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Dentistry/Ageing after teeth extraction


QUESTION: Dear Dr. Joel,

I was wearing braces three years ago and four teeth were extracted, which was a big mistake. My teeth now look very nice but my face has dropped. It went very quick from having a fresh face to an tired look with expression marks around the mouth. Even my skin tone has changed. It's getting worse with the time. I'm now 35 but I've heard people saying they thought I was nearly 40.
I've got healthy teeth, a good family gene and a very healthy diet based on plenty of organic veggie, fruits, grains and nuts. How can I recover bone loss and stop the aging caused by the extraction?  Is there a dental treatment that can be done or any other way that will make me look normal again?

Thanks so much in advance for your response.

ANSWER: Carla -  You don't say which teeth were extracted, but with the change in the facial dimensions you describe, it sounds like the teeth extracted were teeth that acted as a foundation to not only your bite but your face.  If evaluated correctly, any orthodontist who requested the extractions should have realized the changes in facial dimensions and prevented the changes with appropriate tooth movements to compensate for the changes from the extractions.  

Now that the extractions are already done, the only way to regain the facial dimension may require additions to the teeth with crowns or extensive orthodontic movements.  I wish there would be a simpler way, but without examining you it is a little difficult for me to determine.  

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Joel,

Thanks so much for replying. The teeth extracted were the pre-molar (the one after the canine). The gaps are fully closed and my teeth look straight now but I must say it looks flat, not so natural. In result, my lips are now smaller (I used to have full lips and a big smile),  and my face features have changed a bit, making me look older and tired.

Many thanks,


Carla -  The premolar teeth are not considered as teeth that are foundations of the bite.  That is why during orthodontics they are the most often extracted is movement is needed.  So if those teeth were removed, the facial changes you have sustained are probably due to the poor tipping of the front teeth.  Of course, without examining you I cannot be sure, but the lack of lip fullness is often due to an incorrect tipping of the front teeth.  It might be best, if your orthodontist is not sure what to do, seek a second opinion from a different orthodontist.  I wish you well and hope you can find a knowledgeable and skilled one.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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