Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Why do I need teeth removed for my braces?

Posted by Dr. Jorgensen on April 16th, 2012

Dentist Extraction“I want a perfect smile, but I don’t want any teeth removed!” This is one of the most common things that I hear from patients during their initial exam in my office. Why do orthodontists recommend that some patients have teeth removed but not others? Why are teeth sometimes extracted as part of having braces?

All of us have two sets of teeth, primary (baby) and permanent (adult). One of the first things your orthodontist will do at your initial consultation is take inventory of which teeth are in your mouth. Although everyone is different, baby teeth usually fall out by a certain age and in a certain order. They can create orthodontic problems if they fall out too early or too late. If they fall out too early, your orthodontist can help you devise a plan for maintaining the space until the permanent replacements come in. If they don’t fall out soon enough, they may create an orthodontic problem or signal that one already exists. Removing primary teeth is sometimes necessary for the normal eruption and development of the teeth that will come in later.

While most parents have no concerns regarding the removal of primary teeth, some do when the permanent ones are involved. There are a variety of reasons why permanent teeth may need to be removed for braces, but here there are three main ones:

The first is crowding. When the amount of space required to align the teeth is less than the space available, either the size of the arches must be increased or the number (or size) of teeth reduced. Mild to moderate crowding can be addressed with expanders and braces alone up until about age 15. (After that, surgery may be necessary to re-open the sutures.) The amount of expansion may be limited by the bone structure, the facial appearance, or the supporting tissues. If a patient has moderate to severe crowding and insufficient gums or bone, permanent teeth will need to be removed to provide the necessary room.

The second reason is protrusion. The position of the lips is determined by the underlying teeth. If the front teeth are already protrusive, removing some on the sides will allow the orthodontist to move the teeth backwards to improve the lip posture. If the lips are in good position already but the underlying teeth are crooked, removing teeth may be necessary to prevent making the teeth and lips stick out.

The third reason is to correct an overbite or underbite. If the upper an lower jaw sizes are mismatched, the ideal treatment is to surgically reposition them. In most patients however, the jaw size discrepancy is small enough that the teeth can be moved to “compensate” for the problem. This eliminates the need for jaw surgery in the majority of overbite patients and some underbite patients. A patient with a moderate overbite is usually receptive to the idea of having two upper bicuspids removed if it prevents the need for surgery.

There are a variety of other reasons your orthodontist may suggest the removal of teeth as part of your treatment. These include asymmetries and missing, impacted, or extra teeth. Treatment is usually faster for your orthodontist if teeth are NOT removed, so you can assume that if he does recommend extractions, they must really be necessary. As always, ask your doctor for a complete explanation of your specific treatment plan. Educated patients are the best patients!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

247 comments so far in response to “Why do I need teeth removed for my braces?”

  1. Denisse says:

    Good morning Dr.Jorgensen, your response is very much appreciated. I am 24 years old and I need braces. My orthodontist told me he needs to remove four teeth. This is a little scary, is it normal for this many teeth to be removed? I need help because this sounds like a lot, I don’t feel like my mouth is as crowded.Thank you for your help.

  2. Amy says:

    Hi Dr. Jorgensen. I already had 4 of my wisdom tooth extracted. I currently have braces for almost 3 years now. I still have concerns with the position of my lips as they are sticking out a bit. I have 28 teeth in total now (14 upper, 14, lower). Is it still possible to have another 4 teeth removed in order to pull back the front teeth so that my lip position will improve?

    • The removal of wisdom teeth has no effect on the position of the lips. They are too far back. Removing an additional four bicuspids is common when it is desirable to move the lips back to reduce protrusion. I did this on my own wife and daughter.

  3. Claire says:

    Hi Dr. Jorgensen, I have a mild overbite and one upper tooth that is slightly crooked. Otherwise, my teeth are straight with minimal or no crowding and no gaps. I have been advised by my orthodontist that mine is a borderline case and extraction of 4 pre-molars is up to my personal choice. I am worried that extraction may cause my lips to have a dished-in look, while non-extraction may not be able to give the best results. May I seek your kind advice if I should extract or not?

    • In cases where the crowding and protrusion are “borderline,” I usually start without removing teeth and see how the front teeth look after alignment. If your orthodontist gets them all lined up and you are both happy with how they look, don’t remove teeth. If they look protrusive and cause your lips to stick out or not close naturally, then you should consider proceeding with the extractions. Delaying the decision to remove teeth may add a few months to your treatment, but it is a small price to pay if you decide that extractions are not necessary after all.

  4. natasha says:

    Hi doctor, is it possible to remove your braces before the process is complete? I just had a slight problem with gaps in my teeth that has been fixed in the first 6 months. Im happy with the way my teeth look right now. However, my doctor says that it is necessary to extract 2 of my teeth. He told me that this will change the way my face looks, like lips and cheekbones. dont want that.. it possible to just remove my braces without extracting my teeth? My doctor told me that my teeth will fall out if i do so. I would be grateful for bany advice that you have to offer.

    Thank you in advance!

    • You can have your braces removed at any point. The results may be compromised however. While gaps and uneven teeth can be improved in 6 months, bite problems rarely can. As for extractions changing your profile, that is a complex subject and the results vary patient to patient.

  5. Madina says:

    Hi doctor,im 12 and i really want to have braces but i heard that they will take 4 teeth out,is that important cant u leave my teeth with braces ?

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