"My office manager asked a question about a dental procedure that I can't answer, so I thought I'd let you field the question.
"She has three kids and would like to have the procedure performed on them. Her feeling is that there is a substantial difference in price and no emotional trauma that is associated with wearing braces. Her dentist does not want to perform the procedure because he feels it can later lead to TMJ problems. Most of her family has had this procedure done with no ill effects. Is it a financial question or is there proof to back up the doctor's claims?
"She reads Dynamic Chiropractic each month, so you have permission to respond to this letter in Dynamic Chiropractic. I thank you for your time."
What are "serial extractions?"
Serial extraction is a term used for a procedure when a dentist plans a series of extractions of certain deciduous teeth (the so-called baby teeth). Simply stated, the rationale behind this approach is that a serial extraction procedure encourages normal (i.e., straight) eruption of the permanent teeth since the new teeth do not have to contend with pushing the deciduous teeth out of the way. When this procedure is successful, orthodontic care is often avoided or the need for braces is lessened.
At one time, some dentists believed that serial extraction procedures were a panacea and overprescribed this type of care. As one would expect, not every child had a good outcome; some even needed more orthodontic care than if the extractions were not performed in the first place. Yes, it is quite possible that some of these children even developed TM disorders as they grew up.
How do I decide if serial extractions are appropriate for my child?
Essentially, the decision rests with a knowledgeable dentist who has properly examined the child. At this point, it is advisable that the parent sit down with the dentist and listen to advice as to the wisdom of a serial extraction procedure. More often than not, the dentist will be able to use effective visual aids such as models of the child's teeth, computerized predictions of the facial changes, photographs of children who underwent similar procedures, etc.
This also applies to the child for whom serial extraction is not indicated. Again, visual aids come in handy to help the parent understand why the procedure is the wrong one for their child.
What do I do if my dentist feels that a serial extraction procedure may lead to TMJ problems?
This is a hard question to give just one answer. First, one has to consider whether or not the dentist is qualified (by training) to predict that serial extractions may lead to TMJ problems. The odds that the dentist is adequately trained in this area are low, since this type of training borders on that of a specialty.
Secondly, it is possible that the dentist is quite experienced with the serial extraction procedure and, therefore, accurately knows when the procedure is safe.
So what does one do?
The best advice to any parent who wishes their child to have a serial extraction procedure is to seek out the advice of a dentist who is expert in the growth and development of a child's dentition and skull. Usually this means seeking the opinion of an orthodontist, but not necessarily any orthodontist.
The advice I give to my patients in similar circumstances is to seek the opinion of a particular type of orthodontist -- one who is expert in functional orthopedics. The reasons for this are many, but the primary one is that functional orthopedic procedures may be substituted for serial extractions -- often with superior results.
With each article I encourage you to write the questions you may have, commentaries on patient care subsequent to attending the TM seminars, or thoughts to share with your colleagues, to me:
Darryl Curl, D.D.S., D.C.
2330 Golden West Lane
Norco, California 91760
Please enclose your return addressed, stamped envelope.