The problem of extraction in orthodontics

Abstract

To conclude this essay, it will be stated once more that the problem of extraction is essentially a problem of disrelation. This disrelation is latent in recent man on a phylogenetic basis since the teeth are not sufficiently reduced and thus out of proportion to the much reduced jaws. This disrelation becomes still more accentuated if occurring in individuals of certain constitutional pattern. On the strength of these facts, we should adopt a less tooth-centered point of view when appraising our patients and their anomalies. We should speak less of “narrow jaws,” of “too small jaws,” and of the “necessity of widening underdeveloped jaws.” For we have seen that jaws are reduced, that a small or narrow palate, generally, corresponds to the special type of an individual and that, if we want to speak in the case of disrelations of a “fault” at all, it is not the “fault” of the jaws but that of the teeth which are out of proportion to the general habitus of the patients. Since we cannot change the habitus of the patient, we have only the other possibility left: to adapt the denture to the patient by reduction. We have seen that Nature herself has chosen this path, be it by reducing the number of the teeth, be it by reducing their average size. But Nature has not yet succeeded in creating a satisfactory balance. On the contrary, if we look at the problem from an evolutional point of view, we shall realize that recent man's mouth is a battleground where evolution just now is waging a fierce campaign. At the head of this article, a sentence is quoted which Galton wrote more than half a century ago: that man from observation of the past should infer the course evolution is bound to pursue, and that he might devote his modicum of power, intelligence, and kindly feeling to render future progress less slow and painful. With respect to the problem we have discussed, we cannot, in the present state of our knowledge at least, accelerate the evolutional process. But, I think, we can make it less painful by anticipating and executing Nature's own intentions: reduction of the denture.