To feel a little unsure about teeth out for braces?

Your concerns sound understandable, especially when your son already has a narrow jaw and palate and is only 11. Four extractions can feel like a major decision, but whether they are appropriate depends on his individual crowding, bite, tooth positions, facial growth and the overall orthodontic plan. It isn’t necessarily the case that extractions will make his jaw physically smaller.

I’d be inclined to seek a second orthodontic opinion before making an irreversible decision. Take along his X-rays, scans and proposed treatment plan and ask specifically why four teeth need to be removed, whether there are suitable alternatives, how his expected growth has been considered, and what they anticipate for his final bite and smile.

The fact that his father and older brother developed more jaw width later is certainly worth mentioning to the orthodontist, although family growth patterns cannot reliably predict exactly how your son will develop.

A general dentist may also help you understand the wider dental considerations. Shire Doctors and Dentists in Caringbah provides children’s dental care, so it could be another place to discuss your concerns before proceeding, without assuming extraction or expansion is automatically the right approach.

If the first orthodontist’s explanation didn’t leave you confident, getting another professional opinion seems very reasonable.

I was in a similar situation at a similar age and had 4 teeth removed before having braces in about 2000 or 2001. My teeth and smile look "fine" now but I definitely notice a difference to other people's smiles. Mine is short.. is that the right word? My arch is quite narrow now and when I smile there's not much of my top teeth that show and there are gaps at the side of my mouth and sometimes in photos you can see my molars in the back of my mouth. My top teeth stayed straight but my bottom front teeth have moved a little and I looked into getting invisalign a few years ago. I got quotes from 3 different orthodontic dentists and they all said that my jaw is so narrow now that the invisalign might not work and that nowadays they don't remove teeth for braces like they used to.

It's definitely not the end of the world and I'm happy with what my teeth are like overall but I was left to feel like those teeth probably didn't need to be removed so now I wonder "what if.." 😥I gather there have just been changes and advancements in techniques in orthodontics and teeth removal is not as standard as it used to be.

I think you'd be very reasonable to get a second opinion 🙂

I don't have any knowledge of the tooth removal issue. Like you, I was taken aback when the orthodontist mentioned it as a possibility for my daughter, but luckily it wasn't necessary after all and she just had a fixed brace.

But I will say that my daughter found orthodontic treatment difficult and somewhat painful, and in retrospect I'm glad it didn't happen when she was ten, which would have been possible and which I was pushing for - I wanted to get it over with. She was 12.5 when it started, and she needed that extra maturity. Cleaning round the braces properly is hard work. There were some foods she couldn't eat for years while she had the braces on. Every six weeks when they were tightened, it hurt for a few days. She felt rather overwhelmed for the first four months or so, and I don't know that she would have coped any younger. So you might want to consider putting it off for a while.

And along similar lines, I'd suggest trying to time it so that your son doesn't have too much else going on in his life when he first gets the braces. For example, IMO it could be a bad idea to do it just as he's starting secondary school, or moving house, or anything major like that.

Years ago I had a 'fixed' brace. I had 4 molars out (1 at each back left/right upper/lower) before my brace was put on.
However I was older (13/14) and I know from a friend's daughter sometimes it's done too early depending on dentist.
Not sure what techniques are now, definitely moved on, but a jaw can be overcrowded causing the teeth to be out of place.
I've had no issue until my wisdom teeth started coming through. Not enough room , in agony , had them removed too. 30+ yrs and I still get complimented at times.

I had eight teeth removed for braces and then I've had 3 wisdom teeth out too. I have lovely straight teeth and my smile isn't "narrow" and you can't tell I had teeth removed. Because my teeth aren't crowded it's also really easy to floss and clean them.

I had this before being given braces as a child - and now I have horrible gappy teeth. I feel really annoyed that my parents let my healthy teeth be removed like that. They honestly looked better when they stuck out a bit. If I could go back in time and stop it being done to my 12 year old self, I would.

Both my youngest see the same orthodontist, who does not remove teeth. He says it's the lazy way of doing it and your teeth are the scaffolding for your face and you'll look younger and better as you age if all your teeth are left in place. the eldest had orthotropics which is the American way of doing it. Widens jaw and then straightens teeth. Youngest will start hers in a year. Both have v v small jaws. The eldest has the most beautiful wide perfect smile and hopefully the youngest will have too.

Back in the early 1990s I had a palate expander for a few months before wearing a bionator for a couple of years to promote lower jaw growth and bring it forward. Thirty years later and DC2's NHS orthodontist advised use of a twin block appliance which had a palate expander built in. She was just 11 when treatment started - all permanent teeth were through - and had the twin blocks for a year but there was no suggestion of removing teeth unless the brace didn't work (usually only an issue if the child doesn't wear it). She then had fixed braces fitted to sort out a couple of wonky teeth and to neaten up her expanded jaw. The transformation in less than two years has been amazing and she should be done by the time she's 13 (aside from wearing a retainer).

I had 8 teeth out at 11 and people comment even now (I'm 32) on how good my teeth look. Before then my teeth were overlapping, crooked, top teeth stuck out over my lip - honestly, I look like a different person in childhood photos. It wasn't pleasant having those teeth removed (and gave me a bit of long-term dentist aversion) but I'd do it again in a heartbeat if I had to. Extra bonus was that, because I had it all done so early, I had great teeth without braces by 15 whereas quite a few of my friends had braces 15-18 and were self conscious about them at a time when we were wanting to look good in front of boys etc. Shallow reason I know but I do remember feeling so confident in my smile at that age whereas I used to hide my mouth with my hands before then!

I had 8 teeth removed for over crowding then a brace, have nice straight teeth, however, my jaw never grew and now my wisdom teeth are impacted and are causing me issues, god knows how bad it would have been if I had those 8 teeth still. I would trust your dentist, they know best.

Did she continue to wear her retainers every night?

To those that say - listen to your orthodontist as they know best - how do you explain my situation where a second opinion contradicted the original proposal.

My daughter didn’t have teeth out before her braces were put on, and when the braces came off she had a Hollywood smile….for a few years. Unfortunately as she got older the teeth started to crowd together again and overlap at the bottom. We weren’t given a choice, but in retrospect I think a few teeth out would have prevented overcrowding.

Very similar here, 24 of my own and two false ones as I was born without some canines and wisdom teeth. The rest have been removed due to a small narrow jaw and I'm still a bit overcrowded. I had 5 removed in one sitting as a child then wisdom teeth as an adult. I didn't need a brace but the teeth realigned themselves so there were no gaps.

ps: I have 3 wisdom teeth (one was pulled when it got infected/decayed, when I was about 30). I've had so many puzzled reactions from dentists like wisdom teeth shouldn't be there. The teeth caused me just a few aches when they came in, no regrets no crowding, i just let them appear & stay.

Orthodontist said when DS was about 10-11 that he definitely would need teeth removed. Dentist kept saying it was impossible, surgical procedure until he got older. By age 14 he had grown so much he didn't need them removed (!!). I am so glad dentist insisted it was impossible for so long.

DH & his mum had healthy teeth removed, I sometimes wonder how necessary that was. They had a growth pattern of being very short/small until they sprouted up to be taller than average.

Nope definitely do not remove any adult teeth. The U.K. is literally the only country that still does this and it’s why so many adults have unbalanced jaws.

It happened to me as a kid and I had jaw surgery when I lived abroad to fix it. I was a member of a Facebook support group and from that, I learned that the U.K. way of doing this is extremely outdated and it doesn’t happen in any other western countries.

Do not let him have adult teeth removed.

(just to add, I’m in the US. And paying privately for DD and myself. I chose Invisalign for myself because at 37 I really don’t want metal braces!)

I wouldn’t remove teeth. Orthodontics have come along way in the last 10 years. DD has a narrow mouth, before getting braces she had a palette expander for a few months. I recently started Invisalign, I have a small mouth too and nothing was removed. Get another opinion for sure

Teeth out is the cheat's method. The better way to do it as they do in Europe and North America is two stage treatment using an appliance and then a fixed brace. The issue is that you only have a particular window for an appliance (eg palate expander but there are others) before the jaw has grown too much on its own. I had the teeth out treatment, oldest (in USA) had the palate expander and not only is her smile better, her alignment is better, she doesn't have crowding like I do and she has all her teeth. (And the original problem of massive overbite that showed with her mouth closed is gone!)

The NHS uses the extraction method because they push treatment late and want it cheap. If you can afford to, I would get another opinion, and do so ASAP before teeth out is the only option.

Do not do Smile Direct as a pp suggested, it's not a good option for children and really isn't a good method for this sort of problem.

I had braces as a teen and now have adult braces. I have a narrow jaw and my teeth never really straightened well with my first braces, hence having them again as an adult. This time I needed 4 teeth removing. However I see the same issue with my DD and I don't know how I feel about having them removed in a child. I would certainly at least ask of palate expanding is an option first.

*plus not losing healthy adult teeth when you don’t have too.

I work at a Dentist and the children of the staff here all have had/will have this if they need braces.
We also refer our child patients early for this rather than extract perfectly healthy teeth.

You are right to be concerned. Palate expansion is what you want for that wide American smile.
interceptive orthodontics (but he may be too old).

on the NHS you would be lucky to get this, ask for a private opinion and say you don’t want teeth extracted.
better to have wider palate as this is the floor of the sinus. Better for airway health, less TMJ problems in future, space for tongue, nicer profile aesthetically. Plus not lis

things have moved on, but unfortunately you probably will need to pay privately.