Can having permanent teeth removed as part of orthodontic treatment really change your face? The answer is yes. Having teeth extracted along with your braces, can change your face for better or worse. In most cases however, there will be no perceivable change at all. Here is how removing teeth can make your face look better or worse.

In most cases when an orthodontist prescribes the removal of teeth, he does so because there just isn’t enough room. I do not take the removal of any body part lightly! Before making this irreversible decision, I carefully study models, pictures, and x-rays to see if there is any alternative plan that could save all of your teeth. I look at the size of the jaws, size of the teeth, and the position of the lips. If a patient starts with an acceptable profile, my goal is to preserve it. Correctly diagnosed crowding treated with the removal of teeth WILL NOT change the profile at all. X-ray measurements taken before and after treatment confirm that the position of the front teeth, and therefore the position of the lips, does not change after the removal of teeth if moderate to severe crowding existed at the start.

If a patient has moderate to severe crowding and teeth are not removed, the front teeth (along with the overlying lips) will move forward as the arches are aligned. In some patients this is a good thing. In others however, advancing lips that are already full or protrusive will make the patients look even more “buck-toothed” and may even adversely affect normal lip closure. In these cases, not even the use of a palatal expander to create room is sufficient to prevent this undesirable side effect. In other words, not removing the teeth in some patients will make their face look worse!

If patients start with a full profile or have lips that do not touch at rest because of the underlying protrusive teeth (lip strain), the removal of teeth is not only safe, it is the treatment of choice. Removing some side teeth and then using the braces to retract (move back) the front ones can make them look less protrusive, improve the profile, and allow the lips to close more naturally. Experienced orthodontists are also aware of the natural changes that occur with facial aging and can anticipate these in their treatment plan. So in these patients, extracting teeth actually improves their faces.

In over 20 years of treating patients, I can honestly say that I’ve never had a patient unhappy with their profile after having teeth removed. I have had several patients however, who rejected my recommendation to have teeth extracted and regretted it when their braces came off. The “Avoid having teeth removed at all costs!” answer was ignorant at best and harmful at worst. Not only will having teeth removed not harm your face if you’re crowded, when appropriate it will actually give you the very best result possible! Talk to your orthodontist to find out if having teeth removed is right for you!

Here’s how the study was performed. Two groups of patients between the ages of 20 and 79 were interviewed. They were asked to remember how many dental x-rays they had received at the following ages: less than 10, between 10 and 19, between 20 and 49, and over 50. Three types of x-rays were examined; bitewings (single x-rays), panoramic films (about 20 seconds each), and full mouth surveys (up to 21 individual x-rays). Statistical analyses were then performed to compare the recalled number of x-rays received with the presence of tumors. Researchers found no differences in the memories of patients regarding panoramic films or full mouth surveys. They did however report that participants with meningiomas remembered having more bitewings than their counterparts.

This study has serious flaws in its design and it produced some irrational results that cannot be explained, even by the researchers. Its major weakness was in the requirement that participants recall their own radiographic history from decades before, sometimes more than 50 years previous. Can you remember how many bitewings you had before you were 10? How about between 10 and 19? How about in the most recent 10 years? The study might have been more credible had actual dental records been used, but they were not. The data was obtained strictly from the memories of those interviewed. Unexplainably, the study failed to identify any relationship between patients who reported more panoramic films (3 times more radiation) or full mouth surveys (21 times more radiation) and the presence of brain tumors. Claiming a relationship between the lower radiation bitewings and brain tumors but no similar finding for the higher radiation films makes absolutely no biological sense.

My point is not to discount the importance of x-ray safety. All dentists are trained in radiation hygiene and subscribe to the ALARA principle (As Little As Reasonably Achievable). We are now using faster equipment, more sensitive films and sensors, better collimation, lead aprons, thyroid collars, and digital equipment (which greatly reduces the need for retakes) than ever before. These improvements have resulted in a 60% reduction in radiation exposure since I got my license in 1989. Today’s patients receive the equivalent of only one additional day’s worth of background radiation (from the sun) each time they get a bitewing and only three additional days’ for a pano.

X-rays remain a crucial diagnostic tool in today’s dental practice. I myself have discovered half a dozen tumors in my own patients using the very x-rays being demonized in this study. We dentists want to provide the safest procedures possible and welcome any research that actually helps our patients. This article and the TV news reports that followed did nothing more than provide an attention-grabbing headline.

All of us have two sets of teeth, primary (baby) and permanent (adult). One of the first things your orthodontist will do at your initial consultation is take inventory of which teeth are in your mouth. Although everyone is different, baby teeth usually fall out by a certain age and in a certain order. They can create orthodontic problems if they fall out too early or too late. If they fall out too early, your orthodontist can help you devise a plan for maintaining the space until the permanent replacements come in. If they don’t fall out soon enough, they may create an orthodontic problem or signal that one already exists. Removing primary teeth is sometimes necessary for the normal eruption and development of the teeth that will come in later.

While most parents have no concerns regarding the removal of primary teeth, some do when the permanent ones are involved. There are a variety of reasons why permanent teeth may need to be removed for braces, but here there are three main ones:

The first is crowding. When the amount of space required to align the teeth is less than the space available, either the size of the arches must be increased or the number (or size) of teeth reduced. Mild to moderate crowding can be addressed with expanders and braces alone up until about age 15. (After that, surgery may be necessary to re-open the sutures.) The amount of expansion may be limited by the bone structure, the facial appearance, or the supporting tissues. If a patient has moderate to severe crowding and insufficient gums or bone, permanent teeth will need to be removed to provide the necessary room.

The second reason is protrusion. The position of the lips is determined by the underlying teeth. If the front teeth are already protrusive, removing some on the sides will allow the orthodontist to move the teeth backwards to improve the lip posture. If the lips are in good position already but the underlying teeth are crooked, removing teeth may be necessary to prevent making the teeth and lips stick out.

The third reason is to correct an overbite or underbite. If the upper an lower jaw sizes are mismatched, the ideal treatment is to surgically reposition them. In most patients however, the jaw size discrepancy is small enough that the teeth can be moved to “compensate” for the problem. This eliminates the need for jaw surgery in the majority of overbite patients and some underbite patients. A patient with a moderate overbite is usually receptive to the idea of having two upper bicuspids removed if it prevents the need for surgery.

There are a variety of other reasons your orthodontist may suggest the removal of teeth as part of your treatment. These include asymmetries and missing, impacted, or extra teeth. Treatment is usually faster for your orthodontist if teeth are NOT removed, so you can assume that if he does recommend extractions, they must really be necessary. As always, ask your doctor for a complete explanation of your specific treatment plan. Educated patients are the best patients!

Getting your braces on is exciting, but getting them off is the best day ever! Your orthodontist most likely gave you an estimated treatment time before your braces went on. If that day has come and gone, you are probably wondering why your braces are still on. There are three things that could cause your braces to stay on longer than expected: your orthodontist, you, or biology.

Your orthodontist has advanced training to help him diagnose your problems and come up with a treatment plan that will best correct them. His experience should not only allow him to produce the best result, it should also help him select an approach that gets you there in a reasonable amount of time. Not all orthodontists are the same however. Some place more emphasis on speed than quality. Some are “hands-on” while others are not as intimately involved. It is a personality difference. Your treatment time will be directly affected by the treatment plan your orthodontist choses and how efficiently he executes it. Some ways he can make your treatment take longer include 1) problems with the original diagnosis, 2) problems with the original treatment plan, 3) changes in the original treatment plan during the process, 4) too much time between appointments, or 5) insufficient attention to your progress. Some problems really do take 30 months to correct, but an experienced doctor should be able to warn you about those up front.

You (the patient) are the second variable that affects your treatment time. Your orthodontist may have the perfect diagnosis and treatment plan, but he cannot succeed without your cooperation. Some things you might be doing to sabotage your own treatment time include 1) missing, changing, or spreading out your appointments, 2) arriving late to appointments so the technicians don’t have sufficient time to perform all planned procedures, 3) not getting other necessary procedures done in a timely manner (surgeries, extractions, restorative, etc.), 4) breaking or bending your wires or brackets between visits, or 5) not following instructions regarding rubber bands, aligners, and oral hygiene. Doing your part will not only help keep your treatment on schedule, it will give you the best final results too.

Even if your orthodontist is brilliant and you are the most compliant patient in history, there is still one other factor that neither of you can control. That factor is your biological response. Estimates of treatment time are based upon the complexity of the problem and the normal response of teeth to typical orthodontic forces. In some patients the teeth move faster than normal. In others they move slower. Some patients may have a condition called ankylosis where some teeth won’t move at all. In these cases it won’t matter what you or your orthodontist do, treatment time will be extended. The take home message is that even if you and your orthodontist are both vigilant in your roles, you’ll still need for your teeth to cooperate to get done on time.

If you are in treatment now and are concerned by your prolonged treatment time, consider these three factors: Are you really doing your part? Have you discussed your treatment progress with your orthodontist to see if anything has changed from his perspective? If you’re confident that both of you are doing your best, it may be that your body’s response to treatment is just slow. If you haven’t started yet, ask around and see if the orthodontist you are considering has a reputation for efficient treatment plans and finishing on time. Not all orthodontists are the same.

First, consider the organization of the office and staff. Although you may not understand malocclusions or treatment mechanics, you can tell a well-run office when you see one. Is everything clean and in its place? Are the technology and equipment up-to-date? Is the staff friendly, well-trained, and helpful? If so, it is safe to assume that an equal amount of care will go into the treatment they will provide. What kind of care will you receive from a doctor who cuts corners on his facility and staff just so his fee can be a little lower?

Second, what is the doctor’s attitude towards his job? Will he be passionate about your child’s care? Can he communicate his vision of your treatment plan so that it makes sense? Does he have enough integrity and confidence to wait until the ideal time to start treatment, or does he automatically recommend treatment to every patient so that he doesn’t “lose a sale”? Does he remove braces early because time is up, or does he finish the job? Will he examine your child at every appointment to make sure that treatment stays on schedule? Not all orthodontists are “hands-on” and it shows in the final results.

Third, is the orthodontist really a good doctor? How did you find him, a recommendation or an advertisement? Have you actually seen his work? Do you have friends who can vouch for him? There is misconception that as long as a doctor has a degree, he’ll be able to give you the same results as anyone else. If that was the case, finding the lowest fee would make sense. Unfortunately, not all treatment is the same. Some orthodontists remove too many teeth. Some don’t remove enough. Some are very particular about their final results while others are content just going through the motions. Some have an eye for beauty. Others are just mouth mechanics. For something this important, you should ask to see actual examples of their work.

Finally, how do you feel when you are in the office? Is it a good fit for you and your family? Is it a happy, fun place? Unlike your family physician that you only see when you are sick, you will be visiting your orthodontist and his staff for at least a couple of years, sometimes six or seven years if the treatment is done in two parts. You should feel very comfortable and safe. The doctor and staff should make you feel at home.

All orthodontic treatment is NOT the same. The facilities and technology are a reflection of the orthodontist who will create the smile that you or your child will have the rest of your life. You really need to “vet” the doctor to whom you will entrust this important care. As with most things in life, you usually get what you pay for. When it comes to your smile, you can’t afford to make a mistake.

Having examined more than 10,000 patients over the past 20 years, I know that I’ve surprised more than a few parents with treatment estimates longer than they expected. I can imagine the thoughts that run through the minds of parents that don’t know me very well: Is he just trying to make more money? Is he being too picky? She’s only got a little space for heaven’s sake! Understanding my three primary objectives for your children will help you understand why quality treatment takes as long as it does. My goals are to give your child a smile that is 1) attractive, 2) healthy, and 3) stable.

First, while most parents do want a healthy smile, the main reason they seek care for their children is that they want them to look great. Straight teeth, no spacing or overlapping, and no overbite are standard expectations. There is a misconception however that all doctors with a license will produce the same results. A lot of what I do with braces is artwork and not all orthodontists are artists. Being able to visualize how a patient’s smile should look at the end of treatment and then coordinate all of the variables that go into achieving that outcome is complex. Some orthodontists choose treatment plans simply because they like using a certain device that makes their job easier. Others shy away from removing teeth because it makes treatment harder to sell and it takes a little longer. Achieving a great result does take a little more time than just doing an average job.

Second, a healthy smile is one where the jaws are coordinated, the bite comes together evenly so that there is less enamel wear, the teeth nicely aligned so they can be easily brushed and flossed, the incisors are positioned so that the lips close completely and naturally, and the roots of the teeth are anchored in healthy gums and bone. Treatment that addresses only the appearance of the front teeth may ignore the bite, the face, and the health of supporting tissues. It is possible to create a smile that looks good but is actually unhealthy. An experienced clinician will look past the alignment of the front teeth to address underlying factors that determine if the smile is healthy.

Last but not least, quality orthodontic care leaves your child with a result that will be stable after the braces come off. What a shame it is when braces are removed and the teeth are allowed to move back to where they were before. While orthodontic retainers are necessary in all patients, producing a stable outcome actually begins with the original diagnosis. Even though expanding the arches with straight wires is the quickest and easiest route to straight front teeth, doing so when there is not enough supporting gum tissue or bone is not only unhealthy, it is unstable. While aligning only the top front teeth may be in vogue right now (i.e. Six Month Smiles), it may not produce a “set” of teeth that work together and support each other. Even trained orthodontists who do not fully correct an existing overbite may be leaving the teeth in an unstable position. Long term stability is probably the most commonly ignored aspect of orthodontic treatment.

So when your orthodontist tells you that your little girl’s “simple” treatment may take 18 months, you can now keep all three of these objectives in mind. You will undoubtedly be happy with the improved appearance of the teeth in the first six to nine months. At that point however, your mindset should shift to the other two objectives, making the smile healthy and stable. A good orthodontist will keep his eye on all three objectives for you. If you are on board with him throughout treatment, your children will also be more likely to be patient until the job is done right. An extra few months is not a big sacrifice for a smile that she’ll have for a lifetime!

Besides being an incredible bargain when compared to other medical procedures like Lasik or emergency room care (see my article entitled “Orthodontic Treatment is the Medical Deal of the Century”), no-interest financing offered by many orthodontic offices makes getting orthodontic treatment even more affordable. Paying for anything over time costs money. For example, if a $6,000 orthodontic treatment was financed like a car over 24-months, the total amount paid would be about $6,400 (at 6% interest). If your orthodontist offers you no-interest financing however, he is actually paying that $400 of interest for you. That’s a great deal!

The biggest costs associated with your orthodontic care take place right at the beginning of treatment. Models, pictures, x-rays, the diagnosis and treatment plan, and the cost of the braces themselves add up before your first tooth is ever straightened. For this reason, most offices require a significant down payment to get your treatment started. In the above $6,000 case, a typical down payment might be anywhere from $1,500 to $2,000 (25% to 33%). This covers the office’s initial startup costs. Any down payment less than this represents additional financial aid that the doctor extends to families to help them get treatment started.

Jorgensen Orthodontics wants to offer families the best payment arrangements available any place. Most families are able to choose their own financial arrangements. This has nothing to do with their income, only with how they’ve handled their previous financial obligations. Many families choose to make no down payment at all. Others choose to pay their entire fee up front in exchange for a discount. Most arrangements fall somewhere in between by combining a reasonable down payment with regular monthly payments.

We also want to help those who have hit some financial “speed bumps” along the way. Using guidelines developed by our credit management company (that handles our contracts so we can concentrate on your teeth), we are able to offer some level of financing to ALL patients no matter what their credit history. Many families we help could not qualify for financing anywhere else. And while we want all patients to be able to receive the care they need, we don’t want them to start into treatment that they cannot finish (think Fannie Mae).To avoid this, we require a little more down at the beginning of treatment. Following these guidelines has allowed us to offer financial help to more than 8,000 patients.

24 to 36 months of orthodontic visits for about the same cost as a single 30-minute Lasik procedure is incredible enough, but having an orthodontist provide you with a 24-month no-interest loan is even more unbelievable. Not only is orthodontic care “the medical deal of the century,” you’ll also receive a smile that is attractive and healthy for the rest of your life. Now that’s really amazing!

Lasers are used for many applications in medicine and dentistry. Some are designed for hard tissues like teeth and bone. Others are used only on soft tissues. Those most useful in orthodontics are soft tissue lasers. There are at least five reasons why the orthodontist you choose should use a laser.

The first reason is that lasers can help orthodontic patients to feel more comfortable when they have a canker sore or other ulceration adjacent to their braces. By keeping the laser at a distance from the lesion, the energy is absorbed but the tissue is not cut. The effect is that the sore is desensitized and healing is accelerated.

The second reason your orthodontist should use a laser involves the removal of naturally occurring structures that affect the position of your teeth and gums. Muscle attachments known as frena are found between the lips and gums. Some are too long and extend between the teeth creating spaces or recession. Lasers can be used to shorten these attachments to allow space closure as well as to prevent recession. This procedure is known as a frenectomy.

Another reason for lasers in orthodontics involves the removal of swollen tissue. This extra tissue develops as a consequence of poor oral hygiene. Not only does it look bad, it also grows over the enamel and makes future plaque removal even more difficult. Your orthodontist can remove your swollen gums allowing better access to the underlying enamel.

The fourth use of lasers can take place before, during, or after orthodontic treatment. It is gingival contouring (reshaping) to improve the esthetic appearance of the anterior teeth. It is not uncommon for the level of the gums overlying previously crooked teeth to be uneven after alignment. An orthodontist can quickly improve the appearance of your smile by using his laser to even out the height of your gums and reshape the gingival contours.

A fifth use of lasers in orthodontics is the one that actually shortens treatment time. In order for your orthodontist to move your teeth, he must be able to attach braces to each one. There are many times when the surface of the tooth is either fully or partially covered with gum tissue. This may be because the tooth is impacted, or it may be because the tooth just hasn’t come in all the way. For whatever reason, using a laser to remove tissue so that a bracket can be placed early can save six months to a year of waiting. That can substantially shorten your treatment.

Laser treatment is quick and easy. Most tissue is thin and can normally be desensitized with topical anesthetic alone. Because the laser seals as it reshapes the gums, there is little change of bleeding, swelling, shrinkage, or infection. Discomfort is similar to a cold sore and it lasts only a day or so. Another advantage of going to an orthodontist that uses lasers is that you won’t have to go to another office to have your soft tissue procedures performed. Not only will this save you money, it will also save you time as you will not have to delay your treatment until after you get in to see another doctor. Orthodontists who use lasers can get your treatment done quicker with better results.

If you have any questions about lasers in orthodontics, please leave a comment below or ask us on Facebook.

First of all, I need to make a disclosure. I use Damon brackets and I love them. They are currently in their fourth revision and I’ve been a fan ever since they came out in the early 90’s. Having said that, there are myths about what they can and can’t do, and I’d like to share my opinion based upon 20 years of experience.

Damon brackets are a type of bracket known as self-ligating. To “ligate” means to bind or tie. With conventional braces, the wires are held in place by ligatures or o-rings that secure them to the brackets (which are the metal pieces attached to the teeth). With self-ligating braces, part of the bracket itself holds the wire in place without the need for o-rings or steel ties. Some brackets have doors or “slides.” Others have clips. The Damon bracket was not the first self-ligating bracket, but I believe it is the best.

Some of the claims about Damon brackets are that they won’t cause pain as they move your teeth, you won’t need to have an expander or have permanent teeth removed, you won’t need headgear or rubber bands to fix your overbite, and that your treatment will be much shorter than with regular braces. Here’s what I have seen at Jorgensen Orthodontics (and what has been supported by actual research):

If your teeth are being moved (Damon, Invisalign, or anything else), they are going to get sore. In order for orthodontic movement to take place, there must be pressure applied by a wire, elastic, or some other source. Pressure creates inflammation in the tissues around the teeth and that’s what makes you sore. If your teeth aren’t getting sore, they aren’t moving.

Whether or not you need an expander, extractions, or other auxiliary (rubber bands, springs, etc.) is determined by your individual teeth, jaws, bite, and profile, not by which bracket your orthodontist buys. Braces are just a tool. Your teeth don’t know if your braces were made by Damon, GAC, American, or Unitek. They only recognize force and move when it is applied. The company that makes Damon does not have a special agreement with your teeth so that their braces will straighten your teeth any faster. Even though there is less friction with self-ligating brackets and you can go a few extra weeks between adjustments, research has not shown that this reduces your overall treatment time.

So why do I and so many other orthodontists use and love the Damon System? First, I love the look of the bracket. It is small, smooth, and comfortable. Second, I love that it provides consistent results no matter which of my staff members performs your adjustment. Whether my newest assistant or I myself put in your wire, if the slide on the Damon bracket is closed, both of us will achieve exactly the same movement. Third, I love that the amount of time it takes to change a wire in my clinic is faster and easier because of the self-ligating nature of the bracket. Fourth, I like that I can add and take away elastic hooks at any time during treatment which makes you more comfortable and makes it easier for you to brush and take care of your teeth. Fifth, I like that we can eliminate a few appointments during your treatment because the wires can continue moving teeth for a few extra weeks between visits. Sixth, compared to other self-ligating brackets, I just like the way the slide works, how easy it is to open, and how it doesn’t close on its own while I’m adjusting your wires.

So there you have it. Although I don’t believe that Damon braces are magical, my staff and I love them and use them on all our patients. I think the system is well thought out and does save clinic time and office visits for my patients and their families. If you’d like to know more about Damon braces and if they’re right for you, come see me or drop me a note. I think you’ll be impressed!

Six Month Smiles is literally a “braces in a box” kit provided to general dentists with all of the parts included. To become a Six Month Smiles provider, a dentist merely pays a fee and attends a two-day seminar. With only one class under his belt, he can then submit models and begin providing treatment immediately. Within a couple of weeks, the newly trained dentist receives a kit that contains the braces (which have been positioned on the models by technicians at the Six Month Smiles facility), the wires, the o-rings, and even the adhesive needed to attach the braces to the teeth. At the “braces on” appointment, the brackets are placed using mouthpieces provided by the company and the wires are installed. Patients are then sent away and tooth movement begins.

Can the Six Month Smiles system actually move teeth? Yes, it can. Can it make the front teeth look better? Yes, it can. Is it a substitute for regular braces? In some cases it might be. So what are the pros and cons of Six Month Smiles treatment and is it the right treatment for my teeth?

First of all, I need to reveal my bias. I am a board-certified orthodontist with 20 years’ experience treating the most difficult cases. The Six Month Smiles company does not market to me. They market their service primarily to general dentists who want to add orthodontic services to their practices. I have not taken the Six Month Smile certification course, but I have studied their system and talked to dentists and patients in my community who have used it. More importantly, I have been providing orthodontic treatment for 15 years longer than the Six Month Smiles company has even existed.

Six Month Smiles treatment, just one example of “short term orthodontics,” can straighten crooked teeth. The best cases for such limited treatment are patients with a great bite in the back, mild alignment problems in the front, and either mild crowding or slight spacing between the teeth. The main movement patients will experience after braces are glued to the teeth and the flexible wires inserted is expansion. The front teeth will move forward and outward. If the bite is good in the back and the crowding or spacing is mild, the amount of expansion will be minimal and may actually be beneficial in some patients.

The cases in which “prefabricated” braces will be the least successful are the seemingly simple ones where there is an undetected bite problem, where the upper front teeth do not overlap the lower front ones very much, or patients whose front teeth should not be flared any further. Most of the patients that I have re-treated after their Six Month Smiles experience were unsatisfied because of how flared their front teeth appeared and how their bites felt worse following treatment. Short term orthodontic treatment generally focuses on the front teeth and does not concern itself with how the upper and lower arches come together.

Braces are just a tool. They can move teeth only as well as the doctor using them. Just because the Six Month Smiles company puts the brackets on the models for the dentists who have attended its seminar does not mean that these doctors suddenly know anything more about diagnosis and treatment planning than they did before. Getting braces on the teeth is only the beginning. Knowing what to do at subsequent appointments and how to finish treatment is even more important. Just because I can buy a set of power tools from Sears does not mean that I’m any more of a carpenter afterwards than I was before.

In no way am I trying to suggest that orthodontists are smarter than dentists. There are some dentists who can straighten teeth with the best of us, and some of them are doing so using the Six Month Smile system. The key to the results you’ll receive from any treatment lies in the training, experience, and talent of the doctor providing it.