I am Rachel, aged 39 and I also had extractions and retractive orthodontics like so many others. I will tell you my sob story, don't worry, but first I'd like to say that the underlying cause of all this misery is a society that continually by-passes the root causes of problems and opts for the quick-fix, the economic option, sticking plasters every time. Of course, those who have been and are still going through this particular torture know it is a false economy, but it must be said, because it is everywhere you look if you have your eyes open.
So, the story probably started for me with bottle feeding only, thumb sucking, E.N.T problems and mouth breathing and a paediatrician mother who, as an NHS-trained health professional, knew absolutely nothing of the potential dangers of these things. I am sure she was not the only one. I was developing a somewhat retruded mandible, visible in pictures from age 4 or 5. I was taken to the orthodontist at Guy's Hospital in London, UK at age 7, however, which was absolutely the right thing to do. Pity was, the orthodontist did ABSOLUTELY NOTHING! He sent me away again until age 8 when he began pulling out my milk teeth to 'create space'. Unbelievably, you might think, my well-educated parents never questioned this logic. They were not even allowed into the consultation room, just given a form to sign.
At age 9, my four first premolars were removed (I had not fully erupted of course, but the orthodontist said it wouldn't make much difference at what stage he pulled them out...it wasn't as if I was still growing...was it?!!) Then I had retractive braces, fixed braces and rubber bands pulling back on my maxilla consistently until age 13, followed by a retainer. I have attached my 'before and after' X rays and I hope you can publish these as I think even a lay person can see what happened to my facial growth, the shape of my neck and the postural relationship of my head and neck.
The blinding headaches and vomiting started as soon as the braces went on. A migraine diagnosis from my mum....the orthodontist was not even told about them, though I doubt that would have done much good anyway. And then the headaches gradually left. In retrospect, I think my neck managed to reorganise itself around my TMJs and my much more retruded maxilla and mandible, as I think you can see from the 'after' x-ray. Then my shoulder, neck and general muscle pain started and, at age 12, I noticed my jaws had started clicking. That was 'normal', said my mother. Eventually the clicking stopped too. Bye bye discs. Halfway through the orthodontics I started playing the violin. My increasingly painful neck, shoulders and back was put entirely down to this and as I had waited 5 years for the chance to have lessons (music is now my profession) wild horses wouldn't have dragged that violin from me and I shut up pretty quick about the pain.
You see, there is a big danger with potentially painful procedures in childhood or anything that goes against natural growth and development. Most children will try to accept anything if convinced it is 'normal'; they have no experience with which to compare it and, in any case, nowhere to turn for help. I was told the orthodontics were supposed to be painful and uncomfortable. I knew in my very bones that something wrong was happening and I distinctly remember reasoning with myself that I would get through those few years and then go back to the way I was, completely missing the fact in my child-like thinking that this process was a one-way ticket. The powerlessness of all this is quite damaging in itself, I believe. Once something is 'normalised' (in my case constant muscle pain and discomfort) it is buried away and you just stop complaining about it and try to get on with the process of growing up. Which, I understand, can be pretty challenging even without constant pain and the feeling that the machinery of your body just wouldn't coordinate anymore ('gosh, I'm sure I used to be able to run before....it sucks being 11!')
And then there was my face. The skin on the bridge of my nose used to get so tight and shiny, I would have to powder it before school. I was so embarrassed. I would stand next to the double mirror in the bathroom daily, pulling my top lip and jaw forward to try to make my nose look smaller...really! My face was growing down and back at an alarming rate. My top lip practically disappeared. What bad luck to be ugly, I thought. Add that to the pain and I can tell you my confidence was really affected.
I wish I could tell you I have reached a happy ending 30odd years after the ‘treatment’, but so far I can’t. I managed to struggle on (managing symptoms by going from pillar to post: massages, osteopaths and so on) until about age 24, when my body came to a grinding halt. I had had to abandon any thought of a career as a performing violinist as you can imagine, but much more than this I was totally disabled. The list of symptoms read like this: daily blinding headaches until I vomited, very severe neck pain, rigidity in my entire musculature, burning and spasm in throat, face and jaw muscles, hip pain, knee pain, numbness in my arms, post-nasal drip, nausea, constantly feeling shivery and fluey, getting goose bumps all over and tremor. I had to stop work entirely and over the next 10 years went through 3 pain clinics, had practically every body part scanned, tried every drug out there, nerve blocks, injections, psychologists, psychiatrists etc. etc. and was, for a time, totally dependent on disability living allowance and benefit.
Truly nothing helped except training as an Alexander Technique teacher and this, wonderful though it is, is a management strategy.
My jaw joints were finally scanned in 2005 and showed non-reducing disc displacement on both sides, condyles jammed to the back of the joint, arthritis and bone loss. Although there is an acknowledged scarcity of literature on the connection of this damage to occlusion, not to mention symptomology, it did lead me to question ‘why?’ I remembered the orthodontics I went through and that lead me to the basement of Guy’s dental hospital to photograph my notes on microfilm and find those, in my opinion, horrendous scans.
I am exploring various treatment options, but after 10 years of searching I can only say positively that I think at least I have not let anyone make me any worse. We are in the wilderness. The NHS has absolutely no answer to my constant symptoms. Outside that structure there are a number of possibilities but it is a minefield of desperate, expensive and unproven techniques. Instinctively, one wants the whole process reversed, but it is not all that simple. How can you recapture 5 years of growth that was inhibited at such a crucial stage? And what about the myriad adaptations the body has made to this deformity over three decades? Meanwhile, I try to move forward with my life, but I operate day to day with a level of illness and dysfunction that I am sure would have someone without a chronic condition tucked up in bed with a doctor’s note. I have no choice. I love life, I love my work, but physically and emotionally I am butting up against the very limits of my endurance over and over again.
Pre-treatment x-ray: 1985
Post-treatment x-ray: 1989
Pre-Treatment
Mid Treatment, after pre-molar extractions
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May I quote your story in a book I am writing? Richard
Did you got any treatment which can reverse the damages?
I have done quite a few extraction cases and never used a plastic appliance except as a retainer. Perhaps it was some sort of Bionator to try to bring your deficient jaw forward. That was popular at the time you were treated.
Brits are known for narrow skulls, arches deficient in perimeter, and thus crowded teeth. Despite what other people tell you on this forum, a surefire way to grow mandibles does not exist. Mandibular deficiency is a highly inherited trait. Maxillas can be expanded laterally prior to age 17, but if a maxilla is expanded to be wider than the mandible, irreparable harm is done to the patient!
Listen, I have absolutely NOTHING to hide. You use the word ‘blamers’ but I/ we are not. We are whisleblowers, yes. We have consistently spoken in terms of the causes probably being multi-faceted and tried to open a rational and scientific debate. You- the professional orthodontist- are the person who is posting here of your own free will has resorted to insults. I am not sure why. People will make up their own minds.
I am glad your patients have not experienced headaches. Perhaps you are not doing anything that causes their mandibles to retract and press into the joint. Thank goodness.
You had ortho treatment and there were no pre-op nor post-op extraoral and intraoral photos taken???? You realize how extraordinary that is?
You said in your history that you had fixed braces and class II elastics. Now you say you only had only a removable appliance after extractions. What is the truth?
When the decision is made to do premolar extraction, brackets and archwires should already be in place. Things can move very quickly with fresh extraction sites. If the clinician dilly-dallies, results are slower. On a class II extraction case, I like to get the patient in Herbst attached to the archwire as soon as I can fit a rectangular stainless steel archwire.
Concerning headaches: I have been doing full arch ortho for 33 years, on kids and adults. Never have I had a patient start having headaches as soon as treatment has begun. Normal is just soreness around the teeth as they start moving. Along with your nausea and vomitting, I suspect you had a concurrent and unrelated malady about the time orthodontics was begun.
Unfortunately, I live in the U.S., so have absolutely no recourse as I don’t have health insurance, and when I did, it wouldn’t cover sleep apnea. The health insurance companies here do everything they can to make sure they don’t have to pay for treatment, and if the doctors know it will be like “pulling teeth” (very difficult) to get much if any payment from them, they won’t make much effort to help the patients, either. I don’t know how people from the U.S., like me, can afford the treatment. I wish I had some kind of wealth where I could get some help. My job, and life in general, are harder because of my lack of sleep!
Today I received unsolicited via e-mail a plethora of treatment data from a Brit. Unlike many who have replied, she is not an arrogant know-it-all wanting to “set me straight.” She simply wanted sound advice.
The tragedy was the case could have been handled easily enough at a young age, preventing anterior cross bite. Sadly, the abysmal NHS socialist system failed her, as it has failed many other Brit children I have examined.
Like it or not, her case would have been an extraction case even at a young age. Some palatal expansion could have been achieved via Hyrax, but probably not enough to still fit with her small mandible. A hero might have tried a Frankel back in her childhood. Few children cooperate with those. Most gave up on them or broke them.
Her case would not have been so hard, started early enough with the right plan. But what was done? Her 1st premolars we extracted to prevent her canines from coming in bucally like vampire teeth. Nothing else was done to adulthood. No extractions on the lower meant some of her lower anteriors went into crossbite, and the lower arch was STILL too crowded.
Sadly, the lady also had a very flat profile with high interincisal angle. With more age, the anteriors in cross bite would wear badly.
So in her late 50s, she thought she would make matters right. I would have probably treated this compromise case by extracting a single lower incisor and sanding the upper front teeth to make them narrower.
But a Brit orthodontist removed her remaining two upper premolars and lower 1st premolars as well. A disaster in the making for someone with a flat facial profile to begin with.
Where does the blame lie? I am sure all of you would blame the orthodontist who attempted this very difficult adult case with nothing but compromise possible outcomes.
But could not the original NHS childhood dentist be blamed, for possibly not referring this case to a competent orthodontist during the patient’s childhood?
Perhaps the parents were cheapskates, and were not willing to pay privately to have good orthodontic care for their daughter. Perhaps they should share the blame.
Perhaps the crummy Brit socialized system should be blamed, which makes it all but impossible for children to have good dental care due to abysmal fees.
Or Perhaps or anthropologist friend Joe should fault the parent for not feeding the child uncooked vegetables and raw meat, with a few bones with marrow to gnaw on to “develop” great arch perimeter so all the teeth would have fit in perfectly!
So tightly genetically related primitive groups still show now crowding. And you conclude by default it is not due to common hereditary traits, but by eating unprocessed food. What is your evidence?
Good luck convincing parents to provide unprocessed, tough foods for their children to possibly increase jaw lengths. Oh, and this would require more eating time in our fast-paced society as well.
So you don’t ascribe any genetic influence to jaw length and width? I guess the observed tendency of mandibular prognathism in families is just a fluke? What would make the mandible grow TOO LONG, if not genetics? Mandibular prognathics I have treated don’t have any different diets.
“Congratulations, Joe, for possibly the stupidest post by an educated person I have ever found online.”
I see you have now resorted to petty insults. It’s a shame, really. But I cannot blame you. If I my rational and scientifically grounded argument is indeed correct, it would render your entire life’s work as futile – that’s a big pill to swallow. Now let me break down your poor attempt at responding to my claims.
“We diagnose jaw position/arch length/tooth mass discrepancies EVERY TIME before we start a case. THEN we relay the finding to the patient or parent.” Great! But so what? This hasn’t answered my question. I said “Which other profession is responsible for providing preventative dentistry and information about the cause (emphasis) and consequences (emphasis) of poorly developed jaws to the public?” By providing the patient information about the dimensions of their jaw you have neither explained the cause nor consequences of having a poorly developed jaw. You have not explained that malocclusion is caused by environmental factors such as not chewing tough foods. And you have not not explained that having poorly developed jaws greatly increases the likelihood of developing TMD and sleep apnea in later life. You have simply given them the dimensions of their jaw. Pointless!
“If you think arch perimeter can be expanded to prehistoric lengths merely by having a child eat a prehistoric diet you are a fool. Current arch sizes are the result of thousands of years of evolutionary change. They cannot be undone in a generation” No. Current arch sizes are not the result of “evolutionary change.” Well, if you are referring to the average arch size of a person with all 32 teeth and a well developed jaw, then yes, this arch size is a result of evolutionary pressure and may be smaller than the arches of our ancestors that lived say 1 000 000 years ago. But if you are referring to the arch sizes of people with malocclusion, then no, this arch size is not a result of “evolutionary change.” Malocclusion is a modern phenomenon caused by environmental factors. Malocclusion is not the result of evolution. Firstly, the timeframe over which malocclusion has existed in homo sapiens (10 000 years) is not enough time to elicit evolutionary change. If malocclusion were truly a result of evolution it would take say 100 000 – 500 000 years to develop. Secondly, if malocclusion were a result of evolution it would uniformly affect the population – It would not greatly affect some groups of people, such as industrialised America, and negligibly affect others, such as the indigenous people of brazil. Malocclusion is caused by the environment. So yes. I am suggesting that if you change the environment – such as chewing on tough foods – you can change the incidence of malocclusion. If you ask a child to chew on tough foods will it completely cure the malocclusion – probably not. The cause of malocclusion is environmental but also multi-faceted. Maybe the child is a habitual mouth-breather. This would also need to be corrected as mouth-breathing prevents the appropriate muscular stimulus to properly develop the jaw. Or maybe they sleep on their arm (which has been indicated in the cause of malocclusion) and not their back as nature intended. You see, we know malocclusion is caused by environmental factors so we need to pinpoint these factors and prevent them from manifesting. My argument is that it is the role of the orthodontist to do this. It is the role of the orthodontist to pinpoint these factors and present this information to the public. This is not an outlandish statement. Orthodontist study malocclusion of the teeth so it would be their responsibility to do this, no? You see when you frame it like this it really is quite simple. Come on, Kim. This is evolutionary theory 101. It’s not rocket science.
What you write about the biomechanics is directly at odds to what a number of professional orthodontists have told me but indeed they would have to reply on the specifics. I had a number of different appliances and it appears your profession is not in agreement as to exactly what effect each of these have. My upper incisors were retracted and there is plenty of published research to show that this occurs of which I am sure you are aware. I have also seen your response re headaches.
How would you respond if your patients mid treatment report headaches?
Again, I have simply reported my experience: when this brace went on I started to have headaches. This is true. I can describe this brace only as someone who experienced it. It held upper and lower teeth together and I have already described how when the mould was set the condyles of my jaw joints were pushed back into the fossa.
I felt discomfort and pressure in my jaw joints wearing it. I was told it was supposed to be uncomfortable. Were headaches and brace linked? Yes, probably: I think so. Did I make a connection at the time? No: I was A CHILD.
Can I be 100% certain? No, but I can be concerned enough to mention it as part of my experience. But, apparently, you can be 100% certain the other way.
Stress on the TMJ is associated with headaches so to say that this is akin to suggesting that braces could have caused me to catch an infectious disease is too ridiculous to warrant a response.
I am interested in your response to what Joe has asked you below and the fact that I was taken to the orthodontist at age 7 by my parents when growth can still be influenced (as indeed was being done by some at the time) but as I describe above nothing was done and no advice was given.
Please learn a little about orthodontics before you write so you don’t appear so ignorant. Class II elastics are designed to correct DENTAL class IIs. They really don’t have much effect on growth. Incidentally they tend to propel the jaw forward, moving the condyle FORWARD, not impacting it in the back of the glenoid fossa to cause TMJ problems. You don’t have the foggiest idea how biomechanics work.
Congratulations, Joe, for possibly the stupidest post by an educated person I have ever found online.
1. We diagnose jaw position/arch length/tooth mass discrepancies EVERY TIME before we start a case. THEN we relay the finding to the patient or parent.
2. Potential maxillary and mandibular arch length is largely inherited. We can expand the maxilla laterally to infinity, but NOT the mandible. Chin cups have been no help in patients with prognathic mandibles. The excessive length is in the genes. Asking the mandible to grow longer by some pink plastic appliance would be like putting an African pygmy on the rack several hours a day trying to make him grow to our norms in stature.
3. If you think arch perimeter can be expanded to prehistoric lengths merely by having a child eat a prehistoric diet you are a fool. Current arch sizes are the result of thousands of years of evolutionary change. They cannot be undone in a generation.
You say “If we want to get back to our “natural” state, should we quit cooking meat and go back to gnawing on bones, just to grow our arches bigger to house all the teeth? Not many people would agree to do that.” Yes this is exactly what we should be doing – get back to our natural state. Though this does not need to be achieved by quitting cooking or gnawing on bones. This can be achieved through other means – public education (on the importance of chewing tough foods) and functional dentistry.
You see, right now you are aware of the cause of the malocclusion – environmental factors – yet you still choose to let it manifest and deal with the repercussions later.
You claim that “We are not extracting teeth for no reason” and you are right. As you say “leaving wisdom teeth in an arch where there is no room for them causes infection and damage to the 2nd molars” – this is undebatable. But the point is that there should be no need to extract any teeth in the first place. The arch of a child should not be allowed to develop such that it cannot house the wisdom teeth in later life. How is this achieved? Functional or “growth guidance” dentistry. You may argue, well, the evidence supporting this approach is small. And you would be right. The body of evidence supporting this approach is small, but this is not due to a fault in the procedure, it is due to the fact that nobody has actually performed said research. Even with a small body of research, however, this approach should still be the ‘approach of choice’ because it is the only approach that does not violate the scientifically grounded environmental theory of the cause of malocclusion.
You see, right now you claiming that you have seen plenty of patients who have TMD and sleep apnea who have not had orthodontic treatment. You are then arguing that the fact that these people developed TMD and sleep apnea cannot be the fault of the orthodontist because he did not perform any treatment – this statement is false. The orthodontists is indirectly causes TMD and sleep apnea by ‘failing to provide functional orthodontics.’ Legally, this is referred to as ‘failure to diagnose.’ Many medical professions, including orthodontists, have an obligation to diagnose a patient correctly and if they fail to do so they are held responsible for any of the ailments the patient may experience from the misdiagnosis. It’s like watching a crime unfold and doing nothing. Are you responsible? Yes. Yes you are. If you disagree, please tell me who is responsible? Which other profession is responsible for providing preventative dentistry and information about the cause and consequences of poorly developed jaws to the public?
IT IS NOT CLEAR WITHOUT DETAILED CEPH ANALYSIS WHETHER ANY RETRACTION OCCURRED AT ALL. IN CLEAR CUT CASES WE DO EXTRACTIONS EARLY. LATELY IT HAS BECOME MORE POPULAR TO DO IT IN ONE WELL-TIMED PHASE. and 6) the question , once again, is not was this an ‘acceptable’ result in 1990 but whether the intervention supported the growth, development and healthy functioning of the body?
DID YOU WANT TO LOOK BETTER AT THE TIME? I HAVE NOT SEEN THE PHOTOS YET, BUT YOUR PRE-OP PROFILE ON CEPH WAS NOT ATTRACTIVE.
If the answer to the latter is NO then there is no excuse to do this …in 1909, 1990 or anytime. This is not one giant human experiment with children as guinea pigs is it?
WOULD YOU FAULT THE ORTHODONTISTS AT THE BEGINNING OF THE 20TH CENTURY FOR NOT PRACTICING TO CURRENT STANDARDS? IF NOT, WHY WOULD YOU HOLD A 1989 ORTHODONTIST TO CURRENT STANDARDS? KNOWLEDGE IS GAINED ALL THE TIME.
Lower airway on ceph does not change with neck position. However, your airway obstruction could have been hypertrophied turbinates. Strange you say your mother was an “NHS-trained professional but knew absolutely nothing of the potential dangers of these things” She could not get any colleagues to find the origin of your restricted breathing YEARS BEFORE ortho? Another reason why we don’t want socialized medicine here in the US.
The human maxillary sinus is something I would have designed differently. Some people have chronic fluid in their sinuses and thus chronic sinus inflammation and chronic nasal obstruction this could have been you. If this had been treated correctly as a small child, you lower cranium might have grown differently. But then again, it might not have. Would have been interesting to see profile photos of your mother and father, and see if either of these was class II.
I think there is ZERO chance your headaches and vomitting had a thing to do with your braces. If you happened to have had mononucleosis about the same time, would you blame that on orthodontics as well?
On this forum, you have drastically underestimated the difficulty of your original ortho problem. Why would a person do this?
Interesting in arch perimeter is racial disparity. I will call the races by their proper anthropological names.
Negroes often have EXCESS arch length. The most common request by patients of this race is ELIMINATION OF EXCESS SPACE! It is much more common for 3rd molars to erupt in this subgroup of humans, compared to Mongols or Caucasians.
Why is this? Well, Negroes also tend to have large, muscular tongues. Which comes first, the chicken or the egg? Does the tongue enlarge just to fill the space, or does the large tongue develop greater arch size? I am of the latter opinion.
If we want to get back to our “natural” state, should we quit cooking meat and go back to gnawing on bones, just to grow our arches bigger to house all the teeth? Not many people would agree to do that.
We are not extracting teeth for no reason. As I write in “Why Should I Extract my Wisdom Teeth? They are not hurting me” article, leaving wisdom teeth in an arch where there is no room for them causes infection and damage to the 2nd molars. I have done many, many second molar root canals because stubborn patients would not remove wisdom teeth.
Why do Caucasians and Mongols not have the large, muscular tongues so common in Negroes? Why is mandibular retrognathism so common in Caucasians, and maxillary deficiency more common in Mongols? Your guess is as good as mine. Differential distribution of hereditable traits is what makes races in the first place.
Incidentally, I left Australoids out of the discussion because I have never treated one.
By subscribing to this philosophy, however, I’m afraid you are digging yourself into a hole. This philosophy implies that the cause of malocclusion is environmental. It implies that malocclusion is caused by diet and lifestyle changes that occured with the introduction of farming and that reverting to the pre-farming diet and lifestyle would eliminate malocclusion. By acknowledging that the cause of malocclusion is environmental you are also, by deductive reasoning, acknowledging that malocclusion is not genetic. If malocclusion is not genetic then we can assume that human beings are “supposed” (genetically indicated) to have 32 teeth in straight alignment and that any deviation from this can be considered suboptimal. By this logic, any procedure that contradicts the philosophy that human beings should have 32 teeth in straight alignment, such as orthodontic extraction, must be considered harmful.
1st ceph:
Complete anterior open bite. You probably had tongue thrust. Tongue thrust can be, but not always is, indicative of upper airway obstruction.
Possibly 5mm of overjet, and no overbite.
Upper incisors flared too far forward for norms, but cannot quantify without tracing ceph.
Medium mandibular plane angle
Complete molar class II.
Retrognathia. Hard to quantify how much but looks like may be 4 to 5 mm.
You are wrong in saying your only problem was a 3mm overjet. This was a fairly complicated ortho case.
Would probably have treated this with tongue thrust appliance then Herbst later, if I were doing case these days. In other words, two-phase case.
2nd ceph:
Overjet, overbite normal.
Molars close to class I, but skeletal class II persists. Would have been nice to get more mandibular growth, but it did not happen with you.
Mandibular plane angle looks flatter, don’t know why.
In 1990, this would have been considered an acceptable case finish.
The real question is: what is AP position of maxilla pre- and post treatment. Can’t tell without blowing up cephs and trying to find Porion to do Nasion perpendicular measurement.
By the way, on both cephs, your airway space looks good. As I said, apnea usually occurs later in life for non-orthodontic reasons.
Would be interested in seeing introral photos.
After not chewing raw meat and gnawing on bones anymore, the upper cranium was able to expand at the expense of the lower cranium. Arches got shorter, but teeth did not get smaller. In fact, I realized the teeth in the ancient skulls were about the same size and shape of teeth now. Smaller jaws and same size teeth equals crowding.
Of course, the worst crowding is on kids who happen to have small arches and teeth on the large size. When you see a kid with no space between their baby teeth, or even crowded baby teeth, you know it will probably be an extraction ortho case. And no, the extractions will not make the jaws shorter than they would be!
You make the statement “God just gave the child teeth that were too big for the dentoalveolar arch.”
I’m not sure if you’re aware but modern humans, homo sapiens, have existed for over 200 000 years and ancient humans, homo erectus, for over 2 000 000. It is clear from fossil evidence that these ancestral humans did not have any degree of malocclusion. In fact, severe malocclusion only began 250 years ago after the industrial revolution.
Are you telling me that for 99.9% of human existence, god gave children nice teeth and jaws but only very recently has spontaneously decided to give children teeth that are too big for their jaws? This doesn’t seem like a very scientific approach to take. It seems much more likely they these “big teeth” related to a variable that changed after the industrial revolution, would you agree?
Do let me know if I should send you my full records although I feel you have now already said that my treatment was wrong.
This debate is rather important I feel, from the wreckage of my health.
You have now said: “Extraction orthodontics should NOT be initiated before the pubertal growth spurt WHEN THE PROBLEM IS HORIZONTAL MANDIBULAR DEFICIENCY”
Well, that was my problem and THAT IS EXACTLY WHAT HAPPENED TO ME!
HELP !!
I am not being facetious. I am here, alive and in pain.