Objective:The aims of the present study are to determine the causes and pattern of loss of permanent teeth among patients attending a medical college in Uttrakhand. Subjects and Methods: Data collected from patients attending the outpatient wing of the Government Medical College, Srinagar Garhwal , Uttrakhand, during a 12 month period (First Jan 2014- First Dec 2014) was used for the study. The cause for extraction was classified as follows: (1) Dental caries (2) periodontal disease, (3) endodontic failures, (4) trauma, (5) orthodontic needs, (6) impactions, and (7) supernumerary teeth. Results: A total of 1506 permanent teeth were extracted of which 662 (43.95%) teeth were extracted due to caries, 472 (31.34%) due to periodontal disease, 154 (10.4%) for orthodontic purposes, 88 (0.58%) due to impactions, 68 (0.45%) for endodontic treatment , and 44 (0.29%) for trauma and 18 (0.11%) for supernumerary teeth. Conclusions: The results of the present study suggest caries and periodontal disease are the major causes of tooth mortality in the study population.