Why do I need teeth removed for my [braces]?

GIF courtesy of giphy.com

GIF courtesy of giphy.com

Most people think that it’s bad enough that they or their kids have to get braces. The parents are bracing for the cost, and the kids aren’t keen on having to wear them. Then, the happy family gets told that the patient needs to have teeth removed, too. So, why is it that removing teeth for braces (this is called extraction) is sometimes necessary for braces to be successful?

Reasons Why Tooth Extraction for Braces Might be Necessary

1. To reduce or eliminate problems associated with crowding.

Crowded teeth don’t always mean extractions are necessary, but they are one of the situations that can call for teeth to be removed. If the teeth are severely crowded, there are both cosmetic and practical consequences to avoiding extraction. The main cosmetic concern is that the teeth may jut forward, away from the jaw, because of lack of room. This can create a protuberant shape for the lips and lower face as well as when the mouth is open.

There are two major health concerns associated with not removing teeth when the mouth is seriously crowded. The first is called dehiscence, and it is a technical term for a kind of bone loss that can occur. The second is recession of the gums.

  • Dehiscence occurs when the bone covering the outside surface of the teeth is eroded. In the case of dehiscence as a consequence of not extracting crowded teeth, it probably occurs because the crowded teeth put more pressure than normal on the bone and gradually cause erosion. Any time a bone erodes, problems are likely to occur. Loss of the tooth is one possibility, but other problems can present as well.
  • Recession of the gums can be caused by the same pressure that might cause dehiscence. Receding gums are a problem because as they detach from the teeth, little pockets are formed that fill up with bacteria. The bacteria grow in number and begin to erode the teeth, gums, and sometimes even bone.

Expansion of the jaw is sometimes possible in more moderate crowding, but it isn’t appropriate for every case. The jaw bone only expands easily until around age 16, and it expands more easily around age 7 or 8, which is usually well before parents start thinking about orthodontia. In some cases, the jaw may not be able to expand enough, or doing so might risk seriously changing the contours of the face.

2. If the jaws are of different sizes.

In order to make the teeth of a person with an overbite or underbite meet, there are only two options: make the smaller jaw larger, or move the teeth in the larger jaw back. To expand the jaw, generally surgery is required. To make the teeth meet the other way, a tooth extraction for braces to move the teeth back is generally required. Because moving the teeth back means reducing the size of the arc of the teeth, extractions are used to create space for the teeth to move into.

Not all overbite or underbite cases require extractions. However, the orthodontist will recommend what he or she feels will give the best result. If the recommendation is to have some teeth extracted, then he or she feels that it is necessary.

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3. To make space to move teeth during the orthodontia process.

The overbite and underbite mentioned above are examples of why teeth might need to be moved during the orthodontia process. Another example would be if several teeth are crooked but the teeth still fit tightly together. In this case, additional space might be required in order to straighten the crooked teeth out. Without extractions, they might not be able to be straightened because there is nowhere for them to go.

Alternatives to extracting teeth are sometimes available, but they often add considerably to the time required to achieve the desired result. This can significantly increase costs and means more time with braces or other mouth gear on for the patient. Again, if the orthodontist has recommended extraction, he or she has done so for a good reason.

4. For improved overall contours of the face, especially the lips.

Teeth that don’t meet properly, especially those that jut forward in the mouth, can make the lip profile of the face less than desirable. Often, teeth that jut forward are already severely crowded, which is another good reason for extractions. Even if the teeth are not severely crowded in their current state, straightening them up can require more space than is present. Cosmetically, the outcome of orthodontia without removing teeth in these cases can include oddly prominent or forward lips.

Attempting to move forward-jutting teeth into normal alignment without extracting any teeth can cause crowding. However, the crowding comes to be, the same health risks apply. In order to avoid dehiscence, receding gums and other problems associated with crowding, extraction is sometimes the best option.

5. Some or All of the Above

Of course, in any one person, multiple issues may be combined in the same mouth. In these cases, extractions may be extra essential to the success of the braces and even the future health of the patient. Teeth that are severely out of alignment are the most likely to require extreme intervention, but they are also the most likely to cause future problems, so it is usually worth getting treatment.

Image courtesy of arztsamui at FreeDigitalPhotos.net

Image courtesy of arztsamui at FreeDigitalPhotos.net

The Take-Home Message

If a dentist is recommending a certain orthodontic procedure, it is often a good idea to check with a board-certified orthodontist. Despite their extensive training, dentists are not as well-trained as orthodontists in the use of braces and other orthodontic gear. Because of this, orthodontists tend to know more about the outcomes of making certain decisions when it comes to teeth.

Where to Go?

For patients considering getting braces in Southington, Connecticut, or a nearby town, Team Demas provides specialists in both adult and childhood orthodontia. The team comprises only board-certified orthodontists that provide high-quality options for anyone in the market for braces. Affordable options are also available to provide braces for everyone, no matter what their income.

Team Demas Orthodontics

27 Meriden Ave #2a, Southington, CT 06489, USA

Phone: 860-276-0333

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Don Demas

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Dr Don Demas - Team Demas Orthodontics - Specialist in Orthodontics for kids, teens and adults in Watertown & Woodbury CT.

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