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.

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

  1. Arya Mukherjee says:

    I am 17 years boy. Due to moderate crowding of upper teeth Orthodontist recommended to extract 2 teeth at position 4+4 before bracing fixing. My query will the extraction of permanent teeth weaken my future oral strength? If I igo ahead with braces without extraction will it take longer time to align my teeth? Please advise way forward for treatment.

    • Removing bicuspids will not affect the “strength” or health of your other teeth. Your orthodontist is trained on knowing when and when not to remove teeth and will make sure you are left better off than when you started.

  2. Charlotte says:

    Hi, initially i started out this braces treatment is because the dentist say i do not need any extraction. However, as months goes by, the dentist realised my teeth is slight protruding out and recommended me to extract 2 premolar from the too and bottom of my teeth. i was wondering other than extracting are there any other ways to fix my teeth.

  3. pratibha says:

    I have gaps between front of my teeth …dentist told me tooth extraction …but I don’t want my tooth extraction ..what should I do

  4. Mary says:

    Am very concerned mother of my 15 nearly 16 year old son, he has crowding and his jaw is set back, we’ve been told has to wear a Twin Block for 8 months and extract 3 molars and 1 pre molar?. My concerns are 4 good teeth removed can not be re placed, I know he has crowding but don’t want any teeth removed let alone 4, Very worried has he gets older teeth may have fall out naturally leaving him with less teeth. Please advise Thanks Mary

    • My article discusses your concerns. When patients have an overbite or crowding, sometimes teeth must be removed to allow the problem to be corrected. You can refuse to have the teeth removed, but you might be preventing the correction of the problems he has. This is something you must discuss with his orthodontist in person. Good luck!

  5. manish says:

    my son has protrusive upper teeth but no crowding. does he need extraction. please suggest

    • I can’t speak to your son’s condition, but removing two upper teeth can reduce protrusion in some patients. This is one option we use when the only other alternative is to surgically move the lower jaw forward.

  6. Ramyasree says:

    My age is 21…I dont have any gaps between my teeth. My teeth alignment is slightly forward both, up and down…due to which when i smile my lips shape does’nt appear normal. Orthodontist suggested that 2+2 teeth had to be extracted….now my doubt is that, will the gap formed due to this extraction be filled by the time my braces are removed?? or will i have to suffer with gaps in the future??

    • The purpose of removing the teeth in cases of protrusion (the lips are too far forward), is to retract the teeth back as the spaces are CLOSED. Removing the teeth without closing the spaces would serve no purpose.

  7. Brianni says:

    Hi I went to the orthodontist and he told me to take out 4 teeth. 2 at the top and 2 at the bottom. However when I went to the oral surgeon they want me to take out all 4 wisdom teeth. I should I decline that because my orthodontist didn’t tell me to take out those teeth or proceed with the surgery ?

    • The wisdom teeth are separate from the bicuspids and will not help or hurt your orthodontic treatment. You can have them removed before, during, or after treatment and it will not affect anything. Sometime it is easier to just have all 8 teeth removed at the same time.

  8. rizul kalra says:

    i am 20 years old.. i had treatment of teeth when i was just 14 years without removing any of my teeth.. my teeth are crowdy..n fronth 2 teeths are out.. n now they are coming on same position .. wht is the problem ?

    • That’s a perfect question for a local orthodontist in your area who can re-evaluate what has changed since your first set of braces. Keeping the teeth straight is a combination of the appropriate treatment in the first place and continued retainer wear thereafter. Your problem could be caused by one or both of these issues. Teeth always move after treatment without continuing retainer wear no matter what treatment was provided. Retainers are forever

  9. FB says:

    I just got my damon braces today but it is undone because my orthodontist told me that I still need to take out 4 teeth (2 at the top and two at the bottom). Is she going to change the wire after the extraction? Will i get molar band? Thank you in advance..

  10. Bharathi C says:

    I had gap in my front teeth. I wore braces four years back. I used retainers for more than two years.Teeth was not extracted. Now again the gap started coming and my lips looks like protruding.. Doctor has advised to wear braces for the second time.. What should I do.. My age is 29 female . Is there any other way.. Kindly advice..

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