Monday, July 1, 2013

Reconsideration of Tooth Removal in Orthodontic Cases

We (dentists) have all learned that the primary problem in orthodontics is either too much or too little spacing between teeth. When there is inadequate space, teeth come in crowded and crooked. When there is too much space, the teeth will have gaps between them.

Small arch size resulting in crowding
Large arch size resulting in spacing

All dentist to some extent have been trained in  orthodontics. Many general dentist perform orthodontic procedures in their offices. Some refer to orthodontists if they don't enjoy this part of their practice.

When we encounter crowded teeth, we need to create space. There are several ways to create the necessary space. One way is to pull some teeth. Many adult teeth have been pulled with the intent of straightening teeth. While this may solve the patient's primary concern and give them a straight and beautiful smile, we have inadvertently create another problem. That problem is obstructive sleep apneaSleep apnea is very serious and will take 12-15 years off of a typical life-span.

I have spoken to some of my orthodontist friends and discussed this issue. Years ago when I was in dental school (1993-1997), we were taught that this was a good way to create space. This is still being taught. However, as the medical/dental community has learned more about sleep apnea, we have discovered that a narrowed arch will push the tongue upward and/or posteriorly. In either case, the airway is compromised. This will only exacerbate the problem of sleep apnea.

I have been a member of the American Academy of Sleep Medicine for nearly two years. In the last year and a half, I have been trying to educate my general dentist and orthodontic colleagues on this issue. Advancements in medicine and dentistry occur very rapidly these days. As we make new discoveries, we must modify our old ways of thinking. We must consider alternative ways to straighten teeth without narrowing the arch size. Fortunately there are ways to accomplish this. The details are beyond the scope of this blog.

So the message here is this: if you or someone you know will be undergoing orthodontic treatment, carefully evaluate all of your options before having teeth extracted. Your dentist/orthodontist may not yet be fully aware of this issue. They certainly will be soon. But if they aren't aware of this yet, ask questions. Specifically, ask if the arch size will become more narrow and if there is a potential for obstruction of the airway thereby exacerbating obstructive sleep apnea.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

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