Do Orthodontic Extractions Damage Your Face, Narrow Your Arches, or Affect Breathing?

Do Orthodontic Extractions Damage Your Face, Narrow Your Arches, or Affect Breathing?

6 September 2025

When patients look for orthodontic advice online, they often see worrying claims:

• “Extractions ruin your face.”
• “Braces with extractions make arches narrow and cause breathing issues.”
• “You should never let an orthodontist remove teeth.”

These statements sound dramatic, but they are not supported by scientific evidence. Let’s look at what the latest research and professional guidelines actually show.

1. Do Extractions Damage the Face?

No. High-quality studies confirm that extractions do not harm facial aesthetics when treatment is properly planned. In many cases, extractions actually improve lip balance and facial proportions.

• Moon et al., 2021
• Qali et al., 2024

2. Do Extractions Constrict Dental Arches?

No. Extractions create space to align teeth within the patient’s natural jaw size. They do not collapse or shrink the arches.

By contrast, forcing expansion or flaring teeth forward to “avoid extractions” can cause gum recession, bone loss, and instability.

• Aksu et al., 2025

3. Do Extractions Cause Breathing Problems?

No. The American Association of Orthodontists (AAO) reviewed all available evidence and concluded that extractions do not cause obstructive sleep apnoea (OSA). Airway health depends mainly on skeletal anatomy, soft tissues, and body weight, not on whether premolars are removed.

In my own clinical practice, I have seen many patients who never had orthodontic treatment and never lost teeth, yet suffer from severe sleep apnoea. Conversely, I have also treated individuals who lost multiple teeth, sometimes most of their dentition, with or without orthodontic treatment, and who breathe normally without any signs of sleep apnoea. Patients who develop OSA years after orthodontic treatment or after extractions would almost certainly have developed it regardless. To make simplistic correlations between orthodontic extractions and sleep apnoea is not only unsupported by science but also naïve and misleading.

• Larsen et al., 2025

4. Do Extractions Cause TMJ Problems?

Another common myth is that orthodontic extractions lead to temporomandibular joint (TMJ) disorders. This claim is not supported by scientific evidence.

Large systematic reviews and position statements confirm that there is no causal link between orthodontic treatment, with or without extractions, and the development of TMJ disorders. TMJ problems are complex and often multifactorial, involving factors such as genetics, trauma, stress, bruxism, and systemic health conditions.

In my clinical practice, I have seen patients with significant TMJ pain and dysfunction who never had extractions or braces, as well as patients who underwent extraction-based orthodontics and have perfectly healthy joints. The reality is that TMJ disorders can develop with or without dental extractions. Suggesting otherwise oversimplifies a complex condition and risks misleading patients.

McLaughlin et al., 1995

Why Do These Myths Continue?

Some clinicians promote “non-extraction at all costs” treatment. They may expand arches too aggressively or flare teeth unnaturally, often to make their treatment look more appealing.

But this approach can lead to gum damage, unstable results, and poor long-term outcomes.

The truth is simple: extractions are neither always good nor always bad. They are one of many tools. The best treatment is the one designed for your unique biology and long-term stability.

The Bottom Line

• Extractions do not harm facial aesthetics when carefully planned.
• Extractions do not collapse arches—they protect against harmful overexpansion.
• Extractions do not cause breathing problems—this claim is not backed by science.

Patients should be wary of absolute anti-extraction claims. The safest choice is to trust an orthodontist who plans treatment based on evidence, not marketing slogans.