Extraction vs. Non-Extraction - Part 2: How will this decision affect my gums or gingiva?

My last blog focused on the implications of removing or not removing teeth to alleviate crowding and the effects that each of these options had on treatment stability. Now I would like to discuss the effects that non-extraction or expansion of teeth has on gingival health.

Let me begin by stating that choosing to not remove teeth will most often not have any detrimental effects on the gums/gingiva. The most common side effect of expansion treatment in the presence of moderate to severe crowding is recession of the gums leading to root exposure. Depending on the amount of attached gingiva (as opposed to gingiva that is not loosely or unattached) recession may or may not occur. The thicker the attached gingiva pre-treatment, the less likelihood of recession, but if the gums are thin and there is little pre-treatment attached gingiva, there will be a very high risk of gingival recession.

In addition, if the anterior or posterior teeth must be moved outward or tipped forward away from their jaw-bones thus encroaching on the lips or cheeks and their corresponding muscles, they are more likely to relapse following the removal of braces and retainers and they are more likely to cause recession of the gums. In the posterior, if growth is complete and expansion of the upper arch is necessary, simply tipping the teeth out toward the cheeks will place the teeth in a position that is not only prone to relapse, but also places them at a high risk for gingival recession and root exposure.

If on the other hand, the patient is in their early teens, the upper jaw can be expanded predictably without the potential for relapse or without damage to the gums. As we age, past sixteen years old, the suture or junction in the middle of the roof of the mouth fully ossifies and can only be separated via jaw surgery. Without separation of the palatal suture, severe tipping of the posterior teeth occurs resulting in heavy forces applied to the bone just outside of the roots resulting in loss of bone and corresponding recession of the gums and subsequent exposure of the roots of the posterior teeth. This results in the need for gingival graft surgery.

So in summary, more often than not, we can treat most cases with mild crowding without the removal of teeth. However, the more crowding present, the higher the risk for gingival recession or the less attached gingiva, the higher the risk of recession and concomitant need for gingival graft surgery.