Points of Interest presented by doctors and associated specialists.

Extraction Retraction Regret Syndrome(E.R.R.S.) – The Preventable Syndrome..are you a sufferer?

“I look like an old lady, and I’m crying myself to sleep at night…you have to help me.” These are the words of a desperate woman contacting us for the very first time after she noted facial changes she felt were brought on by orthodontic treatment with removal of bicuspid teeth and subsequent retraction (pulling back) of her teeth in her face. Has this really happened for her, or is she crazy? I’m not qualified to judge that, but she’s not the only one to contact us with similar concerns about changes to the face and teeth which she feels were a direct result of the orthodontic treatment she has undergone. We hear from people around the world all the time.

Am I the only one this has happened to and who feels this way? Can we help her? Can the problems she feel were caused by retraction be reversed and the teeth be replaced? Will it be exactly the way it was before the teeth were removed and the retraction completed? Are esthetics the only concern, or are there functional issues which may accompany the esthetic concerns? Will surgery be required to reverse the retraction? Are orthodontists still doing this? These are all great questions that require time to answer, and the answers may be different for each patient. For almost all patients there is a solution.

We have been reopening previous orthodontic extraction spaces since 1989 and have treated many people with similar concerns as the woman noted above. We started doing this when another woman who was desperate to relieve headaches which had been ongoing for years forced us to try to reopen her spaces.  We promised her only that we would do our best, and that is all we have ever promised. With no experience doing this and nothing in the orthodontic literature to guide us to know that it could even be done, we warned our first patient of many dire consequences we thought might occur if we attempted to open the spaces.

Those warnings included possible recession of gum tissue, possible tooth loss, and possible need for surgery to make the teeth fit.  Her response to all our warnings was, “I don’t care” which pretty much defined how desperate she was to find a solution. We never promised that we would be successful in opening her spaces, nor that we would eliminate even one symptom. Fortunately we were successful. She was thrilled with the esthetic improvement in her facial appearance. Her headache pattern was eliminated, and has remained gone for all these years.

After our first success we found many other patients who had esthetic and functional concerns which we were able to address by reopening their extraction spaces and reverse the retraction done with their original orthodontic treatment. With 27 years of experience treating patients who have had orthodontic extraction/ retraction or just retraction without extraction it became obvious we were dealing with a syndrome.

We’ve identified this syndrome and call it Extraction Retraction Regret Syndrome (E.R.R.S.). It is defined as: “A constellation of esthetic, functional, and emotional signs and symptoms caused by tongue space/airway reduction from orthodontic retraction….all of which is preventable.” Given the fact that retraction is always a choice we have termed it The Preventable Syndrome.

Esthetic Concerns

Most esthetic concerns center on changes to the face with lips becoming recessed, thinner, cheeks flatter, smile narrower and darker, front teeth tipped back, etc. Some note these changes during the treatment, but others note them only at the termination of treatment. Many feel that the growth of their lower face was affected and believe that their jaws failed to grow forward after their adolescent treatment.

Functional Concerns

Many patients will note that their jaw joints (TMJ’s) started clicking during or soon after the treatment. Some will experience ringing in the ears. Most will sense that their lower jaw would like to be forward, but the upper front teeth force the lower jaw to be back (entrapment of the mandible). Some have experienced the inability to open all the way, and many experience pain in the muscles of the face, neck, and back. Others complain that they no longer can breathe as easily, that snoring began after the retraction, and this has affected their sleep. Obstructive Sleep Apnea (OSA) has been linked to the retraction by many patients.

Emotional Concerns

Some have pain or sleep issues so severe that their lives are significantly impacted. Many see the esthetic changes they hate getting even worse over time. Frequently the esthetic and functional concerns adversely affecting patients converge over time producing significant emotional issues which adversely impact their lives. Some cannot enjoy their children because of their symptom pattern. Some stop smiling to hide their teeth from others, and they withdraw from social situations where they feel they will be embarrassed. Some become so affected that they have no energy and cannot work. Most do not know there can be a solution, and they are elated to know that there are solutions.

Treatment to reverse such retraction hinges on a very careful examination and diagnosis of all the esthetic, functional, and emotional issues. Clinical examination, x-rays, sleep tests, autonomic testing, and other modalities may be involved in the examination and diagnosis phase of treatment. Some patients have such severe problems that only surgery to advance both jaws can remedy the problem. Others can have two or four extraction spaces opened and achieve a dramatic improvement esthetically and functionally. Since we are dealing with humans and reactions can vary tremendously, we literally never promise resolution of any esthetic or functional concerns.

Having said that we have seen OSA be eliminated with space reopening.  We continue to be amazed at patients who report that their pain patterns are gone or greatly reduced and symptoms which we never thought might be related are eliminated.  Face and neck pain, snoring and OSA, neck pain, pain down the arms, sinus infections, balance issues, numbness issues, etc. have been reported to be eliminated or reduced with reopening spaces giving people back their tongue space/airway.

Watch This Video Before You Choose Your Orthodontist.

My daughter is doing functional treatment with Dr Tony O’Connor in Cork. For you childrens health, insist that there are no extractions. The problem is not that the teeth are too big for the jaws. The problem is that jaws are too small for the teeth. The solution is to gently expand the jaws to make room for the teeth.


Posterior crossbite – treatment and stability

Posterior crossbite is defined as inadequate transversal relationship of maxillary and mandibular teeth. Even when eliminating the etiologic factors, this malocclusion does not have a spontaneous correction, and should be treated with maxillary expansion as early as possible. This treatment aims at providing a better tooth/skeletal relationship, thereby improving masticatory function, and establishing a symmetrical condyle/fossa relationship. Should posterior crossbite not be treated early, it may result in skeletal changes, demanding a more complex approach. Additionally, an overcorrection expansion protocol should be applied in order to improve the treatment stability. Although the literature has reported a high rate of relapse after maxillary expansion, the goal of this study was to demonstrate excellent stability of the posterior crossbite correction 21 years post treatment.

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Mouth breathing: Adverse effects on facial growth, health, academics, and behavior: Yosh Jefferson, DMD, MAGD

The importance of facial appearances in contemporary society is undeniable. Many studies have shown that individuals with attractive facial features are more readily accepted than those with unattractive facial features, providing them with significant advantages.

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A note from Yosh Jefferson, DMD, MAGD

The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity.

It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.
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  • paul
    At 15 I had braces for 2 years with the extract and retract method. I now have an inverted top lip I have no side profile I have to over exaggerate to smile, I am now 58 years old and would love to […]
  • Thank You
    I feel very strongly that some dentists and orthodontists are still feeding people with ill informed advice and getting paid for it. If the mouth is overcrowded the advice still seems to be […]