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spacers always should be removed when the braces are placed. You are lucky it has worked it was up rather than down as it could cause very serious problems!...get it out ASAP and have your dentist check for any damage

What happens if a spacer grows into your gums? (Photo)

photos alone are not sufficient to make an accurate diagnosis having said that it appears that you have a large teeth and small jaws extractions may be needed. The one thing I would stay away from is treatments labeled Epigenetic or neuromuscular orthodontics..treatments recommended by a very small number of doctors (not even orthodontists) who subscribe to a philosophy of treatment that is not supported by the vast amount of scientific research (kind of like climate change deniers)

I am 18year old male. Tell me what is wrong with my Teeth/smile? Tell me what is wrong with my jaw? (photos)

Couple of reasons why this is happening The teeth roots move through your bone faster than the gums have time to adjust...so the crowns of your front teeth act as "snow plows" pushing all of the gum tissue together into a big pile which swells over the teeth and braces.&nbsp; The second reason is that some people's gum just overreact to irritation and swell up. The third reason is that poor brushing can cause overgrowth of the gums At this time all you can do is brush and floss real well..the tissue will eventually start shrinking but sometimes surgery is necessary to remove the excess

Why my gum is coming over my teeth? (photos)

Braces can change how protrusive or retrusive your lips are to some extent but have no real control over your facial shape

Braces and face shape?

If even 1/2 of what you say is true I would find a new office as soon as possible, it sounds like you are in a "factory" type clinic where the doctors are just rotating through with little concern for their patients&nbsp;

I wore braces for 19 months out of an estimated 24 with no improvement. Expander &amp; elastics worked. Is this normal?

always have to answer when I see answers from people like Dr. Shapira who bad mouth "contraction orthodontists" as apposed to some miraculous treatment done by "physiologically inclined dentists and orthodontists" Extractions are simply a tool of orthodontics. Used correctly for the right reason and they are the right solution. Used incorrectly for the wrong reason and they are the wrong solution...just as not taking out teeth when they should be taken out is wrong and not taking out teeth when they shouldn't be taken out is right! Always love how general dentist...not experts in orthodontics are often the ones who promote this nonextraction at all cost treatment...perhaps because they don't have the skill to treat extraction cases correctly? There is simply no scientific &nbsp;proof that extraction cause sleep apnea, headaches or tmj problems when done correctly. anyway...I have often confronted this issue and have written a paper on it if you are interested: see below 

 

Premolar Extractions Controversy

 

There is probably no facet of
orthodontic treatment that has caused as much controversy as the decision to
extract, or not to extract, permanent teeth: and more specifically, whether to
extract four premolars or to “develop” room for non-extraction treatment. 

 

Besides the obvious reasons of avoiding the trauma and
expense of surgery, and the desire to preserve permanent teeth; other alleged
negative sequela, such as TMD problems, flattened facial profiles, and “dark
buccal corridors” have contributed to the premolar extraction controversy. Like
a pendulum, the popularity of premolar extractions has swung back and forth,
between the extremes of non-extraction at any cost and “routine” extractions to
achieve arbitrary cephalometric norms. 

 

Some of the factors we consider
are: 

 

<ul>
 <li>When dealing with a fairly “normal” orthodontic
 problem (no gross asymmetries) the decision to extract four
 premolars is straightforward although often not easy. It is impossible to
 extract less than a whole tooth, and usually the extraction of a tooth on
 the left requires an extraction on the right to balance the midline.
 Likewise, lower extractions usually require upper extractions (and visa
 versa) to prevent excessive overjet or underbite. These constraints
 normally lead to extraction of four first premolars or to treat as a
 non-extraction case.. There are times when upper premolars only, a single
 lower incisor extraction, molar extraction, or interproximal enamel
 reduction (IPR) are appropriate but, in general, the decision for
 extractions is often framed around “4-bi’s”. In other words…even
 though the amount of crowding is a simple variable (from slight to very
 severe), the “correction” is an all or nothing decision (4 teeth
 extraction or no extractions at all).</li>
</ul>

 

<ul>
 <li>Given the usual all or nothing nature of the
 premolar extraction decision, it is no surprise that different
 orthodontists often appear to have conflicting treatment plans for
 the same patient. The reason is not that they see very
 different problems or have radically different philosophies of treatment,
 but rather that each doctor has a different line in the gray area between
 extractions and nonextraction. Two treatment plans that appear very
 different can both be based on a similar analysis of the patient’s
 problem, but end up with very different treatments due to the black and
 white nature of the decision making process. </li>
</ul>

 

<ul>
 <li>It is important to understand that in borderline
 cases there are no correct or right answers. Both treatments
 performed by competent orthodontists would produce a good result, but
 neither is perfect. Each option would have pros and cons, and
 orthodontists and dentists could (and do!) spend endless amounts of time
 debating which option is “right”.</li>
</ul>

 

<ul>
 <li>We try to avoid extractions as much as possible, but extractions should be considered when
 esthetics and stability call for it. 
 Truthfully, almost any patient can be treated without
 extractions and, often, it is the technically the easier way. This is the reason that the weekend orthodontic
 courses, aimed at general dentists, almost always stress nonextraction
 treatment.</li>
</ul>

 

<ul>
 <li>Where there is a conflict between
 facial esthetics and dental stability, it is our judgment to favor
 esthetics. This is not to say that patients with
 flat facial profiles and extreme crowding should be treated without
 extractions, nor that patients with full profiles and large tongues should
 have teeth extracted, but rather that esthetics should be the primary
 determinant of treatment in any borderline situation. In these cases it is very important that
 the patient understands the necessity of long-term retention</li>
</ul>

 

<ul>
 <li>Contrary to the beliefs of many nonextraction
 proponents, good scientific studies (evidenced based) done on TMD and
 orthodontic treatment fail to show any correlation between the
 development of TMD type problems and the extraction (or
 nonextraction) of teeth. All
 dentists can remember patients who develop TMD problems after extraction
 treatment and, if you feel there is a correlation, you will fixate on
 these patients. Statistically, you
 are just as likely to find TMD problems in patients treated nonextraction
 or, for that matter, patients who never received orthodontic treatment at
 all.</li>
</ul>

 

<ul>
 <li>Scientific studies have also shown that well
 treated extraction cases do not adversely affect facial profiles. Again, it
 is easy to visualize patients with flat profiles who have had premolar
 extractions. Assuming a good
 treatment decision, these patients would have had a flat profile even if
 they never had treatment (and an extremely unstable dental alignment if
 they had been treated without extractions). The truth is: tight facial
 structures (flat faces) lead to crowding, which leads to extraction rather
 than extractions cause flat faces. As a matter of fact, the most dished in
 and flattened faces often belong to those patients whom we have treated without
 any extractions. Like the TMD controversy, negative esthetic effects
 attributed to extractions fall into our favorite logical fallacy “post
 hoc ergo propter hoc” (after this therefore because of this). Other studies have also shown that dark
 buccal corridors and a narrow smile are not “caused” by premolar
 extractions. </li>
</ul>

 

<ul>
 <li>A good selling point for premolar extractions can
 be a patient with moderate crowding and well-formed and positioned third
 molars. Treated without premolar extractions
 this patient usually needs third molars removed. Extract premolars, close
 some of the space by mesial movement of the posterior teeth, and hopefully
 the thirds can erupt and be kept—an exchange of four small, easily removed
 teeth for four molars that would be difficult to extract. Unfortunately no
 guarantee can be made that the thirds will always come in with enough
 room. </li>
</ul>

 

<ul>
 <li>There seems to be a great deal of confusion about
 early expansion treatment (AKA arch
 development or growth
 modification). There is a
 important difference between expanding a constricted upper arch to match a
 normal lower arch (OK) and significantly expanding both arches in a
 patient whose arches may be narrow, but are in a normal transverse
 occlusal relationship to each other (not OK). Although it is possible to upright
 lingually verted lower posterior arches (which may have collapsed in, to
 compensate for a narrow maxillary arch), it is not possible to expand the mandibular
 basal bone, as there is no suture to distract as in the maxilla. Of all the inviolate “facts” of
 orthodontics, one of the most established is the stability of the lower
 inter-canine width. Expansion
 beyond the original width is almost a guarantee of collapse and
 recrowding. </li>
</ul>

 

<ul>
 <li>Every decade or so a new “magic bullet” comes
 along promising the ability to create space and avoid extractions or
 unstable expansion. The latest
 iteration of this is the Damon&trade; orthodontic bracket with its
 manufacturer’s promise of extremely light forces that “grow” more room
 than regular braces. As usual, no
 good science backs up these claims!</li>
</ul>

 

In an attempt to avoid first
premolar extractions, various alternatives can be considered: 

 

oExpanding the arch, especially in a flat-faced
individual, is often preferable to extractions, with the understanding this is
an unstable correction and perpetual detention will be needed. 

 

oFor
patients with a good posterior occlusion, a good upper arch with relatively
small upper incisors, moderately severe lower crowding, and minimal overbite,
the extraction of a lower incisor can be considered. Extraction
of an incisor should be evaluated very carefully, for it can result in an
untreatable problem with excessive overjet/overbite in the wrong individual. 

 

oInterproximal
enamel reduction (IPR)
can provide a moderate amount of room but should be reserved for older
patients. Excessive IPR as an initial treatment complicates the orthodontist’s
ability to correct minor relapses in the future. 

 

oConsider
extraction of second premolars rather than first premolars.
Theoretically, this reduces the amount of anterior retraction when only some
space is needed for crowding and the facial profile is acceptable. This works best when the second premolars resemble
the first, but large, molar-like second premolars may provide too much room and
small, canine-like first premolars may not work against first molars. 

 

oDistilization
of full arches is very difficult so extraction of third molars or even second
molars to provide anterior room has never been shown to provide significant
space. With the advent of temporary
anchorage devises (TAD’s) this may become a “new” way to treat
nonextraction…. we’re already trying it! 

 

Bottom line: Extractions are just a tool, not good or bad
in themselves. Used right, they improve
the quality of treatment, used wrong they may create a poor result. Finally,
ask you self: “what is really the most conservative treatment: extract
some teeth and end up with a stable and functional result for the next 50 years
of your life or, treat “conservatively” without extractions and end up with a
result that will relapse the second you stop wearing your retainers&nbsp;

I am 25 and I just got braces. My orthodontist suggests that I get one of my bottom teeth pulled to get the best results

Very simple answer:&nbsp; Get someone to recommend a good dentist and go see him or her!&nbsp; You are not the first person to let themselves go and finally sees the light...Dentists love to help people like you as long as you are committed to a life long change in your dental health...good luck

How do I fix my hideous teeth?

there is simply no good scientific proof that extractions cause TMJ or apnea problems!&nbsp; Some doctors try to separate themselves from traditional orthodontic treatment by trying to treat everyone without extractions and they try to justify it by telling scary stories.&nbsp; Done correctly for the right reasons extractions are a good tool for specific problems.&nbsp; I don't have all your records but from the photos you sent it certainly looks like this is a correct treatment for you the following is a white paper I wrote on this subject: hIn
response to another doctor’s comments about how wrong extractions for
orthodontics is I am providing copy from a newsletter I wrote on this
subject…If you REALLY want to know about this subject, read it! 

Premolar Extractions Controversy

 

There is probably no facet of
orthodontic treatment that has caused as much controversy as the decision to
extract, or not to extract, permanent teeth: and more specifically, whether to
extract four premolars or to “develop” room for non-extraction treatment. 

 

Besides the obvious reasons of avoiding the trauma and
expense of surgery, and the desire to preserve permanent teeth; other alleged
negative sequela, such as TMD problems, flattened facial profiles, and “dark
buccal corridors” have contributed to the premolar extraction controversy. Like
a pendulum, the popularity of premolar extractions has swung back and forth,
between the extremes of non-extraction at any cost and “routine” extractions to
achieve arbitrary cephalometric norms. 

 

Some of the factors we consider
are: 

 

<ul><li>When dealing with a fairly “normal” orthodontic
 problem (no gross asymmetries) the decision to extract four
 premolars is straightforward although often not easy. It is impossible to
 extract less than a whole tooth, and usually the extraction of a tooth on
 the left requires an extraction on the right to balance the midline.
 Likewise, lower extractions usually require upper extractions (and visa
 versa) to prevent excessive overjet or underbite. These parameters
 normally lead to extraction of four first premolars or to treat as a
 non-extraction case. There are times when upper premolars only, a single
 lower incisor extraction, molar extraction, or interproximal enamel
 reduction (IPR) are appropriate but, in general, the decision for
 extractions is often framed around “4-bi’s”. </li></ul>

 

<ul><li>Given the usual all or nothing nature of the
 premolar extraction decision, it is no surprise that different
 orthodontists often appear to have conflicting treatment plans for
 the same patient. The reason is not that they see very
 different problems or have radically different philosophies of treatment,
 but rather that each doctor has a different line in the gray area between
 extractions and nonextraction. Two treatment plans that appear very
 different can both be based on a similar analysis of the patient’s
 problem, but end up with very different treatments due to the black and
 white nature of the decision making process. </li></ul>

 

<ul><li>It is important to understand that in borderline
 cases there are no correct or right answers. Both treatments
 performed by competent orthodontists would produce a good result, but
 neither is perfect. Each option would have pros and cons, and
 orthodontists and dentists could (and do!) spend endless amounts of time
 debating which option is “right”.</li></ul>

 

<ul><li>We try to avoid extractions as much as possible, but extractions should be considered when
 esthetics and stability call for it.Truthfully, almost any patient can be treated without
 extractions and, often, this is technically the easier way.This is the reason that the weekend
 orthodontic courses aimed at general dentists almost always stress
 nonextraction treatment.</li></ul>

 

<ul><li>Where there is a conflict between
 facial esthetics and dental stability, it is our judgment to favor
 esthetics.This is not to say that patients with
 flat facial profiles and extreme crowding should be treated without
 extractions, nor that patients with full profiles and large tongues should
 have teeth extracted, but rather that esthetics should be the primary
 determinant of treatment in any borderline situation.In these cases it is very important that
 the patient understands the necessity of long-term retention</li></ul>

 

<ul><li>Contrary to the beliefs of many nonextraction
 proponents, good scientific studies (evidenced based) done on TMD and
 orthodontic treatment fail to show any correlation between the
 development of TMD type problems and the extraction (or
 nonextraction) of teeth.All
 dentists can remember patients who develop TMD problems after extraction
 treatment and, if you feel there is a correlation, you will fixate on
 these patients.Statistically, you
 are just as likely to find TMD problems in patients treated nonextraction
 or, for that matter, patients who never received orthodontic treatment at
 all.</li></ul>

 

<ul><li>Scientific studies have also shown that well
 treated extraction cases do not adversely affect facial profiles.Again, it
 is easy to visualize patients with flat profiles who have had premolar
 extractions.Assuming a good
 treatment decision, these patients would have had a flat profile even if
 they never had treatment (and an extremely unstable dental alignment if
 they had been treated without extractions). The truth is: tight facial
 structures (flat faces) lead to crowding, which leads to extraction rather
 than extractions cause flat faces. As a matter of fact, the most dished in
 and flattened faces often belong to those patients whom we have treated without
 any extractions. Like the TMD controversy, negative esthetic effects
 attributed to extractions fall into our favorite logical fallacy “post
 hoc ergo propter hoc” (after this therefore because of this).Other studies have also shown that dark
 buccal corridors and a narrow smile are not “caused” by premolar
 extractions.</li></ul>

 

<ul><li>A good selling point for premolar extractions can
 be a patient with moderate crowding and well-formed and positioned third
 molars.Treated without premolar extractions
 this patient usually needs third molars removed. Extract premolars, close
 some of the space by mesial movement of the posterior teeth, and hopefully
 the thirds can erupt and be kept—an exchange of four small, easily removed
 teeth for four molars that would be difficult to extract. Unfortunately no
 guarantee can be made that the thirds will always come in with enough
 room. </li></ul>

 

<ul><li>There seems to be a great deal of confusion about
 early expansion treatment (AKA arch development or growth
 modification).There is a important
 difference between expanding a constricted upper arch to match a normal
 lower arch (OK) and significantly expanding both arches in a patient whose
 arches may be narrow, but are in a normal transverse occlusal relationship
 to each other (not OK).Although it
 is possible to upright lingually verted lower posterior arches (which may
 have collapsed in, to compensate for a narrow maxillary arch), it is not
 possible to expand the mandibular basal bone, as there is no suture to
 distract as in the maxilla.Of
 all the inviolate “facts” of orthodontics, one of the most established is
 the stability of the lower inter-canine width.Expansion beyond the original width is
 almost a guarantee of collapse and recrowding. </li></ul>

 

<ul><li>Every decade or so a new “magic bullet” comes
 along promising the ability to create space and avoid extractions or
 unstable expansion.The latest
 iteration of this is the Damon&trade; orthodontic bracket with its
 manufacturer’s promise of extremely light forces that “grow” more room
 than regular braces.As usual, no
 good science backs up these claims!</li></ul>

 

In an attempt to avoid first
premolar extractions, various alternatives can be considered: 

 

oExpanding the arch, especially in a flat-faced
individual, is often preferable to extractions, with the understanding this is
an unstable correction and perpetual detention will be needed. 

 

oFor
patients with a good posterior occlusion, a good upper arch with relatively
small upper incisors, moderately severe lower crowding, and minimal overbite,
the extraction of a lower incisor can be considered. Extraction
of an incisor should be evaluated very carefully, for it can result in an
untreatable problem with excessive overjet/overbite in the wrong individual. 

 

oInterproximal
enamel reduction (IPR)
can provide a moderate amount of room but should be reserved for older
patients. Excessive IPR as an initial treatment complicates the orthodontist’s
ability to correct minor relapses in the future. 

 

oConsider
extraction of second premolars rather than first premolars.
Theoretically, this reduces the amount of anterior retraction when only some
space is needed for crowding and the facial profile is acceptable.This works best when the second premolars
resemble the first, but large, molar-like second premolars may provide too much
room and small, canine-like first premolars may not work against first molars. 

 

oDistilization
of full arches is very difficult so extraction of third molars or even second
molars to provide anterior room has never been shown to provide significant
space.With the advent of temporary
anchorage devises (TAD’s) this may become a “new” way to treat
nonextraction…. we’re already trying it! 

 

Bottom line: Extractions are just a tool, not good or bad
in themselves.Used right, they improve
the quality of treatment, used wrong they may create a poor result.

Did I really need those '4 PREMOLAR REMOVALS' for braces? (photo)

Invisalign or any type of orthodontic treatment is not a commodity like gasoline or sugar. &nbsp;The quality of the final result depends on the doctor, not the appliance. &nbsp;Talk to your doctor if you are not happy with the results....if still not happy you might have to chalk it up to experience and do more research before putting your money down.&nbsp;

Can I get my money back? If not, where do I go from here?

my daughter wanted to be a dancer...unfortunately, she didn't have the body for it...Everyone has a body type and yours comes with narrow dental arches...Orthodontics, especially Invisalign, has a hard time changing this structure, and the more you expand the arches the more unstable the final result is

I would like to know if Invisalign could widen my smile. Any suggestions? (photos)

Robert Waxler, DMD, MS

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Robert Waxler, DMD, MS

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