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.

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

  1. Alexes says:

    I recently had teeth pulled (2 days ago)and i was really worried whether or not the gap would close and if it was medically correct. Im really scared on the whole braces idea

  2. ayushi aswal says:

    sir, i’m 23 yrs old.. my vry front tooth of upper jaw is crooked.. it appears to be very forward. i’m very uncomfortable about it. my orthodontist had said that apart from the front tooth of upper jaw, front teeths of my lower jaw are also less crooked & has suggested that i need to have four extractions to get them align..
    sir, i’m vry scared with the number of extraction.. i need to know will it cause some kind of serious problem in near future?? kinldy tell, i’m going for extraction tommorow..

    • Orthodontists have been removing teeth as part of orthodontic treatment for over 100 years. It is a safe and effective procedure when it is needed. Your orthodontist would surely not remove teeth if it was not the best option for you

  3. hamza says:

    the 12 12 year old daughter’s orthodontist told me that four of her teeth need to be removed as part of the treatment. That in addition to the brace and extender. Should I go for a different orthodontists for second opinion. I have heard so many bad things about the long term affect of teeth removal at this earlier age. Please suggest!

    • Please read the articles that I have written about extractions. I am not against them in the right cases. In fact, there are cases where treatment without extractions will make things worse. Find an orthodontist you trust and let him do his job.

  4. Sarahh says:

    Hello Doctor,
    I have a good bite and generally straight teeth except my 2 front teeth which are kind of overlapping and sticking out making a 3mm overjet!
    MY orthodontist said to remove 4 premolars, I already had 2 of them removed from one side, now I read that it causes sleep apnea and TMJ problems!
    My bottom teeth are absolutely straight, still they are removing 2 of them, so it makes sense that after closing of those gaps that area will become smaller and tongue space will be reduced and it can cause sleep apnea!
    What should I do doctor? I feel so helpless, please guide me on this

    • I cannot tell you what to do in your individual case, but there is no scientific evidence to support the idea that removing teeth as part of orthodontic treatment causes either TMD or sleep apnea.

  5. Alvin says:

    Hello Dr. Jorgensen,

    I am 30 years old Asian male, I have got my 4 wisdom teeth extracted, and I have total of 28 teeth now. I visited a reputable orthodontist in my city today, and was advised that i will need to pull 4 healthy teeth in order to make room for alignment and retraction. I have a slight protrusion in upper teeth and one overcrowded canine at the bottom, my lips profile is slightly pucked due to the protrusion of the upper teeth. I have asked questions like possible long term effects of sunken (dished in) facial profile etc, he told me it should not happen, as he is able to control and plan for the retraction, he also told me i fall in 90% of the general case, it is not of concerns. My question is, how common is it for an adult to pull 4 teeth in today’s orthodontics practice?

    • Removing teeth is much more common in adults than adolescents as they have no growth potential like kids. It sounds like your orthodontist has evaluated your case carefully and your results should be be predictable.

  6. Arthur says:

    I hv sent my daughter for braces. The braces was done by an ordinary orthodontist assistant who has worked with an orthodontist before. She is currently just doing it at home and just do this as part time basis. My daughter has the upper front teeth protrude out. The “orthodontist assistant” examine my daughter teeth and straight away do the braces for her. I asked her about whether need to remove the one or two teeth and she said it was not necessary as there is gap at the teeth for the braces purpose. At first she applied glue on the teeth and out the braces. We went back the next day and she said it was firm already and she did the first tighten on the wire. Roughly what is the gap required between the teeth for the braces. If the gap is not enough and a patient didn’t remove the teeth, will it cause serious problem in future?

    • I’m not sure where you live, but what you are describing is totally illegal in the United States. I would never trust an orthodontic assistant to treat a patient without the diagnostic and treatment planning expertise of a licensed orthodontist. If you care about your daughter, you should never let her return to that assistant again!

  7. Willana says:

    I’m 18 and I just got braces yesterday I didn’t really get it, the assistant had told me that I needed my wisdom teeth extracted from the back but I wasn’t sure if she meant both from the top or bottom also was I suppose to get those teeth extracted before or after I got the braces… the question is While I have these braces on will anything affect my teeth or gums because they didn’t extract my teeth that they were talking about I’m pretty confused here? Help.

    • You need to have a consultation with the DOCTOR where you’re being treated. Ask him or her why you need your wisdom teeth out and when that would be necessary. I can’t answer that for you and I wouldn’t allow the doctor’s assistant to answer for your doctor either.

  8. Yons says:

    Will extracting the 4th tooth from both the right and left side of the face (upper jaw), by any chance, cause trigeminal neuralgia? A relative of mine did get it after extracting a molar

    • I have had thousands of patients have teeth removed as part of their orthodontic treatment without incident. I’m not saying that it couldn’t happen, but I haven’t seen it. I’m not an expert on extracting teeth, but I know that third molars are close to the major nerve in the lower arch and that could have been related to your relative’s issue.

  9. BobMarleySr. says:

    i went to orthodontist he advised to have two teeth removed just to provide movement in which i refused and he opted to put on the braces even without removing those teeth he advised, now after a month i decided that it would be better be removed before my next readjustment. would that be ok knowing that i just had my braces on already?

    • Removing teeth can be done before or after the braces go on. A good oral surgeon can work around the braces. Just make sure there are no braces attached to the teeth that need to be removed before you go.

  10. kanan says:

    Doctor, I am wearing braces for past 1 and half years and the doctor now says I have to get my 4 teeth removed so that it would be better ….. I m concerned about teeth removal …. What to do plz help me

    • You’re leaving a comment on one of many articles I’ve written about having teeth removed. Re-read it and then look at some of the others under the topic heading “Extractions.”

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