Extraction vs. Non-Extraction - Part 4: How facial features will affect this decision.

When making a decision to either extract teeth-usually four premolars-or expand the dental arches to alleviate crowding, consideration of facial esthetics is a major factor in this decision making process. Of prime interest is the size of the nose, in particular, the naso-labial angle. This is the angle that is made by a line drawn tangent to the underside of the nose and the upper lip. In addition, the prominence of the upper and lower lips and the chin are of prime concern. These factors are often evaluated prior to any treatment decision as they are consistently affected by the position of the upper and lower incisors, or front teeth.

If removal of teeth will require much space closure, and the final position of incisors will be altered significantly, then the degree to which these teeth are altered will determine the impact on the facial features described above. On the other hand, if there will be very little space to close after the removal of teeth, as in the case where there is severe crowding, then there will be very little movement of the incisors, and consequently, the lips will be minimally impacted if any at all by removal of teeth. As far as the size of the nose and chin is concerned, these features continue to grow with age due in large part to soft tissue growth and ethnicity. Therefore, if the patient exhibits very thin lips, often removal of teeth in the presence of mild to moderate crowding will make the nose and chin appear relatively larger with age. However, if the crowding is severe as mentioned above, the removal of teeth will have very little impact on the lips regardless of their size because as one tooth is removed, another tooth, often the canine, will erupt into the extraction site leaving very little-if any-residual space to close. So what you see pre-treatment is what you see post treatment in reference to the lips.

Often the removal of teeth will accentuate the appearance of the chin by retraction of the incisors which also retracts the lower lip thus making the chin appear more prominent. And just the opposite occurs when expansion or non-extraction of teeth is the treatment of choice; the chin seems to “disappear” as the lower incisors get flared-out toward the lip and the position of the lower lip makes the patient appear to be constantly ‘pouting’ because the lower lip is often more prominent than the upper lip. Our next blog will discuss the effects on the length of the roots of teeth when we either extract or non-extract.