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!

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

  1. shaunee says:

    Hi Dr! I am already 21 and just recently got braces. I had 1 baby teet removed which is the upper first molar and the gap shows if i smile. It’s depressing me because I’m already too old to have a gap. I always worry that someone will notice whenever I talk. How long will the gap close? It’s about 1cm.

  2. lol says:

    Ive been putting braces for 6 months for both my upper and lower teeth. However, the dentist said that i need to extract 2 teeths from the bottom when it is already very straight. But is there a need for this?

    • Sometimes orthodontists remove teeth in one arch to make it match the other. Even if both sets of teeth are straight, removing teeth can help camouflage a jaw size discrepancy. I’d have your orthodontist explain why he’s recommending this approach for you.

  3. jasmine says:

    Hi doctor,

    I recently put braces on for about 3 months and just yesterday, my orthodontics gave me a call and said that for best results, i should have two of my tooth on the bottom row removed! I’ve already removed two premolars from the top row due to overcrowding but have yet to remove any from the bottom. My bottom row of tooth are quite neat (in fact there are some very small gaps to close) so i do not understand why i have to remove 2 tooth from the bottom row. I am afraid the gap will be too big to close but he said that shouldn’t be something i should worry about. Is it needed to extract my tooth after i did banding? Shouldnt extraction be done before banding?

    Thank you in advance! :)

    • As outlined in the article, there are several reasons orthodontists have teeth removed. It sounds like after having the top ones taken out (for whatever reason) it now looks like the top will match the bottom better with two removed down there too. This happens sometimes. It is not uncommon to take a “wait and see” approach if a patient is borderline extraction in either arch.

  4. Ruby says:

    Hi Dr!
    I’m 25 years old and I really want to do braces. However, the orthodontic told me that I need to remove 2 teeth on the top row and 2 teeth on the bottom row. I have not remove any wisdom teeth yet.
    My question is that it is still good if I have only 28 teeth? And are there any affect on the rest of my teeth when I am getting older?
    When the teeth move to closed during the braces and will they move back to their position after I am done prosess ?
    Thanks Dr!

    • The point of my article was to answer your question. Sometimes teeth must be removed for treatment. There is no perfect number of teeth for all patients. There is only the right number for your mouth.

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