Extractions (Tooth Removal) Extractions are doneas a last resort in the case of severe tooth decay, if an orthodontist requests it, or if a patient has a baby tooth that will not fall out by itself. If a primary molar is removed prematurely, a space maintainer will be placed. Some extractions are needed for orthodontic reasons to help facilitate tooth alignment when crowded teeth are present. Primary teeth are essential in maintaining the correct spacing in your child’s jaw for the permanent teeth.