“I extract for the face. I don’t need to extract for space.” That’s the adage coined by world renowned Australian orthodontist Derek Mahony to explain how he approaches children who come to him because they have overcrowded mouths.

And when Ministry of Health data shows that 34% of 7 to 9-year-old and 50% of 13 to 17-year-olds in New Zealand exhibit malocclusion (or mis-aligned teeth) this is clearly an issue that faces parents throughout the country – whether to extract teeth or find an alternative approach. When it comes to Dental Artistry, we follow Dr Mahony’s approach.

In the same interview from which the above quote was taken, Derek Mahony recalled he was taught the traditional method at orthodontics school, where they would extract teeth to relieve crowding. “I distinctly remember we used to do a study model analysis, any crowding greater than 5 mm, we’d take out four bicuspids. We now realize you can resolve crowding with new techniques on a non-extraction basis.”

The issue with the extraction and retraction method is that although the teeth would look straighter, the overall profile would push the front of the jaw backwards at a time when the facial structures such as the chin and nose are still growing. And this can create a more sunken appearance later on in life.

The second issue with traditional dentistry is that by pushing the bottom jaw back to create straighter top teeth, you are actually pushing the whole bone into the Temporomandibular joint, which is the point just below your ear where your jaw meets your skull and allows you to talk, chew and yawn.

Long-term misalignment of this joint can lead to arthritis or TMD (short for Temporomandibular disorder) which causes severe pain and discomfort including symptoms such as:

  • Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide.
  • Jaws that get “stuck” or “locked” in the open or closed-mouth position.
  • Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew.
  • A tired feeling in your face.
  • Trouble chewing or a sudden uncomfortable bite, as if the upper and lower teeth are not fitting together properly.
  • Swelling on the side of your face.

In his book, Straight Talk About Crooked Teeth, Dr Mahony says that poorly thought through orthodontics carried out on children can often lead to further treatment later on in life because of TMD.

“Unfortunately, dentists performing treatment for TMD often see patients who previously had orthodontic treatment and now are seeking help because of a painful TMD disorder,” he writes. “They report that the clicking jaws and the problem of the dysfunctional TMD may or may not have been present when the orthodontics was performed, but were not addressed with treatment. One of the common ways orthodontics can negatively affect the TMD’s is the retraction of upper anterior teeth, leading to the trapping of the lower jaw. This typically occurs with the older extraction methods or the use of headgear in some types of traditional orthodontics.”

In order to avoid these pitfalls, as well as further costly treatment later on in life, Dental Artistry prefers to work on catching the potential issues as early as possible (The American Association of Orthodontists recommends your child is checked out before the age of seven) and using orthopaedic treatment to expand the jaw to create wide smiles and attractive profiles.

While the child’s face is still growing, this concentration on the bone structure (orthopaedics) rather than movement of teeth (orthodontics) means you can focus on the skeletal imbalance and use removable plates to complete the work.

The added bonus of dealing with orthodontics early on in a child’s life is that we can also help correct any abnormal oral habit that may be creating the issues in the first place. Dental Artistry’s use of Oral Myology can help a child un-learn bad habits such as mouth breathing and poor tongue placement that may have contributed to poor teeth alignment in the first place.

Do be aware that there are some cases where extractions are in fact necessary. Dr Sauer does a very thorough analysis to ensure that extractions are only recommended in cases where they are actually necessary and will enhance, rather than impair the structure and appearance of the face now and in the future.