Is Tooth Extraction Required for Braces?

Many parents have a belief that removing a healthy permanent tooth for braces might have a crucial impact on the child’s smile. However, there is nothing to worry about it. Tooth removal for braces is a general procedure that is performed to enhance the smile of the child.

Additionally, not every person undergoing orthodontic treatment requires tooth extractions. Every person experiences dental and skeletal growth differently. When deciding to undergo orthodontic treatment, there is always a small possibility that one or more teeth may have to be removed to allow proper teeth alignment. (1)


An orthodontist is the best person to determine the necessity of tooth extraction. Tooth removal is usually required in the following cases –

  • Crooked smile where there is not enough room for the developing teeth to erupt in the mouth
  • Overcrowding of the teeth – this can lead to protrusion of the teeth. Moreover, it can bring changes to teeth and bone structures.
  • Spacing between the teeth (2)
  • Improper bite

It is essential to understand that you cannot forge ahead with orthodontic treatment without the prescribed extractions, as it may lead to aesthetic issues. Moreover, the success rate of orthodontic treatment may be compromised.

Why is a tooth extraction necessary for braces?

Tooth extraction for braces is typically the last resort for orthodontists to treat the patient’s smile. Most orthodontists perform a detailed clinical and radiological examination to determine the need for tooth extraction. Some of the criteria that make it necessary to get tooth extraction before an orthodontic therapy is given below –

  • When the jaws of the patient are not large enough to accommodate all the permanent teeth. This leads to crowding of the teeth, especially in the front. (3)
  • Large teeth on the small jaw are another example of tooth extraction. Similarly small sized teeth on a large jaw can create spaces between the teeth that can cause misalignment of the teeth
  • A decayed tooth or a fractured tooth can lead to malocclusions
  • Impactions are often a significant roadblock in the orthodontic treatment. They can potentially lead to long term failure of the procedure.

Straightening teeth without prescribed tooth extractions often lead to instability of the treatment in the long run.

What happens during tooth extraction?

  • In most cases, tooth extraction is performed under local anesthesia.
  • The orthodontist or the oral surgeon will then luxate the tooth to make it mobile
  • Once the tooth is entirely mobile, it is removed from the socket using an extraction forceps.
  • The socket is then cleaned and gauze is placed to stop the bleeding. Pain medications and in some cases and antibiotic coverage is prescribed to allow proper healing of the extraction site. (4)

What are the complications of tooth extraction in children?

Tooth extraction is a surgical process and usually comes with a set of complications that might happen if proper care is not taken. Although orthodontists take extreme precautions while performing the procedure to ensure quick healing. However, there still might be a small percentage of risk associated with tooth extraction. Some of the common complications of tooth extraction include –

  • Swelling around the surgical site
  • Pain and discomfort
  • nausea and vomiting
  • prolonged bleeding from the extraction site which can even last for around 12 hours
  • chest pain
  • shortness of breath (5)

it is essential to get immediate dental care to manage the symptoms and prevent the condition from worsening.


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