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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At least we agree on one thing. Extraction orthodontics should NOT be initiated before the pubertal growth spurt WHEN THE PROBLEM IS HORIZONTAL MANDIBULAR DEFICIENCY. I sure would not do it just to correct a minor overate problem. When the true problem is maxillary prognathism, which is rare, a headgear would be appropriate. It is impossible to get a child to wear one these days.
We still (rarely) set children up for serial extractions pre-puberty when there is severe arch perimeter deficiency, such that there is not possibility of ever getting all the teeth in the arch. And ONLY in cases where there is no palatal constriction. Palatal expansion is always tried to gain space, but expanding the palate too much is a tragic, uncorrectable mistake.
Very rarely in severe crowding cases is there room for the 3rd molars, even after premolar extraction. God just gave the child teeth that were too big for the dentoalveolar arches.
Were you in anterior cross bite before treatment?
Some patients live “on the edge” of TMD, and any change tip them over the edge into dysfunction. In the mid 1970s when I was trained, they were very strict about correcting bites before major restorative treatment. Almost no adults wanted braces in those days, so we altered their bite by grinding and repolishing back teeth to theoretical perfection. As a young student, I was told to do this to one patient. She never had any TMJ symptoms. After I altered the fit of her teeth WITHOUT BRACES OR EXTRACTIONS, she developed a click in one of her joints. Go figure. She was probably on the edge of TMJ malfunction. Now this procedure, “occlusal equilibration,” is rarely done.
I would further suggest also that if the orthodontics happens BEFORE the mandible growth and the appliances worn (I had a removable appliance at first that fixed the bite…upper and lower) fix the bite with the condylar head pressed back into the fossa then this could well have an effect on the growth pattern and , frankly, could well cause jaw joint issues.
I mean, what possibly could be a POSITIVE reason to do this to a growing child?
How do I “capitalize on other peoples’ suffering and the destruction of their health and lives?” Did you even bother to read the link to my practice webpage the journalist-researcher provided? How is straightening children’s teeth, almost always without orthodontics, a bad thing? Many of these children have been teased horribly at school. You think I should do this orthodontic treatment for free? You think I am HARMING these children?
Here is a cause of apnea few people think about. Over time, I get patients who don’t take care of their teeth and have molars extracted, then premolars. This decreases the efficiency of chewing. To make up for it, the tongue enlarges to help pulverize the food. Guess what else happens when to tongue enlarges? It occludes the airway space between it and the soft palate when lying down. And a patient gets sleep apnea.
The size and thus the pressure of the tongue molds the maxilla, not vice-versa.
Didn’t tell you I have mild sleep apnea. Had orthodontics as a teen, but not extractions nor headgear, het I still have mild apnea. An oral appliance is just enough to correct it. The probable cause in my case is a mandible about 4mm too short by the norms, plus probable muscle weakening with age.
The purpose of this survey is to get statistical data on the percentage of extraction cases that incur TMD, sleep apnea and other symptoms compared to the average population.
Please post on your social network as well. https://forms.gle/F5LEdN9ujjiMu4Mt6
What is sad on this thread is that any one would need to lower themselves to respond to unscientific claims by a blowhard.
It is really a blame game, isn’t it? You want someone to blame your problem on to make you feel better. And you have found a bunch of fellow blamers on this forum. You feel so enpowered, don’t you? You know SO MUCH from reading the other blamer’s posts, don’t you? Why, you know far more than educated professionals like me! We are dumb compared to you. The “Truth” has never been revealed to us!
It is like trying to blame a COVID-19 infection on a specific event or person, isn’t it? Everyone likes to blame a misfortune on someone or something. It is much more comforting to us humans to know the origin of a malady.
You CAN NEVER KNOW what your sleep apnea would have been like without orthodontics. Very likely, it would have been the same. I see tons of sleep apnea patients who never had orthodontics. The majority never had orthodontics, in fact. A game I like to play is “Predict Sleep Apnea After A Clinical Exam.” I look at things like retrognathia, size of tongue, soft palate drape, presence and size of tonsils, oropharynx width, and other things. ENTs do the same. Then I form an opinion and ask the patient about apnea. My batting average for being right is pretty good.
One explanation may be that women internalize stress more. This shows up time after time in patient interviews. I ask them, “How do you cope with stress?” Men are more likely to state a way such as running or weighlifting. Many times when I ask women I can see the muscles in their face twitch as they are grinding their teeth. And then they deny doing it!
Yet another explanation is that women generally have more petite muscles of mastication than men. Women are more likely to fatigue their muscles and send them into painful spasm. Whereas the larger muscles of men tend to break and wear teeth before the muscles are fatigued. Supporting this is that when I find a man that is petitely built in the masticatory muscle department, he tends to have muscle spasm and pain like women.
Extraction orthodontics was/is done equally often in men and women, so that would not account for the difference in TMJ malfunction.
There is a radical school of orthodontics, taught by Witzig I think, who teach that extraction orthodontics does all sorts of heinous things and should NEVER be done. When presented with very crowded cases that cannot be done without extractions, they just retort that orthodontics should not be done. Try to tell a parent this with a child that is being teased cruelly at school!
Actually, the most stressful thing to a TMJ is not extraction orthodontics, but an uncorrected Class II Divison II occlusion where the retroclined upper central incisors wedge the condyle back in the glenoid fossa. Many times the TMD improves when overbite is decreased and the upper incisors are flared forward. If the child is pre-growth spurt, many times we get lucky and get additional mandibular growth. Past the growth spurt, our luck usually runs out!
Could I please confirm that you are the same Kim Henry that is listed on this website? https://www.kimhenrydental.com/patient-stories-orthodontic.html I am a journalist and a research professor, writing an article on the debate post the Brimm lawsuit of 1986 regarding the controversial question: do premolar extraction/extraction orthodontics cause TMD/ I will be citing both sides of the debate, from Dr. Rinchuse’s claims that orthodontics have no relation to TMD issues to those of TMD specialists who claim that extraction-retraction orthodontics has a direct causal affect on TMD.
I will be citing your comment below:
“TMD is a mystery. The argument forever is whether it has a psychological basis. Lately I have read that females exhaust serotonin levels faster, and internalize stress more often, and this is the reason for their 5 to 1 ratio disparity of TMD compared to men.” I need to confirm, as a journalist, that your identity indeed is that of the Georgian practitioner in the website above. If not, could you please provide your full name and address, for reference in my article? If you have any links to articles you have published on stress (and gender) being the cause of TMD, I will cite these as well in my article. Please provide links to your research in this site.
I will post a link to my article on this site, once published.
A minor child cannot give legal consent. Your parents are the only one that could have done this.
The great majority of female patients have TMJ and never had extraction orthodontics. TMD is a mystery. The argument forever is whether it has a psychological basis. Lately I have read that females exhaust serotonin levels faster, and internalize stress more often, and this is the reason for their 5 to 1 ratio disparity of TMD compared to men.
Again, I say that not matter what nonsense you read on the internet, some children are so crowded that extractions are unavoidable. We try to avoid extractions whenever possible. That being said, when a child is so crowded that the canines are completely out of the arch, nothing much happens to the skeleton when premolars are extracted. The anterior and posterior teeth stay about where they are, and the canines just scoot over to where the premolars were.
Orthodontics vary from country to country. The orthodontics in Great Brittain were not very good 20-30 years ago. Don’t know if it has improved since then. I encourage a Brit whose daughter had severe asymmetry to take action now, and she was determined to wait to see if NHS would pay for it.
Incidentally, WHATEVER THE CANT OF THE NECK, the head should be level in a lateral ceph x-ray. The Frankfort horizontal plane should be parallel to the floor before taking the x-ray. It was NOT in the 2nd x-ray film. It was sloppily taken.
Airway is an important part of our diagnoses. I routinely refer to ENTs before treatment. HOWEVER, the ENTs cannot always re-establish a better airway, especially in allergic problems. Otherwise, it would take turbinate surgery, which many parents would not agree to.
By all means in life and death situations the professionals step in and act but removing body parts of a Gillick competent child without any discussion with the child themselves for the sake of a bit of possible overcrowding that hasn’t actually happened yet?
surely it was incumbent on any orthodontist now and in the past to make sure at least that any treatment is not harmful. There is a period of natural growth and there is no question that my forward growth was stunted. Can you explain to me why anyone would have attempted to stunt the forward growth of my face and where the proof is that this is a harmless thing to do to a child?
Unfortunately I think I could probably answer these questions from the point of view of the orthodontic profession at that time. They were looking only at my teeth. They saw the 3mm gap between top and bottom teeth. They saw that I had pretty small jaws (and yes: I totally agree that if I were mouth breathing that would absolutely contribute to a growth problem, but why then did no one suggest I was helped to breathe through my nose?) Instead, they thought it would be a jolly good idea if they made sure that every tooth came in poker straight by REMOVING teeth. They removed my deciduous canines age 8. As the teeth come in they GROW the jaws. Is it not absolutely obvious that if you start removing teeth you negatively affect the growth of the jaws? It is actually pretty easy to allow a face to collapse down and back, though more difficult (from what I have seen) to actively encourage forward growth.
And then to remove permanent teeth before full eruption and before puberty and the accompanying growth spurt commences is surely unethical? It is a permanent change to my body before anyone could say for sure that it was necessary as I was in a period of growth.
I am afraid that this was a treatment based entirely on what my teeth would look like and they pulled my upper jaw back to ‘fit’ with a lower jaw that was retruded and not fully grown by any means.
My main concern I assure you is what the heck to do with the situation now, but regarding this treatment why was the onus not on the orthodontic profession to prove that this will not have detrimental effects or AT LEAST be honest about the possible negative consequences. I don t think many parents who agree to premolar removal have any idea these are permanent teeth and they certainly don t think they are agreeing to something which will change the shape of the soft tissues to make the upper lip more retrusive (and there IS evidence to prove the latter)
Where is the Hippocratic oath in all this?
Forward head posture can be caused by many things, not just orthodontics. I have it, because as a boy and teen I hunched over a worktable for many hours building model airplanes.
Likewise, many things can cause TMJ damage. The most common I see is women grinding and clenching. Most of these never had any orthodontics, much less orthodontics with headgear. Disc degeneration and arthritis are two other causes of TMJ damage.
You miss my point about the ceph x-ray. Your whole cranium is canted downward in the second film. They are not accurate to compare, unless you correct them. I don’t know if it is positional error, but you have open lip posture in the first film, which is undesirable.
At the time you were treated, there was a huge bias toward premolar and even second molar extraction. The pendulum swung way too far the other way about 10 years ago, and remains stuck there. I see teeth that have been ground on just to avoid extractions. Now the teeth are very sensitive. You cannot imagine how much goes into a proper orthodontic workup. Very often times we must make compromises, even in children. We like to think we can modify growth a little, but it does not always happen.
I am not going to pretend to have the full scientific facts behind why the forward head posture comes about but from experience of enduring this procedure I think it has something to do with making the airway open and comfortable and also needing to pull the head back (ie shortening the occipital muscles) in order to open the mouth to, for example, eat. That is simply because there is so little space between jaw and throat that to keep the neck aligned the jaw hits the throat when opening to eat. The problem is that the body adapts very fast and unconsciously in order to maintain basic functions and people (medics, parents) are mostly oblivious to what this looks like from the outside and the child knows nothing different. I should say that now (I am 44 now) my jaw joints are so badly damaged (and that is not a matter of conjecture…that is on CT and MRI) that I can barely open my mouth anyway.
What is so devastating to me is that in 35 years of suffering no one has given me any scientific reason for the medical need to remove teeth before puberty and start retracting my upper jaw well before my lower jaw was fully grown. And what was this terrible original symptom I had? A 3mm gap between upper and lower teeth at age 7. There was no protrusion of my front teeth. My lips met without any strain. My upper jaw/ face was clearly not growing too much forward…far from it. My profile up to my mandible looked absolutely normal or if anything possibly slightly flat. So would someone please explain to me what would be the health benefit to me of retracting my face before it was anything like fully grown? Quite clearly from looking at my profile before and after there was certainly no aesthetic benefit. If I can I will add some pictures. I would say that my looks were ruined. But the main problem is that function and form are closely allied and I am debilitated by continuing symptoms and that this continues to devastate my life on every level