My 17 year old son had his first premolars extracted due to overcrowding of his teeth. We were not told the effects of removing those four teeth. My son feels he lost his character in his smile. He feels his face is caving in. He feels his jaw is moving back. We want to preserve the wide smile. Is there any way to continue treatment of closing the gaps without all that damage to the face. As in narrowing the smile. The feeling of the face caving in. Should we remove the braces and keep the spaces open for now and eventually put implants there? My son is having severe panic attacks he can't sleep at night.

Sandy -  If the extraction of the premolars have caused a change in your son's facial appearance, that he is not comfortable with, I assume it is not the extractions, but the subsequent orthodontic treatment.  The question is does the orthodontist know what he is doing.  What was the purpose of the extractions?  Did your son have a big overbite?  Before any orthodontics, besides xrays, the orthodontist should have taken pictures of your son's mouth, his face and his profile.  Regaining the profile that was lost, if it was good for your son can usually be regained.  Will orthodontics do it?  It may, but sometimes surgery by an oral and maxillofacial surgeon might be needed in addition.  

So, of course, without examining your son it is a little difficult for me to tell you the best solution.  In New York there are many qualified skilled doctors who should be able to attain the results you and your son want.  If you wish, get back to me, tell me where in New York you live and I will try to send you names of doctors who are skilled at establishing facial contour that you think is best.  The doctors might think otherwise and offer different options, but if you and your son know what you want, it can usually be achieved.


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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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