When Are Extractions Necessary With Overcrowded Teeth?

Life Is Better With a Smile

The best orthodontist around can do some amazing things when it comes time to straighten your teeth or improve how they come together. Sometimes, their advice will be to remove one or more teeth as part of this process to create room for amazing results.

The reasons might be easily seen or hidden problems that only x-rays can reveal, but, on average, 25% of orthodontic patients will need to have a tooth extracted as part of their treatment plan.1 Of course, your unique situation will be explained to you clearly, but let’s talk about the main reasons teeth are extracted, how this improves a smile, and the best ways to prepare yourself or your child for tooth extraction.

Why Is A Tooth Extraction Needed To Straighten Teeth?

There are a number of reasons a tooth extraction becomes necessary. As part of orthodontic treatment, a permanent tooth may need to be removed in order to:

  • Eliminate overcrowding. Sometimes the jaw is simply not large enough to accommodate the size of the permanent teeth. Teeth crowding each other is one reason that they shift or erupt into unusual positions in the first place. Removing one or two strategically placed teeth can allow braces to move the others back into the right places.
  • Correct protruding teeth. When the front teeth begin to stick out or protrude, it changes the person’s profile, affects speech, and can even lead to teasing. Teeth also protrude on one side, making the lips stick out. By removing overcrowding at the back, the front teeth can be moved back into a nice straight line.
  • Eliminate unusual teeth. Did you know that some people have extra teeth? These can apply pressure and move teeth to odd angles. Sometimes a tooth appears that is oddly shaped, tiny, or overly large. These teeth can be removed and the space filled by shifting other teeth into that open space with braces.
  • Help the jaw develop normally and increase stability. It takes an orthodontist’s training and skill to determine the best alignment to help growing jaws develop properly. For the teeth to become fully stable, there must be sufficient room available and all pressures pushing things out of place need to be eliminated. Tooth extraction makes treatment goals possible and protects the results.
  • Remove impacted teeth. A determined tooth might try to grow behind or on top of its neighbor because there is not enough space available. It might come out next to another tooth or remain in the gums, possibly getting infected. Usually, your orthodontist or dentist will find this tooth in an x-ray. One of the two conflicting teeth will need to be extracted to allow the other to line up properly.

A Little More About Impacted Teeth

When teeth become impacted, they may stay inside the gums and not emerge at all. These hidden teeth move others into strange positions and may damage the teeth with which they overlap. They can even cause decay and become infected.

Impacted teeth can be identified in an x-ray. It may require oral surgery to correct impacted teeth, but it is very important to do so to eliminate causes of infection, maintain good oral health, or to continue with orthodontic work.

Symptoms of impacted teeth include:

  • Unexplained headaches
  • Swollen gums
  • Pain and discomfort
  • Teeth moving out of position

Why Are Crowded Teeth So Common?

You might be curious about why so many of us have overcrowded teeth. Scientists have wondered about that also. Studies of jaw size and tooth wear over the centuries have shown that our jaws are getting smaller while our teeth stay full size.1

They suggest that people used to do much more chewing on unprocessed or stone-ground grains, resulting in big strong jaws and worn-down teeth. So, perhaps our crowded smiles are a result of taking better care of our teeth and eating softer cooked foods. It’s the price of giving up grit in your daily diet!

Alternatives To Tooth Extraction

Especially for young people, there may be other techniques your pediatric orthodontist can use to create more space between teeth for metal braces. Expanders are sometimes used, widening the jaw to accommodate large teeth in children who still have a malleable mouth structure. For other young people and most adults, extraction may be a necessary part of straightening overcrowded teeth and correcting the bite.

The Modern Process Of Extracting Teeth

Tooth extractions are done with medications that numb pain, relax the patient—or, if necessary—allow them to sleep through the procedure. So, as we describe the process, keep in mind that the comfort of the person always comes first.

  • You will meet with the orthodontist, dentist, or oral surgeon to discuss the process.
  • Music, toys, books, and blankets are welcome for comfort and relaxation.
  • The tooth itself will be numbed with an injection, and sedation is common.
  • General anesthesia may even be used, especially if several teeth must be extracted or if they are impacted.
  • The tooth will be first loosened from its socket with dental tools and then removed.
  • Gauze will be placed in the empty socket and held with pressure to help stop bleeding.
  • An ice pack may be applied in the first 20 minutes to reduce swelling.
  • Before the numbing medication has worn off, take over-the-counter pain medications or other medication as prescribed.
  • Gauze will need to be changed regularly for the first few hours.
  • Follow instructions about rinsing your mouth frequently but gently.
  • Try not to dislodge the protective blood clot that develops in the empty space.
  • Rinsing with a mild saltwater solution will speed healing in the first week.
  • You should be able to eat soft foods and liquids but should avoid using a straw for 24-48 hours.

Preparing Your Child For Tooth Extraction

So, with the best orthodontists’ advice, you know that your child needs to have some teeth extracted. What can you do as a parent to help your child be ready and comfortable with the procedure?

  • Talk to your doctors about the exact process and sedation options so that you can describe the experience in positive terms to your child.
  • Understanding the available treatment options will help you show that you are confident and calm about this beneficial procedure.
  • Listen to their concerns and reassure them that having one tooth removed will help the other teeth grow straighter and stronger.
  • Share useful information at their age level about what they will see and hear so that they are not surprised.
  • Check beforehand if your child will be allowed to keep the tooth; very often, it must be left at the dentist for the “tooth fairy” to pick up.
  • Bring comfort items along, such as favorite toys or music, as well as activities for any time spent waiting.
  • Avoid exposure to stories from well-meaning friends who might describe their own experiences in a frightening manner.
  • Do have friends or relatives who have had a tooth extracted offer encouragement and comfort without dwelling on the details.

Starting Off Orthodontic Care With Room To Move

Tooth extraction is often one of the first steps of orthodontic treatment. By creating the right environment for straightening the rest of the teeth, amazing changes can happen! The place where that unnecessary tooth was will heal quickly and the exciting part of your orthodontic treatment can begin.

Some of the smile-enhancing benefits include:

  • Eliminating speech impediments
  • Promoting strong healthy teeth
  • Feeling self-confident and smiling more

When it is time to find an orthodontist in Maryland, come visit with us at Labbe Family Orthodontics. With our four convenient locations and over 40 years of combined experience, we can’t wait to meet with your family. Our team has the expertise, experience, and a family focus that make orthodontic appointments fun!

Call us today and schedule a consultation for yourself or your loved ones to give those crowded teeth the space they need to shine. Building a relationship with an orthodontic practice that truly cares will give you peace of mind about the process and the people who help your family smile brighter.


  1. https://academic.oup.com/ejo/article/39/2/109/3045908