I know when my adult patients ask me this question what they are really asking is: “Do I get to have the fun of having a few teeth taken out for the braces?”

Perhaps I exaggerate.

Truthfully, most adults have absolutely no desire to have a tooth taken out for any reason, let alone for the purpose of braces. But we all remember from our adolescence the all too typical removal of as many as four teeth to allow the dentist to move teeth and get the desired result. So it’s an understandable concern.

Interestingly enough, the practice of removing teeth has gone through many ups and downs. That is to say that the removal of teeth as a fairly routine part of orthodontic treatment falls in and out of favor. Some practitioners do it as a matter of course whenever they are confronted by a fairly crowded set of teeth. Others avoid it as much as possible, preferring other methods to gain the needed room.

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Since adults usually get braces for the sole purpose of correcting cosmetic issues, we often do not need to remove any teeth. When we do, it is often one single tooth just to gain space to un-crowd the teeth.

When we treat adult patients with braces (we do not treat kids any longer) we try hard to avoid the removal of any teeth. If we absolutely have to remove one, we usually find that it is a single lower front tooth. Then we straighten the teeth out quickly with our short-term orthodontics (STO) and no one is the wiser. Have you ever counted how many lower front teeth someone has? Of course not. Nobody notices the missing tooth.

When we aren’t removing teeth but we still have significantly crowded teeth (meaning we need more room to fit the teeth properly), we sometimes narrow the teeth. This is not typically noticeable to anyone either.

Alternatively, sometimes we can just line them up and not change the size or number of teeth at all. In this case we simply allow the upper or lower arch of teeth to become somewhat longer by letting the teeth move forward, which gives us the needed space.

My final answer – no, you do not necessarily have to have teeth removed to shape up a crowded arch of teeth. We certainly let you know your options before any treatment is started.

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