Will Bicuspid Extraction Cause TMJ?

It is truly unfortunate when misinformation is disseminated to the unsuspecting and trusting public.  Certainly, matters of professional opinion can differ but are best resolved by professionals and one of those methods is through the use of research and peer-reviewed publication.  Making brash, bold, and unsubstantiated claims and generalizations not based in reality, especially in this type of forum where patients may use the information to make treatment decisions is at best, simply unbecoming of a learned profession.  Statements such as "creates excess," "often cause," "are the result," "primary reason" attended without in fact are a disservice by the uniformed to the layperson.  

 

The prospective patient is searching for information to make an informed consent and would be best served first suggesting that they personally return to a licensed orthodontic specialist or two to gather this information; not propagating myths. 

 

First, "Damon" is a name brand of braces and there are hundreds of brands.  It has nothing to do with preventing extractions or reducing TMD.  There is no evidence.  It is marketing. 

 

In regards to your question, there is a plethora of data on the question at hand.  Doing a simple PubMed search using keywords is a good place to start.  Also contacting the NIH for their position white paper (i.e., paraphrasing "orthodontics is not a cause or cure of TMD (including the extraction of premolars") might be useful.  To give you a start, below is the abstract from a peer-reviewed paper (one of numerous others) that provide with the answer:  Extracting premolars (a procedure that provides substantial improvements for patients that need them) is not a risk factor for TMJ (PERIOD).

Orthodontic risk factors for temporomandibular disorders (TMD). I: Premolar extractions by Kremenak, Kinser, Harman, Menard, Jakobsen, American Journal of Orthodontics and Dentofacial Orthopedics, Vol. 101, Issue 1, Pages 13-20, January 1992.

"Concern about claims that premolar extractions may put patients at risk for temporomandibular disorders (TMD) led to this study. We report first findings from a longitudinal study of orthodontic patients begun in 1983. By using the methods of Helkimo, we collected TMD data before initiation of orthodontic treatment, between 0 and 12 months after debanding, and 12 to 24 months after debanding. Analyses related Helkimo scores with premolar extractions in 65 patients for whom orthodontic treatment had been completed. Twenty-six patients were treated without premolar extractions, 25 had four premolars extracted, and 14 had two upper premolars extracted. Tests for significance of differences between mean Helkimo scores were conducted for the nonextraction group compared with the extraction groups, and between pretreatment and posttreatment Helkimo scores for each group. Results included: (1) no significant intergroup differences between mean pretreatment or posttreatment scores, and (2) small but statistically significant (P < 0.05) differences (in the direction of improvement) between mean pretreatment and posttreatment scores for both the nonextraction group and for the four premolar extraction group."

 

 

If the orthodontic treatment is well done there is absolutely no scientific proof that extraction of premolars cause TMJ problems.  This does not mean that TMJ problems can not occur after extraction treatment but that this is no morelikely to occur than if the patient was treated without extractions.

Unfortunately, some dentists and orthodontists use the fear of TMJ problems to promote their nonextraction orthodontic philosophy....when in doubt ask for the scientific proof of what they say!