Impacted Canines

When a tooth does not erupt in the right manner through the gums, it is usually referred to as an impacted tooth. This type of tooth usually gives people problems which include painful infections. Because the third molar (wisdom) teeth are rarely used, it is usually preferable to take them out if they are causing discomfort. Close to the wisdom tooth, the maxillary cuspid (also known as the upper eyetooth) is the second most common tooth that fails to erupt properly into function. The cuspid teeth, which have the longest roots of all the teeth, are important teeth in the human dental arch and perform a vital function in the chewing process. The upper eyeteeth have very strong biting abilities and they are built to be the first teeth that contact each other when the upper and lower jaws come together. As such, they are responsible for directing the rest of the teeth into the right bite.   

The upper eyeteeth normally erupt through the gums after all the other “front” teeth have come into place. At around the age of thirteen, your maxillary cuspid teeth would usually erupt into position. When this occurs, it makes any space present between the upper front teeth to seal firmly together. In case an upper eyetooth fails to erupt as desired, you should seek the assistance of a dental specialist to ensure it comes out properly in the dental arch. The methods used to ensure the eruption takes place without any problems can also be used for any impacted tooth in the upper or lower jaw. Nonetheless, the methods are normally used for aiding the proper development of the upper eyeteeth. About 60% of these impacted maxillary cuspid teeth are situated on the palatal area of the dental arch. The rest of the impacted cuspid teeth are located at the center of the supporting bone. However, they are fixed in a raised position above the roots of the nearby teeth. Some of the remaining 40% can also be situated out to the facial area of the dental arch. 

 

Early Detection is the Solution to Successful Treatment

It is usually difficult for the impacted cuspid teeth in older patients to erupt only by means of natural forces, irrespective of whether there is sufficient room for the tooth to position itself in the dental arch.   The American Association of Orthodontists (AOO), the professional association of orthodontists in the United States, advocates that a panoramic x-ray, together with a dental assessment, be carried out on every dental patient at 7 years old. The main purpose of these tests is to know the number of teeth and discover at an early stage any future problems with the eruption of the adult teeth. It is essential to establish if all your adult teeth are available or if some of them are lacking.

A general dentist or hygienist normally carries out these tests. If a problem is discovered, you will be referred to an orthodontist for further checkups and treatment. When treating such a condition, an orthodontist may use braces to open spaces, enabling the adult teeth to erupt without any difficulties. Treatment may also involve an oral surgeon who will remove any abnormal baby teeth still present and/or certain adult teeth that are preventing the proper development of the maxillary cuspid teeth. Furthermore, an oral surgeon such as Dr. Dhadli – may also extract any extra teeth or abnormal growths that are hindering the proper development of any adult teeth.

If the eruption passage is cleaned to remove all the obstructions and the space is unblocked when the patient is around eleven to twelve years of age, then there is high possibility that the impacted cuspid teeth will develop naturally. In case no effort is made to prevent the cuspid teeth from excessively growing below the surface (when the patient is around thirteen to fourteen years old), then the impacted cuspid teeth will fail to erupt on its own, even after the space is unblocked for its development. If the individual is older (more than forty years old), it is very likely that the tooth will have fused tightly into position in the mouth. If this happens, the tooth will not move, regardless of the interventions made to make it erupt into place. Unfortunately, the only alternative at this point is to remove the impacted tooth and replace it.

When there is No Spontaneous Eruption

In some cases, the maxillary cuspid teeth will fail to erupt spontaneously even if adequate space is present. When this happens, Dr. Dhadli will collaborate with an orthodontist to solve this problem. They will assess every case carefully and recommend the most appropriate treatment plan. Usually, the orthodontist will put braces on the upper arch teeth region so that sufficient space is created for the impacted tooth to be shifted into its right location. In case the baby cuspid tooth has not come out already, it is normally not disturbed until the adult cuspid tooth has sufficient room for eruption. When the space is ready, the orthodontist will refer the case to Dr. Dhadli. She will then expose the impacted cuspid tooth and bracket it properly.

During a simple surgical procedure carried out at our office in Hillsboro, Oregon, Dr. Dhadli will raise the gum above the impacted tooth to expose the concealed tooth below it. If she finds a baby tooth, it will be taken out at the same time. After the tooth is exposed, Dr. Dhadli will tie an orthodontic bracket to the uncovered tooth. The bracket will contain a tiny gold chain fastened to it. Dr. Dhadli will direct the chain back to the orthodontic arch wire where it will be fastened for the time being. Depending on the situation, Dr. Dhadli can leave the uncovered and impacted tooth completely naked through stitching the gum up high on top of the tooth. She may also decide to make a window in the gum enveloping the tooth. In most instances, the gum will be taken back to its initial position and stitched back with only the chain staying noticeable, since it is present as a tiny opening inside the gum.

Soon after the surgical procedure (usually between one to fourteen days), the patient will go back to see the orthodontist. The orthodontist will connect a rubber band to the chain. This is important for exerting a slight eruptive pulling pressure on the impacted tooth so that the tooth can be budged to its right position. This process is carefully controlled to avoid any complications that may arise. Usually, it takes place slowly for up to one year. Keep in mind that the intention is to erupt the impacted tooth and not to remove it from the dental arch. After the tooth has budged into the arch in its eventual location, the gum surrounding it will be assessed to ensure it has enough strength and quality to maintain normal function throughout the lifetime of the patient. Sometimes, particularly when the tooth was budged for a long time frame, a minor “gum surgery” may be necessary to ensure the gum tissue is of sufficient quality. Dr. Dhadli and your orthodontist will give details about this procedure in case it relates to your particular condition.

It is possible to modify these basic principles to solve the problems of any impacted tooth in the dental arch. It is not that rare for both of the eyeteeth to fail to erupt in the right manner. During such instances, the space in the dental arch will be made ready on both sides at the same time. When the orthodontist is ready, Dr. Dhadli will uncover and bracket both teeth during the same visit. This way, you will heal only from one surgical procedure. The front teeth (incisors and eyeteeth) and the bicuspid teeth are tiny in size with single roots. As such, they are much easier to erupt in case they are impacted than the posterior molar teeth, which are much larger with several roots. The orthodontic movements required to operate an impacted molar tooth successfully can be complex due to their position at the posterior of the mouth.

Recent research has revealed that identifying and beginning treatment of impacted cuspid teeth when the patient is still young usually yield better results than in older patients. This also applies to every other impacted tooth apart from the wisdom teeth. When a general dentist or hygienist spots a possible difficulty in eruption, then a referral to an orthodontist will be recommended. Sometimes, the individual may be referred to an oral surgeon prior to braces being placed on the teeth. As pointed out earlier, the surgeon may take out any abnormal baby teeth still present and/or certain adult teeth that are hindering the proper development of the maxillary cuspid teeth.

The surgeon may also take away any extra teeth or growths that are obstructing the normal eruption of the growing adult teeth. Lastly, the surgeon may be required to uncover an impacted cuspid tooth without fixing a bracket and chain to it. Actually, this is a simpler surgery to carry out instead of uncovering and bracketing the impacted tooth. This will stimulate a bit of eruption to take place before the tooth grows to be completely impacted. When an individual will have reached the age for the orthodontist to put braces to the dental arch, the cuspid tooth will have sufficiently erupted. As such, the orthodontist will be able to conveniently attach a bracket to it and budge it into position without having to exert excess pressure for it to erupt. This is advantageous for the patient because of the significant amount of time saved from having to be in braces.


Exposure and Bracketing of an Impacted Cuspid


Expectations After Surgery

The surgical procedure to uncover and bracket an impacted tooth is normally very simple. We usually perform it at our office in Hillsboro, Oregon, using laughing gas and local anesthesia. In some cases, we carry it out using intravenous sedation(IV sedation) particularly when the patient wants to be asleep. The surgery usually takes about seventy-five minutes if a single tooth is being exposed and bracketed. If both sides need treatment, it will take a bit longer.

Following the procedure, you may start experiencing a slight oozing of blood from the surgical sites. You should expect to feel some discomfort after surgery at the surgical sites.  After 2 to 3 days from the surgery, patients normally do not take any more drugs.

You can expect some swelling to occur due to lifting the lip up to reveal the surgical site. You can manage this swelling with placing ice packs to the lip for some time after the surgical procedure.

 Initially, it is advisable to maintain a soft, bland diet, but you can get back to your usual diet whenever you are ready. It is recommended that you stay away from sharp foods such as crackers and chips, since they will inflame the surgical site when coming into contact with it.

We will want to schedule an appointment within 7 to 10 days after the surgical procedure to assess the progress of the healing process and ensure your oral health is on track. You should also schedule an appointment with your orthodontist within two weeks to trigger the eruption process (placing the right rubber band on the chain on your tooth). As always, Dr. Dhadli is available to respond to any issues that may arise after the surgical procedure. You can call us at Hillsboro Office Phone Number 503-547-8879 in case you need any assistance.