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.

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

  1. Nat says:

    I got 4 teeth removed before I got my braces and I was wondering if I still had to get my wisdom teeth removed

    • Although having bicuspids increases your chances of keeping your wisdom teeth (decreasing from 85% to 50%), there is still a 50-50 chance you’ll need to have them removed.

  2. morgan says:

    Do needles hurt when you getting braces I’m having my 2fangs took out tomorrow and I’m scared for the needles.
    Pls reply asap any one

  3. Jen says:

    Hi Doctor,

    I’m 21 this year and have a moderate to severe overbite problem. I was told that I have narrow dental arches. Just recently, I visited a Dentist and was told to remove 4 wisdom teeth and 4 other teeth for braces. Is that necessary to take out 8 of my teeth as many people do extract 4 instead of 8. I’m quite worried to get 8 of my teeth removed and wonder if it I should seek another Dentist.

    • Everyone is different and having four teeth (plus wisdom teeth) removed is not uncommon. My wife and daughter both had that many removed and their smiles are perfect. You must trust your orthodontist or find one that you do trust.

  4. Emily says:

    Hello doctor! I’m a 20 year old female. My problem is that my upper set of teeth protrudes out above my lower teeth.I recently consulted a dentist and after I showed him the OPG and Cephalogram scans, he suggested that I have 4 of my premolars removed; 2 from each arches. My parents are against me removing any of my teeth and I’m quite hesitant about it myself because the thing is I have perfectly healthy and normal teeth, great even! Can you please advice me on whether I should get them extracted or not, and if there will be any consequences because of that? Thank you!

    • Only your local orthodontist can determine the right treatment plan for you. Please read all of the articles about the removal of teeth on this blog in the EXTRACTIONS (REMOVING TEETH) section. You’ll understand why it is sometimes necessary to remove seemingly healthy teeth to obtain healthy, attractive results with braces.

  5. Erica Newberry says:

    Hello Dr Jorgensen, My daughter had braces put on 18 months ago at the age of 13 to create a gap for an eye tooth to come down. We had an appointment today and were told that her 2 premolars need to be removed in order to correct her overbite and to prevent her teeth and lips protruding. Is this a normal process at this time of her treatment as I am worried about removing her adult. Your advice would be much appreciated. Thank you.

    • Sometimes the need for extractions is not apparent until the teeth are aligned. It is quite possible that your doctor was trying to avoid extractions but now that the space has been created for the canines, the protrusiveness has tipped the scales in the other direction. This very thing happened with my own daughter

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