Tooth Extraction for Braces over 40. Is Your Face Likely To Collapse at This Age?

Hi, I am 44 years old and just started metal braces a month ago. I had an appointment to get 4 teeth extracted (my orthodontist told me it is necessary to create space) but ended up canceling because a friend of mine scared me to death. Shehad her braces after 40 and had 4 teeth pulled, and according to her, not-so-supple over-40 skins and muscles would not be able to adjust to the extraction, and your face would just collapse, sink and sag. Is this common?

Doctor Answers 2

Will Extracting Teeth Before Orthodontics Change the Face?

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YES, extracting teeth before orthodontics at ANY age can and will dramatically change the shape of your face as well as the shape and size of your upper lip. A study was done on identical twins where one sister was treated with extractions before orthodontics and the other twin sister was treated without extractions. After completion of the orthodontics they no longer even looked like twins because their faces were radically different. Guess which sister had the more attractive're correct if you guessed the one treated without extractions.


More often than not, when I see orthodontic cases where bicuspids are extracted there is too much space created which not only requires over tipping and over retracting of the front teeth but spaces are never fully closed so the patient ends up with gaps between the teeth. Before any teeth are ever moved the practitioner should consider what the affect will be on the face and joint. If the practitioner says there is no affect on the face or TMJ then you need to RUN from that office.  


Extractions before orthodontics is generally easier and quicker treatment but the adverse affects on the face, lips and TMJ are always a MAJOR consideration. I would strongly suggest you consult with at least two other practitioners before proceeding with treatment. 


I treated a patient in my practice not long ago who came to me so unhappy with the orthodontic treatment she received in another office that she was in tears. She said it completely ruined her face and smile. She begged me to undo the orthodontic treatment which required moving the front teeth back where they originally were and placing implants where the teeth were extracted. She was thrilled with the results but WOW, what a roundabout way to get to where she could easily have gotten without extracting teeth.  


People see your teeth 60% of the time but see your face 100% of the time so do not allow movement of your teeth to adversely affect your face and/or TMJ.


Good luck, hope this helps!

Extracting Teeth Does NOT Always Change Your Face for the Worse

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NO! Stating that extracting bicuspids will cause the same result in every patient is a myth that has been disproven time and time again in the scientific literature. The decision to remove teeth or not remove teeth is a complicated one that cannot be over generalized. As a board-certified orthodontist treating over 8,000 adults, teen, and children over the past 20 year, I can honestly say that I have NEVER has a single patient complain about their profile following extraction treatment. That is because I only prescribe the removal of teeth when it is necessary. Conversely, I've had many complain that they looked "too protrusive" when extractions should have been done but were declined. When are extractions necessary? 1) when the teeth are too crowded to be aligned and still remain in the gums and the bone, 2) when the teeth already stick out and the patient desires a cosmetic improvement, 3) when the patient has an overbite and does not want to have a jaw surgery to correct it, and several other very specific situations where teeth are missing, broken down, etc. I take the decision to remove permanent teeth very seriously and use models, pictures, x-rays, and a very thorough interview and exam to make my educated decision. This has resulted in about one in five of my patients having teeth removed. Your best bet is to have a personal consultation with an experienced, board-certified specialist who can really explain how your face and smile will be affected rather than hearsay from a friend.

Greg Jorgensen, DMD, MS
Albuquerque Orthodontist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.