Teeth may need to be extracted because they are so badly decayed or broken that they cannot by restored.  Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth.  Sometimes an extraction is performed when a tooth becomes impacted due to complications they can cause to surrounding tissues.  Tooth extractions can usually be performed with local anesthesia.  Alternatively patients may elect to have extractions done under sedation while he/she is asleep.