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.

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

  1. Ashley says:

    Hi. I got tooth pulled yesterday (first molar) I have braces and I’m just 14 years old. My dentist said that I sill have 3 tooth to be pulled out, He said that it has cavity and need to pulled out. I really don’t want my tooth to be pulled out because I’m scared of the result. Will it grow again or I need an implant? Can I still get perfect teeth after braces when my tooth got pulled? Please tell me your opinion or suggestion. Please. Thank you. Btw sorry for my grammar, I’m really not good with it. Thank you very much if you answer.

  2. Gisle says:

    hi,
    my wife is going through orthodontic treatment for about 3 month now. it looks like she is having good movement and she doesnt have crooked teeth on top anymore. she is getting her bottom braces in few weeks. she lacks a tooth in her upper arch for number of years and her orthodontist says that it usually goes fine lo close up such spaces in upper jaw. but what we worried about is – can teeth fall out that are moved there? her teeth are a bit mobile since treatment start (what is probably normal, or?) but it seems like one tooth next to that space in uper jaw is more mobile than others, is that smth to concern about 8this tooth has already moved into that space a bit)? is also seems that this tooth is the first to have contact with lover jaw as the tooth under is a bit higher than the rest, smth probaly to blame for missing an antagonist for several years. can that be to blace that is is moveing more cause it hit harder that the rest? is that a good idea we continue this treatment? they already extracted her other teeth for treatment so we realy are lost what to fo. thtank you for answer

    • There are always concerns when you move a tooth in to a space that has been there a long time. There is less bone in that area. I’ve done it before and I’ve seen some go well and some have issues. Only your doctor can monitor this for you.

  3. Val says:

    Hi. I had my lower right first molar removed 2 days ago. If I wear braces, does my 2nd molar will close the space left behind by the first molar? I’m 19 years old. Is this a good idea? Dental implant is expensive. I’m thinking of having it in 5 years when I have money. Please help me

    • It is unlikely that braces will be able to close a space that big. Although possible, it would take a lot of time in braces, cause other issue further forward in the mouth, and may cause the second molar to be lost as well. An implant or a bridge will probably be a healthier solution.

  4. Suddy says:

    My teeth slightly protrude on both my upper and lower jaws. But i am able to close my lips alright. My orthodontist says that 4 of my bicuspids have to be removed. Is there any chance that this number can be reduced? I mean im able to close my lips, so I’m guessing its not that bad. Can you give me your opinion on this one?

    • Being able to close your lips is just one factor. There are many more. Ask your orthodontist to explain exactly what will happen in your case if you don’t have your teeth removed. Good luck!

  5. sapphire says:

    I have to say i am really really scared about pulling my adult teeth out to get braces, i missed out as a child and now during my adult years i want to get that perfect smile to boost my confidence and my only worry is having my teeth extracted and then when getting the braces it causes problems from when the new teeth take the place. Is there any way possible that i can have the braces without having to pull out any of my teeth? My teeth are crooked and i have a large gap on my bottom two teeth, surely it could be straightened without having any teeth pulled out?

    • I cannot diagnose your case on the Internet. Only your local orthodontist can do that. There are just cases where teeth must be removed, plain and simple. Good luck!

  6. Cara says:

    Hi im 14 and due to have braces in 2 weeks or so then in about a month have 2 teeth taken out. I’m confused, can they be extracted with the brace on?

    • Removing teeth for orthodontic reasons can take place before or after the braces go on. I like to wait until after so that 1) the braces camouflage the spaces, 2) the oral surgeon pulls the right teeth, and 3) so we can start moving the other teeth right away.

  7. Suddy says:

    I got my braces now for the lower set of teeth. My ortho put some “cement” on one of the tooth so that the upper teeth do not disturb the lower set. Obviously as a consequence, I cannot close my mouth enough to chew food properly. Any means of survival? How am i supposed to chew my food? And this cement is going to be as long as the braces are there……..?

    • This is a very common TEMPORARY practice that helps your teeth move faster and prevents your bite from interfering with the brackets and your treatment. Your orthodontist will remove the cement as your treatment progresses.

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