It sounds like your doctor is recommending extracting four bicuspid teeth in order to straighten your teeth. This will work if all you care about is having straight teeth. However, if you are concerned about how your face will look after your teeth are straightened then bicuspid extraction orthodontics is definitely NOT the best choice. Whenever you have dental crowding there are only three possible solutions: extract teeth, slenderize teeth or develop the dental arches. Each option has consequences. Some doctors believe that developing the dental arches is not possible in adult patients. This is simply not true. We develop dental arches with great success every single day in young patients AND adult patients. It is done using simple, comfortable removable appliances. No surgery. Extracting bicuspid teeth before braces will cause: a long narrow face, small lips, narrow smile, compromised facial profile, wrinkles at the corners of the mouth, bigger nose and compromised TMJ and airway.Find a doctor who understands the relationship of orthodontics to facial aesthetics and TMJ/airway health. If the doctor can not talk confidently about the effects of orthodontics on facial aesthetics then you need to find another doctor.Good luck!