Extracting Premolar Teeth for Orthodontic Treatment: The Risks

Patients Report Health and Aesthetic Consequences

Reviewed by Dr. Noel Stimson, Dr. Ben Miraglia and Dr. Skip Truitt

Graphics by Alexandre Ruze

50% of patients in braces worldwide on average get their premolar teeth extracted for braces.

Today when a patient goes to get orthodontic treatment, there is a chance that the orthodontist will say that adult teeth have to be extracted: usually 2 upper premolars and/or 2 lower premolars (and perhaps 4 wisdom teeth). The patient might be concerned: is it a good idea to extract healthy adult teeth? Are there any consequences to losing these teeth?

Searching the Internet for answers, they may find claims that extracting premolar teeth can lead to “flattened” profiles and recessed jaws, and assertions that these are just rumors. They may see posts on social media of patients grateful for their beautiful new smile as well as posts from patients complaining Extractions have ruined my face! They might also come across reports that orthodontic extractions can lead to longterm serious health issues such as temporomandibular disorder, jaw joint damage, chronic neck/shoulder pain, a reduced oral cavity, tongue space constraint, narrowed airways and breathing disorders such as obstructive sleep apnea.

Do these negative reports have any basis in fact?

Before turning to an orthodontist for a response, people should be aware that the orthodontic specialty is also troubled by this question. Orthodontists have been debating amongst themselves whether premolar extractions cause negative consequences on aesthetics and health for at least eight decades, ever since American orthodontist Dr. Charles Tweed first promoted the controversial PER method at an orthodontics conference in 1940. This debate is ongoing and unresolved today, and is so charged that premolar extraction is termed in-house the “greatest controversy in orthodontics.”

The public is for the most part unaware of this in-house “great controversy,” one that divides orthodontists into two opposing camps: one camp arguing that PER is a benign and excellent way to approach treatment, the other that it is a damaging method to be avoided in all but rare cases. Evidence is produced for…