Why can braces cause sunken cheeks?
Sunken cheeks during orthodontic treatment mainly occur in cases where teeth need to be extracted to create space for tooth movement. When the dental arch narrows after closing the extraction space, the lips and cheeks, which were supported by the old tooth structure, will slightly sink in due to the new relationship. This is not a loss of cheek fat or soft tissue damage, but rather a change in the support relationship between the bone-teeth framework and the external soft tissues (lips, cheeks) as the teeth move.
This phenomenon is more common in cases of overbite requiring tooth extraction to retract the front dental arch, which is analyzed in detail in the article on orthodontic treatment for overbite.
At what stage of orthodontic treatment does sunken cheeks appear?
Sunken cheeks do not appear immediately after the braces are fitted, but gradually become more apparent during the closing of the extraction space, that is, when the dental arch is being pulled closer together after the initial space has been created. In the initial stages of treatment (aligning teeth, before closing gaps), the lip-cheek relationship remains almost unchanged because the dental arch still retains its original width.
The degree of cheek hollowing is usually most noticeable towards the end of the gap-closing process and stabilizes after braces are removed, without further changes during the retainer wearing phase. Therefore, if you notice your cheeks appear more hollow than before during the treatment, this is a normal progression of the treatment mechanism and not an abnormal sign that needs immediate attention.
What signs indicate normal cheek hollowing, and what signs indicate abnormality requiring examination?
Cheek hollowing is considered normal when it occurs gradually, symmetrically on both cheeks, increases progressively as the gap-closing process progresses, and stabilizes after treatment is complete without worsening. This type of change is predictable and does not involve other symptoms besides changes in appearance.
Sunken cheeks are considered abnormal and require immediate dental attention if any of the following signs appear: noticeably asymmetrical sunken cheeks, sunken cheeks accompanied by pain or numbness in the face, or sunken cheeks that worsen after braces have been removed and retainers have been worn instead of stopping. These three signs are not part of the normal lip-cheek relationship changes and may be related to other factors (such as jaw muscle or soft tissue issues) requiring a direct examination by a dentist to determine the cause; self-monitoring should be avoided.
How serious is sunken cheeks caused by braces?
In most cases, sunken cheeks due to braces are mild, only noticeable when comparing before-and-after photos or viewing from a side angle, and do not significantly alter overall appearance when viewed directly. The degree of noticeable cheek hollowing depends on three factors: the number of teeth extracted (extracting many teeth to close large gaps tends to result in more pronounced changes), age (older people have less elastic soft tissue, making changes more noticeable), and the natural structure of cheek fat (those with thicker cheek fat are less affected than those with thinner faces).
Children and teenagers undergoing orthodontic treatment generally have a lower risk of cheek hollowing than adults, because their jawbones and soft tissues are still developing, with better adaptability and regeneration capabilities compared to fully stabilized soft tissue in adults. This is why the ""age"" factor affecting the degree of cheek hollowing is not only true when comparing adults to older adults, but also clearly evident when comparing children/teenagers to adults.
Does orthodontic treatment without tooth extraction cause sunken cheeks?
Orthodontic treatment without tooth extraction significantly reduces the risk of sunken cheeks compared to cases requiring extraction, because the dental arch is not narrowed, but only the teeth are rearranged within the existing jaw structure. This is why assessing whether tooth extraction is necessary at the initial examination stage directly impacts whether facial changes are noticeable after orthodontic treatment, not simply a technical decision regarding space.
How to reduce the risk of sunken cheeks during orthodontic treatment?
The most effective way to reduce the risk of sunken cheeks is to have a thorough discussion with your dentist at the initial examination and treatment planning stage. This allows you to assess whether tooth extraction is truly necessary or if there are other options (such as palatal expansion or appropriate interdental grinding) to avoid unnecessary extractions. Not every case requiring space necessitates tooth extraction, and this decision should be based on the doctor's professional assessment, not on the patient's subjective desire to avoid cheek hollowing.
The doctor can make a relatively accurate prediction of the likelihood of cheek hollowing during the initial examination, based on the number of teeth to be extracted, jawbone structure, and cheek fat percentage from clinical examination and X-rays. However, this is a general prediction, not an absolute figure, as it depends on each individual's soft tissue reaction during actual treatment. Therefore, discussing this with the doctor beforehand helps patients get a general idea of the possibility, but the final result is only clear after the gap closure phase is complete.
This is one of the risks/concerns to consider, alongside other oral health complications during orthodontic treatment, as summarized in the article ""Are there complications and risks associated with orthodontic treatment?"".
Frequently Asked Questions About Sunken Cheeks During Orthodontic Treatment
Do all people who have teeth extracted during orthodontic treatment experience sunken cheeks?
No. Sunken cheeks only occur in some cases and to varying degrees depending on facial structure, age, and the number of teeth extracted; it's not a consequence for everyone who has teeth extracted during orthodontic treatment.
If you're worried about sunken cheeks, which orthodontic method should you choose?
No orthodontic method (braces or clear aligners) inherently determines whether or not you will have sunken cheeks. The main factor is whether or not teeth were extracted, not the type of appliance used. You can refer to our comparison of orthodontic methods for more information on choosing a method.
Will sunken cheeks after braces heal on their own over time?
After stabilization at the end of the gap-closing phase, the lip-cheek ratio usually remains the same and does not continue to change further when wearing retainers. If you notice your cheeks continuing to sink in more significantly after this phase, it is an abnormal sign that needs to be checked by a dentist instead of waiting for it to improve on its own.
In short, sunken cheeks during braces are a phenomenon that can occur mainly in cases requiring tooth extraction, appearing most noticeably during the gap-closing phase and after the braces are removed. Normal cheek sunkenness occurs gradually, symmetrically, and without pain; conversely, asymmetrical cheek sunkenness, accompanied by pain/numbness, or continuing to worsen after treatment stabilization is a sign that needs immediate dental check-up. A thorough discussion with your dentist from the initial examination helps to predict the likelihood of this happening, although the exact result will only be clear after the gap-closing phase is complete.