In this interview, a clinician (Speaker A) introduces and defines "Extraction Retraction Regret Syndrome" (ERS), a collection of aesthetic, functional, and emotional symptoms that arise after orthodontic retraction following premolar extractions. The clinician presents the case of Tamara, a computer‑science‑trained engineer who had two upper bicuspids extracted and the spaces closed by retraction, which she describes as trapping her lower jaw and causing chronic facial and neck muscle pain, worsening migraines, and severe disability after a car accident. Tamara recounts months of bedridden pain, heavy reliance on pain medication, and the social isolation that resulted. The clinician explains the corrective treatment: reopening the extraction spaces, moving the upper front teeth forward, and restoring tongue space and airway, which quickly alleviated Tamara’s symptoms and restored her quality of life. The clinician concludes with a broader advocacy message, urging the orthodontic profession to abandon routine retraction practices to prevent ERS in future patients.
Chapters
After reopening extraction spaces for nearly 30 years, I identified a syndrome which I call Extraction Retraction Regret Syndrome. I define it as a constellation of aesthetic, functional, and emotional signs and symptoms brought on by orthodontic retraction, all of which is preventable because frankly, retraction is a choice. It's preventable.
My degrees are in computer science. I've done a lot of engineering, so going out to me, it was just It's simple logic that, you know, we took 2 teeth out here, so when this comes back, this is going to pull your jaw back. And, you know, no wonder these muscles are tight all the time.
Tamara is actually a classic case of extraction-retraction regret syndrome. She had 2 upper bicuspid teeth removed. She had the spaces closed by retraction, which essentially trapped the lower jaw. This wreaks havoc on the masseter and anterior temporalis muscles and Predictably, almost all the muscles of her face and neck were on fire when we examined her. She had the symptom pattern begin immediately after her treatment was completed, and she lived for years with the symptom pattern thinking that it was, you know, what she had to do. The straw that broke the camel's back for her was really her car accident and put her over the edge, and she became bedridden. And at that point, she had to seek treatment because her quality of life was so poor.
You know, I've always had migraines a little bit. So, you know, a few times a year I get a good one and lots of pain pills. But I was in a car accident 2 years ago, Mother's Day, and that just sent me for a loop. I had about 7 months where I just, I didn't get out of bed. I took every pain pill I had in the house that I'd collected over years. When you're in pain constantly, you almost, you almost become a recluse. It's too much effort to talk to anybody. It's too much effort to get out of bed. You know, I thought it was gonna be horrible, and to be honest, when he first— the first appliance, and you're gonna screw it down every 2 days, and I thought, yeah, right. 'Cause let's be real, if I'm out to dinner with clients or I'm, you know, social functions, I'm not gonna wear that. I'll tell you what, you get into that much pain, Nothing, nothing is as bad as what you're going through. So it, it really wasn't bad. The appliance and the moving the teeth out, it was so much easier than I thought it would be.
In Tamara's case, we got resolution of symptoms rather quickly. We never promise anybody resolution of any symptom pattern, but when we move the upper front teeth forward and free the lower jaw up, I usually expect the patient to walk in with a smile on their face and give me a nice hug, thanking me for either eliminating or dramatically reducing their symptom pattern, it's always a good idea to give patients back their tongue space and airway, and we see nice resolution of symptoms when we do that.
Your life, it's not worth— well, I guess all of my minutes were in bed, so what were— what was a day or so here? And the financial aspects, you know what, if you can't live, What good is it? So it's the money, the time, it's nothing to get your life back.
It's very gratifying for me to be able to help somebody like Tamara eliminate their symptoms. But the real victory here will come when I don't get emails from people all over the world, and I don't have to have people travel from other countries to see me for me to resolve their symptom pattern and reverse their ERS. It'll be a great day when the orthodontic profession stops retracting completely. I know I'll accomplish my mission.
