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.

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

  1. Thomas says:

    Hello I’ve had the 6 month smile now twice on my upper teeth and I wear the retainer every night but they have moved a bit since I had my brace off 18 months ago but I’ve checked my retainer for cracks and can’t see none at all .. I wish my orthodontic removed some teeth now instead of grinding My teeth down.. Should I go else where and see what another orthodontic says ? Help

    • Six Month Smiles is typically not used by orthodontists, but rather by general dentists. If you are not happy with your results, you should see an ORTHODONTIST (a braces specialist) this time

  2. Lauren says:

    Hi Dr. Jorgensen, i’ve had braces for 4 months now and recently, a friend told me that i shouldve waited til my wisdom teeth appear since they may cause crowding again after wearing braces. What do you think?

  3. stannus says:

    hey..I and 21 years old and want to get braces on. Othodontist said he will extract four teeth before puttin braces on. Is it fine???

    • Having teeth removed for braces is a common technique and appropriate in the right patients. I cannot tell you if it is the right option for you. Only a local orthodontist can tell you that.

  4. Josh says:

    I was looking for information on removing adult teeth and I think I have my answer. Our son is 10 and our dentist is recommending he have 4 adult teeth removed before braces, said his mouth is VERY small. I trust my dentist but had never heard of removing adult teeth in a 10-14 year old. I see, after reading this, it is not that uncommon. He is a dentist not an orthodontist but he is a personally trusted, high rated family dentist/(friend), and has experience doing this you would say he is right? I guess it just seems weird to me because we are not in the industry…

    • I can’t make the decision for you, but I would not trust a four-bicuspid extraction case to a general dentist. Extraction treatment is complex and should be performed and overseen by a trained, experienced specialist.

  5. Lisa says:

    Hi Dr.Jorensen! My orthodontist told me that I have to have braces on for 2 years beacuse I had a small overbite and crowed teeth so they removed 2 teeth on the top and 2 teeth on the bottom.But right now I had braces for 2 month and my teeth are pretty straight, but there is like 2 teeth that are kind of crowed. Sp my question is do I really need to wear braces for exactly 2 years like my orthodontist say?

    • There is a lot more to correcting your orthodontic problems than just aligning the teeth. There is correcting the bite, matching the midlines, reducing the protrusion (if there is any), and closing the remainder of the extraction space. Only your orthodontist can give you an accurate estimate of how long your braces will need to be on.

  6. Mona Barry says:

    HI. I am 51 one years old and have recently gone to two orthodontists..one in late 60’s and one much younger. The younger orthodontist receommended a mouth guard for grinding my teeth at night for 6 months and 4 teeth extractions BEFORE I get on the braces. The older one did not…I am so confused…… my teeth are not that bad so I dont know what to do..shud I get a third opinion?

    • If you don’t trust one more than the other, get a third opinion. I’m not a fan of removing teeth before treatment begins. Too many things can happen if treatment can’t be started as planned after the teeth are gone.

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