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.

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

  1. Maha says:

    I’m 21 years old. My teeth are over crowded, in the upper jaw. The orthodontist said that first, he’ll get me to wear the braces then remove my teeth, if necessary. Is it necessary to get teeth removed before fixing the braces?

  2. muhammed says:

    hello sir! i am muhammed.my age is 15.the doctor odered to remove two of my premolar teeth in lower jaw for brace alteration.is this cause any disadvatage (or)harm.reply me fast

  3. Mays says:

    I have two questions:
    1. Why don’t doctors recommend removing canines instead of premolars? It seems like canines are thinner and removing them would cause less damage. Plus, for vegetarians, canines typically don’t serve their original purpose.
    2. Nowadays, orthodontists recommend two phases of treatments. One when the child is around 8-9 years old and the other after the permanent teeth have come in. Is there any disadvantage to such a treatment. Eg. Changing face shape negatively. There seem to be papers floating around about how orthodontics can make faces longer etc.

    • Thank you for your questions Mays. First, canines are a very interesting tooth that serves an important transitional role in the dental arch. If you look at it from above, it is flat on the front like the incisors in front of it and round on the back like the bicuspids behind it (it helps make the transition from the front to the back teeth). In cases where the canine must be removed (i.e. it is severely impacted) the transition from the lateral incisor to the bicuspid is abrupt and not as attractive or comfortable as the cuspid. Also, the shape of the back of the canine is a slope that guides the lower jaw during chewing movements. The inside slope behind the upper cuspid rests against the front surface of the lower canines and guides or discludes the lower set of teeth from the uppers helping protect them during chewing. The answer to your second question is that there is no difference in the facial structure caused by doing two phases as opposed to one. My primary reason for approaching treatment early is to create room for and bring the permanent teeth into the arch. In doing so, I reduce the number of teeth I have to recommend being removed during the teenage years. I believe this does more to help the face rather than harm it.

  4. Yasmeen says:

    Hi Dr, I had medium crowding in both arches and got 4 premolars extracted. My question is can extraction of teeth cause bone loss. Bone loss can cause changes in the jaw structure.
    Please advice.

    • Removing teeth is only done when you don’t have room for all of your teeth. The other teeth will be shifted around to close the spaces and the structure of your jaw will not be changed (removal does not cause bone loss)

  5. Pratima says:

    Today I have done teeth extraction of two upper and two lower, how much it ll take to fill the gap? As I am able to go outside because it is looking really odd. Could you please tell me how much time it will take.

  6. zy says:

    hi DR,i had jst finished my braces treatment and i did not extract any of my teeth but after my treatment , i realised that my front teeth is abit protruding and there’re still some gaps in between my teeth.However,my dentist told me that that was not counted as a gap as the teeth is already touching the other teeth and so cannot be moved even with braces.He also told me that if i want my front teeth to move inwards ,i’ll need to extract 4 teeth,but the problem is i’m fine with my lower teeth so isn’t extracting 2 teeth enough?could u tell me if it’s worth it to extract my teeth and also if having braces back is enough to close the small gaps?

    • There are a lot of issues here. If your teeth are protrusive, sometimes extraction is necessary for correction. This is a complex decision and not one that I can make for you over the Internet. As for the the number of teeth that have to be removed, if your jaw sizes are the same, you will usually need to have the same number of teeth removed in the top as in the bottom, otherwise the sets of teeth won’t match. If you have a small lower jaw, then the removal of only two on top is an option (and the opposite is true for a large lower jaw). Finally, if the “spaces” between your teeth are actually there because of the shape of the teeth, they may actually already be touching one one part of the tooth but look like they are apart elsewhere. Please discuss your options with your local orthodontist who can best answer your questions because he has all of the necessary information about you. Good luck!

  7. Lim says:

    Hi Dr, my no.6,21,23,26 teeths missing. My ortho advise to remove teeth no. 12, 28, 1, 16, 32 for braces. My concern is i will then only left total 23 teeths, will it cause any problem later?

    • I can’t comment on your particular case, but I can say this in general. There is no “best” or healthiest number of teeth. It is different for every patient. The key is a thorough diagnosis and treatment plan that determines how many teeth will fit into your smile and what be healthiest and most attractive. Most have room for 28. Some 32. 24 is common (my daughter and my wife), so it is very possible that 23 could be right for you.

  8. Grace says:

    Hello. Today I had two teeth extracted for braces and my appointment is still in another month. My question is have I done it too early? Because I don’t want new tooth to start forming!

  9. Vanessa LRQ says:

    I am planning on doing my braces but I’m afraid that the extraction procedure will hurt… if I have both 14 tooth on my upper jaw and lower jaw, do I need any extraction? And will the extraction hurt?

    Thank you.

    • Extractions are only required in about 20% of patients. Only your local orthodontist can tell you if you need to have teeth removed as part of your treatment. If you do, the oral surgeon who will remove them will make sure you are comfortable.

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