If you spend enough time on TikTok or YouTube, you’ll eventually hear someone say:

“Orthodontic extractions ruined my face.”

It’s one of the biggest controversies in modern orthodontics.

Some people believe removing premolar teeth automatically causes:
• Flat faces
• Smaller airways
• TMJ problems
• Aging appearance
• Poor tongue posture
• Sleep apnea

But is that actually true?

As a certified specialist orthodontist and University of Toronto orthodontic faculty member, Dr. Anuraj Kochhar believes the answer is much more nuanced.

The reality is this:

Not every case is extraction.
Not every case is non extraction.

Good orthodontics is individualized treatment planning — not social media ideology.

## Can Orthodontic Extractions Be Harmful?

Yes. In the wrong patient, poorly planned extractions can create problems.

Orthodontics is not simply about straight teeth. It involves:
• Facial balance
• Airway considerations
• Skeletal pattern
• Lip posture
• Gum and bone support
• Long term stability
• Function

If teeth are removed without understanding facial growth, soft tissue support, and biological limitations, outcomes can suffer.

That is why diagnosis matters more than trends.

## When Extractions May Actually Be Necessary

There are many situations where extractions can improve both dental health and facial harmony.

### Severe Protrusion

Some patients have significantly protrusive teeth and lips that cannot be corrected safely with expansion alone.

In these situations, extraction treatment may:
• Improve lip competence
• Reduce strain during mouth closure
• Improve facial balance
• Reduce trauma risk to protruding teeth

Many patients with severe protrusion actually achieve a softer, more harmonious profile after properly planned extractions.

## Lip Incompetence

Lip incompetence means the lips do not naturally close at rest without muscular effort.

Patients often:
• Strain to close their mouth
• Develop dry lips
• Mouth breathe
• Experience facial muscle fatigue

In selected cases, reducing dental protrusion through extractions can improve natural lip seal and facial comfort.

## Periodontal Limitations

One of the most ignored realities online is gum and bone anatomy.

You cannot move teeth infinitely forward without consequences.

Excessive expansion or pushing teeth outside the supporting bone may increase risks such as:
• Gum recession
• Bone loss
• Instability
• Root damage

Sometimes extraction therapy allows teeth to remain within healthier biological boundaries.

Orthodontics must respect anatomy.

## What About Airway Concerns?

Airway discussions are important — but they are often oversimplified online.

Current evidence does not support the idea that every premolar extraction causes airway collapse or sleep apnea.

Airway health depends on many factors including:
• Jaw structure
• Nasal breathing
• Tongue posture
• Muscle tone
• Obesity
• Skeletal growth pattern
• Genetics

That said, modern orthodontists absolutely should evaluate airway considerations during treatment planning.

At Care Orthodontics, Dr. Anuraj Kochhar evaluates not just the teeth, but the entire facial and skeletal picture before making treatment decisions.

## Does Invisalign Avoid Extractions?

No.

Invisalign is simply a tool used to move teeth.

Some Invisalign cases still require:
• Premolar extractions
• Interproximal reduction (IPR)
• Expansion
• Elastics
• Orthopedic correction

The treatment philosophy matters more than the appliance itself.

Braces and Invisalign can both be used successfully in extraction or non extraction treatment plans.

## The Biggest Mistake in Orthodontics

The biggest mistake is treating every patient the same way.

Some faces benefit from expansion.
Some require extractions.
Some require surgery.
Some require growth modification.

Orthodontics is individualized medicine.

The goal is not to follow trends.

The goal is:
• Functional balance
• Stable results
• Healthy gums and bone
• Proper bite relationships
• Facial harmony
• Long term health

## Final Thoughts

The internet often presents orthodontics as black and white.

Real orthodontics is not black and white.

Extractions are neither inherently “good” nor inherently “bad.”

The key is proper diagnosis, proper planning, and understanding the limits of biology and facial balance.

As Dr. Anuraj Kochhar often says:

“Not every case is extraction and not every case is non extraction. Every patient deserves individualized treatment based on their own anatomy, function, and facial goals.”