Exposure of Impacted Teeth in Salem OR
If you have any questions regarding the the surgical removal of impacted canine teeth, please call our office in Salem, OR Oral Surgery Office in Salem Phone Number 503-581-0223.
Impacted Tooth Removal by Dr. David C. Swiderski
An impacted tooth simply means that it is stuck and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get stuck in the back of the jaw and can develop painful infections among other problems. Since there is rarely a functional need for wisdom teeth, they are usually extracted. The maxillary cuspid (upper canine tooth) is the second most common tooth to become impacted. The canine tooth is a critical tooth in 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 tooth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
Normally, the maxillary canine teeth are the last of the front teeth to erupt into place. They usually come into place around age 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 in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary canine teeth. Sixty percent of these impacted canines are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted canines are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the face side of the dental arch.
Early Recognition of Impacted Canines
Early recognition of impacted canine teeth is the key to successful treatment. The older the patient, the more likely an impacted canine tooth will not erupt by natures forces alone even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panoramic screening x-ray, along with a dental examination, be performed on all dental patients at around the age of seven years to count the teeth and determine if there are problems with eruption of the adult teeth.
During that examination, it is important to determine the following:
- Are all of the adult teeth present or are some adult teeth missing?
- Are there extra teeth present or unusual growths that are blocking the eruption of the canine tooth?
- Is there extreme crowding or too little space available causing an eruption problem with the canine tooth?
This exam is usually performed by your general dentist or hygienist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces to allow for proper eruption of the adult teeth. Treatment may also require referral to an oral and maxillofacial surgeon for extraction of retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important canines. The oral and maxillofacial surgeon will also need to remove any supernumerary teeth (extra teeth) or growths that are blocking eruption of any of the adult teeth. If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance the impacted canine will erupt with natures help alone. If the canine is allowed to develop too much (age 13-14), the impacted canine will not erupt by itself even with the space cleared for its eruption. If the patient is too old (over 40), there is a much higher chance the tooth will be fused in position. In these cases the tooth will not budge despite all the efforts of the orthodontist and oral and maxillofacial surgeon to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (a dental implant).
What Happens if the Canine Tooth Will Not Erupt?
In cases where the canine teeth will not erupt spontaneously when proper space is available, the orthodontist and oral and maxillofacial surgeon work together to get these unerupted canine teeth to erupt. Each case must be evaluated on an individual basis but treatment will usually involve a combined effort between the orthodontist and the oral and maxillofacial surgeon. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby canine tooth has not fallen out already, it is usually left in place until the space for the adult canine is ready. Once the space is ready, the orthodontist will refer the patient to the oral and maxillofacial surgeon to have the impacted canine tooth exposed and bracketed.
In a simple surgical procedure performed in the surgeons office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present, it will be removed at the same time. Once the tooth is exposed, the oral and maxillofacial surgeon will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. The oral and maxillofacial surgeon will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed impacted tooth completely uncovered by suturing the gum up high above the tooth or making a window in the gum covering the tooth (on selected cases located on the roof of the mouth). Most of the time, the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.
Shortly after surgery the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it! Once the tooth is moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor gum surgery required to add bulk to the gum tissue over the relocated tooth so it remains healthy during normal function.
Recent studies have revealed that with early identification of impacted canine (or any other impacted tooth other than wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral and maxillofacial surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted canine tooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the canine tooth will have erupted enough that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption.
What to Expect from Surgery to Expose & Bracket an Impacted Tooth
The surgery to expose and bracket an impacted tooth is a very straightforward surgical procedure that is performed in the oral surgeons office. For most patients, it is performed with using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is generally not necessary for this procedure.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not common after this procedure. You should plan to see your orthodontist within a few days to activate the eruption process by applying the proper rubber band to the chain on your tooth.