Is Tooth Extraction for Braces Really Safe for Airway Health?

Many dental and orthodontic treatments can significantly alter one’s oral health and even affect overall well-being. One such treatment, often recommended by orthodontists, involves the extraction of teeth for better alignment and positioning of the remaining teeth. This process can be crucial for achieving a perfect smile, yet it raises important questions regarding its impact on airway health. In this article, we will explore the relationship between tooth extraction for braces and airway reduction, highlighting the potential risks and scientific evidence supporting the concerns.

Understanding the Need for Tooth Extraction in Orthodontic Treatment

Orthodontic treatment, such as braces, aims to align and straighten teeth to improve oral health and overall dental aesthetics. In some cases, dental professionals recommend removing certain teeth to create enough space for better alignment. This process is often necessary when the teeth are overcrowded, ensuring that each tooth has the appropriate room to move into its optimal position.

One common approach is to extract the first, second, or even the third premolars. The orthodontist may suggest removing these teeth to provide more space for the front teeth, allowing them to move inward. While this procedure can result in a more aesthetically pleasing smile, it raises important questions about its impact on airway health.

The Potential Impact on Airway Health

The removal of teeth can have a significant impact on the structure of the oral cavity and, consequently, on the airway. Research has shown that tooth extraction can reduce the size of the airway, which can have severe consequences on one’s respiratory health.

A study by Bhatia et al. (2016) demonstrated that retraction of anterior teeth can lead to a reduction in the size of the pharyngeal airway and a change in the position of the hyoid bone. Similarly, Chen et al. (2012) found that large incisor retraction can cause a reduction in the upper airway morphology, posing a risk for sleep apnea.

Sharma et al. (2014) conducted a systematic review that concluded that first premolar extraction can lead to a narrowing of the pharyngeal airway, changes in tongue position, and a reduction in oral cavity space, thus increasing the risk of sleep apnea. These findings suggest that tooth extraction, even when aimed at improving dental aesthetics, can have adverse effects on airway health.

Scientific Evidence and Research Findings

Several scientific studies have provided evidence supporting the idea that tooth extraction can negatively impact airway health. For instance, Zheng et al. (2017) used computational fluid dynamics to simulate the upper airway response to large incisor retraction in adult class I patients with bimaxillary protrusion. Their findings showed a significant reduction in the upper airway dimensions, indicating that tooth extraction can indeed alter the structure of the airway.

Additionally, Wang et al. (2012) demonstrated that orthodontic treatment for class I bimaxillary protrusion can lead to changes in the pharyngeal airway size and hyoid bone position. These changes can have serious implications for respiratory health, particularly for individuals already at risk for sleep apnea.

Conclusion: Evaluating the Safety of Tooth Extraction for Braces

The evidence clearly shows that tooth extraction for orthodontic purposes can reduce the size of the airway, potentially leading to serious health issues such as sleep apnea. While tooth extraction can achieve ideal dental alignments, the risks associated with airway reduction should not be overlooked. Patients and dental professionals must carefully consider the potential long-term effects of tooth extraction on airway health before proceeding with this treatment.

Given the significant impact on airway health, it is crucial for dentists and orthodontists to embrace holistic treatment approaches that prioritize both dental aesthetics and overall respiratory health. Airway-centric orthodontic philosophy, for instance, focuses on maintaining the health and integrity of the airway during treatment.

As a concerned patient, it is essential to discuss all potential risks and benefits of tooth extraction with your dental professional. Consider seeking a second opinion or exploring alternative treatment options. Maintaining an open and informed dialogue with your healthcare providers will ensure that you can make an informed decision about your dental and overall health.

References

Bhatia, S., Jayan, B. C., Chopra, S. S. (2016). Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillary dentoalveolar protrusion. Med J Armed Forces India, 72(Suppl 1): S17-23. Chen, Y., Hong, L., Wang, C. L., Zhang, S. J., Cao, C., Wei, F., et al. (2012). Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients. Angle Orthod, 82(6): 964-70. Choi, J. Y., Lee, K. (2022). Effects of four first premolar extraction on the upper airway dimension in a non-growing Class I skeletal patients: A systematic review. Journal of Oral Medicine and Dental Research, 31: 1-16. Guilleminault, C., Abad, V., Chiu, H.-Y., Peters, B., Quo, S., et al. (2010). Missing teeth and pediatric obstructive sleep apnea. Journal of Sleep Research, 19(4): 583-591. Hang, W. M., Gelb, M. (2017). Airway-centric TMJ philosophy/airway-centric orthodontics ushers in the post-retraction world. Angle Orthod, 87(1): 68-78. Wang, Q. Z., Jia, P. Z., Anderson, N. K., Wang, L. L., Jiuxiang, J. (2012). Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion. Angle Orthod, 82(1): 115-21. Zheng, Z., Liu, H., Xu, Q., Wu, W., Du, L., Chen, H., Zhang, Y., Dongxu, L. (2017). Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class I bimaxillary protrusion patients. Scientific Reports, 7(1): 45706.