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I’m getting braces. Why must I have teeth removed?

Patients often ask why it’s necessary to have teeth removed when getting braces. Well, if possible, we prefer not to remove teeth—treament is faster if we don’t. However, to ensure your treatment is successful, the removal of some teeth is often recessary.

There are several reasons why you may need teeth removed when receiving orthodontic treatment. Here are three common reasons:

  1. crowding
  2. poor lip posture
  3. mismatched jaw size.

The teeth that most often need to be removed are premolars — the ones between your eyeteeth (below your eyes) and molars (the biggest ones at the back of your mouth).

Note: As orthodontists, we don’t usually remove teeth ourselves. Instead, we’ll refer you to your family dentist.

1: Crowding

Crowding is more common in modern humans than our ancestors. This is because, thanks to evolution, modern jaw bones have become smaller and are often too small for their teeth to fit.

You see, we don’t need as much force to eat our food like we used to. Our diet is softer — less gritty — so our jaws have become smaller and our teeth are subjected to less wear and tear.

With crowding, removing some teeth is sometimes necessary to get the best and most stable outcome long term for the patient.  Trying to keep teeth in cases where there is severe crowding,  can cause a patient’s teeth to stick out and also result in gum or bone loss.

In the case of mild crowding, expansion, rather than extraction, can be an option. (This is when the size of the patient’s arch is increased by moving the teeth outwards using what’s known as an expander appliance).

2: Poor lip posture

If you have poor lip posture, your face can have an unbalanced look. Lip posture is affected by the position of the underlying teeth. If your front teeth stick out, removing some teeth will enable us to move them back to improve your lip posture. If your lip posture is already good, failure to remove teeth could cause your teeth and lips to stick out, and we won’t be able to close your lips.

3: Mismatched jaw size

If your upper and lower jaws are mismatched, you will have either an under or overbite. With an overbite, your lower teeth could bite into the roof of your mouth. In the case of severely mismatched jaws, surgery can be the best treatment. However, if the mismatch is mild, or surgery is not an option for you, the removal of teeth can compensate and camouflage the jaw mismatch.

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