The most common problem requiring orthodontic treatment is overly crowded teeth. There are multiple ways to correct overcrowding: 1) extract multiple teeth, 2) extract a single tooth, 3) make the existing teeth more narrow or 4) make the dental arches larger. Unfortunately, there is not a consensus in the dental community about the best way to fix dental crowding. For example, some believe that developing dental arches is not stable and can't even be done once a patient stops growing. Others believe that if teeth need to be extracted they should be bicuspid teeth while others believe that you should extract second molars, not bicuspids. Some believe narrowing teeth can harm the teeth while others believe it's fine to just extract a single bicuspid or a single lower front tooth to prevent the development of excess space caused by taking too many teeth out. This is a controversial subject within the dental community and an extremely confusing one to patients with crooked teeth. What I can tell you is that cases requiring bicuspid tooth extraction are extremely rare and you are definitely NOT one of them.Will your face change drastically? That's difficult to predict but I guarantee you that it will change. How can a face not change if you are moving teeth? A face covers the teeth you are moving and the same bone structure that holds the teeth in the mouth also forms part of the facial skeleton. Any dentist or orthodontist who says facial changes do not occur with tooth movement are either incredibly naive or simply not truthful. We want to ENHANCE facial beauty whenever we move teeth; we definitely don't want to detract from facial aesthetics. What can happen when bicuspids are extracted is too much space is created and teeth have to be over retracted and pulled back to close the excess space. This can cause narrowing of the dental arches which can cause a narrowing and lengthening of the face (especially in patients still growing). Over retracting teeth can cause diminished lip support and a compromised facial profile. Other considerations that should be made before teeth are extracted or even teeth are moved is what will the effect be on the patient's airway and TMJ. These are vital and critical structures that can be adversely affected by improperly performed orthodontics. Orthodontics goes FAR beyond simply moving teeth and making them straight. I'm sure your case will turn out fine and you will be very happy with the results. Good luck!
