Impacted Canines

An impacted tooth simply means that the tooth is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molars, known as wisdom teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems. Because there is rarely a functional need for wisdom teeth, they are typically extracted. The maxillary canine (upper eyetooth) is another commonly impacted tooth. The canine is critical to the dental arch and plays an important role in your “bite”. The canine teeth are very strong biting teeth, and have the longest roots of any human teeth. They are designed to be the first teeth that touch when you jaws close together, and they guide the remaining teeth into the proper bite position.

Typically, the maxillary canine teeth are the last of the “front” teeth to erupt into place. They usually come into place around the age of 13, and cause any space left between the upper front teeth to close tighter together. If a canine tooth gets impacted, every effort is made to get it to erupt into its proper position. The techniques used to assist in eruption can be applied to any impacted tooth, but are most commonly applied to the maxillary canine.

Early Recognition for Successful Treatment

The older a patient, the more likely an impacted canine will not erupt naturally, even if the space is available for the tooth to fit into the dental arch. The American Association of Orthodontists recommends that a panorex screening x-ray, along with a dental examination, be performed on all dental patients around the age of seven to count teeth and determine if there are problems with eruption of the adult teeth. It is crucial to determine whether all the adult teeth are present or not. Other circumstances to consider include whether there are extra teeth or unusual growths, extreme crowding or other blockages.

The exam is usually performed by your general dentist, and referrals to orthodontic care are given if needed. The problem is often treated with braces to allow for proper eruption. However, treatment could also include a referral to an oral surgeon for the extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the canine. Any extra teeth or growths may also be removed. If the space for the eyetooth is cleared by age 11 or 12, it is very likely the tooth will erupt naturally. If the eye tooth develops too much before there is space for its eruption, the eyetooth may stay in place. When patients wait until later in life, typically over 40, there is a much higher chance the tooth will have fused into its position. At this point, the only option becomes extracting the tooth and considering alternatives to replace it.

What if the Eyetooth Doesn’t Erupt, Even with Proper Space?

In cases where the canine teeth don’t erupt, an orthodontist and oral surgeon can work together to bring these teeth into their proper placement. Each case is evaluated individually, but common treatment will include an orthodontist placing braces. Once there is space provided for the impacted tooth, an oral surgeon will expose and bracket the impacted canine so it can be pulled into its appropriate placement.

Recent studies have revealed that early identification of impacted canines can help in simplifying treatment. Once a general dentist or hygienist identifies a possible eruption problem, the patient should be referred to an orthodontist for early evaluation. By identifying the problem early, the orthodontist and oral surgeon can work to correct this issue before the tooth becomes completely impacted (stuck).

What Can I Expect from Surgery to Expose and Bracket an Impacted Tooth?

The procedure to expose and bracket an impacted tooth is a very straightforward procedure, performed at your oral surgeon’s office. For most patients, only laughing gas and local anesthesia is required. In selected cases, the procedure may be performed under IV sedation if the patient prefers to be asleep, but this is generally not necessary. The length of the procedure can vary, but all issues pertaining to your case are discussed in advance with your doctor during your preoperative consultation.

You can expect a limited amount of bleeding from the surgical sites following your procedure. Although there will be some discomfort after surgery, most patients find that an over-the-counter pain medication is adequate to manage any discomfort. Two to three days following surgery, there is typically no need for medication at all.

There may be some swelling, but it can be minimized by applying ice packs following surgery. Bruising is uncommon in this procedure. A soft, bland diet is recommended following surgery, but you may resume your normal diet as soon as you feel comfortable chewing. It is recommended that you avoid sharp food items, such as crackers and chips, as they may irritate the surgical site during initial healing. Plan to see your orthodontist within two weeks to activate the eruption process.

As always, our surgeons are available at the office, or can be reached after hours if any problems should arise.