One objection that some patients have to getting orthodontic treatment is that they just don’t want to have “healthy teeth” removed. Is it wrong to remove teeth when there is seemingly nothing wrong with them? Are there alternatives to removing healthy teeth?

The decision to remove teeth is based upon numerous variables
As I’ve explained in other articles, there are several reasons why orthodontists prescribe the removal of permanent teeth in some treatment plans. The most common are crowding, overbite, protrusive teeth, and asymmetries. While it is may be theoretically possible to treat all of these orthodontic problems without removing teeth, orthodontists must consider the overall picture when determining if the removal of teeth is necessary. Key variables that have a bearing on this decision include the length of treatment, treatment efficiency, condition of the teeth, the cooperation of the patient, the patient’s chief complaint, and the cost (if keeping the teeth will take longer). There really are situations where the best outcome cannot be achieved with a full set of teeth and extractions are unavoidable. Eliminating severe crowding or dental protrusion in both arches for example usually require the removal of teeth.

Rarely are teeth removed for braces because they are not healthy
I’ve had patients who are adamant that teeth not be removed because they are healthy. Their reasoning derives from misconceptions like they may need them someday if the others go bad, losing healthy teeth will somehow make other teeth unhealthy, or that if God didn’t want them to have all their teeth He wouldn’t have put them there in the first place. Removing teeth for orthodontic treatment is rarely done because they are unhealthy. Although there are times when there are unhealthy teeth present and the orthodontist has them removed as part of the treatment plan, this is the exception and not the rule. Most times the teeth that are removed are perfectly healthy and are sacrificed so that bigger problems can be corrected.

Healthy teeth may need to be removed for the best results
One definition of the word “sacrifice” is “giving up something good to get something better.” Three examples of giving up healthy teeth to achieve better results include making room so that straightening them won’t push them out of the bone or cause gum recession, creating space to scoot all the front teeth back so that the lips can close more naturally, and allowing the top teeth to be moved back to correct an overbite preventing the need for surgery. Yes, the teeth being removed may be healthy, but the results made possible by their removal are usually more desirable overall.

Orthodontists would actually prefer to keep all of your teeth
Contrary to what you may read elsewhere, we orthodontists are not uncaring monsters who don’t care about preserving healthy teeth. Rather, we are doctors who identify all of the problems that exist, evaluate every option available, and then formulate a plan that provides the maximum benefit for each individual patient. If I can provide treatment without removing teeth, that is my preference. If I can remove unhealthy teeth instead of healthy ones, I’ll do that for sure. The best way to make sure you’re receiving the best treatment plan for you is to find an experienced orthodontic specialist who will carefully evaluate your individual case and then put your trust in him. In the end, your customized treatment plan will give you a result that is much healthier than before your treatment began.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.