“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!
Hi,
I’m 15 years old and planning to get braces. I have 14 teeth at the top and 14 teeth at the bottom. Do I need to get any teeth extracted in order to get braces?
There is no sacred number of teeth. A “full set” is 32, but only 15% of the population have room for them all (hence wisdom tooth extraction). One of the first things your orthodontist will do is evaluate the size of your teeth and jaws. He will recommend the removal of teeth only if you don’t have room for all of them. Most patients end up with 28 teeth just like you. Many with overbites end up with 26 teeth (because it is common to remove upper bicuspids to fix overbites). Patients with a lot of crowding many times require the removal of four bicuspids in addition to their wisdom teeth. They end up with 24. The key is not how many you have, just that you have the right number for you. Good luck!
Hi,
I’ve had braces for 5 months now. It’s going great so far. My open bite is closing nicely but my lips are still protruding.
My ortho. suggested that i get 4 teeth removed in order to correct this. But he said that if i’m comfortable with how they look now then i can decide not to do the extractions. What i’m concerned with is how my lips are going to look if i should get my teeth removed, and how far will my teeth be pulled in after the extraction & treatment is complete? I am afraid that my teeth will be too far back and might cause my lips to drop. Is it necessary to get extractions?
If your lips are protruding and it bothers you, you should choose the extraction option. I have never had a patient go from too protrusive to too flat EVER! Even if your orthodontist tries, he will not be able to move your front teeth back more than 3 or 4 mm. That’s not much at all.
It depends upon how complex your case was. The important thing is that you know what your orthodontist is trying to accomplish and that you see and feel like your treatment is progressing. Talk to your orthodontist. Rather than ask, when do I get my braces off, ask him what remains to be done and does it look like I’m progressing. That will give you a better perspective of how you’re doing and if three years is appropriate for you.