Blog

One of the most common comments that our patients or their parents make during the initial examination in our office is “why do teeth have to be removed before the braces go on?”  The answer to this question depends on several factors.

Everyone has two sets of teeth.  The first teeth to grow into the mouth are the primary or “baby” teeth.  These teeth typically fall out on their own between the ages of 5 and 12 years.  The second set of teeth to grow into the mouth is the permanent or the “adult” teeth.  These teeth replace the baby teeth between the ages of 5 and 12 years.

One of the first things an orthodontist will do at the initial examination is take inventory of which teeth are in the patient’s mouth.  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 likely will place a “space maintainer” to help maintain the space until the permanent replacement teeth grow in.  If they don’t fall out soon enough, they may actually create an orthodontic problem or signal that one already exists (such as an impacted cuspid).  Removing primary or baby 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 teeth are involved.  There are a variety of reasons why permanent teeth may need to be removed for braces:

The first and most common reason 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 the teeth reduced. Mild-to-moderate crowding can be addressed with expanders before all of the permanent or adult teeth erupt (before the age of 12).  However, 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 space required.

The second reason is to correct an overbite or an underbite.  If the upper and 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.

The third reason is protrusion of the front teeth.  The position of the lips is determined by the underlying teeth.  If the front teeth are already flared or protrusive, removing some on the side teeth will allow the orthodontist to move the front teeth back 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 front teeth and lips stick out.

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.

By Dr. Gary Reichhold