Extraction vs. Non-Extraction - Part 3: How oral hygiene will affect this decision.

The presence or absence of crowding will often dictate whether teeth are extracted or not, but before this decision is made, an assessment of the patient’s oral hygiene must be considered. The more severe the crowding the easier it is to justify extraction of teeth to alleviate the crowding. But when there is moderate crowding present, the case can often be treated either way; that is, non-extraction or extraction of teeth. So after consideration has been given to the gingival health, one must next take into account the patient’s oral hygiene.

Non-extraction orthodontic therapy involving treatment of moderate to severe crowding can often take longer than the extraction treatment option.  Therefore it is incumbent on the patient to have excellent oral hygiene if the retention of teeth is the option chosen. If oral hygiene is poor, it is often easier to extract teeth and treat the case faster thereby reducing the risks associated with poor oral hygiene. All things being equal, the better the oral hygiene, the faster the treatment. So if oral hygiene is good, this can off-set the negative effect of expansion or non-extraction treatment and make it easier to treat without the removal of teeth.