La Habra/Chino Hill, CA – The journey to achieving a straighter, more confident smile often involves orthodontic treatment, and for many, braces are a tried-and-true method to achieve that goal. However, one common question that arises when considering braces is whether teeth need to be removed before treatment begins. Dr. Robert Gire of Gire Orthodontics explores the factors that determine whether tooth extraction is necessary before getting braces and discuss the role of orthodontists in making this decision.

If you’ve heard that most orthodontic patients require teeth to be extracted prior to orthodontic treatment, Dr. Robert Gire has some good news for you. In most cases, extractions may not be necessary – most orthodontic patients requiring extractions are those who have very severe crowding issues.

Understanding the Orthodontic Process

Before delving into the need for tooth extractions, it’s crucial to understand the basics of orthodontic treatment. Braces are designed to correct misaligned teeth and bite issues by applying gentle, continuous pressure to move teeth into new positions over time. While braces can address a wide range of orthodontic concerns, not all cases require tooth extraction.

Children Vs. Adults

“We always try incredibly hard to keep the integrity of all the teeth in place during orthodontic treatment,” says Dr. Gire. “For younger children with jaws that are still growing, we will do all we can to guide the growth of the jaw to allow for the permanent teeth to erupt properly and without crowding. And even in older patients who no longer have the benefit of jaw growth, we will always do everything we can to work around having to extract teeth. That being said, I will not compromise the future health and stability of the teeth and surrounding structures and if extractions are necessary, I will absolutely recommend it.”

For adolescent patients, tooth extraction is often considered a last resort, because the jaws are still growing. Treatment can be used to guide jaw growth to allow for proper eruption of the permanent teeth. Braces can then be used to move the teeth to their ideal locations.

We sometimes see dentists encouraging extraction in children if they believe the baby teeth are taking too long to fall out. While this may seem like a good idea, it can create an orthodontic headache. If the baby teeth aren’t ready to fall out and the permanent teeth aren’t ready to replace them, the surrounding teeth could drift into the open spots which can lead to an issue that might never have been there had the teeth not been removed. 

Factors Influencing the Decision

The decision to remove teeth before getting braces depends on several factors, here are the most common reasons, which could potentially require extraction:

1. Crowding: One of the most common reasons for tooth extraction before or during braces is dental crowding. Crowding occurs when there isn’t enough space in the jaw for all of the teeth to align properly. In such cases, removing one or more teeth can create the necessary space for the remaining teeth to be aligned.
2. Protruding Teeth: If your front teeth protrude significantly, your orthodontist may recommend extraction to address this issue and improve your bite.
3. Bite Problems: Severe bite problems, such as underbites or overbites, may require tooth extraction to achieve proper alignment and a functional bite.
4. Jaw Size: The size of your jaw plays a crucial role in determining whether tooth extraction is necessary. A smaller jaw with larger teeth may not have enough space for all the teeth to align without extraction.
5. Supernumerary Teeth: Too many teeth (in rare cases, people are born with more teeth than are needed)
6. Abnormal Tooth Size/Shape: Teeth that are too big or abnormally shaped and do not fit in their location
7. Tooth Decay and Space Loss: Tooth is damaged by decay and some space is lost as teeth will drift
8. Orthodontic Goals: The specific goals of your orthodontic treatment will also influence the need for tooth extraction. Some cases may prioritize aesthetics, while others may focus on functional improvements.
9. Other reasons could include impacted teeth, midline shifts, or a lack of facial symmetry.

Tooth extractions are deemed necessary when it is believed that the ideal results cannot be achieved without it, or if the end results will be unstable resulting in relapse. The goal of your orthodontist is to create a healthy, stable bite that will last a lifetime, so if it is believed extractions can help achieve that your orthodontist may discuss this with you. 

For older patients who no longer have a growing jaw, great results can still be achieved but it may require additional work. Some patients may require jaw surgery to help accommodate all the teeth, especially for patients who do not want any teeth extracted. 

Signs You May Need Tooth Extraction for Orthodontics

• Oversized Teeth: Tooth/teeth is/are too large and cannot fit in its correct position
• Misaligned Growth: Tooth/teeth is/are growing in the wrong way
• Intractable Tooth Pain: Tooth/teeth is/are painful and it/they can’t be helped with restorative or other means
• Decay and Discoloration: Tooth/teeth is/are decayed or discolored
• Persistent Sensitivity: Tooth/teeth is/are sensitive and it/they can’t be helped with restorative or other means
• Structural Damage: Tooth/teeth is/are cracked, chipped or otherwise damaged
• Looseness Teeth: Tooth/teeth is/are already loose due to periodontal disease or decay
• Biting and Chewing Difficulties: Tooth/teeth causes an issue with biting or chewing

“It is important to note that even if some of these apply to you, that doesn’t mean you will require teeth to be extracted,” says Dr. Robert Gire, orthodontist in Chino Hills and La Habra CA. “The best way to determine your best course of action is through a consultation with a board certified orthodontist. We work daily to help patients achieve their most ideal smiles and we have all the tools and experience necessary to make that happen. Even if your dentist tells you that you need teeth extracted to accommodate your smile, it is always a good idea to follow up with an orthodontist for a second opinion.”

Consultation with an Orthodontist

The decision to extract teeth before getting braces is not one that you should make on your own. Your first step should be scheduling a consultation with an experienced orthodontist. During this consultation, the orthodontist will conduct a thorough examination, including X-rays, photos, and a scan of your teeth, to assess your unique situation.

Based on their assessment, the orthodontist will develop a personalized treatment plan that may or may not include tooth extraction. They will discuss the reasons for their recommendation and provide you with a clear understanding of the expected benefits of extraction, if necessary.

“I’m not a fan of removing teeth if at all possible,” states Dr. Gire. “One of the main reasons I don’t like removing teeth is there’s usually nothing wrong with those teeth. Most of the time, the teeth are free of fillings, root canals, crowns, etc. However, I will not compromise the future health and stability of the smile and function and in some cases you absolutely have to remove teeth and in those situations I will.”

“The decision to remove teeth is never made lightly,” says Dr. Gire. “I prefer to not remove any teeth if at all possible. It may actually lengthen your time in orthodontic treatment, so we reserve it only for patients who we know really need it and we know the only way to achieve the best smile possible is through extractions.”

Dr. Gire further explains, “if the case is a borderline case and I can make an argument to keep all the teeth or to remove some teeth, I’ll do what’s called a ‘therapeutic diagnosis.’ I’ll place the braces, resolve the crowding, and make an assessment about six months down the road. If everything looks good, gum tissue is healthy, speech is normal, then we proceed without taking teeth out. If the patient is too full or flared out, gum tissues are thinning, speech is impacted, the patient can’t close their lips, then we take teeth out. It’s always nice to see what things look like down the road before you take teeth out. Because once we take a tooth out, we can’t put it back in.”

The Importance of Informed Decision-Making

It’s essential to be well-informed and ask questions during your consultation. Understanding the reasons for tooth extraction, the potential benefits, and the expected outcomes will help you make an informed decision about your orthodontic treatment.

The need for teeth to be removed prior to getting braces is a decision that depends on several factors, including crowding, bite issues, and jaw size. Consulting with an experienced orthodontist is crucial in determining whether extraction is necessary for your specific case. Remember that the goal of orthodontic treatment is not just to straighten teeth but also to create a healthy, functional, and aesthetically pleasing smile. Trusting the expertise of your orthodontist and engaging in open communication will help you achieve the best possible outcome on your orthodontic journey.

“The truth of the matter is, when it comes to orthodontic treatment, there is no one size fits all plan,” says Dr. Gire. “Some patients may require teeth extracted while others do not. A certified orthodontist will have the skill and knowledge to not only diagnose your issue but create a treatment plan designed to meet your individual needs, based on scientific evidence and experience.”