Doctor's Answers (2)
I certainly agree with Dr Singh’s comments. It sounds like your canine is of poor quality as one dentist advised you to keep the healthy premolars? Extraction treatment plans should answer these questions:
1) does the facial and lip profile need to be softened by changing the lip support via extractions? Would taking out teeth cause excessive space to undermine lip support that is currently good, causing an ageing look?
2) Are there alternative ways to create space other than extraction of teeth? Can this be safely achieved? Will it take forever?
3) if extractions are needed, can good quality teeth be preserved? Can teeth that have decay, large fillings, weirdly shaped, cracked teeth be taken out for space without sacrificing biomechanics and increasing treatment time unrealistically?
Do consider bringing up these points when you next discuss your treatment options with your dentist.
Dr POON Kee Hwang
The first thing we normally establish is if indeed there is a need for extractions. This depends on several factors including the amount of crowding, the specific orthodontic issues we are trying to correct and your specific facial profile.
We would discuss the advantages of extractions vs non extractions and see which you are most comfortable with.
Once we decide that extractions are needed to achieve your desired result, and you are happy to proceed with that treatment plan, then we would go into what specific teeth ought to be extracted.
Now once again, the teeth we extract is highly dependant on what specific orthodontic problems we are trying to correct.
From a conventional perspective, should extractions be needed and agreed upon; it would be preferable to remove a premolar instead of a canine. Thats not to say that canines are never removed. It very well may be if your specific set of corrections require a canine removal.
However, all things being equal and if there are no special or extenuating circumstances, we general endeavour to avoid the removal of a canine and go with removing a premolar instead.
There are several reasons for preserving a canine. Briefly: canines are very significant in the determination of a healthy and stable bite. It is extremely useful to have canines during the movement required to chew (like sideways movements of the jaw and forward/back movements of the jaw).
Canines are also one of the only teeth in our mouths which is used for shearing forces. We generally use our front teeth for cutting and back teeth for grinding. But canines exclusively are used to shear during chewing. So having 4 healthy canines adds a great deal to someone's chewing capacity.
Once again, this is a general outline and there are certain cases where a canine ought to be removed. But all things being equal, I would say most dentists would advise you to keep a healthy canine if possible.
I do hope this has been helpful and useful to you.
Dr Hardev Singh