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Dr. Bullwinkel is proud to partner with The Charleston Moms Blog in ‘Ask The Experts.’  ‘Ask The Experts’ is a monthly publication where local professionals answer any and all questions that LowCountry parents have regarding family and life. 

Q: My child has some severe crowding and it’s been recommended to have some permanent teeth pulled prior to starting braces treatment. Is there any way to avoid this and if not, how do I prepare my child for this experience?

A: Great question! Orthodontic treatment plans come in all shapes and sizes just like our children. When someone is very crowded, you have to create room for all of the teeth to fit safely and aesthetically within the arch (bone that holds the teeth).

I like to compare it to a crowded city parking lot. You only have two options: You can make the parking lot bigger or you can take cars out of the parking lot.

When making the parking lot bigger there are biologic constraints. You can only make the arch as wide as the bone structure will allow, but things like expanders can create a wider arch to fit the teeth. Additional space can be gained by the front teeth coming forward, but you certainly don’t want your front teeth coming through the door before you do!

Sometimes these outside factors push a treatment plan towards removing teeth. The teeth that are typically used to create space are called “premolars.” There are a pair of these premolars in each quadrant of your mouth so they are GREAT space creators and do not affect chewing function or smile aesthetics. In short, you won’t miss them! The only people who will know you are missing these teeth will be you, your orthodontist, and your dentist.

Bottom line is that extraction versus non-extraction is very case by case dependent. Ultimately, you want the healthiest, most stable, and most aesthetic smile possible for your child.

Prepare you child by letting them know WHY they are having teeth pulled. Assure them that there will not be any space when treatment is over- that is usually their biggest concern. Sometimes I will even put the braces on first so that the extractions aren’t noticeable… you get a hall pass once braces are on- PROMISE! They will be a little sore after the extractions, but most kids heal incredibly fast and are back to normal as early as the next day.

Final thoughts- pick a doctor you trust, ask questions, and make sure you understand the treatment plan. Sometimes this requires a few conferences with your doctor so that everyone is on the same page.

I hope this helps!


Dr. Katie Bullwinkel
Board Certified Orthodontist
Bullwinkle Orthodontics