When & Why You Need Tooth Extraction for Orthodontic Treatment

Orthodontic Patient with Extraction

What is a Tooth Extraction? Why Do I Need One? Treatment Options and More

For certain orthodontic cases, tooth extraction – or pulling out teeth to remove them – is necessary to achieve the best results, with straight teeth and a healthy smile.

Pulling teeth is only done if absolutely necessary: your orthodontist will consider all options to achieve a healthy smile before recommending an extraction. For those with extra teeth or too much crowding to fit all the teeth, extraction is an extremely safe and effective way to help align the teeth properly.

Getting teeth extracted can make people nervous. With careful supervision from an experienced orthodontist and an expert extraction procedure from a qualified dentist or oral surgeon, your extraction experience will be comfortable and effective and allow you to achieve the healthy smile you deserve.

This guide will inform you of everything you need to know about dental extractions before or during braces or Invisalign orthodontic treatment.

About Tooth Extractions

Tooth extraction is when a tooth – or several teeth – are pulled out of the mouth and removed. There are many reasons to have a tooth extracted: one reason is in treating a patient for orthodontic care, to achieve straight teeth, a healthy bite, and a beautiful smile.

In certain orthodontic cases, dental extractions are sometimes necessary to alleviate crowded teeth and to establish a stable bite. These extractions are done before or during orthodontic treatment.

Not all cases will require extractions – in fact, it is usually not necessary. If it’s possible to align all existing teeth into a healthy bite and correct positioning, then they will do it without extractions – but for certain patients, tooth extraction is an effective part of achieving straight teeth with long-lasting results.

Your orthodontist will refer you for extraction of 1 to 4 teeth, depending on your specific diagnosis. (Wisdom teeth are considered separately from orthodontic extraction cases since there are other reasons for removing those molars). Removing an odd number of teeth is common when treating asymmetry in the bite pattern or traumatic biting.

When deciding which teeth to remove, your orthodontist will consider how best to fit the other teeth into their healthy, correct positions, with the least possible disruption to the mouth or the patient’s facial shape and tongue positions. 3D-modeling scans can help orthodontists determine with extractions will be the most useful.

  • Teeth cannot be straightened with braces without first undergoing extraction(s)
  • Tooth is too large to fit in mouth
  • Tooth grows in the wrong direction
  • Tooth is sore or painful
  • Tooth is discolored
  • Tooth is sensitive to the touch
  • Tooth appears chipped, cracked, or otherwise damaged

Which Teeth Get Extracted?

Which teeth are extracted depends on the patient’s specific case, but generally, the premolars (the 4th and 5th teeth in order from the front) are the most likely to be removed.

In some cases, a back molar may be removed in addition, or instead, of the premolars.

Alternatives to Extraction

For certain patients, it may be possible to widen the dental palate in order to make room for the teeth, rather than extracting them. This is more commonly effective in children, whose bones are still growing and can thus adapt quickly to the expansion of the palate. For adults, whose bones have stopped growing, this may be less effective.

When it can’t be expanded, some surgical procedures can add bone to the palate, allowing for more expansion in adult palates. Alternatively, it is sometimes possible to shift the teeth further back into the mouth using orthodontic care (called distalization), making more room for crowded teeth rather than extracting them. While these are newer treatments, both of these procedures have been found to be effective.

Tooth extraction is a reliable, safe, and effective method for straightening teeth with long-lasting results and healthy smiles. Your orthodontist will only refer you for a tooth extraction if they determine that it is the best intervention for achieving the best results for your smile.

Dental extractions are usually done by a general dentist or an oral surgeon, not in an orthodontic office. Your orthodontist will do a thorough examination, including x-rays and/or 3D imaging, and will issue a referral for removal only if extractions are absolutely necessary. Once teeth are extracted and the area has healed, you can begin the rest of your orthodontic treatment.

When and Why is a Tooth Extraction Necessary Before Orthodontic Care?

Not all orthodontic cases require tooth extractions. In fact, only a small percentage of cases require extractions and those cases are usually having very crowded teeth (as stated above, many people will have wisdom teeth removed, but for reasons unrelated to orthodontic care).

Tooth extraction is necessary to achieve the right results in cases where keeping all the teeth in will not allow for straight teeth and a healthy bite. Only severe dental crowding requires extraction.

Some Common Reasons for Dental Crowding:

  • Too many teeth
  • Jaw too small to support all the teeth properly
  • Teeth are too big, or a specific tooth is too big or abnormally shaped

Other Reasons for Extraction

In certain cases, a tooth may need to be extracted prior to orthodontic treatment because it has decayed or become damaged from prior crowding, due to bacterial growth and plaque build-up. If the decay is too advanced, it may be more effective to simply remove the teeth and align the teeth properly without it, by filling the vacant space with healthy teeth, guided into position by braces or Invisalign.

Extractions are especially necessary for cases in which the results will be unstable without removing teeth, resulting in shifting and misalignment later on, requiring more orthodontic care to correct. In that case, it makes more sense to extract teeth in the first place to achieve healthy, safe results designed to last.

A very severe bite issue, such as underbiteopen bite, or deep overbite, may be fixed with help from tooth extraction, especially if the patient elects not to have surgery to correct the condition.

Signs You May Need an Extraction

Your orthodontist will thoroughly examine your teeth, including comprehensive x-rays, to determine the placements of each tooth and what will need to be done to achieve a healthy bite and smile – including the possibility of extractions.

Some of the following signs may indicate a need for extraction, but it depends on the specifics of your case – even if some of these apply to your teeth, it does not necessarily mean they will need to be removed.

  • Tooth is too large to fit in position
  • Tooth growing in the wrong direction
  • Tooth is sore or painful
  • Tooth is discolored or exhibits signs of decay
  • Tooth is very sensitive to the touch
  • Tooth appears chipped, cracked, or damaged
  • Tooth is loose (adult tooth) due to decay or periodontal disease
  • Issues with biting or chewing

This list is just to help you understand some of the signs of possible extraction cases: it does not mean your teeth will have to be extracted! If your orthodontist suggests an extraction, you can be sure it’s an informed opinion to achieve the best results, for a smile you’ll love and a healthy bite built to last.

How Teeth Are Extracted

If your orthodontic case requires dental extraction, your orthodontist will refer you to a general dentist or oral surgeon for the extraction. Orthodontists are dedicated entirely to shifting teeth, while general dentists and oral surgeons offer a wider variety of procedures, so they have all the medical equipment necessary to extract teeth. Basic tooth extraction is usually done at your general dentist’s office, while more complex extractions may be done by an oral surgeon.

Teeth may be extracted before or during orthodontic treatment with braces or Invisalign. Once the extractions have healed properly, the teeth can be guided into the site vacated by the extracted tooth.

You will not feel pain during the extraction: your dentist or oral surgeon will use either local anesthesia or sedation to remove teeth without pain. The dentist or surgeon will expertly and swiftly remove the teeth. After extractions, they may use a few small stitches to close the hole. These will either dissolve or be removed after a week or so when you come in for a check-up.

You can go home the same day. You may feel a bit of pain or discomfort when the anesthesia wears off: use any over-the-counter pain medication to treat. Avoid crunchy or sticky foods for a few days whole the holes heal, and rinse your mouth out with salt water or an antiseptic rinse provided by your dentist to keep them clean.

Your dentist may also provide you with a specialized oral syringe to wash out any potential food or debris that could get caught in the holes left by extractions. Your mouth is one of the fastest healing parts of your body, so the holes will heal over very quickly.

Once the holes from tooth removal have healed, you can begin or continue orthodontic treatment: before too long, the gap created by the extraction will be filled by the healthy teeth in proper alignment, under supervision by your doctor.

Dental Extractions Before Orthodontic Treatment: Before and After

Alonda, 23 years old, lower incisor extraction case, before and after Invisalign treatment

Alonda, 23 years old, lower incisor extraction case before and after with Invisalign treatment

Nia, 19 years old, extraction case, before and after Invisalign treatment

Nia, 19 years old, extraction case, before Invisalign treatment
Nia, 19 years old, extraction case, after Invisalign treatment

Frequently Asked Questions about Teeth Extractions