Extractions are not always necessary to conduct orthodontic treatment. Extractions are more common before orthodontic treatment in children, who may have baby teeth that are late to fall out and need to be removed to allow adult teeth to erupt properly. Occasionally, teeth may also need to be pulled to correct overcrowding. Your orthodontist will do everything possible to correct your alignment without extracting teeth. An extraction may be recommended in preparation for orthodontic treatment if teeth are: Extremely sensitive Sore or painful Severely decayed Growing in the wrong direction Too large to fit in the mouth Unable to be straightened without an extraction A threat to future shifting and misalignment Chipped, damaged, or cracked In most cases when extractions are necessary, the teeth extracted prior to orthodontic treatment are usually your premolars, which are the fourth and/or fifth teeth from the front.