Dr. Greg Jorgensen
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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, remove tooth, 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!

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

  1. Annike C. says:

    My daughter, aged 13, has been treated with a lip bumper for 2 years, to make space because of moderate crowding, but the orthodontist now says it’s not been efficient enough and she’ll probably need to have 4 premolars extracted soon. I’ve read that some people complain that teeth extraction can change people’s profile, by reducing the size of/pushing back the jaws, and as such could have an impact on her smile/lips. Based on your experience, is this true and have you already noticed that type of consequence ? My daughter already has very small lips and I wouldn’t want to make it worse…

  2. Claire says:

    I have a impacted tooth that will not come down. It’s not my wisdom teeth I think it is a premolar maybe. It’s a permanant tooth. My orthodontist is saying that since it’s crooked and won’t come down that it’s best to remove it and also remove another permant tooth on the other side but the other tooth he wants to remove isn’t the Same one that will not come down. He had mentioned that we could try attaching a chain to it and pulling it down but we took a new x ray and he said it was too risky to try and do that because it’s so far over in my mouth that it could damage another tooth. Does this sound normal? I am just worried that I will have not enough teeth to filly mouth.

    • It sounds to me like your orthodontist knows what is going on. Have him explain it all to you so you know exactly what he has planned, but it is not uncommon to remove an impacted tooth and another one on the other side to keep symmetry.

      • Linda says:

        Is it safe to tamper with impacted teeth while the pre-molars can be extracted? Please help,because I wouldnt want to go on with a surgery that would bring more harm. My orthodontist suggested that.

        • Not only is it safe, it is preferable. You’ll already be anesthetized and the surgeon will have better access because of the other procedure that are being performed. I haven’t looked at your case specifically, so I can’t comment on your mouth, but I have recommended this in many of my own patients.

  3. Angel says:

    Hi, when I visited my dentist last year, she suggested that I should have braces on because of my overbite. Well, my upper teeth are perfectly aligned. It’s just that it’s not aligned to my lower teeth. I have plans of saving money for the braces but I have fears of injections if ever my teeth needs to be extracted. Do you think I need to have some of my upper teeth pulled out?

    • I cannot answer that question Angel. You’ll need to talk that over with your orthodontist. He will need to consider your facial structure, tooth position, jaw relationship, amount of crowding, etc. If your teeth are straight but you have an overbite, the probable cause is that your jaw sizes are mismatched. If that is the case, you can either move the jaws (surgery) or move the teeth to match them (camouflage). This may or may not require the removal of teeth depending upon the previously listed variables. Good luck!

  4. Adrian says:

    Hi I’m 20 and I have had my braces for 2 years now. I have had my two bottom wisdom teeth removed because I have a overbite and the ortho wants to remove my first premolar on my right side of my mouth to align my top teeth with my bottom ones. He tells me that if I don’t get it removed that I will have either jaw or bone structure problems when I grow up. Is this true? I don’t want to get it removed unless I really have to for it won’t affect me later on in life. Thanks for your help

    • The removal of wisdom teeth has little or no effect on the correction of an “overbite.” Those teeth are just too far away from the problem. I cannot advise you on the necessity of removing teeth in your particular case, but I would recommend that you have your orthodontist explain in clear terms exactly what he’s trying to accomplish and how removing teeth will help you get there. Good luck!

  5. Lily says:

    Will removal of four permanent teeth change my physical appearance? I am in my mid twenties and already had four wisdom teeth removed, but now the orthodontist wants to remove four bicuspids for crowding. I am finally happy with my looks and I have just read horror stories about teeth removal changes the look of your cheeks, lips, and face in general. Is there any other way to correct crowding and an open bite without removing four teeth?

    Another reason I am concerned is that two of the molars don’t seem to be in the best shape, so I’m removing four perfectly good teeth (bicuspids) but leaving the two molars (that had fillings early on) in! Is there anything else I can do?

    Please advise.

    • Every case is different. As I’ve mentioned in my article and in many responses to comments in this blog, removing teeth in the wrong patient can have bad consequences for some patients and good results for others. On the other hand, NOT removing teeth in some patients can be unhealthy, unstable, and make them look worse. You need to discuss your individual case with your doctor and make sure you understand his rationale for recommending extractions.

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