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Although used fairly frequently in the old days, tooth extraction is a procedure that most dentists dread. They do not want to pull teeth out except when it becomes medically necessary, and no other treatment will do. This is why so many orthodontic patients are surprised when the orthodontist tells them that some teeth will need to be pulled. How can this be medically necessary? Is the doctor asking me to have my teeth pulled for cosmetic reasons? The answer is simple: the dentist would not ask you to pull teeth for aesthetic reasons, but certain cases require tooth extractions to correctly align the teeth. Below is a description of these types of tooth extractions for braces broken down by category.
Milk teeth
Before orthodontic treatment can begin, all milk teeth need to be gone from the oral cavity. Some people retain their milk teeth for an exceedingly long period of time, and these people may need to get tooth extractions before orthodontic treatment can begin. This is hardly a problem, as milk teeth are not permanent, and would fallout on their own anyhow.
Crowding
The most frequent reason that patients undergo a tooth extraction for braces is crowding. Crowding is when the teeth overlap each other and are in the same position, taking up the same space in the mouth. If the crowding is too severe, then there is no other choice but to pull some of the teeth, as they cannot be shifted back into position. This is the case when there is not enough space for all of the teeth to erupt into. In these cases, the crowding simply cannot be fixed, and some of the teeth will have to go in order to prevent tooth decay in the future, and to avoid complications.
Mismatched jaws and protrusion
Sometimes the upper and lower jaws are not very compatible with each other. A properly aligned dentition is still possible, but it may require some adjustments, and may require certain teeth to be pulled, so that the bite matches and locks well. This is usually necessary because otherwise TMJ pain and back and neck pain will result as a complication of the mismatched bite. Protrusion also may require certain teeth to be pulled, as there is no healthy way to resettle those teeth in the mouth.
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