18 y/o. Should i get 4 premolars removed for braces?

Treatment with out extractions will make your teeth straight, but the overjet will increase and your teeth will be more horsey.  If one of the reasons you got braces was to correct your overjet, then extractions are needed.  If you are OK with your teeth sticking out further, then you can probably do without the extractions.  Search this web site for "unhappy after braces", or "teeth stick out after braces" for some examples of what this can look like.  Remember, Orthodontists don't like extraction either.  It means the case is more complicated and requires much more careful treatment.  Also, we know patients hate extractions and there is always someone willing to straighten the teeth with out any consideration for future gum recession, or the resulting horsey smile.  Non extraction is an easier "sell" and usually more profitable.  Teeth are always straighter and "better" after any treatment so people don't complain much even if their teeth stick out more.  The true test is a side view smiling selfie.  If your teeth look like the stick out a bit or more, extraction treatment is your best option.Your face will change after braces either way, but the change is limited to your lips only.   In a case with overjet   Non extraction:  Lips stick out more.  Extractions:  lips stick out less.  (crowding cases are different, often there is no lip change.)  What do you want?  Another thing to check:  Often times, excess overbite causes the lower lip to curl under the upper and actually stick out further than the upper lip.  Moving the teeth back with extractions usually reduces this problem and results in a fuller, more exposed upper lip.

You should be scared. I have been doing orthodontic treatment on patients for 25 years and I have extracted bicuspid teeth (two of them) on exactly ONE patient. In other words, the need to extract bicuspid teeth in order to straighten teeth is EXTREMELY rare. When teeth are too crowded there are three options for creating the necessary room to straighten them: 1. extract teeth, 2. slenderize teeth, or 3. enlarge the space. My preference is in reverse order of the options listed above. When teeth are extracted in order to create sufficient space to straighten them it ALMOST ALWAYS creates an excess amount of space. In order to close this excess space teeth have to be retracted and jaws have to be constricted. The patient ends up with facial deformities, airway problems and often TMJ problems as well. BEFORE you agree to extract any teeth ask your doctor what the effects will be on your airway, TMJ and facial aesthetics. If he/she can not speak confidently and intelligently on all three issues then I would terminate treatment immediately and seek treatment from a doctor who can speak intelligently and confidently on the subject.This is your mouth, your smile, your long-term health in question. DO NOT proceed with treatment that you don't feel comfortable with. BTW, extracting teeth should have been discussed long before the doctor put a single bracket on your teeth. In my estimation, the fact that this was not discussed is reason alone to abort treatment with no penalty to you. Good luck!