The aim of the study was to determine the etiology and pattern of tooth extractions in permanent dentition. A cross sectional prospective study was conducted at the department of Oral & Maxillofacial Surgery, Faisalabad Medical University, Faisalabad from October 2018 to March 2019. A total of 1656 patients were picked through non-probability consecutive sampling and data was collected by a skilled clinician using a specially designed performa after informed verbal consent from the patient. Quantitative variables like age were presented as mean and standard deviation. Qualitative data like gender, reason of extraction of tooth, tooth loss pattern and socioeconomic status were presented as frequencies and percentages. In 1656 patients, a total of 2253 teeth were extracted. There were 639 (38.6%) males and 1017 (61.4%) females with a male to female ratio of 1:1.6. Majority of the patients 1235 (74.6%) belong to lower socioeconomic status and 421 (25.4%) belong to middle socioeconomic status. The main etiology of tooth extraction in this study was caries 1503 (66.7%) followed by periodontal diseases 288 (12.8%) and impaction 237 (10.5%). The pattern of tooth removal showed that third molar tooth was the frequently extracted tooth 522 (23.1%) followed by the first molar tooth 438 (19.4%) in both the arches. The results of this study showed that caries followed by periodontal disease were the major cause for tooth extractions. These are largely preventable causes of tooth extraction therefore there is a need for commencement of far reaching preventive actions. Significant consideration should be applied to expand peoples awareness and recognition of their overall dental health and change of their viewpoint and behaviour in connection to oral care.