Purpose: The aims of this study were first to identify the risk indicators for permanent tooth extraction in patients who were receiving free dental treatment, and second to determine whether or not the reasons for tooth extraction are related to socio-demographic factors. Materials and Methods: Bangladeshi adults who visited Dhaka Dental College Hospital participated in this study. For each extraction, the clinician recorded age, sex, educational status, type of tooth extracted, dietary habits, oral hygiene, history of smoking and betel quid chewing and reasons for tooth extraction. A series of bivariate analyses and logistic regression analyses were carried out to assess the effects of major variables. Results: A total of 868 teeth were extracted from 582 patients. Among them, 586 (67.5%) of the teeth were extracted due to caries and its sequelae, 161 (18.5%) and 121 (13.9%) were extracted for periodontal and other reasons. Logistic regression analysis revealed that tooth extraction due to caries had significant associations with age (P = 0.0001), tooth type (P = 0.013), consumption of sweets, snacks and soft drinks (P = 0.0001 and P = 0.0001, respectively), frequency of teeth cleaning (P = 0.007) and dental attendance pattern (P = 0.004). For tooth extraction due to periodontal disease, associations with age (P = 0.001), educational level (P = 0.018), tooth type (P = 0.024), betel quid chewing (P = 0.0001), smoking habit (P = 0.032), method of teeth cleaning (P = 0.001) and the use of dentifrices (P = 0.024) were statistically significant. Conclusions: In this group of patients, caries and its sequelae were the most common reasons for extraction of teeth, followed by periodontal disease. Betel quid chewing, smoking and dietary and oral hygiene habits were also significant predictors of tooth loss. Keywords: betel quid chewing, dental caries, periodontal disease, permanent tooth loss, poor adult population