Extractions as part of orthodontic treatment are required rather less frequently these days on account of advances in orthodontic techniques. New types of braces can enable orthodontists to take advantage of the growth of the patient’s jaw, creating small amounts of additional space in the dental arch. These braces, often known as functional appliances, are routinely used by many orthodontists and often mean that extractions can be avoided. But they are not appropriate for everyone. For some patients, in order to get the best long-term result, extractions are essential.

It is sometimes asserted that functional appliances are appropriate in all cases and that narrow jaws can always be widened to bring overcrowded teeth into line without extractions. But the evidence is that this approach, applied uncritically, greatly increases the risk of subsequent relapse.

There is little doubt that good orthodontic treatment can enhance a patient’s dental appearance or facial aesthetics considerably and appropriate choice of extractions can be part of this process. Nevertheless orthodontic treatment, whilst improving looks, cannot totally over-ride the underlying genetic disposition.

Prior to reaching a decision on extractions, a full assessment of the patient’s face, teeth and state of development must be carried out. This will often involve taking X-rays, impressions and photographs. It is important to note that, in the absence of this assessment, a meaningful opinion cannot be given on whether extractions will be required. Every course of treatment has to be tailored to the needs of the individual patient