The Question I Had About Orthodontics and My Airway

I was 12 when I got braces. Four premolar extractions. "It'll give you a beautiful smile," they said.

Age 13: chronic exhaustion began. Brain fog. Napping after school. Couldn't focus like I used to.

I thought it was puberty. Hormones. Growing pains.

Years later, I was diagnosed with UARS — upper airway resistance syndrome — at 25. A CBCT scan showed a narrow, "straw-like" airway. And when I looked back at the timing — braces at 12, exhaustion at 13 — I found it hard to see it as a coincidence.

I want to be careful here, though, because this is one of the most contested questions in the whole airway world. So before I tell you what I believe about my own case, let me tell you what's actually known and what's disputed.

I'm writing this in the depths of December. Short, dark days. The kind that make chronic illness feel heavier. But there's something about this time of year — the stillness, the permission to rest — that makes space for hard questions. This is one of them.

The Hypothesis — and the Dispute

Some airway-focused clinicians hold a hypothesis that goes like this: when premolars are removed to "make space" for orthodontic alignment, the dental arches can end up narrower, and because the palate is both the roof of your mouth and the floor of your nasal cavity, a narrower arch could mean less room for the tongue, more nasal resistance, and — in people who are already anatomically vulnerable — a smaller, more collapsible airway.

I need to be honest with you: mainstream orthodontics disputes this, and the research does not back it up as a general rule.

A systematic review by Hu and colleagues in 2015 looked at the effect of teeth extraction for orthodontic treatment on the upper airway and did not find consistent evidence that extractions harm it. A more recent systematic review with meta-analysis, published in the European Journal of Orthodontics in 2025, went further: on average, premolar extractions during comprehensive orthodontic treatment appear to have little to no negative effect on airway volume or minimum cross-sectional area.

So if you came here hoping I'd tell you that extractions cause UARS — I can't. The evidence doesn't say that. What I can tell you is that some airway-focused clinicians believe there may be a subgroup of people (narrow jaws, small airways to begin with) for whom the standard studies don't capture what happens. That remains a hypothesis, not an established fact.

And I can tell you what I believe happened in my own case.

My Timeline

Age 12: Orthodontic extractions and braces Age 13: Exhaustion, brain fog, constant need to nap Age 13–25: Years of doctors dismissing me. "Depression." "Anxiety." "Just tired." "Fibromyalgia." Age 25: UARS diagnosis. CBCT scan shows a very narrow airway.

I can't prove the extractions did anything. I already had a narrow face and a small jaw before anyone touched my teeth — it may well be that my airway was always going to be like this, extractions or not. Honest researchers would tell me that timing isn't causation, and they'd be right.

But when I lay my own life out like that, I personally believe the narrowing of my mouth played a part in my story. That is my conclusion about my body, not a finding you can generalise from.

You're Not Alone (But Be Careful With Patterns)

When I joined UARS communities online, I kept seeing the same story: "I got braces with extractions as a kid. I've been exhausted ever since." Often from young women, slim and "healthy-looking," with naturally narrow jaws.

I found that comforting — someone else's timeline looked like mine. But I also have to be fair: communities like that are self-selected. The thousands of people who had extractions and breathe perfectly well aren't posting in a UARS forum. Shared stories are a reason to ask questions, not proof of a mechanism.

What the pattern did do for me was give me the confidence to push for a proper sleep assessment. That part I'd recommend to anyone.

What Helped Me Think It Through

If you already had extractions and suspect UARS:

The useful question isn't "did my braces do this?" — nobody can answer that for you, and dwelling on it nearly ate me alive. The useful question is "do I have a sleep-breathing problem now, and what can be done about it?" That's a question for a sleep physician, and it gets answered with proper testing, not with a theory about your teenage orthodontics.

If you are diagnosed with UARS or another form of sleep-disordered breathing, there are options your clinicians may discuss — palatal expansion, jaw surgery, CPAP/BiPAP, myofunctional therapy. There's no one-size-fits-all. What I chose (double jaw surgery) might not be right for you, and even then it didn't "cure" me (see my other post about that). None of these are things to pursue as a way of "undoing" extractions — they're treatments for a diagnosed condition, chosen with a clinician.

If you're a parent considering braces for your child:

Please don't read my story as a reason to fear orthodontic treatment. The best available research — those systematic reviews I mentioned — has not found that extractions harm the airway on average, and untreated orthodontic problems have real costs of their own.

What I'd gently suggest is simply talking to your orthodontist. Ask whether they've considered your child's breathing and sleep as part of the assessment, and what the options are. Good orthodontists welcome those questions. That conversation is worth far more than anything a stranger on the internet — including me — can tell you.

The Winter Paradox

It's the week before Christmas as I write this. The darkest time of year. For those of us with chronic illness, winter is... complicated.

The hard parts:

• Less sunlight = worse symptoms (for many of us)
• Holiday pressure to be "festive" when you're barely functional
• Family gatherings highlighting how much you've lost
• Cold weather making everything harder

But also:

• Permission to rest (it's winter, everyone slows down)
• Dark evenings making early bedtimes feel less isolating
• The quiet between Christmas and New Year — a liminal space for reflection
• Less expectation to be "productive"

I'm learning to lean into the stillness instead of fighting it. To let winter be what it is: a season for hibernation, for turning inward, for surviving more than thriving.

If you're chronically ill with limited support during the holidays, I see you. You're not failing for resting. You're not dramatic for finding this season hard.

We're just trying to make it through. And that's enough.

If This Sounds Familiar

If you've struggled with exhaustion, brain fog and unrefreshing sleep for years and nobody can tell you why — whatever your orthodontic history — it's worth asking about sleep-disordered breathing, including UARS. That's the thread that finally led somewhere for me.

You're not crazy. You're not making it up. And you don't need to settle the extraction debate to deserve a proper sleep assessment.

This isn't about blaming orthodontists. The question of extractions and airways is genuinely unsettled, and the people treating me were working with the best knowledge they had. But you can still advocate for care that takes your breathing seriously.

You deserve answers. Keep pushing.

If you're newly diagnosed or suspect UARS, start here: What is UARS?

For more on why treatment doesn't always work: The CPTSD-UARS Connection

Sources and review

I reviewed this post on 19 August 2026 and checked the claims in it against the sources below.

• Hu et al., "The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review," Sleep and Breathing, 2015
• "Extraction of premolars in orthodontic treatment does not negatively affect upper airway volume and minimum cross-sectional area: a systematic review with meta-analysis," European Journal of Orthodontics, 2025
• Guilleminault et al. on upper airway resistance syndrome, Chest, 1993
• Bao & Guilleminault, "Upper airway resistance syndrome — one decade later," 2004
• de Godoy et al. on UARS treatment, Sleep Science, 2015

To be completely clear: the idea that my extractions contributed to my airway problems is my personal conclusion about my own case. Mainstream orthodontics disputes the extraction–airway link, and the systematic reviews above have not found consistent evidence for it. I'm not a doctor or an orthodontist. If you're weighing up orthodontic decisions — for yourself or your child — please talk them through with your own clinicians rather than acting on my story.