The Bicuspid Controversy in Orthodontics (Ep 17)

Bicuspid extractions for orthodontics remain a hot topic worldwide. Pam and Mac tackle this issue head-on and share the good and the bad.

Mac brings fifty years of experience working with various orthodontists—some great, some less so. Pam, who performs much of her own orthodontic work, responded emphatically to Mac’s initial question on bicuspid extractions with, “Do not do it!”

Removing bicuspids creates a large gap on both sides of the mouth, which can simplify tooth movement during orthodontic treatment. However, this can also lead to long-term issues, such as TMD (temporomandibular disorder) pain and airway complications like obstructive sleep apnea. While there’s debate over whether this technique directly causes such problems—since not every patient with extractions develops these issues—many clinicians treating adult TMD patients report a significant number have undergone bicuspid extractions.

"Four-bicuspid" extraction cases may initially appear successful but can restrict and compromise jaw closure and contribute to a deficient maxilla, as discussed in our Trifecta Podcasts. Although some orthodontic studies deny this correlation, practitioners dealing with TMD pain often see a different reality.

Bicuspid extractions can also alter facial structure, often resulting in a flattened profile. James Nestor, author of the bestseller Breath, has publicly shared his own experience with bicuspid extractions and recovery on the Joe Rogan Podcast, further highlighting its relevance in the dental industry.

Pam also discusses the optimal age for children to be screened for orthodontic intervention and shares her differing views on craniofacial development compared to many orthodontists. Compressed airways in children can lead to chronic oxygen deprivation, causing them to "live in a fog."

In this episode, Pam and Mac challenge certain established dental practices, offering a unique perspective. Once patients complete orthodontic treatment, orthodontists typically don’t see them again—general dentists do. Unfortunately, many dentists are not equipped to treat TMD, leading to referrals to specialists like Pam and Mac. Having seen retraction orthodontics cause TMD countless times, they emphasize its impact.

If you’ve undergone orthodontics or have children in need of it, this podcast is essential listening. It’s a controversial discussion, as intended.

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