Exposure of Impacted Teeth

A tooth may become impacted or stuck in a position where it fails to erupt into the mouth. This condition is known as impaction and can occur in either primary (deciduous) or permanent teeth.

Exposure of Impacted Teeth

Patients most commonly develop impaction with the third molar or wisdom teeth (see Impacted Wisdom Teeth) which are usually extracted if they develop any problems. For all other teeth, the goal is to erupt the teeth at an early age because, as a child becomes an adult, the roots of the tooth become less elastic and able to adjust as needed for eruption.

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The maxillary cuspids or canines are aligned right below the eyes and are also known as the upper eye teeth. They are the second most common teeth to become impacted. Since the canines are the first teeth that touch when your jaws close together–they guide the rest of the teeth into the proper bite. If they do not emerge properly, impacted canines can cause strain on your child’s jaw joint in the long term, so treating this as soon as possible is important for your child’s future oral health.

Successful exposure and eruption of an impacted tooth often requires teamwork between a pediatric dentist and an oral and maxillofacial surgeon. The treatment plan options depend on the reasons why the canines are not emerging and include:

  • If your child’s dentist notices space for the permanent tooth to grow and erupt without causing any damage to other teeth, he/she may suggest monitoring the impacted tooth over time to see if it erupts into the mouth. Signs of progress may include loosening of the tooth, increased pain at eruption, and/or a shift in position.
  • If extra teeth or unusual growths are blocking the eruption of the eye tooth, extraction of over-retained baby teeth or adult teeth that are blocking the eruption of the eye teeth is done. This is because the eye teeth are functionally critical.
  • If there is extreme crowding or a very narrow space available for eye tooth eruption, placing braces to open spaces and allowing for proper eruption of the adult teeth may be a good option.
  • If the tooth does not erupt spontaneously besides the space being cleared up (by age 11 or 12), the canine develops too much and may not be able to erupt by itself (by age 13 or 14), a simple surgery is then needed to lower the canines into proper position. Your pediatric dentist or orthodontist may consult with an oral and maxillofacial surgeon, a specialist in diseases and surgery of the mouth, jaws, and face.
  • For those over 40 years old, there is a much higher chance that the impacted tooth will have fully fused in position. The only option is to extract such impacted tooth and replace it with a crown on a dental implant or a fixed bridge.

The impacted canine tooth is usually very deep in the jaw. The best, quickest, and least traumatic method for exposing an impacted tooth is to cut the gum away from the tooth to create a flap. Once any obstructing baby tooth is removed and the hidden tooth has been exposed, an orthodontic bracket is bonded to it. A miniature gold chain is then attached to the orthodontic arch wire. The gum flap is sutured back leaving the gold chain slightly exposed. In the follow-up appointment after gum surgery, a rubber band is attached to the chain to help with gently pulling down the tooth to its proper place in the dental arch. This is a slow and carefully controlled process that takes up to a year to accomplish.

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