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.

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

  1. Portia Good says:

    Hi Dr. Jorgensen,

    I have just had all four of my wisdom teeth extracted in preparation of getting braces. I was wondering how long you’d advice me to wait before proceeding to get the braces fixed or would you recommend I go ahead with the orthodontic treatment right away.

    Thanks in advance!

  2. Mez says:

    Hello Dr Jorgensen, My daughter is 13 years old and needs to have 4 teeth out as part of her braces treatment. She is having expanders as well. Is it best to have the teeth out before the braces are put on or after?
    Many thanks for your advice.

    • I’m curious about why she’d having expanders AND extraction. The only scenario where I would do this would be an extremely crowded mouth with a posterior crossbite. If she only has crowding I would either remove four teeth or do an expander, not both. As for the timing of extractions, I prefer to have teeth removed after the braces are on.

  3. Shamila says:

    i need to get 4 of my teeth to be extracted before proceeding to braces fixing. Today i got one teeth extracted and left 3 to go. I would like to know when can i get my 2nd teeth extracted as the doctor leave it to us to decide.I am planning to get my next teeth extracted after 2 days which is Monday.
    thank you

    • It really won’t matter. My daugther and wife both had all of theirs removed at the same time so they were done and didn’t have to go back. That’s usually what I recommend for my patients.

  4. Jenny says:

    I had a consultation with my doctor today and they told me i need 2 teeth removed from my bottom jaw before braces since my lower jaw is too big for my upper jaw. I will also need jaw surgery later on for my severe crossbite and I already had all 4 of my wisdom teeth removed. I got really hesitant about getting anything done at all after they told me i need the 2 teeth removed before braces, so my question is do you swell a lot after removing the teeth (i had a lot of swelling after wisdom teeth removal) and will the missing teeth be really noticeable before they close the gaps up with braces? how long could it take for them to close it up?

    • Swelling is common with the removal of wisdom teeth but not so common with the removal of bicuspids. Everyone is different however. As for the time is takes to close the spaces, that varies between 6 to 12 months.

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