Do Any Teeth Have to Be Removed Before Getting Braces?

Modern materials and techniques allow us to avoid extracting teeth, while in the past it was routine to extract. While it cannot be avoided sometimes, if arch expansion is possible, it is usually advised.

In my opinion, teeth should only be removed when absolutely necessary to gain space to align the other teeth.  Whenever possible it is better to retain all the teeth and develop good broad arch form.  Many people don't realize the connection between well developed dental arches, airway (sleep apnea), and lower jaw position in relation to the base of the skull.  When teeth are removed unnecessarily the result can be less room for the tongue to posture, less open airway, more difficulty with good sleep, and a jaws that are retracted.  This can lead to imbalanced muscle activity and TMJ problems

Whether or not extractions are needed prior to braces depends on the severity of the crowding.  In any situation where extractions are recommended I would recommend getting another opinion from a dentist or orthodontist who practices functional orthodontics.  Many times, expansion can be done to develop the dental arches properly and make room for all of the teeth.  When dental arches are developed properly, this can result in the best facial balance and esthetics.  

With more traditional orthodontic treatment (braces only) many times permanent teeth have to be extracted when crowding and overbites are present.  Adding what is called Dentofacial Orthopedics (fancy retainers to expand bone structures) prior to braces can eliminate the need for permanent teeth extractions in almost all cases.  In my practice, permanent teeth have to be removed in well under 1% of the cases.  Many of the before and after pictures I submitted used Dentofacial Orthopedics and none needed permanent tooth removal.

This depends on the individual situation. However, in my practice, less than 3% require extractions vs. the national average of 15-20%. I prefer not to extract, when possible, so that natural dentition is preserved.