Does my child really need healthy teeth pulled?

Have you or your child been told you need teeth taken out as part of an orthodontic treatment plan? While many orthodontists try to avoid pulling teeth as their first option, sometimes teeth must be removed. We at OSIV understand that the idea of removing teeth can be pretty unsettling. The amount of information available today can be pretty overwhelming and whenever there is conflicting data, arriving at the best decision can be difficult. The following is meant to help clarify some commonly held myths about extractions in orthodontics:

  • Expanders and/or other appliances avoid extractions– This is true!….for the most part. There was a time in the history of orthodontics that almost everyone undergoing orthodontic treatment had 4 premolars removed as part of their plan. The idea was that big teeth in small jaws required tooth removal in order to place the teeth back in their most esthetic position. Today, we realize that very often the jaws are underdeveloped and need to be guided into a better position and relationship. Expanders take advantage of growth and the ability to make more room in the upper jaw. However, there are still limitations as to how far one can expand and extractions may still be necessary.


  • There are newer modern braces that align teeth without the need for extractions or expanders– This is a myth. There currently is no evidence to support the idea that any bracket system can avoid the need for extractions. A bracket or bracket system is merely a handle or “steering wheel” to align a tooth. It is still up to the orthodontist, or “driver”, to guide the teeth into the proper position. Orthodontic treatment plans are focused on placing teeth into their most ideal position for both esthetics and function. Any bracket system can be used to accomplish this.


  • Removing premolar teeth will cause jaw problems and sleep apnea later in life- Currently, there is no evidence to support this claim. Systematic reviews have shown that orthodontic treatment, even with the removal of teeth, does not put one at risk for developing jaw problems… This text opens a new tab … (‘TMJ’ or TMD) later in life. Also, the idea that removing premolars constricts the size of the jaws, pushes the tongue further back and causes sleep apnea cannot be validated. There is currently no evidence to support this concept. As more sophisticated 3D diagnostic images emerge, we will have a better understanding as to how the size of the jaws affect the volume of the airway and what impact moving teeth can have on this. There is definitely a relationship between airway development, jaw development, and tooth development. We at OSIV screen all our children for sleep disturbed breathing (enlarged tonsils/adenoids, snoring at night, etc) or any factors that can affect the function of a developing mouth (see the previous blog).

Children’s Dental Health



The success of your orthodontic treatment plan is built around trust…trust between you, your child, and the orthodontist. As specialists, we are constantly taking continuing education focused on orthodontics and make diagnosis and treatment planning very seriously. The ultimate goal is to place teeth into the most esthetic and functional position…function including chewing AND breathing. Each case is unique and requires an examination. Learn how to request a free video consultation, give us a call at 215-799-4602, or schedule online on our homepage.


Dr. Justin

2 comments on “Does my child really need healthy teeth pulled?”
  1. Avatar for Dr. Justin Silvestre

    Thanks for Sharing this valuable information. It is very useful for me and also useful for who wants Dental information.

    Dental information.

    1. Avatar photo
      Dr. Justin Silvestre

      I am glad you found it useful!

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