Tooth extraction and IPRQuestion before treatment

If I need four premolars taken out, in what order are they removed? Can it be done all at once?

Answered byDr Ivelina Ivanova-Koycheva, Orthodontist (MSc)Master's degrees in orthodontics in Rome and in aligner treatment in Turin, international lecturerPublished on 12 November 2026

This is best discussed with your chosen oral surgeon. In some cases, surgeons go along with the patient's wishes and can extract all the planned teeth in one visit. This is done under local anaesthetic, with the patient remaining conscious. The main advantage of removing them all at once is that you recover from everything in one go, within a few days.

On the other hand, this approach causes more discomfort after the procedure and makes eating harder, as there are wounds on both the left and right sides of the mouth. For this reason, surgeons usually recommend removing the teeth in stages – first two premolars (upper and lower) on one side, so that the patient can eat more easily. Once the discomfort from the first procedure has settled, usually after about a week, the remaining two teeth on the other side are removed.

This answer is for general information. Your own case needs an examination by an orthodontist.