who have issues with extractions are the ones who had them done when they were not an ideal candidate for them. my ortho did xrays, pictures, and very precise measurements to make sure everything would work. My arch is actually wider than it was before braces. But this is just me. Every case is different, and I'm not saying I'm pro-extractions. I just think in some cases, it's not always a bad thing.

kennyandrew85, I've been very careful to outline that when I refer to my opinion of extractions, I am referring to extractions for overjet treatment, rather than for crowding issues. I believe they are very different issues.

I don't presume to comment on extraction experiences due to crowding, as I've pointed out several times in several related threads, as I haven't experienced it myself. What I have experienced, and feel justified in sharing with others, is that in my case, extractions and the following retraction precipitated real physical problems for me.

I am aware that I am not the only one for several reasons. There are numerous threads discussing exactly the same situation as my own, both here on Archwired, as well as on many other forums online, not to mention Youtube. There is also a growing number of Functional Orthos and NeuroMuscular dentists who specialise in successfully treating TMJ by reversing extractions. I am aware that I may be in the minority in terms of overall ortho patients, but I'm also aware that I'm not in a minority of one. The very existence of specialists who work with TMJ and successfully treat post-extraction TMJ patients with reversal techniques tells me I'm not the only person for whom extractions were detrimental to their health. I am aware that I am not the only one experiencing this problem as I have discussed it at length and in person with not one but two NM dentists, one CranioFacial Chiropractor, and communicated via email with several other orthodontists interstate who have moved into the functional approach to orthodontics exactly because of the post-extraction TMJ patients they encountered and went on to treat successfully with extraction reversal techniques. I know two NM dentists who have experienced it personally themselves. One of who went on the undertake specific training in post-extraction TMJ treatment from Tuffs University in Boston. I don't flatter myself that a whole course exists at a premier American university to deal with a condition I am the only person suffering from.

I've viewed the media reports on the growing trend of expanding palates in young children in an attempt to avoid extractions and exactly the same kind of problems I've experienced. I am aware that not all extractions cause problems, I think this is self-evident. If extractions caused issues for every patient, the practice would have died out soon after it was trialled. Personally, I think it's because only a number of the extraction patients develop extraction-related issues that it's imprecise and something of a gamble.

But just because extraction doesn't case problems for all doesn't mean it doesn't cause problems for some. It obviously didn't cause any problems for you, so well done to you and I wish I could say the same. Enjoy your lovely smile and unhampered function. I certainly didn't want it to cause issues for me. But please don't disregard my experiences simply because they differ from yours. I don't try to push my opinion by trying to discredit yours. Of course I don't know specific numbers of ex-extraction ortho patients suffering TMJ issues. I've observed a similar response from you to others on numerous threads relating to extraction experiences, when they've also tried to share their negative experiences. As I've said, I don't claim extractions are always bad. In my experience, for me they were. I am entitled to say this. As are you entitled to say that for you extractions were beneficial. One opinion does not discount the other.

When people post asking for others' experiences with extractions, I can and will respond, just as you can with whatever your experience has been. If you read my posts carefully, you will notice that I never suggest people should not get extractions. I always suggest people consult a functional professional who will consider their long term health as well as their cosmetic dental appearance. This is a reasonable suggestion to make. I do this as I was not experienced enough when receiving ortho treatment the first time around, and I am suffering the result now. I take some time to ensure my posts are careful and considered, and not alarmist. I never, ever suggest people do not undertake orthodontic treatment or any way discount improving your smile. That indeed would be sad. I comment when people post about extraction because I wish I'd received the same advice when I had braces first. I misunderstood, and assumed that an orthodontist wouldn't provide treatment that could cause ongoing health problems.

If you read my posts carefully, you might also notice that I do not advocate that people don't improve their smiles. All I do is offer an account of my experience through my own naivety, in the hope that anyone looking who is in the same situation I was, can be more informed than I was. I advocate due diligence in selecting your ortho or dentist, and an awareness of protecting your own health. I can't go back and warn my younger self, but I can let others be warned by my mistakes. Please don't disrespect that.

I totally agree JillD, that's why I've provided detailed info in my posts; I'm appalled any health professional can advocate and undertake a course of action that can be (and often is) so detrimental to their patients' long term health.

This is simply not true.

Your post implies that often people who have extractions will have long term health issues.

I have said this a few times on this board, but had I read your post in 2011 and gone to multiple orthodontists who said I required extractions I may not have gone through with this process.

Sure, you're highlighting the risks involved but you shouldn't make it sound like it's a problem likely to occur when in fact it's a very very small minority of cases.

Non-extraction treatment when extractions are needed could cause serious problems with your teeth. To make room for all teeth they extend jaw and push teeth inward. This movement is involved with high risk of root resorption, making tooth dead, and gums recessions and bone loss around teeth with may result with the lose of some teeth in the future.
At the other board I've seen a girl, she was treated without extractions, Damon braces and her upper canine become dead and gray during the treatment and it was only short term side effects.