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.

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

  1. Rebecca says:

    Thank you for answering many questions about my son’s need for teeth extraction to help fix his overbite. This article wad extremely helpful!

  2. Rebeca Chavez says:

    so i went to the orthodontist for the first time , because my parents finally agreed with getting braces so yay . while he was checking my teeth , he said I needed four teeth removed , and my parents didn’t like the sound of that because they said I’m too young for teeth removal . (I’m 15.) so we left and decided we try another orthodontist . he checked my teeth and he did not mention anything about having teeth removed . when i tomd him about the first orthodontist , he disagreed and said that my teeth will be enlarged to create more space and teeth removal isn’t necessary . I’m scared and don’t know who to believe . 🙁 please help

    • I can’t decide this for you Rebeca. You need to ask lots of questions and then decide as a family which doctor you trust. You could also get a third opinion if the first two were completely different.

      • Elisha says:

        Omg! Same thing here im 15 and the orthodontist wants to extract 4 teeth but ive only been to him everyone keeps saying i should get a second opinion which i want to because why get rid of FOUR HEALTHY teeth? He also said he can push all my teeth outwards?? I dont know how that will help??

        • I think your orthodontist is describing the effects of the two treatment plans. If you are crowded, removing four teeth will provide the room necessary to align the teeth without changing their position in your profile. If you do not have teeth removed, aligning them will push them outwards. For some this is not a problem. For others, the teeth will look protrusive if pushed forward and they may also prevent relaxed lip closure. This is why it is important to find a trained, experienced specialist who will do the RIGHT thing, not the popular thing.

  3. Nigel Howard says:

    My daughter is having a tooth removed and braces to realign her teeth. My wife wants to know why the wisdom teeth can’t be removed to make space since these are so often troublesome later in life?

  4. Kat says:

    Hi. I’ve been wearing braces for a while now and before I had them, I had 4 teeth removed. But my teeth are actually quite big for my mouth and the orthodontist can’t make them straight even after she did that thing to create gaps between my teeth to pull it in even more. She said that she can’t do it anymore since my enamel is wearing down so I was wondering if I have to extract more teeth. Or is it not safe to do so?

  5. Hani says:

    Hello Dr. Jorgensen! I have protruding upper teeth and a weak chin. I got 4 teeth removed for braces, but the ortho will only install braces in a week time. Is it possible for braces to correct my weak chin without surgery? Are there any other alternatives? Thank you for your time!

    • Removing bicuspids and moving the lips back may make your chin look bigger by comparison, but orthodontic treatment alone will not make your chin any bigger. It is possible to get a chin implant or chin advancement (genioplasty) that is completely cosmetic.

  6. Sedna says:

    The orthodontist has recommended the extraction of one lower front permanent tooth before fitting braces for a crowding problem which exists both on the top and the bottom. Please advise if this is normal practice. Thankyou.

  7. Lisa says:

    Dr. Jorgensen. I have general query regarding extractions that is when we extract teeth and create gaps, the other teeth are forced to occupy their new places. Does this cause any long term jaw pains and affect the roots of the tooth?

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