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.

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

  1. Rashi says:

    Hi Dr.. I had already 4 of my wisdom teeth extracted but still I am not satisfied with the position of my lips.is it still possible to have another 1 teeth to removed to pull back the front (upper) teeth to get perfect position of my lips.is it safe if more than 4 teeths are removed

    • Having wisdom teeth removed has NO effect on your lip position. They are located so far back in the mouth that they do nothing to the front teeth. Wisdom teeth removal is a dental procedure that is sometimes necessary because of crowding in the back of the mouth but it rarely helps with orthodontic issues in the front. Patients who require the removal of bicuspids to treat protrusive teeth or crowding must usually also have their wisdom teeth removed too.

  2. robin says:

    My 14 year old has to have 2 teeth removed one of her teeth is positioned higher than the others and another for over crowding on the top. what is this called in insurance terms, impacted?

  3. zoe says:

    I want to open the smile with braces and put the same teeth they took out of my mouth wrongly.and make it how it supposed to be at the first place.do you think it worth making all these procedure?

    • What makes you think that your teeth were moved erroneously? I have never had a patient in 25 years in which I felt that spaces could or should be reopened so that teeth could be reinserted. I do not believe that you would benefit by having this done.

  4. Daiva says:

    Hi, I would like to ask you when 2 upper teeth need to be removed and when 2 upper and 2 lower teeth need to be removed? I had a consultation with my orthodontist and she suggested me to extract 4 teeth, but I know that in some practice only 2 teeth is removed before having braces. What is the difference?

    • Although there are different diagnoses and treatment plans, four teeth are usually removed when there is crowding or protrusion in both arches. Orthodontists usually only remove two in the upper if the upper jaw is bigger than the lower jaw.

  5. Francesca Psaila says:

    Hi there, thank you for all your informative posts. I have a class III skeletal pattern and my orthodontist had suggested jaw surgery but I decided to stick to orthodontic treatment alone as my jaw does not bother me so much and I am happy with the shape of my face. So I currently have upper lingual braces on to correct crowding, and I will be getting a lower brace this week. But I will have to extract my lower right first premolar before my lower braces can be put on, to provide space for the lower teeth to move to the right, straighten them and tilt them backwards slightly.

    My concern is whether this extraction and treatment with the lower brace make my jaw look worse or will it just stay the same? I have been reading horrific stories on how tooth extraction has changed faces and I don’t want that to happen to me.

    Thank you very much!

    • Your jawline will not change at all by having a tooth removed, but the position of your lips may change slightly as the space is closed and the front teeth are shifted back and to the right. That is a compromise you have chosen by not having the jaw surgery. If you had the surgery, not only might it be possible to keep your tooth, the surgeon could actually improve your profile.

  6. Suguna says:

    Hi, 2 months back my dentist extract my lower wisdom tooth which got a cavity. It went normal and no complications at all.
    But my concern about my cheek got flat compare with other cheek.
    Extracted cheek bone became narrow and other one looks wide. I look two different face appears.
    I am 35 years old woman. Please help me and give me solution,I am having hard time to solve this.

    • I have never heard or read of the removal of a wisdom tooth changing the shape of a cheek. Never. Not once in 25 years. The wisdom teeth are so far away from the cheek back in that part of the mouth that I can’t see how one could cause the other. I doubt they are related, but you should ask your oral surgeon.

  7. Georgina says:

    Hi I had braces fitted in about 6 months ago. And I have to have 4 wisdom teeth taken out, I understand the two that were taken out from the top (this was to create room for my two higher teeth that were coming down) but I do not understand why they removed two of the bottoms. Will I forever have to gaps on my bottoms on each side? No one will see but it will still bother me. will this create any gaps within my front teeth at all? I am 17.

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