Will having teeth removed ruin my face?

I was recently scanning the question-answer section of a popular online health website. I’m interested in the questions by consumers seeking dental advice for themselves and their children. I am sometimes surprised by the answers given by the so-called experts. (By the way, these experts only qualification seems to be that they can fill out an online registration form… I know because I’ve done it myself.) In response to the question “Will having teeth removed ruin my face?” the “expert” (a general dentist with no orthodontic training) gave an emphatic, unqualified “YES! Avoid having teeth removed at all costs!” Hang on. Don’t board-certified orthodontists sometimes recommend have teeth removed as part of orthodontic treatment? Are they actually ruining faces?

Removing permanent teeth can affect the face
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.

Thorough diagnosis helps orthodontists decide about extractions
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.

Not removing teeth can make some patients look worse
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!

Remove teeth can improve the face in some patients
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.

One size does not fit all!
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 short-sighted 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!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.