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!

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

  1. Keri says:

    My daughter who is 14 has worn braces for 3 years and at her last ortho appt, her ortho gave us a referral for an oral surgeon for jaw surgery. we went to appt and she needs upper jaw surgery to bring her upper jaw forward, as when she bites, her top teeth touch her bottom teeth- he also wanted to pull all 4 wisdom teeth. Went to a different ortho for a consult and he wants to pull 4 bicuspids and keep braces on and not do jaw surgery as he thinks he can make it work..She does have big teeth and looks crowded. I can send a photo. Just do not know what to do?!

    • I cannot diagnose individual patients Keri. You need to hear out both orthodontists and have them explain their proposed treatments. The treatments are very different and will give different results. Your job is to decide which orthodontist has the most logical approach as well as experience with these types of cases. Good luck!

  2. April says:

    Hi I’m 16 and an on coming junior. I have a baby tooth that never fell off that I need to get extracted in the front. How long would it take for that open space to close?

    • Spaces do not close on their own. If you have braces, the length of time it will take for the space to close is determined by the size of the space, the amount of crowding, etc.

  3. Lisa says:

    I’m 13 years old and my teeth are not straight espically the bottom ones and the 2 in the middle are not beside eachother, 1 is in front and 1 is in the back. And I wanna get braces soon but I think I have a problem, I have 1 more tooth that has to fall and even the new 1 is coming out but it’s still not loose! And 3 teeth that fell already aren’t all out. So Am I ready to get braces? Or should I wait until all my teeth fall and the premannt ones come out? Pls help and thank U.

    • Timing of treatment varies from patient to patient. In general I like to begin after the last primary tooth is gone and the 12-year-molars are at least poking through. If you are in a hurry, I would ask if you can have your dentist remove your remaining baby teeth.

  4. Bryony says:

    Im 15 years old and have just had my orthodontics consultation. I have always had a fear of the dentist and I am already panicking. My biggest fear is being told they would need to remove a tooth. Is there anyway you can avoid having teeth removed?

    • There are ways to avoid extractions if you have the right teeth, bone, gums, lips, etc. In many patients removing teeth is the wrong thing to do and we avoid it at all costs. In other patients is would be a mistake to not remove teeth. Your challenge is to find an orthodontist that you trust that knows the difference.

  5. Janeth says:

    I’m 13. My dentist told me that I have a tooth growing on top of another tooth in the back corner of my mouth and I need a surgery to remove that. But I don’t really want to. It doesn’t really affect my eating or anything. And it doesn’t hurt at all. Would it be ok if I just let it be, or will anything develop in the future?

    • If one tooth is growing on top of another and you can’t keep it clean, you could have decay, gum disease, abscesses, etc. There is a reason that your doctor is making this recommendation. Discuss it with him.

  6. Olivia says:

    I’m 14 and my dentist said that I have an impacted canine. I have my first orthodontist appointment in a month. Will I need braces?

  7. Karen P says:

    My son is 14 and has had his braces on for over 3 years now. Our orthodontist recommends removal of the upper second permanent molars to allow for more room allowing for the wisdom teeth to come in and eventually take up those spaces. Is this something you have heard of and does it make sense? Thanks!

    • I have only heard of orthodontists recommending the removal of upper second molars DURING treatment. Unless there is a problem with those teeth, I would not remove them to save the wisdom teeth. “A bird in the hand is worth two in the bush.”

      • Karen P says:

        So – as it turns out – we are in treatment and have been for a few years! The bite is still not aligned and our orthodontist actually recommended having the second molars pulled a while ago to facilitate treatment. Thoughts?

        • Second molar extraction is not common, but I haven’t see the case. Most orthodontists have bicuspids removed because they are closer to the crowded, crooked teeth which are usually in the front of the mouth. There are times however when there is so much crowding in the back of the mouth that the second molars are halfway impacted in bone (especially in the lower). In these cases, orthodontists don’t have a lot of options.

  8. Joey says:

    I am 15 year old. I have two is on top(1 on each side) because my baby was pull out too late. Those two teeth cause my gum to bleed when I brush it because when I brush it,it touch the gum a little and it hurt when I touch I gum. I also have two crooked teeth at the front bottom and the two top front teeth a little out. don’t know i should expand it or pull out four tooth…I search on the web and it said expanding jaw may cause tmj or jaw point and pulling out four teeth can cause you difficult chewing or grinding your teeth start in the early 20s…what should I do? Put out four teeth,expanding the jaw or don’t do any thing..

  9. Katy says:

    Hi, My son is 10. We have been told he has the mouth of a 13yr. old and is ready for treatment. We have been given two treatment options. 1) Remove to adult premolars on the top, then braces to correct overbite, deep bite, and slight crossbite, as well as helping his top and bottom jaw align.
    2)Surgery to correct his jaw, then braces.
    My son’s facial profile and appearance as far a jaw line look fine, So as for now we have chosen option 1.
    He is 10 and has a lot of growing left I am sure! Have you seen any patients as older teens or adults where this choice has been a mistake? or that the patient had to have surgery anyway down the road?

    • I cannot diagnose your son from here, but I can say this. Patients with large overbites at age 10 do not outgrow it. If they have an overbite at 10, they’ll still have an overbite at age 15. There are growth modification appliances that can be effective in 10-year-olds who are still growing. These include headgear and functional appliances. Whether or not these would be effective in your son is something you can ask your orthodontist. As for the decision between camouflage (removing teeth) and surgery, the biggest consideration is profile. If he looks fine to you, don’t have the surgery unless your orthodontist feels there is no alternative.

  10. Marrieth says:

    Hi. I’m 21 yrs. old. The two lateral incisors of my upper teeth are root canal(ed). Also, I have a total of 15 upper teeth, my tooth (first molar) have no pair on the right side. That makes my left central incisor the very center. It doesn’t look good, I can’t smile without being conscious. I really want it to be corrected. Can braces correct it? If yes, how? And will it affect my 2 root canal lateral incisors? Thanks very much!

    • Asymmetries like you are describing can be corrected through braces. The teeth with root canals can be a part of that process. Cases like yours are more complex and should be seen by a specialist with advanced training and experience. It can turn out very nice in the right hands.

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