Should I get teeth extracted, or do I keep them?

March 4, 2013 10:56 AM

My orthodontist wants me to get rid of 4 premolar teeth before giving me braces. Googling tells me this is very common, but is it just an easy fix for them, or really a basic part of the process?

I went to a consult with an orthodontist because I want to fix a tooth that is beginning to get crooked on my bottom front teeth. The doctor focused more on my upper teeth, as they have a sort of elevated angle where instead of pointing straight down, they go a bit forward. It has never bothered me and otherwise my teeth are OK. It's an aesthetic issue and I agree that they would look much better after treatment.

The doctor tells me that I need braces to correct the angle of my teeth, but that there's "no room" for them to move and suggests I get 2 premolar teeth from the top and 2 from the bottom removed. I'm apprehensive about this, as I'm quite a bit attached to my teeth! The procedure seems normal enough, but is it the "easy fix" for orthodontists? If I get a second opinion would I get the same answer or should I keep looking for a doctor with a different approach? I wouldn't want to waste more time and money on studies and consults with other doctors only to end up with the same result. If it matters, this is one of the top orthodontists in my city, with a good reputation.

posted by CrazyLemonade to Health & Fitness (34 answers total)

There is no way I would ever let anyone pull a completely healthy, non-impacted tooth from my mouth.

My uncle is a dentist and I have heard him rant before about unnecessary tooth pulling.

Ask this orthodontist what his plan of attack is if you do NOT pull any teeth, and see what he says. If he says there's no way, get a second opinion.
posted by phunniemee at 11:01 AM on March 4, 2013 [4 favorites]

Extracting teeth to prepare for braces and straightening is pretty common - I had teeth removed when I was teen (and even had my lower jaw surgically broken to alter my bite!).

However, I've always thought that dentists and orthodontists tend to be a little entrepreneurial than doctors, so why not get a second opinion?
posted by KokuRyu at 11:02 AM on March 4, 2013

I didn't have any teeth pulled to have braces. I was 12 though.

Ultimately I did have all 4 Wisdom Teeth pulled, as they would have undone 7 years of extensive orthodontia.

Don't miss them a bit!
posted by Ruthless Bunny at 11:06 AM on March 4, 2013

I'd get a second opinion, but I had molars pulled when I was younger, which fixed tooth crowding all on its own, without the need for braces.
posted by xingcat at 11:06 AM on March 4, 2013

Braces can absolutely be done without pulling teeth. The process will take longer but it can be done.

I'd strongly suggest a second or even third opinion. You might want to look for orthodontists who advocate use of "self-ligating braces." That method is much more gentle than traditional braces and the orthos who use it tend to err on the side of less invasive procedures in general.
posted by cooker girl at 11:13 AM on March 4, 2013 [1 favorite]

Having had extensive relationships with dentists and periodontists trained in both the US and the UK and elsewhere, especially regarding the few remaining teeth in my mouth, I do know that my latest (I"m helping with his Ferrari ;p) mentioned that the ideology for dental education and treatment is different between continents and countries, with the US being far more aggressive re: tooth pulling and the UK being far more conservative (he's studied in both locations).

I would second the recommendation to get another opinion.
posted by infini at 11:13 AM on March 4, 2013

I had 4 teeth pulled when I was ten, and then got braces. I don't know if the two incidents were connected because I was only ten and didn't pay much mind; but the pediatric dentist who pulled my teeth and the orthodontist who gave me my braces were two different people.

But this is indeed a common enough Thing; basically, my teeth were too big for my jaw, and that's what lead to my need for the teeth being pulled (and was the source of most of my other orthodontic woes).

Check with another dentist if a second opinion would make you more comfortable, by all means, though; but it doesn't sound weird to me.
posted by EmpressCallipygos at 11:14 AM on March 4, 2013

Response by poster: The doctor did give me the option of going ahead with braces without extracting teeth, but says that if my teeth need to go down, say, 30 degrees (with extraction), I would only get 10 degrees keeping my teeth. In his words "if you were my sister I'd tell you to go ahead with the extraction". As I said, the doctor has a good reputation, but he did seem a bit pushy to me.

I did think about skipping the second opinion and telling this one "I'm keeping my teeth, what's the best you can do?".....but if that's a mistake and getting teeth extracted is no big deal, well...... That's why I came to AskMe.
posted by CrazyLemonade at 11:14 AM on March 4, 2013

Response by poster: I had my wisdom teeth taken out as a teenager, by the way.
posted by CrazyLemonade at 11:15 AM on March 4, 2013

I had two teeth pulled on top when I got braces. But I have a small mouth and had severe crowding. I think in some cases it is definitely necessary, but that dentists also can tend to be pull-happy, as it were. Look at your mouth. A second opinion will help, but common sense can probably tell you if have any room in your mouth for your teeth to move back without pulling a few.
posted by catatethebird at 11:16 AM on March 4, 2013

By the way, having teeth pulled is....I'd say a medium-big deal. I was in pretty severe pain for a couple days, but my asshole orthodontist didn't give me any instructions for aftercare, any pain medication, or tell me I'd be bleeding for a couple days. I still don't know if that was normal. So if you do go for it, make sure they tell you what to expect, and the symptoms of a dry socket. My sister suffered for days because she assumed the excruciating pain she was in was normal, and they didn't tell her that that could happen. And ask for a prescription for pain meds. Ibuprofen doesn't cut it.
posted by catatethebird at 11:23 AM on March 4, 2013 [1 favorite]

It's really case by case. My daughter had to have some teeth out when she had braces put on and it made things much much easier in her case, but in general, I think the answer is that it's not routine, and nothing you'd do without a specific reason to do it, but it's not rare either. In our case we did get multiple opinions before going ahead.
posted by tyllwin at 11:30 AM on March 4, 2013

I had two teeth pulled when I got braces in sixth grade to fix an overbite/bad crowding (canines were coming in in front of my other teeth). Seemed pretty normal at the time (although sucky), and I've heard that lots of other people have had that experience as well. Twenty years later, I don't even realize I have two fewer teeth than everybody else. (Positive strange side effect is that it meant I got to keep my wisdom teeth, all four of which came in perfectly).
posted by General Malaise at 11:30 AM on March 4, 2013

I'm not medically qualified to tell you that you should or should not have teeth pulled. However, FWIW, I currently have braces, and have had them for about 2 years. Before I started I had 8 teeth extracted (all 4 wisdom teeth, plus 4 premolars to make more room). My teeth were very crowded to begin with. Now that my teeth have had 2 years to move, I can see that the remaining teeth have all but occupied all the space in my mouth, and are still somewhat crowded in some areas. So I can see why the extraction was done.

As far as what KokuRyo said that "dentists and orthodontists tend to be a little entrepreneurial" - I agree. But the tooth extraction was done by an oral surgeon who my regular dentist referred me to and who was not connected to my orthodontist in any way. So I don't think my orthodontist recommended the extraction due to any sort of financial incentive.

For me, the extractions were no big deal. I had a local anesthetic during the procedure and didn't feel any pain. Then my mouth was a bit sore for a couple weeks and I had to eat soft foods and keep the wounds clean. But it didn't slow me down too much. I was eating french toast and omelettes the same day as the operation!

However, I know others who seemed to have a more painful experience, so YMMV.
posted by Vorteks at 11:31 AM on March 4, 2013

It basically boils down to this: does the size of your jaw allow your teeth to be positioned in the way that gives the result you want without gaining space by extracting the teeth. if your teeth can be positioned in the space you have then you do not require extractions, but extractions could make the process easier and quicker. If there is no room then there is no room.
In order to get a good looking result AND have a functional bite in the end, both the top and bottom teeth have to be moved into correct position, so dont judge based on just the top or the bottom.
a second opinion is usually worthwhile if your current orthodontist is not being clear enough as to why he wants to treat you in a particular way.
compromise is just that, if you compromise the treatment plan, you compromise the result.
posted by OHenryPacey at 11:32 AM on March 4, 2013 [3 favorites]

I'd get a second opinion. I had 4 premolars removed when I was 10 to fix overcrowding and they straightened them alright, but by pulling all the teeth back to fill the gaps. Then at 40, I had to get braces again and my jaw broken and reset to bring it all back forward where it should have been. Ask them if there is no way your arch can accommodate your teeth as they are now.
posted by jmmpangaea at 11:33 AM on March 4, 2013

Damon claims that extractions are rarely needed with their "self ligating" brackets, and you get quicker, better results with less pain than traditional braces. I would suggest a second opinion with an ortho who uses Damon brackets. I can't vouch for the extractions as I had 4 pre molars removed with my first round of orthodontia. 20 years later I am back in braces and the Damon brackets nowhere near as painful as I recall. Good luck.
posted by zoel at 11:39 AM on March 4, 2013

You might also be interested in the archwired site, which I found throug askmefi. There's lots of info related to adult braces there.
posted by zoel at 11:44 AM on March 4, 2013

It really depends so much on the situation. If your teeth are sufficiently crowded to require to get your jaws expanded so you end up looking like Kermit, extractions are probably your better bet. The other thing with a jaw expansion to make every tooth fit in is that the result easily collapses (I believe I heard that it's rarely done in adults also because the method is so slow). Forget your retainers for a week, and there's trouble already.

That said, a second opinion can never hurt.

[for the record they tried the Kermit treatment when I was in my teens, and the four-premolar-extraction tactic when I was 24, because the first result had gone to the dogs and how. Second treatment result still fine. I'm 53.]
posted by Namlit at 11:56 AM on March 4, 2013

Yeah, this is really dependent on your situation, but ancedata, I had 8 baby teeth pulled (they were baby teeth, but x-rays showed I was never going to have the adult ones come in) before braces to allow the adult teeth I do have to move/come forward, and I wish my parents had gotten a second opinion before that happened. Pulling teeth is a really a bigger deal than you think, and the gaps that were created are a giant annoyance visually for me, and until I get the guts to go back to an orthodontist to get it all re-fixed again (and after all the pulling/braces, I'm terrified of dentists/teeth-y issues), my teeth are the biggest thing I'm self conscious about. I would really really think and get second opinions before going ahead.
posted by zara at 12:11 PM on March 4, 2013

My father had severe crowding. I seem to have inherited his big teeth and small jaws. I had 4 premolars out when I was 12 or so, before getting braces, and I'm very happy with the results (I'm now 45).
posted by brianogilvie at 12:12 PM on March 4, 2013 [1 favorite]

I am not an expert, but I had 4 premolars out when I got braces as a teen and my current dentist seems to be very against the practice. He says that over time it tends to leave gaps in the teeth that won't close.

Here's the part where I start to get concerned:

It has never bothered me and otherwise my teeth are OK. It's an aesthetic issue and I agree that they would look much better after treatment.

If this has never bothered you before, and it's not a function issue but an aesthetic one, why would you pay the money for an extraction and full braces on the upper teeth? I would definitely get a second opinion and personally, I would be very hesitant to start pulling healthy teeth to fix a purely cosmetic issue that never bothered me until it was pointed out.
posted by muddgirl at 12:21 PM on March 4, 2013 [1 favorite]

Before my teen-aged nephew got braces, his orhodontist said "we can take out 4 teeth, or we can try to expand his palate and see how much space we gain." The kid ended up not needing extractions.

I know only that some sort of appliance was used. I don't know how much space can be created or if adult palates are harder to expand.
posted by wryly at 12:30 PM on March 4, 2013

In my teens I had a lower front tooth extracted for overcrowding.

By my mid twenties, I had to get a root canal on the neighboring tooth- the endo I saw then told me that sometimes this can be caused by aggressive orthodontics. I have no idea if that's actually true (I also grind my teeth pretty badly and that likely contributed), but I certainly would ask about it (possibly a different orthodontist).
posted by nat at 12:31 PM on March 4, 2013

I had four bicuspids pulled out before getting braces because I have big teeth and a small mouth. Dentists prefer to pull teeth out in pairs to make things look even. My mother had had one bicuspid removed when she had braces and I thought it was funny because if you were looking for it, you could see that it looked like she had a fang on one side of her mouth but not the other.

In general though, take things that the orthodontist says with a grain of salt. They're going to try their best but they're not perfect and they can't predict exactly what your teeth are going to do. A friend had braces three times in high school. They ended up needing to break his palate to straighten his teeth.
posted by kat518 at 12:42 PM on March 4, 2013

I would definitely get a second opinion, if you can; as a patient of an orthodontist who avoids extractions and surgery whenever possible (and also uses the self-ligating brackets, FWIW), my understanding is that orthodontists don't necessarily all take the same approaches regarding these things, and it's possible another one would be able to give you a better outcome without it.
posted by beryllium at 12:43 PM on March 4, 2013

I had two teeth out in my teens as a part of getting braces, because I had extra teeth on top and wisdom teeth coming in literally sideways. I think it was good on the whole-- not crazy painful, a couple of days of ice cream and codeine. My wisdom teeth grew in straight and relatively normally. However, my teeth have crazy long roots and there are still gaps on the side that the other teeth never slid into. I think it was still better than too many teeth, but sometimes the gaps kind of bother me. Since you're an adult without growing wisdom issues, I would get a second opinion.
posted by jetlagaddict at 12:46 PM on March 4, 2013

I'm another big teeth, small jaw person.

Around age 12-13, my parents took me to a dentist (a friend of my father's) who had a side line in orthodontia. He absolutely did not want to pull teeth. Result: I went from having crowded, not badly crooked teeth (kind of like the singer Jewel) to having perfectly straight teeth with an overbite jutting out like a horse's. Totally ruined my self-esteem for many years.

So finally in my late 20s, I went to an orthodontist who also specialized in dentofacial orthopedics. He removed my four bicuspids with a technique meant to minimize bone loss (think wiggling them out, rather than pulling). Then 18 months of braces. Finally he had to make some of my front teeth narrower vertically. Then a few more months of braces. And now, at almost 30, I finally like my teeth and my face. If the price of that was $5000 and 4 bicuspids, I think it was worth it.

Good luck!
posted by lily_bart at 12:57 PM on March 4, 2013

My orthodontist said to remove teeth to make room; my mother chose not to have it done to me, purely because she thought it was unnecessary.... years later, I wish those teeth HAD been pulled, it would have saved a lot of subsequent time and bother. Get a second opinion, but yeah: pulling them may be needed.
posted by easily confused at 2:13 PM on March 4, 2013 [1 favorite]

I would go and get a second opinion from a prosthodontist on the crooked bottom tooth you originally went seeking advice for. Sit for a while on the decision to modify your entire bite for the sake of aesthetic reasons only, especially when you seem otherwise happy with what mother nature has gifted you.
posted by Under the Sea at 5:01 PM on March 4, 2013

When I got my braces, I was in middle school or early high school. I was given the option of getting teeth pulled (I think 2, upper jaw only), or not. I chose not, and they instead had me wearing a "headgear" kind of thing every night (not as bad as it sounds, just a strap that goes behind your head and hooks into two little slots on the sides of your braces) to pull my teeth apart far enough. During the day I just had normal braces. They ultimately pulled them apart too far, and they put a small plate in behind my two front teeth that's still there to this day to hold them together again. I don't know if I made the right choice or not, but it was a perfectly fine procedure and didn't bother me any.

They only thing I regret is having stopped wearing my retainers. :)
posted by segfault at 5:02 PM on March 4, 2013

I once heard a dentist say that if a someone tells you that you need a tooth removed, a second opinion. And that if that second dentist tells you that you need a tooth removed, go to another dentist and get a third opinion. You can't unremove a tooth.
posted by aniola at 7:59 PM on March 4, 2013

Response by poster: Ok, seems like a second opinion is the way to go here. Thanks everyone for your input, I appreciate it.
posted by CrazyLemonade at 9:54 PM on March 4, 2013

And I'm having a tooth removed on Friday! Consider it done on your behalf :p
posted by infini at 11:33 PM on March 4, 2013 [1 favorite]