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!

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

  1. Denice says:

    My daughter, age 11, has to wear braces. i just received a call from the ortho that she has an extra canine tooth that must be removed. I just thought of this (and both our regular office and ortho office are closed). Will the space where the extra tooth lived still be visible after braces?

  2. Sat says:

    I am 16 years old.My two front teeth are protruding outwards. My dentist advised me to use braces and he also suggested me to remove my 4 teeth. Then I went for a second opinion. The second dentist warned me that removal of teeth shall result in empty spaces between teeth after five to six years and using braces may damage the roots and advised to avoid the treatment. I’m really confused, please guide me whether i should go for teeth extraction or is there any other way around. Thank you.

  3. NAVIN says:

    does removing your permanent teeth cause any problem after some years??? pls help me out

    • Some patients have too many teeth for the size of theirs jaws. In these cases, if treated correctly, you cannot tell they ever existed and there are no long term consequences. In other patients, removing teeth is not appropriate or necessary. The key is finding an orthodontic specialist who knows the difference.

  4. Maria says:

    I have a 12 year that is in need of braces real bad she has overcrowded teeth in the front some are still baby teeth that must be taken out but her regular dentist didn’t do it and he send me to an orthodontist but I didn’t have any insurance at the time so I didn’t take her. Now that I have insurance I took her for an appointment for braces but the dentist told me she would need jaw surgery in order to get her teeth nice and straight that was a year ago. I’m so scared for her to get jaw surgery and the clinic where they send me to is not accepting any new patients, I don’t know what to do. Can she still get braces without the surgery? That’s my biggest concern. Can you advice me?

    • It is impossible to diagnose any patients over the Internet. I will say this. There are some patients who require surgery. There are those for whom there are options. You need to discuss the reasons why surgery has been recommended in her case.

  5. Joanna says:

    I am 12 years old and am wearing braces, while i was wearing braces my dentist suggested to remove my 2 teeth in my lower jaw. Now that i have the teeth pulled out, I look at my lower lip and notice that i have some veins that look swollen but aren’t and are purple near to where my teeth that were pulled out were , the veins make my lip look like i have 2 bumps under my lip. Is that normal,and what treatment could i use to remove those bumps under my lip

  6. Naomi says:

    My daughter’s orthadontist noticed that my daughter has protrusive teeth. He recommended that she have four teeth removed so that her teeth would move back. By doing so, her lips would close naturally, unlike now where she has to force her lips shut. He has not recommended any other options so we are definately considering it. But I am a little reluctant on removing her four teeth because they are four healthy teeth. Do you think she should remove her teeth? Is there any other options?

    • If your daughter has protrusive teeth, removing some may be necessary even if they are healthy. It does no good to have a mouth full of healthy teeth if there is not enough room for them.

  7. Tyler Kewla says:

    Hey Doc, im 16 years old and will be getting braces next week. I was not told about them having to extract any of my teeth, but if they do decide its necessary to take out teeth are they able to do it after my braces are put on? Or is it better that they do it before. I have an over bite, crowding on the top row, and my K9 on the lower left jaw is completly un-aligned with the rest of my teeth.

    • I recommend having the teeth taken AFTER the braces go on for three reasons: 1) the braces hide the holes where the teeth are missing, 2) the teeth can start moving into the new space immediately if the braces are in place, and 3) it is more difficult for the wrong teeth to be removed if they are the only ones without braces.

  8. Lucy says:

    Hello Dr. Jorgensen,
    I have a tongue thrust which has resulted in a failed attempt at braces with a unexperienced doctor that was painted to be respectable. At the time, I was a young girl and as a result, was unaware of what I know now about tongue thrusts. Because of my tongue thrust, I have a misaligned bite as well as flaring on both top on bottom. I went for an evaluation at a great orthodontist that my mother took my older sister and he stated that to correct the flaring and lip protrusion (my lips are not closed at rest) that I will need to remove my top bicuspids as well as the bottom teeth in the same spot. I don’t know their name. I bring this up because during the consultation/evaluation, he stated that I have a small jaw couple with an oversized tongue. Wouldn’t removing the four teeth lead to even less space for my tongue? As he wants to place an appliance so the teeth can be pulled back without losing maximum space. I’m worried that this will make it even more problematic. He also has mini-speech therapy people to help me with my tongue thrust. But wouldn’t removing teeth make my tongue feel even larger?

    • This is way too complex to diagnose over the Internet Lucy. You are right about the amount of tongue space being reduced. The key is whether your tongue is too big or just too active. If it is really too big (which I’ve only seen once in 25 years), then it really needs to be reduced in size (yek!). If it really is too big and you leave it that way, you’re front teeth will never come together. If it is too active, then you have a different problem. Removing the teeth may allow the front teeth to come back together, but keeping them there will be a retention challenge. There is no ideal solution except long-term retention.

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