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healthy_back Ещё одна статья: https://karinbadt.medium.com/the-science-of-orthodontics-511e94795aa (https://disk.yandex.com/i/NgJc9lo5ou_zbQ)
Статью я выложу только ссылкой, сюда не буду (27 страниц). Но у меня ещё есть пассаж без ссылки, но явно её авторства. Вот он под катом на английском.
This is a moot argument because the orthodontic AAO Guidelines to Orthodontists specifically state that if TMD develops during or after the treatment it is to be considered a coincidence. They wrote these guidelines after the Brimm lawsuit of 1986, to make sure no orthodontist blows the whistle and starts noticing there is a causal relationship. They are trained to say it has nothing to do with each other. For example, my TMD was caused by condyles being too back. With some reversal treatments, my condyles came forward. I no longer have TMD. When I point that out to pro-extraction orthodontists, they say it is a coincidence that you had TMD after extraction orthodontics, and now that it has gone away because I reversed extraction orthodontics, it does not mean it is not a separate condition and will come back later. TMD is so vaguely defined that the orthodontists can basically have a field day with denying it has anything to do with occlusion, movement of teeth, or even jaws. One study surveyed about 80 Brazilian orthodontists and asked if they thought TMD could be caused by orthodontics. About 60% of them said yes (let me find the article): especially those who'd been practicing for a long time. The conclusion of the authors of this study was that they had to "re-educate" those orthodontists to know that it is just a coincidence, that "high quality" post-Brimm case studies have "proved no connection between jaw joint and orthodontic movement" and that these orthodontists who continue to think that orthodontic treatment can cause TMD are dangerous for the profession and need to be "re-educated" to know "the truth" that there is no such thing as TMD after orthodontics, or else their "false belief" will end up giving orthodontics a bad reputation. A reputation that it deserves. Let me find that article, it was fascinating, the Orwellian double-think. My figures might also be a bit off, as from memory. One thing you CAN prove with before and after xrays is if the condyle has distalized, which is a cause of TMD. Another thing to prove is that mandibular movements changed, but this is too late, because this is not something measured from a conebeam.
The research paper they probably presented was a 1992 study published in the AJO-DO. The 1992 journal has several publications that had been commissioned by the American Association of Orthodontists to protect themselves from lawsuits, after the 1.3 million dollar lawsuit from 19 year old Susan Brimm, who had severe TMD from extraction/retraction (PER). If you read these journal articles, they are absurd. They say that occlusion has nothing to do with the jaw joints hence no connection to TMD. TO combat them, you could collect articles on Bruxism and TMD which prove the correlation between....occlusion and TMD. There is also Witzig's 1960 article on TMD and premolar extractions. There is also the 2023 research article published in a high impact journal establishing that PER causes changes in mandibular kinematics and position and 'Is a risk for TMD." That is some ammunition for you. I have posted links to all these articles on the FB group Extraction Orthodontics Reversal, as well as hyperlinked some of these articles in my MEDIUM article on the Risks of Premolar Extractions. If your lawyer wants to speak to me, I can give him/her some tips of how to approach this industry. I had communication with the lawyer who won Susan Brimm in Michigan the 1.3 million dollars. (Poor woman, her sister tells me that 40 years later, she still suffers from severe jaw pain).
Here are the articles that were commissioned by the AAO to deny the findings of the Brimm Case: deliberately published so future patients like you cannot win a lawsuit against an orthodontist for TMD issues. The articles are in these links. The one shown by the defending lawyers in your case was probably by either Rinchuse, Giannely or Johnston (you can read them here in the links). Rinchuse's article is required reading on the Board Exams, so every orthodontics student gets the propaganda and now all orthodontists repeat like monkeys:" "High quality evidence have proven there is no link between orthodontic treatment and TMD." Your lawyer should be aware of this cover-up and what he or she is fighting against. They should also take a look at the AAO Guidelines to Orthodontics which lists risks with orthodontics that orthodontist at their own discretion can "choose" to disclose to patients. They have a very suspicious clause at the end of their list. "If your patient develops TMD during your treatment, this is to be considered a coincidence and due to pre-existing conditions." Like it is a coincidence if one dies at the same time that a truck runs over you. Your lawyer is fighting against something much bigger than he knows: the entire orthodontic specialty, and 60 years of trying to keep the TMD risk from coming out of the bag. Read my article on Medium which describes the TMD and PER relationship coverup.
There is also an 80 year old orthodontist who knows a lot about this cover-up--including seeing advertisements to orthodontists to write these articles--whose email I can share if interested.. I have personally helped 3 premolar extracted people get their treatment costs back from their orthodontist after TMD developed, by composing a letter for them. These orthodontists obliged the patients to sign a Release of Liability form in exchange for the treatment cost return. The lawyer in Michigan who won the case is Gittleman. He may be a good contact for your lawyer. Why not forward this entire message to him? 2 of my articles are on the list. I also have over 3000 responses to my survey on premolar extractions, and 45% of these report TMD. If your lawyer is in the US, he or she may want to consider escalating the case to a group action lawsuit. I can share with them the survey data and the verbatims.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3989577/
"This issue has been noted by many researchers in academic dental training centers worldwide. The results of many studies in this field have shown surprisingly high prevalence rates of TMJ injuries (50-63 %) after extracting mandibular teeth by dental students".
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1566010221024177/
Pertinent to those who have had premolars extracted:
The AAO’s Position on Premolar Extractions and the Narrowing of the Airway: Is It Ethical?
Karin Badt
Introduction
The American Association of Orthodontists (AAO) in its White Paper on "Obstructive Sleep Apnea and Orthodontics” (2019) affirms that orthodontic treatment involving premolar extractions "may narrow the upper airway.”[i] However, the potential narrowing of a person’s airway due to extraction orthodontic treatment is presented as unproblematic. In the AAO’s view, if a patient has healthy airway muscles, these muscles will "compensate" for the iatrogenically narrowed airway and “the airway will not collapse,” i.e. cause Obstructive Sleep Apnea (OSA). Thus a potentially narrowed upper airway is not presented as a reason to limit premolar extractions.
It is to be noted that the AAO does not consider the potential other effects of a narrowed airway such as reduced vocal resonance; diminished stamina; and breathing disorders such as snoring, Upper Airway Resistance Syndrome, or habitual mouth-breathing.
Contradicting the AAO White Paper’s claim that a narrowed airway does not cause airway collapse (i.e. OSA) is an earlier section of the same AAO White Paper which details how a narrowed airway causes airway collapse (i.e. OSA):
“As the upper airway is narrowed or completely occluded, the patient's effort during breathing progressively increases. Owing to the airflow restriction, there is a relative increase in serum carbon dioxide (CO2; hypercarbia) and decrease in serum oxygen (hypoxemia). The escalating respiratory effort causes a cortical arousal from sleep, which results in the upper airway opening so that normal airflow is reestablished. Once the patient falls back to sleep, the upper airway may collapse again with recurrence of the above-noted process. This breathing sequence may have significant consequences for the child (p.20).”
Yet in the later section of the paper discussing premolar extractions, the AAO insists that if airway collapse results from a narrowed airway, it would not be due to the narrowed airway, but to the patient’s failure to adequately compensate for their narrowed airway with their airway muscles.
The reasoning rests on a dangerous assumption. Airway muscles predictably weaken with age, and other factors. Consequently, muscular compensation is not guaranteed to prevent airway collapse for the duration of a patient’s life.[ii]Even in childhood or early adulthood, there is no certainty that a narrowed airway can be adequately compensated.
There is currently no legal obligation for orthodontists to disclose to patients that premolar extractions may narrow their airway--and that they may need to “compensate” with their airway muscles for the rest of their lives to avoid developing Obstructive Sleep Apnea.
I asked ChatGBT Plus if this was ethical.
Here is ChatGBT's response:
You're correct in recalling that the American Association of Orthodontists (AAO) White Paper on obstructive sleep apnea (OSA) discusses the role of airway muscles in maintaining airway patency, when anatomical narrowing occurs due to orthodontic treatments like premolar extractions.
The White Paper acknowledges that orthodontic treatments can affect the dimensions of the upper airway. However, it emphasizes that a reduction in airway size does not necessarily lead to functional impairment.
Specifically, the document states:
"In discussing orthodontic treatment to changes in the dimensions of the upper airway, it also is helpful to understand that an initial small or subsequently reduced or increased size does not necessarily result in a change in airway function. Reflecting the higher significance of neuromuscular control on airway function during sleep, it has been demonstrated that a narrow airway does not result in OSA, but rather it is an inability for a patient's airway muscles to compensate adequately that leads to obstruction and sleep‐disordered breathing."
ME:
"Do you think it is right to narrow a person's airway without disclosing to them prior that it may be narrowed, and they will need to "compensate" for the iatrogenic deformity all their lives?"
ChatGPT said:
That’s a deeply important and ethical question—and you’re absolutely right to raise it.
FROM A MEDICAL ETHICS STANDPOINT:
No, it is not right to alter a person’s airway—especially in a way that could have lifelong consequences—without fully informing them. This is fundamentally about informed consent, which is a legal and ethical cornerstone of medical and dental practice.
Here’s how this breaks down:
1. INFORMED CONSENT = FULL DISCLOSURE
Patients have the right to know:
That premolar extractions and retraction mechanics can narrow their airway.
That they may need to "compensate" neuromuscularly to avoid symptoms of sleep-disordered breathing.
That this compensation may not always succeed, especially with age, weight gain, or other factors.
To withhold this information—or frame it as unimportant—is not just unethical; in some jurisdictions, it could be considered negligence.
2. “COMPENSATION” SHOULD NOT BE THE GOAL
Imagine a surgeon telling a patient:
"We’ll remove part of your lung, but don’t worry—your other lung will compensate."
Or:
"We’ll make your nose smaller than your airway needs, but the muscles in your throat will figure it out."
That’s what’s happening here—iatrogenic narrowing of the airway, often without even acknowledging it, then relying on the body’s adaptation to prevent health issues like sleep apnea. That's a physiological gamble, not patient-centered care.
3. THIS ISN’T ABOUT BLAME—IT’S ABOUT EVOLVING THE STANDARD
Most orthodontists don’t set out to harm their patients. Many were simply taught that extractions and retraction are standard, safe, and effective. But when science advances, so should practice standards.
Ignoring emerging evidence—or dismissing concerns because "compensation works for many patients"—is a form of institutional denial that prevents the profession from growing.
BOTTOM LINE:
Patients deserve to be told when a treatment could narrow their airway. They deserve to know the long-term risks. And if orthodontists continue using retractive methods, disclosure must be part of the process.
ENDNOTES
[i] The following peer-reviewed studies have established that premolar extractions with retractive orthodontics reduces airway space and alters hyoid position. Some of these papers are cited in the AAO White Paper.
1. Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillarydentoalveolar protrusion
"The size of the pharyngeal (velopharyngeal and glossopharyngeal) airway reduced and hyoid bone position changed after retraction of the incisors in extraction space in bimaxillary protrusive adult patients."
Bhatia S, Jayan B, Chopra SS.
Med J Armed Forces India. 2016 Dec;72(Suppl 1):S17-S23. doi: 10.1016/j.mjafi.2016.06.006. Epub 2016 Oct 17. PMID: 28050064; PMCID: PMC5192225.
Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.
2. Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients - PMC.
"Large incisor retraction leads to narrowing of the upper airway in adult bimaxillary protrusion patients."
Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.
Angle Orthod. 2012 Nov;82(6):964-70. doi: 10.2319/110211-675.1. Epub 2012 Mar 30. PMID: 22462464; PMCID: PMC8813144.
3. Effects of Four First Premolar Extraction on the Upper Airway Dimension in a Non-Growing Class I SkeletalPatients: A Systematic Review
A systematic review that concludes that premolar extraction/retraction can cause the narrowing of the pharyngeal airway, a change in tongue position, and the reduction of oral cavity space, and hence is a risk for sleep apnea.
Choi JY, Lee K.
J Oral Med and Dent Res. 3(1):1-16. (2022)
4. Missing teeth and pediatric obstructive sleep apnea.
"Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep."
Guilleminault Christian, Abad Vivien C., Chiu Hsiao-Yean, Peters Brandon, Quo Stacey. doi: 10.1080/08869634.2016.1192315.Sleep Breath Epub 2016 Jun 30. PMID: 27356671.
5. Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post- retraction world oforthodontics.
“We recommend that optimizing the airway for every patient and never doing any treatment [such as retraction]which will diminish the airway, even minutely, needs to become the standard of care in Airway Centric® Dentistry."
Hang William M., Gelb Michael. Cranio. 2017 Mar;35(2):68-78.
6. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review.
"Extractions followed by large retraction of the anterior teeth in adult bimaxillary protrusion cases could possibly lead to narrowing of the upper airway. Mesial movement of the molars [instead of retraction] to closethe extraction spaces appeared to increase the posterior space for the tongue and enlarge the upper airway dimensions."
Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S
2015 May;19(2):441-51. doi: 10.1007/s11325-015- 1122-1. Sleep Breath. Epub 2015 Jan 28. PMID: 25628011.
7. Effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults: a retrospective cephalometric assessment.
“A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I [40 class I patients with bimaxillary protrusion and maximum anchorage] , III [40 class II patients with maximum anchorage], and IV [22 skeletal class III patients with maximum anchorage] (P < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors (r = 0.6- 0.😎. In group II [40 class I patients with moderate crowding and anchorage], a significant increase was observed in oropharyngeal and velopharyngeal dimensions (P < 0.001). A significant increase in nasopharyngeal dimensions occurred in allgroups (P < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions (r = 0.4 - 0.6). According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions.”
Mortezai O, Shalli Z, Tofangchiha M, Alizadeh A, Pagnoni F, Reda R, Testarelli L.
PeerJ. 2023 Oct 23;11:e15960. doi: 10.7717/peerj.15960. PMID: 37901473; PMCID: PMC10601897.https://pubmed.ncbi.nlm.nih.gov/37901473/
8. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal class II cases.
“Study concludes that with the closing extraction spaces, the maxilla and the mandible retrude, causing a retrognathic mandibular position and consequent constriction of the oropharyngeal airway.”
Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E.
Angle Orthod 1998;68:327-36. https://pubmed.ncbi.nlm.nih.gov/9709833/
9. Effect of orthodontic treatment on the upper airway volume in adults.
Study concludes that in general there is no difference between those who get extractions with orthodontic treatment and those who get orthodontic treatment alone: both lose 5% of airway volume which the authorsconsider an insignificant loss. However, the study did note a “significant narrowing” of the airway if the patient presents with moderate or little crowding. In these cases [which constitute the majority of cases in which premolar extractions are used] the retraction and shrinkage of the dental arches and the [loss of oral cavity space] is “significant.”
Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR.
Am J Orthod Dentofacial Orthop. 2016;150(6):937-944. https://pubmed.ncbi.nlm.nih.gov/27894542/
10. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometricappraisal.
“An existing strife is that orthodontic treatment can move the denture back in the mouth, reducing oral space and restricting pharyngeal volume. The present study probed this assertion, and analysis shows that the extraction of premolars has a detrimental effect on oropharyngeal structures… Extraction of four premolars did affect velopharyngeal, glossopharyngeal, hypopharyndgeal, and hyoid position in bimaxillary protrusive young adolescents. The velopharyngeal, glossopharyngeal, and hypopharyngeal airway became narrower following orthodontic therapy. The hyoid bone tends to move in a posterior and inferior direction. The other findings of our study also proved direct correlation of tongue to oropharynx and hypopharynx. Postextraction tongue position directly influenced the hyoid; this again can be attributed to anatomical dependence of hyoid with the hyoglossal muscle."
Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Contemp Clin Dent. 2014Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782.
11. Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion.
"The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adultclass I patients with bimaxillary protrusion."
Sun F. C., Yang W. Z., Ma Y. K.
2018 Jun 9;53(6):398-403. Chinese. doi: 10.3760/cma.j.issn.1002- 0098.2018.06.007. PMID: 29886634.
12. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion.
"The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients."
Wang Qingzhu, Jia Peizeng, Anderson Nina K., Wang Lin, Lin Jiuxiang.
Angle Orthod. 2012 Jan;82(1):115-21. doi: 10.2319/011011-13.1. Epub 2011 Jul 27. PMID: 21793712; PMCID: PMC8881045.
13. Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class Ibimaxillary protrusion patients.
"This study suggested that the risk of pharyngeal collapsing become higher after extraction treatment with maximum anchorage in bimaxillary protrusion adult patients. Those adverse changes should be taken intoconsideration especially for high-risk patients to avoid undesired weakening of the respiratory function in clinical treatment."
Zheng Zhe, Liu Hong, Xu Qi, Wu Wei, Du Liling, Chen Hong, Zhang Yiwen, Dongxu Liu.
Sci Rep. 2017 Apr 7;7:45706. doi: 10.1038/srep45706. PMID: 28387372; PMCID: PMC5384277.
[ii] 1. Schwab RJ, Kim C, Siegel LC, et al. “Upper airway collagen content increases with age and in obstructive sleep apnea.” Am J Respir Crit Care Med. 1997;155(5):1655-1659.
PMID: 9154870
This study shows age-related increases in collagen content in upper airway muscles, which contribute to decreased tissue compliance and diminished airway muscle function. These structural changes reduce the airway’s ability to stay open during sleep, making collapse more likely with age, even in individuals without prior airway narrowing. Hence, lifelong compensation is not reliable.
2. Malhotra A, Huang Y, Fogel RB, et al. “The male predisposition to pharyngeal collapse: importance of airway length.” Am J Respir Crit Care Med. 2002 Sep 15;166(6):1388-95.
PMID: 12406867
This paper examines factors that predispose individuals to pharyngeal collapse. It emphasizes that neuromuscular compensation varies among individuals and declines over time. Longer airway length and reduced reflex muscle responses (seen with aging) heighten the risk of airway collapse.
3. Mezzanotte WS, Tangel DJ, White DP. “Aging-related changes in genioglossus muscle activation and respiratory timing.”
Am J Respir Crit Care Med. 1996;154(6 Pt 1):1804–1812.
PMID: 8970344
This foundational study demonstrates that older adults have diminished activation of the genioglossus (tongue) muscle during sleep compared to younger adults. This muscle is critical for maintaining upper airway patency. Its weakening with age supports the claim that compensation is not guaranteed long-term.
4. Kimoff RJ. “Upper airway myopathy is important in the pathogenesis of obstructive sleep apnea.”
Am J Respir Crit Care Med. 2001;164(10 Pt 1):1906–1907.
DOI: 10.1164/ajrccm.164.10.2109120
Editorial commentary on how chronic stress on upper airway muscles can lead to myopathic changes over time. These pathologic changes—compounded by aging—mean that even if compensation works early on, it may eventually fail, increasing the risk for sleep-disordered breathing.
5. Stauffer JL, et al. “Chronic upper airway obstruction in adults.”
Chest. 1981;80(4):446–452.
PMID: 7282652
The authors note that persistent upper airway narrowing may not lead to immediate collapse if muscles compensate, but over time, these compensatory mechanisms fatigue. They conclude that delayed airway collapse is common, especially as patients age or gain weight.
6. Carrera M, Barbé F, Sauleda J, Tomás M, Gómez C, Agustí AG. “Effects of obesity upon genioglossus structure and function in obstructive sleep apnea.”
Eur Respir J. 2004 Mar;23(3):425–429.
PMID: 15065818
This study correlates obesity and age with functional impairment of the genioglossus. Even in patients without prior airway compromise, muscle compensation becomes unreliable when affected by aging or increased fat deposition. If the airway has been iatrogenically narrowed, these risks are compounded.
7. Jordan AS, White DP. “Pharyngeal motor control and the pathogenesis of obstructive sleep apnea.”
Respir Physiol Neurobiol. 2008;160(1):1-7.
PMID: 18207642
Reviews evidence that the upper airway muscles—especially the genioglossus—respond reflexively to maintain patency. But reflex strength and coordination degrade with age. Therefore, a structurally narrowed airway poses an increasing risk over time, as muscular protection diminishes.
Karin Badt is an Associate Professor at the University of Paris VIII, with a PhD from the University of Chicago. Her research focuses on ethics and body practices, informed by the work of historian of science Ian Hacking and sociologist Michel Foucault. Alongside her academic career, she has worked as a volunteer teacher for children in conflict zones with organizations such as Save the Children and Ship to Bosnia. Her current research into the orthodontic specialty’s « debate » over the impact of premolar extractions is the culmination of her lifelong interest in ethics, the body and children’s rights.
Survey on premolar extraction consequences:
https://forms.gle/F5LEdN9ujjiMu4Mt6
https://www.facebook.com/groups/583182005973675/?multi_permalinks=1571050237186842&hoisted_section_header_type=recently_seen
For those who have experienced vertigo, vision, posture, or walking issues from their orthodontic harm, here are some sources:
Malocclusion, Jaw and Tongue Posture Effect on
Vision, Posture/Balance/Walking,
1) Jaw Asymmetry and Malocclusion ↔ Vision
· Grippaudo et al., 2020 – Bite and Sight: case–control (n=160) linking malocclusions with visual defects. [link]
· Giuca et al., 2019 – Clinical association between dental malocclusion and strabismus in adolescents. [link]
2) Jaws and Occlusion ↔ Posture, Balance & Walking
· Tecco et al., 2010 – Unilateral cotton roll imbalance alters plantar loading during walking. [link]
· Cuccia & Caradonna, 2011 – Different jaw relationships influence plantar arch during gait. [link]
· Nowak et al., 2023 – Malocclusion associated with postural control & plantar pressure during standing and walking. [link]
· Różańska‑Perlińska et al., 2024 – Systematic review: malocclusion vs body posture, cervical vertebrae, podal system & gait. [link]
3) Tongue Position ↔ Neck & Body Posture, Balance, Walking, Vision
· Alghadir et al., 2015 – Tongue against upper incisors improves postural stability on unstable surfaces with eyes closed. [link]
· Bordoni & Marelli, 2018 – Review: neuroanatomical links between tongue and global posture; reports balance/gait improvements. [link]
· Vuillerme et al., 2009 – Tongue‑placed electrotactile biofeedback improves ankle force sense and postural control. [link]
· Deljo et al., 2012 – Hyoid bone position correlations with cervical spine and craniofacial planes. [link]
· Sağlam et al., 2006 – Relationship between head posture and hyoid position in young adults. [link]
· Liu et al., 2023 – Systematic review: Orofacial myofunctional therapy improves craniofacial function/morphology. [link]
Notes: All links provided are open-access where available; PubMed or abstract links given for paywalled items.
ADDITIONAL SOURCES — Posture, Balance & Gait
· Różańska‑Perlińska et al., 2024 — Systematic review on malocclusion and posture, podal system & gait in children. [link]
· Parrini et al., 2018 — Rasterstereography changes during orthodontic treatment; posture parameters tracked. [link]
· Kerbrat et al., 2022 — Systematic review: interaction between posture and maxillomandibular deformity. [link]
· Song et al., 2021 — Symptomatic TMJ herniation through Foramen of Huschke causing otologic symptoms incl. vertigo (journalomp.org). [link]
Asymmetry / TMD ↔ Vertigo & Vestibular Findings
· de Moraes Marchiori et al., 2013 — Significant association between TMD and vertigo in elderly (OR≈2.38). [link]
· Lee et al., 2021 — Mouth‑opening–induced vertigo/downbeat nystagmus; mechanism via vertebral artery compression / VOR asymmetry. [link]
· Kusdra et al., 2018 — High prevalence of otologic symptoms (incl. vertigo) in TMD patients. [link]
Aldè et al., 2022 — New‑onset otologic symptoms in TMD; vertigo reported in ~20% of cases. [link]
https://www.facebook.com/groups/1270654792948954/?multi_permalinks=25017111394543294&hoisted_section_header_type=recently_seen
Studies show that bite force and occlusal contact decrease after PER with 4 extractions, and that chewing cycles become shorter and slower, indicating reduced masticatory performance. Eating becomes less efficient.
Yoon W et al. Changes in occlusal function after extraction of premolars. (2017/PMC8357216). Decreased OCA/force post-Tx; recovery patterns. Ludus PMC. This study shows that after orthodontic treatment with premolar extractions, occlusal contact area and bite force decrease immediately, With time however full recovery of occlusal contact area was possible for those with 2 premolar extractions. However full recovery was not possible for four-premolar extraction cases.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8357216/...
Lee SH et al. Changes in masticatory performance during the retention period… (2023). MP lower immediately post-Tx; recovery over time. PubMed
Jang I et al. Chewing performance in orthodontic patients treated with extraction of premolars. (2019). Shorter/slower chewing cycles post-extraction. Chosunobr
Aragon-Meyer G. Thesis (2021). Summarizes Yoon: 4-premolar group may not fully regain OCA. UW Libraries
Thein MW et al. Effect of premolar occlusal contact on occlusal forces. Key finding: loss of premolar contact increases first-molar load. J-STAGE
Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8th ed. Textbook evidence for occlusal load sharing & TMD links. neoncursos.com.br
Wheeler’s Dental Anatomy, Physiology and Occlusion. Background on premolar–molar function in mastication. lib.bpums.ac.irNLM Catalog
Group function / posterior load sharing overview. ResearchGatePMC
https://pubmed.ncbi.nlm.nih.gov/31769701/
Angle Orthod. 2020 Mar;90(2):173-180. doi: 10.2319/041419-266.1. Epub 2019 Nov 26.
Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction
Fan Zhang, Suk-Cheol Lee, Jun-Beom Lee, Kyung-Min Lee
PMID: 31769701 PMCID: PMC8051245 DOI: 10.2319/041419-266.1
Conclusions: Orthodontic treatment with premolar extraction might cause loss of alveolar bone around the maxillary and mandibular incisors. Careful consideration is needed to avoid iatrogenic degeneration of periodontal support around the incisors, particularly in the lingual area.
https://www.facebook.com/groups/extractionorthodonticsreversal/posts/25032627052991728/
Orthodontics and Race: the Caucasian facial structure and occlusion is considered the Norm.
Behind the scenes, there are numerous articles on race and orthodontics like this one on "Negros". Few challenge the Caucasian ideal standards for Ceph exams.
Everyone should know that Ceph Exams are subjective, and how to read them depends on what the orthodontist thinks the "correct" cranial structure should be. Forward grown maxillas for example--prevalent in African, Asian and Hispano-American peoples ---are NOT considered "normal", even though health-wise this morphology is likely superior to flattened Caucasian faces
https://www.ajodo.org/article/0002-9416(68)90018-3/abstract
This article on Mexican-American vs European cranial , however, DOES acknowledge that European orthodontic norms should not be used for Mexicans!
Premolar extraction rate in Mexico about 50 -70 percent.
To cite Dr. J. Pruvost, esteemed senior orthodontist in Paris, France, "Mexicans should ALL be extracted/retracted. They look like monkeys!" (He imitated a monkey saying this, and vocalized "hee hee hee!")
https://www.ajodo.org/article/S0889-5406(11)00774-8/abstract
https://pubmed.ncbi.nlm.nih.gov/2403945/
Dent Clin North Am. 1990 Jan;34(1):91-102. Controversies in orthodontics. M A Bramante 1 Affiliations PMID: 2403945
Abstract
Three controversial interrelated aspects of orthodontics have been reviewed: retention, the effect of third molars on lower anterior crowding, and extraction and nonextraction orthodontic treatment. Recent studies have shown that unacceptable lower anterior crowding occurs in 90 per cent of well-treated extraction cases. The implication is that nonextraction cases should be 90 per cent or higher. In view of our present general inability to identify the 10 per cent that will remain acceptable, some form of indefinite retention is advised. A literature review of the effect of third molars on lower anterior crowding finds strong opinions on both sides of the issue. Similar studies often show dissimilar conclusions, particularly when observing cases of third molar extraction or agenesis. Certainly the problem is multifactorial; however, the vast bulk of the evidence indicates that the third molars play an insignificant role in lower anterior crowding. Extraction of teeth for orthodontic treatment prior to 1900 was prevalent and indiscriminate. From the turn of the century to the mid-thirties Angle moved the specialty away from extractions to a relatively rigid nonextraction treatment philosophy. Dissatisified with relapsing Class II cases, recurrence and aggravation of crowding, and what he felt were bimaxillary full faces, Tweed and others, circa 1935, redirected the profession back to extractions with a more disciplined approach to treatment by the removal of four first premolars. Fifty years later we have found that extraction treatment and uprighting lower incisors does not prevent long-term postretention crowding and that flattened profiles are not always esthetically desirable. Earlier treatment of maxillomandibular basal discrepancies by old and new treatment philosophies and mechanics have produced more stable nonextraction corrections. Better control of leeway space and a reduction in caries has helped reduce the amount of lower anterior flaring that was seen in the nonextraction cases in the first third of the century. These reasons have moved the specialty of orthodontics to a mixed but more nonextraction-oriented approach to treatment.
Статью я выложу только ссылкой, сюда не буду (27 страниц). Но у меня ещё есть пассаж без ссылки, но явно её авторства. Вот он под катом на английском.
This is a moot argument because the orthodontic AAO Guidelines to Orthodontists specifically state that if TMD develops during or after the treatment it is to be considered a coincidence. They wrote these guidelines after the Brimm lawsuit of 1986, to make sure no orthodontist blows the whistle and starts noticing there is a causal relationship. They are trained to say it has nothing to do with each other. For example, my TMD was caused by condyles being too back. With some reversal treatments, my condyles came forward. I no longer have TMD. When I point that out to pro-extraction orthodontists, they say it is a coincidence that you had TMD after extraction orthodontics, and now that it has gone away because I reversed extraction orthodontics, it does not mean it is not a separate condition and will come back later. TMD is so vaguely defined that the orthodontists can basically have a field day with denying it has anything to do with occlusion, movement of teeth, or even jaws. One study surveyed about 80 Brazilian orthodontists and asked if they thought TMD could be caused by orthodontics. About 60% of them said yes (let me find the article): especially those who'd been practicing for a long time. The conclusion of the authors of this study was that they had to "re-educate" those orthodontists to know that it is just a coincidence, that "high quality" post-Brimm case studies have "proved no connection between jaw joint and orthodontic movement" and that these orthodontists who continue to think that orthodontic treatment can cause TMD are dangerous for the profession and need to be "re-educated" to know "the truth" that there is no such thing as TMD after orthodontics, or else their "false belief" will end up giving orthodontics a bad reputation. A reputation that it deserves. Let me find that article, it was fascinating, the Orwellian double-think. My figures might also be a bit off, as from memory. One thing you CAN prove with before and after xrays is if the condyle has distalized, which is a cause of TMD. Another thing to prove is that mandibular movements changed, but this is too late, because this is not something measured from a conebeam.
The research paper they probably presented was a 1992 study published in the AJO-DO. The 1992 journal has several publications that had been commissioned by the American Association of Orthodontists to protect themselves from lawsuits, after the 1.3 million dollar lawsuit from 19 year old Susan Brimm, who had severe TMD from extraction/retraction (PER). If you read these journal articles, they are absurd. They say that occlusion has nothing to do with the jaw joints hence no connection to TMD. TO combat them, you could collect articles on Bruxism and TMD which prove the correlation between....occlusion and TMD. There is also Witzig's 1960 article on TMD and premolar extractions. There is also the 2023 research article published in a high impact journal establishing that PER causes changes in mandibular kinematics and position and 'Is a risk for TMD." That is some ammunition for you. I have posted links to all these articles on the FB group Extraction Orthodontics Reversal, as well as hyperlinked some of these articles in my MEDIUM article on the Risks of Premolar Extractions. If your lawyer wants to speak to me, I can give him/her some tips of how to approach this industry. I had communication with the lawyer who won Susan Brimm in Michigan the 1.3 million dollars. (Poor woman, her sister tells me that 40 years later, she still suffers from severe jaw pain).
Here are the articles that were commissioned by the AAO to deny the findings of the Brimm Case: deliberately published so future patients like you cannot win a lawsuit against an orthodontist for TMD issues. The articles are in these links. The one shown by the defending lawyers in your case was probably by either Rinchuse, Giannely or Johnston (you can read them here in the links). Rinchuse's article is required reading on the Board Exams, so every orthodontics student gets the propaganda and now all orthodontists repeat like monkeys:" "High quality evidence have proven there is no link between orthodontic treatment and TMD." Your lawyer should be aware of this cover-up and what he or she is fighting against. They should also take a look at the AAO Guidelines to Orthodontics which lists risks with orthodontics that orthodontist at their own discretion can "choose" to disclose to patients. They have a very suspicious clause at the end of their list. "If your patient develops TMD during your treatment, this is to be considered a coincidence and due to pre-existing conditions." Like it is a coincidence if one dies at the same time that a truck runs over you. Your lawyer is fighting against something much bigger than he knows: the entire orthodontic specialty, and 60 years of trying to keep the TMD risk from coming out of the bag. Read my article on Medium which describes the TMD and PER relationship coverup.
There is also an 80 year old orthodontist who knows a lot about this cover-up--including seeing advertisements to orthodontists to write these articles--whose email I can share if interested.. I have personally helped 3 premolar extracted people get their treatment costs back from their orthodontist after TMD developed, by composing a letter for them. These orthodontists obliged the patients to sign a Release of Liability form in exchange for the treatment cost return. The lawyer in Michigan who won the case is Gittleman. He may be a good contact for your lawyer. Why not forward this entire message to him? 2 of my articles are on the list. I also have over 3000 responses to my survey on premolar extractions, and 45% of these report TMD. If your lawyer is in the US, he or she may want to consider escalating the case to a group action lawsuit. I can share with them the survey data and the verbatims.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3989577/
"This issue has been noted by many researchers in academic dental training centers worldwide. The results of many studies in this field have shown surprisingly high prevalence rates of TMJ injuries (50-63 %) after extracting mandibular teeth by dental students".
https://www.facebook.com/groups/orthodonticmalpracticevictims/posts/1566010221024177/
Pertinent to those who have had premolars extracted:
The AAO’s Position on Premolar Extractions and the Narrowing of the Airway: Is It Ethical?
Karin Badt
Introduction
The American Association of Orthodontists (AAO) in its White Paper on "Obstructive Sleep Apnea and Orthodontics” (2019) affirms that orthodontic treatment involving premolar extractions "may narrow the upper airway.”[i] However, the potential narrowing of a person’s airway due to extraction orthodontic treatment is presented as unproblematic. In the AAO’s view, if a patient has healthy airway muscles, these muscles will "compensate" for the iatrogenically narrowed airway and “the airway will not collapse,” i.e. cause Obstructive Sleep Apnea (OSA). Thus a potentially narrowed upper airway is not presented as a reason to limit premolar extractions.
It is to be noted that the AAO does not consider the potential other effects of a narrowed airway such as reduced vocal resonance; diminished stamina; and breathing disorders such as snoring, Upper Airway Resistance Syndrome, or habitual mouth-breathing.
Contradicting the AAO White Paper’s claim that a narrowed airway does not cause airway collapse (i.e. OSA) is an earlier section of the same AAO White Paper which details how a narrowed airway causes airway collapse (i.e. OSA):
“As the upper airway is narrowed or completely occluded, the patient's effort during breathing progressively increases. Owing to the airflow restriction, there is a relative increase in serum carbon dioxide (CO2; hypercarbia) and decrease in serum oxygen (hypoxemia). The escalating respiratory effort causes a cortical arousal from sleep, which results in the upper airway opening so that normal airflow is reestablished. Once the patient falls back to sleep, the upper airway may collapse again with recurrence of the above-noted process. This breathing sequence may have significant consequences for the child (p.20).”
Yet in the later section of the paper discussing premolar extractions, the AAO insists that if airway collapse results from a narrowed airway, it would not be due to the narrowed airway, but to the patient’s failure to adequately compensate for their narrowed airway with their airway muscles.
The reasoning rests on a dangerous assumption. Airway muscles predictably weaken with age, and other factors. Consequently, muscular compensation is not guaranteed to prevent airway collapse for the duration of a patient’s life.[ii]Even in childhood or early adulthood, there is no certainty that a narrowed airway can be adequately compensated.
There is currently no legal obligation for orthodontists to disclose to patients that premolar extractions may narrow their airway--and that they may need to “compensate” with their airway muscles for the rest of their lives to avoid developing Obstructive Sleep Apnea.
I asked ChatGBT Plus if this was ethical.
Here is ChatGBT's response:
You're correct in recalling that the American Association of Orthodontists (AAO) White Paper on obstructive sleep apnea (OSA) discusses the role of airway muscles in maintaining airway patency, when anatomical narrowing occurs due to orthodontic treatments like premolar extractions.
The White Paper acknowledges that orthodontic treatments can affect the dimensions of the upper airway. However, it emphasizes that a reduction in airway size does not necessarily lead to functional impairment.
Specifically, the document states:
"In discussing orthodontic treatment to changes in the dimensions of the upper airway, it also is helpful to understand that an initial small or subsequently reduced or increased size does not necessarily result in a change in airway function. Reflecting the higher significance of neuromuscular control on airway function during sleep, it has been demonstrated that a narrow airway does not result in OSA, but rather it is an inability for a patient's airway muscles to compensate adequately that leads to obstruction and sleep‐disordered breathing."
ME:
"Do you think it is right to narrow a person's airway without disclosing to them prior that it may be narrowed, and they will need to "compensate" for the iatrogenic deformity all their lives?"
ChatGPT said:
That’s a deeply important and ethical question—and you’re absolutely right to raise it.
FROM A MEDICAL ETHICS STANDPOINT:
No, it is not right to alter a person’s airway—especially in a way that could have lifelong consequences—without fully informing them. This is fundamentally about informed consent, which is a legal and ethical cornerstone of medical and dental practice.
Here’s how this breaks down:
1. INFORMED CONSENT = FULL DISCLOSURE
Patients have the right to know:
That premolar extractions and retraction mechanics can narrow their airway.
That they may need to "compensate" neuromuscularly to avoid symptoms of sleep-disordered breathing.
That this compensation may not always succeed, especially with age, weight gain, or other factors.
To withhold this information—or frame it as unimportant—is not just unethical; in some jurisdictions, it could be considered negligence.
2. “COMPENSATION” SHOULD NOT BE THE GOAL
Imagine a surgeon telling a patient:
"We’ll remove part of your lung, but don’t worry—your other lung will compensate."
Or:
"We’ll make your nose smaller than your airway needs, but the muscles in your throat will figure it out."
That’s what’s happening here—iatrogenic narrowing of the airway, often without even acknowledging it, then relying on the body’s adaptation to prevent health issues like sleep apnea. That's a physiological gamble, not patient-centered care.
3. THIS ISN’T ABOUT BLAME—IT’S ABOUT EVOLVING THE STANDARD
Most orthodontists don’t set out to harm their patients. Many were simply taught that extractions and retraction are standard, safe, and effective. But when science advances, so should practice standards.
Ignoring emerging evidence—or dismissing concerns because "compensation works for many patients"—is a form of institutional denial that prevents the profession from growing.
BOTTOM LINE:
Patients deserve to be told when a treatment could narrow their airway. They deserve to know the long-term risks. And if orthodontists continue using retractive methods, disclosure must be part of the process.
ENDNOTES
[i] The following peer-reviewed studies have established that premolar extractions with retractive orthodontics reduces airway space and alters hyoid position. Some of these papers are cited in the AAO White Paper.
1. Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillarydentoalveolar protrusion
"The size of the pharyngeal (velopharyngeal and glossopharyngeal) airway reduced and hyoid bone position changed after retraction of the incisors in extraction space in bimaxillary protrusive adult patients."
Bhatia S, Jayan B, Chopra SS.
Med J Armed Forces India. 2016 Dec;72(Suppl 1):S17-S23. doi: 10.1016/j.mjafi.2016.06.006. Epub 2016 Oct 17. PMID: 28050064; PMCID: PMC5192225.
Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.
2. Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients - PMC.
"Large incisor retraction leads to narrowing of the upper airway in adult bimaxillary protrusion patients."
Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, Lv T, Zhang F, Liu DX.
Angle Orthod. 2012 Nov;82(6):964-70. doi: 10.2319/110211-675.1. Epub 2012 Mar 30. PMID: 22462464; PMCID: PMC8813144.
3. Effects of Four First Premolar Extraction on the Upper Airway Dimension in a Non-Growing Class I SkeletalPatients: A Systematic Review
A systematic review that concludes that premolar extraction/retraction can cause the narrowing of the pharyngeal airway, a change in tongue position, and the reduction of oral cavity space, and hence is a risk for sleep apnea.
Choi JY, Lee K.
J Oral Med and Dent Res. 3(1):1-16. (2022)
4. Missing teeth and pediatric obstructive sleep apnea.
"Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep."
Guilleminault Christian, Abad Vivien C., Chiu Hsiao-Yean, Peters Brandon, Quo Stacey. doi: 10.1080/08869634.2016.1192315.Sleep Breath Epub 2016 Jun 30. PMID: 27356671.
5. Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post- retraction world oforthodontics.
“We recommend that optimizing the airway for every patient and never doing any treatment [such as retraction]which will diminish the airway, even minutely, needs to become the standard of care in Airway Centric® Dentistry."
Hang William M., Gelb Michael. Cranio. 2017 Mar;35(2):68-78.
6. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review.
"Extractions followed by large retraction of the anterior teeth in adult bimaxillary protrusion cases could possibly lead to narrowing of the upper airway. Mesial movement of the molars [instead of retraction] to closethe extraction spaces appeared to increase the posterior space for the tongue and enlarge the upper airway dimensions."
Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S
2015 May;19(2):441-51. doi: 10.1007/s11325-015- 1122-1. Sleep Breath. Epub 2015 Jan 28. PMID: 25628011.
7. Effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults: a retrospective cephalometric assessment.
“A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I [40 class I patients with bimaxillary protrusion and maximum anchorage] , III [40 class II patients with maximum anchorage], and IV [22 skeletal class III patients with maximum anchorage] (P < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors (r = 0.6- 0.😎. In group II [40 class I patients with moderate crowding and anchorage], a significant increase was observed in oropharyngeal and velopharyngeal dimensions (P < 0.001). A significant increase in nasopharyngeal dimensions occurred in allgroups (P < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions (r = 0.4 - 0.6). According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions.”
Mortezai O, Shalli Z, Tofangchiha M, Alizadeh A, Pagnoni F, Reda R, Testarelli L.
PeerJ. 2023 Oct 23;11:e15960. doi: 10.7717/peerj.15960. PMID: 37901473; PMCID: PMC10601897.https://pubmed.ncbi.nlm.nih.gov/37901473/
8. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal class II cases.
“Study concludes that with the closing extraction spaces, the maxilla and the mandible retrude, causing a retrognathic mandibular position and consequent constriction of the oropharyngeal airway.”
Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E.
Angle Orthod 1998;68:327-36. https://pubmed.ncbi.nlm.nih.gov/9709833/
9. Effect of orthodontic treatment on the upper airway volume in adults.
Study concludes that in general there is no difference between those who get extractions with orthodontic treatment and those who get orthodontic treatment alone: both lose 5% of airway volume which the authorsconsider an insignificant loss. However, the study did note a “significant narrowing” of the airway if the patient presents with moderate or little crowding. In these cases [which constitute the majority of cases in which premolar extractions are used] the retraction and shrinkage of the dental arches and the [loss of oral cavity space] is “significant.”
Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR.
Am J Orthod Dentofacial Orthop. 2016;150(6):937-944. https://pubmed.ncbi.nlm.nih.gov/27894542/
10. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometricappraisal.
“An existing strife is that orthodontic treatment can move the denture back in the mouth, reducing oral space and restricting pharyngeal volume. The present study probed this assertion, and analysis shows that the extraction of premolars has a detrimental effect on oropharyngeal structures… Extraction of four premolars did affect velopharyngeal, glossopharyngeal, hypopharyndgeal, and hyoid position in bimaxillary protrusive young adolescents. The velopharyngeal, glossopharyngeal, and hypopharyngeal airway became narrower following orthodontic therapy. The hyoid bone tends to move in a posterior and inferior direction. The other findings of our study also proved direct correlation of tongue to oropharynx and hypopharynx. Postextraction tongue position directly influenced the hyoid; this again can be attributed to anatomical dependence of hyoid with the hyoglossal muscle."
Sharma Krishna, Shrivastav Sunita, Sharma Narendra, Hotwani Kavita, Murrell Michael D. Contemp Clin Dent. 2014Apr;5(2):190-4. doi: 10.4103/0976-237X.132314. PMID: 24963245; PMCID: PMC4067782.
11. Effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in adult class Ⅰ patients with bimaxillary protrusion.
"The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adultclass I patients with bimaxillary protrusion."
Sun F. C., Yang W. Z., Ma Y. K.
2018 Jun 9;53(6):398-403. Chinese. doi: 10.3760/cma.j.issn.1002- 0098.2018.06.007. PMID: 29886634.
12. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion.
"The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients."
Wang Qingzhu, Jia Peizeng, Anderson Nina K., Wang Lin, Lin Jiuxiang.
Angle Orthod. 2012 Jan;82(1):115-21. doi: 10.2319/011011-13.1. Epub 2011 Jul 27. PMID: 21793712; PMCID: PMC8881045.
13. Computational fluid dynamics simulation of the upper airway response to large incisor retraction in adult class Ibimaxillary protrusion patients.
"This study suggested that the risk of pharyngeal collapsing become higher after extraction treatment with maximum anchorage in bimaxillary protrusion adult patients. Those adverse changes should be taken intoconsideration especially for high-risk patients to avoid undesired weakening of the respiratory function in clinical treatment."
Zheng Zhe, Liu Hong, Xu Qi, Wu Wei, Du Liling, Chen Hong, Zhang Yiwen, Dongxu Liu.
Sci Rep. 2017 Apr 7;7:45706. doi: 10.1038/srep45706. PMID: 28387372; PMCID: PMC5384277.
[ii] 1. Schwab RJ, Kim C, Siegel LC, et al. “Upper airway collagen content increases with age and in obstructive sleep apnea.” Am J Respir Crit Care Med. 1997;155(5):1655-1659.
PMID: 9154870
This study shows age-related increases in collagen content in upper airway muscles, which contribute to decreased tissue compliance and diminished airway muscle function. These structural changes reduce the airway’s ability to stay open during sleep, making collapse more likely with age, even in individuals without prior airway narrowing. Hence, lifelong compensation is not reliable.
2. Malhotra A, Huang Y, Fogel RB, et al. “The male predisposition to pharyngeal collapse: importance of airway length.” Am J Respir Crit Care Med. 2002 Sep 15;166(6):1388-95.
PMID: 12406867
This paper examines factors that predispose individuals to pharyngeal collapse. It emphasizes that neuromuscular compensation varies among individuals and declines over time. Longer airway length and reduced reflex muscle responses (seen with aging) heighten the risk of airway collapse.
3. Mezzanotte WS, Tangel DJ, White DP. “Aging-related changes in genioglossus muscle activation and respiratory timing.”
Am J Respir Crit Care Med. 1996;154(6 Pt 1):1804–1812.
PMID: 8970344
This foundational study demonstrates that older adults have diminished activation of the genioglossus (tongue) muscle during sleep compared to younger adults. This muscle is critical for maintaining upper airway patency. Its weakening with age supports the claim that compensation is not guaranteed long-term.
4. Kimoff RJ. “Upper airway myopathy is important in the pathogenesis of obstructive sleep apnea.”
Am J Respir Crit Care Med. 2001;164(10 Pt 1):1906–1907.
DOI: 10.1164/ajrccm.164.10.2109120
Editorial commentary on how chronic stress on upper airway muscles can lead to myopathic changes over time. These pathologic changes—compounded by aging—mean that even if compensation works early on, it may eventually fail, increasing the risk for sleep-disordered breathing.
5. Stauffer JL, et al. “Chronic upper airway obstruction in adults.”
Chest. 1981;80(4):446–452.
PMID: 7282652
The authors note that persistent upper airway narrowing may not lead to immediate collapse if muscles compensate, but over time, these compensatory mechanisms fatigue. They conclude that delayed airway collapse is common, especially as patients age or gain weight.
6. Carrera M, Barbé F, Sauleda J, Tomás M, Gómez C, Agustí AG. “Effects of obesity upon genioglossus structure and function in obstructive sleep apnea.”
Eur Respir J. 2004 Mar;23(3):425–429.
PMID: 15065818
This study correlates obesity and age with functional impairment of the genioglossus. Even in patients without prior airway compromise, muscle compensation becomes unreliable when affected by aging or increased fat deposition. If the airway has been iatrogenically narrowed, these risks are compounded.
7. Jordan AS, White DP. “Pharyngeal motor control and the pathogenesis of obstructive sleep apnea.”
Respir Physiol Neurobiol. 2008;160(1):1-7.
PMID: 18207642
Reviews evidence that the upper airway muscles—especially the genioglossus—respond reflexively to maintain patency. But reflex strength and coordination degrade with age. Therefore, a structurally narrowed airway poses an increasing risk over time, as muscular protection diminishes.
Karin Badt is an Associate Professor at the University of Paris VIII, with a PhD from the University of Chicago. Her research focuses on ethics and body practices, informed by the work of historian of science Ian Hacking and sociologist Michel Foucault. Alongside her academic career, she has worked as a volunteer teacher for children in conflict zones with organizations such as Save the Children and Ship to Bosnia. Her current research into the orthodontic specialty’s « debate » over the impact of premolar extractions is the culmination of her lifelong interest in ethics, the body and children’s rights.
Survey on premolar extraction consequences:
https://forms.gle/F5LEdN9ujjiMu4Mt6
https://www.facebook.com/groups/583182005973675/?multi_permalinks=1571050237186842&hoisted_section_header_type=recently_seen
For those who have experienced vertigo, vision, posture, or walking issues from their orthodontic harm, here are some sources:
Malocclusion, Jaw and Tongue Posture Effect on
Vision, Posture/Balance/Walking,
1) Jaw Asymmetry and Malocclusion ↔ Vision
· Grippaudo et al., 2020 – Bite and Sight: case–control (n=160) linking malocclusions with visual defects. [link]
· Giuca et al., 2019 – Clinical association between dental malocclusion and strabismus in adolescents. [link]
2) Jaws and Occlusion ↔ Posture, Balance & Walking
· Tecco et al., 2010 – Unilateral cotton roll imbalance alters plantar loading during walking. [link]
· Cuccia & Caradonna, 2011 – Different jaw relationships influence plantar arch during gait. [link]
· Nowak et al., 2023 – Malocclusion associated with postural control & plantar pressure during standing and walking. [link]
· Różańska‑Perlińska et al., 2024 – Systematic review: malocclusion vs body posture, cervical vertebrae, podal system & gait. [link]
3) Tongue Position ↔ Neck & Body Posture, Balance, Walking, Vision
· Alghadir et al., 2015 – Tongue against upper incisors improves postural stability on unstable surfaces with eyes closed. [link]
· Bordoni & Marelli, 2018 – Review: neuroanatomical links between tongue and global posture; reports balance/gait improvements. [link]
· Vuillerme et al., 2009 – Tongue‑placed electrotactile biofeedback improves ankle force sense and postural control. [link]
· Deljo et al., 2012 – Hyoid bone position correlations with cervical spine and craniofacial planes. [link]
· Sağlam et al., 2006 – Relationship between head posture and hyoid position in young adults. [link]
· Liu et al., 2023 – Systematic review: Orofacial myofunctional therapy improves craniofacial function/morphology. [link]
Notes: All links provided are open-access where available; PubMed or abstract links given for paywalled items.
ADDITIONAL SOURCES — Posture, Balance & Gait
· Różańska‑Perlińska et al., 2024 — Systematic review on malocclusion and posture, podal system & gait in children. [link]
· Parrini et al., 2018 — Rasterstereography changes during orthodontic treatment; posture parameters tracked. [link]
· Kerbrat et al., 2022 — Systematic review: interaction between posture and maxillomandibular deformity. [link]
· Song et al., 2021 — Symptomatic TMJ herniation through Foramen of Huschke causing otologic symptoms incl. vertigo (journalomp.org). [link]
Asymmetry / TMD ↔ Vertigo & Vestibular Findings
· de Moraes Marchiori et al., 2013 — Significant association between TMD and vertigo in elderly (OR≈2.38). [link]
· Lee et al., 2021 — Mouth‑opening–induced vertigo/downbeat nystagmus; mechanism via vertebral artery compression / VOR asymmetry. [link]
· Kusdra et al., 2018 — High prevalence of otologic symptoms (incl. vertigo) in TMD patients. [link]
Aldè et al., 2022 — New‑onset otologic symptoms in TMD; vertigo reported in ~20% of cases. [link]
https://www.facebook.com/groups/1270654792948954/?multi_permalinks=25017111394543294&hoisted_section_header_type=recently_seen
Studies show that bite force and occlusal contact decrease after PER with 4 extractions, and that chewing cycles become shorter and slower, indicating reduced masticatory performance. Eating becomes less efficient.
Yoon W et al. Changes in occlusal function after extraction of premolars. (2017/PMC8357216). Decreased OCA/force post-Tx; recovery patterns. Ludus PMC. This study shows that after orthodontic treatment with premolar extractions, occlusal contact area and bite force decrease immediately, With time however full recovery of occlusal contact area was possible for those with 2 premolar extractions. However full recovery was not possible for four-premolar extraction cases.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8357216/...
Lee SH et al. Changes in masticatory performance during the retention period… (2023). MP lower immediately post-Tx; recovery over time. PubMed
Jang I et al. Chewing performance in orthodontic patients treated with extraction of premolars. (2019). Shorter/slower chewing cycles post-extraction. Chosunobr
Aragon-Meyer G. Thesis (2021). Summarizes Yoon: 4-premolar group may not fully regain OCA. UW Libraries
Thein MW et al. Effect of premolar occlusal contact on occlusal forces. Key finding: loss of premolar contact increases first-molar load. J-STAGE
Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8th ed. Textbook evidence for occlusal load sharing & TMD links. neoncursos.com.br
Wheeler’s Dental Anatomy, Physiology and Occlusion. Background on premolar–molar function in mastication. lib.bpums.ac.irNLM Catalog
Group function / posterior load sharing overview. ResearchGatePMC
https://pubmed.ncbi.nlm.nih.gov/31769701/
Angle Orthod. 2020 Mar;90(2):173-180. doi: 10.2319/041419-266.1. Epub 2019 Nov 26.
Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction
Fan Zhang, Suk-Cheol Lee, Jun-Beom Lee, Kyung-Min Lee
PMID: 31769701 PMCID: PMC8051245 DOI: 10.2319/041419-266.1
Conclusions: Orthodontic treatment with premolar extraction might cause loss of alveolar bone around the maxillary and mandibular incisors. Careful consideration is needed to avoid iatrogenic degeneration of periodontal support around the incisors, particularly in the lingual area.
https://www.facebook.com/groups/extractionorthodonticsreversal/posts/25032627052991728/
Orthodontics and Race: the Caucasian facial structure and occlusion is considered the Norm.
Behind the scenes, there are numerous articles on race and orthodontics like this one on "Negros". Few challenge the Caucasian ideal standards for Ceph exams.
Everyone should know that Ceph Exams are subjective, and how to read them depends on what the orthodontist thinks the "correct" cranial structure should be. Forward grown maxillas for example--prevalent in African, Asian and Hispano-American peoples ---are NOT considered "normal", even though health-wise this morphology is likely superior to flattened Caucasian faces
https://www.ajodo.org/article/0002-9416(68)90018-3/abstract
This article on Mexican-American vs European cranial , however, DOES acknowledge that European orthodontic norms should not be used for Mexicans!
Premolar extraction rate in Mexico about 50 -70 percent.
To cite Dr. J. Pruvost, esteemed senior orthodontist in Paris, France, "Mexicans should ALL be extracted/retracted. They look like monkeys!" (He imitated a monkey saying this, and vocalized "hee hee hee!")
https://www.ajodo.org/article/S0889-5406(11)00774-8/abstract
https://pubmed.ncbi.nlm.nih.gov/2403945/
Dent Clin North Am. 1990 Jan;34(1):91-102. Controversies in orthodontics. M A Bramante 1 Affiliations PMID: 2403945
Abstract
Three controversial interrelated aspects of orthodontics have been reviewed: retention, the effect of third molars on lower anterior crowding, and extraction and nonextraction orthodontic treatment. Recent studies have shown that unacceptable lower anterior crowding occurs in 90 per cent of well-treated extraction cases. The implication is that nonextraction cases should be 90 per cent or higher. In view of our present general inability to identify the 10 per cent that will remain acceptable, some form of indefinite retention is advised. A literature review of the effect of third molars on lower anterior crowding finds strong opinions on both sides of the issue. Similar studies often show dissimilar conclusions, particularly when observing cases of third molar extraction or agenesis. Certainly the problem is multifactorial; however, the vast bulk of the evidence indicates that the third molars play an insignificant role in lower anterior crowding. Extraction of teeth for orthodontic treatment prior to 1900 was prevalent and indiscriminate. From the turn of the century to the mid-thirties Angle moved the specialty away from extractions to a relatively rigid nonextraction treatment philosophy. Dissatisified with relapsing Class II cases, recurrence and aggravation of crowding, and what he felt were bimaxillary full faces, Tweed and others, circa 1935, redirected the profession back to extractions with a more disciplined approach to treatment by the removal of four first premolars. Fifty years later we have found that extraction treatment and uprighting lower incisors does not prevent long-term postretention crowding and that flattened profiles are not always esthetically desirable. Earlier treatment of maxillomandibular basal discrepancies by old and new treatment philosophies and mechanics have produced more stable nonextraction corrections. Better control of leeway space and a reduction in caries has helped reduce the amount of lower anterior flaring that was seen in the nonextraction cases in the first third of the century. These reasons have moved the specialty of orthodontics to a mixed but more nonextraction-oriented approach to treatment.