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.

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

  1. oluwatobi says:

    I want to ask what will happen if I did not go to see my orthodontist for check up because I have to be in the laboratory for my project atleast 2 times daily. It’s now 10weeks since I have my braces on and am suppose to go see him but won’t be able to go until week12

    • At minimum, the length of your treatment will be extended. At worst, something could be going wrong and it will just get worse the longer it goes without attention.

  2. Heidi says:

    I am a 38 year-old female, currently residing in Okinawa Japan, due to my husband’s military service. We will reside here for 24 more months. We have financially saved for me to get braces, as we will have to pay out of pocket, for all treatment. I have had two consults so far, one recommended 4 extractions, one recommended none. My mouth is small with a somewhat narrow jaw line. My concerns are should I start treatment with 24 months left here, in the long run is it better to have extractions or not, are the Orthodontists here as well trained as in the States, and is $6,000 about an average estimate? Our base dentists are not permitted to comment on services within the local community. Any advice? Thank you in advance!

    • Extractions are still a necessary procedure in some patients. Only your local orthodontist can determine if that is right for you. Most adult extraction cases take 24 to 30 months to complete, so you’d be pushing it if you are moving in 24. As for the cost, $6000 is on the low side for adult treatment in the states.

  3. Kim says:

    I need a root canal on either tooth 5 or 6. Do i have to have a root canal before i get braces or can i just get the tooth pulled and my orthodonist shift my teeth to fill in the whole.?

    • Every patient is different. If you need a tooth removed because of crowding, then removing one that has been endodontically treated makes sense. Closing spaces however can lead to other problems like asymmetry, midline discrepancies, and extended treatment times. Only your local orthodontist can help you decide the best option for you.

  4. Robin Olivarez says:

    If one tooth is removed, the formation of my teeth will not become balanced. I’ll not be able to have that so called perfect smile Lol. My question is will my teeth still look fine after the tooth removal?

    • The only time I remove one tooth is when there is already an asymmetry in the smile. If there is, removing one tooth may correct it. If you are symmetrical at the start and only remove one tooth, more than likely the treatment will introduce an asymmetry. Talk to your doctor about why you only need one removed.

  5. Victoria Grimen says:

    I am considering braces and I was wondering about one thing. I have been missing first molar for several years due to failed root canal treatment. My question is is that possible to close this space with braces? I am considering braces not only because of that space but I have very crowded and crooked teeth. I have had extra extractions now to be able to start treatment. but one thing really puzzles me :I read that after extraction bone shrinks and that is why I wonder how will that be possible to close that missing tooth space where I miss tooth for number of years? Hasn’t bone shrunk there? I have no clue about dentistry but common sense tells me that if it shrinks that it will not be sufficient to support teeth that will be moved there? Or it that wrong? As far as I understood from the dentist that referred me that they will use spaces (both one old one and there new (done recently for treatment) to straighten my crooked teeth. Thank you very much in advance for your answer.

    • Closing spaces where teeth were removed previously and the bone has “atrophied” is more difficult and does not give the same results as when we are able to close the space immediately. I have seen acceptable results however and every case is different. As for closing first molar spaces, they are twice as big as bicuspid spaces and I’ve been disappointed with the results the few times that I’ve attempted it (early in my career when I was young and would try anything). Nowadays I will usually not close molar spaces but recommend an implant instead.

  6. Sachin says:

    I am 20 year old male. I have a crossbite where my 3 tooth meet edge to edge with eachother.
    I have heard that slow palatal expansion can be used in adults. Is that true?

    • Any expansion gained in a 20-year-old will only be from moving the teeth since growth was completed sometime between 15 and 17 years of age. You are not really going to see “palatal expansion” no matter how slow you go unless a surgeon re-opens your mid-palatal suture.

  7. Judy says:

    My almost 15 year old daughter had braces for an overbite the past 2.5 years. Her orthodontist says that the overbite is corrected now, however he recommends extracting four teeth for the following reasons:
    1. As a result of the overbite correction, her lower teeth protrudes from her jaw, so by removing the teeth he will push in both the upper and lower teeth.
    2. If she does not have her teeth removed as mentioned above, there is a greater chance of falling back if she doesn’t wear her retainers.
    Is this reason enough to have the teeth removed?

  8. Elf says:

    Is pulling 5 teeth out normal, two on top and 3 on bottom, when my orthodontist suggest it I was very afraid that getting 3 pull out on the bottom is too much for me . But I have an underbite, What if the gapes between the teeth dose not close up? I am worried!

    • There is no ideal number of teeth to remove. Three is an uncommon number for the bottom arch. Just make sure you discuss your concerns with your doctor before the teeth are taken out and be sure you are comfortable with his explanation.

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