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See also dental cysts; wisdom
teeth
What are impacted teeth?
When one or more teeth fails to grow in the correct position
and is therefore held below the normal gum line, it is called
an impaction. This can be complete, such as completely unerrupted
(buried) third molars (wisdom teeth)
or partial when just part of the tooth is visible in the mouth.
Why are impactions important?
For best function and appearance the teeth should grow in a
healthy alignment. When one or more teeth is impacted, this can
affect the function of that tooth but also the function and appearance
of other teeth.
Whether all impactions should be treated is still controversial
and your dentist and oral and maxillofacial team can explain the
advantages and disadvantages or treatment for you, which is usually
surgical.
If impacted teeth are not treated, some can lead to medium and
long-term problems such as decay, infection, gum disease and dental
cysts - but these can all be watched out for by dentists.
What are canine teeth?
Normally, every adult has two canine teeth in each upper and
lower jaw. They are the 'pointier' eye teeth ('fangs' in animals)
that are in line with the corner of your mouth.
Children also have the same number of canine teeth but these
will normally be shed when the adult (permanent) teeth replace
them.
Canine teeth are more important than some other teeth for the
correct function of the teeth and also for appearance. This is
why dentists and orthodontists like to correct their position
if possible.
When do permanent canine teeth appear?
Normally, the adult/permanent canine teeth in the upper jaw
(maxilla) appear in the mouth (erupt) between the ages of 11 and
13 years. Just before this time, they can usually be felt as bumps
on the gum.
What can go wrong with canine teeth?
Sometimes, because of the way teeth grow in the jaws and gums,
one or both canine teeth develop in the wrong position for normal
appearance or function. For example, they might erupt in the wrong
position or not at all.
Dentists and orthodontists usually detect a problem with the
canine teeth in children around the ages of 10-14 years, which
is a time when they will recommend treatment.
Why can canine teeth grow incorrectly?
Canines are just one type of tooth. Some people never grow some
teeth, which can be an inherited condition. Others have problems
with the size, number or alignment of some or all of their teeth.
The reasons for this can result from a mismatch in the size and
shape of teeth, the soft tissues and underlying jaws - or it might
be the result of early loss (or removal) of 'baby' (deciduous)
teeth. Sometime people are just unlucky.
What can a misplaced canine look like?
Canines can fail to grow completely on one or both sides; this
can either leave a gap between the incisors and premolars or the
deciduous canine tooth will be retained, which in time might look
too narrow or short.
Misplaced canines can also grow in the wrong place. They can
erupt at the wrong angle or even behind the teeth in the palate.
What will happen if I have a misplaced canine?
The treatment options for impacted or misplaced canines will
depend on the type and severity and the alignment of other teeth.
Your dentist, orthodontist and/or oral and maxillofacial surgeon
will explain the options to you, which can include surgery.
What might happen if I decide not to have treatment for my
impacted canine tooth?
If an impacted canine is not treated, it can just remain buried
and give you no more problems. Alternatively, it can lead to the
following, which might or might not give you problems in the medium-long-term:
-
The tooth can continue to grow behind the other teeth in
the roof of the mouth. In an effort to find a path into the
mouth, some impacted canines might damage adjacent teeth by
eating away or resorbing part of their roots, which might
or might not give you problems.
-
If the deciduous canine has been lost and the permanent canine
remains impacted, you might have a gap, which you might want
to close up or replace with a false tooth of some kind (denture
or 'bridge').
-
Sometimes a cyst can form around the crown of the buried
tooth and this can push other teeth out of position.
If you have an impacted canine, you do not have to have surgery
- this will be explained by your dentist or orthodontist. For
example, if the buried tooth has not damaged the adjacent teeth,
is not causing symptoms and the dental appearance is good then
no treatment might be necessary.
Your dentist will probably want to keep an eye on the tooth though
by taking regular X-rays.
Who will carry out the surgery for impacted canine teeth?
Who carries out surgery on canine teeth depends on the expertise
of your own dentist or orthodontist and the nature and extent
of the surgery required. Your dentist will explain this to you.
If you are referred to an Oral and Maxillofacial Department in
a hospital such as Addenbrooke's, they will work closely with
your own dentist and/or orthodontist. Your treatment will be carried
out at Addenbrooke's and the options will be explained to you
(you might have surgery under local or general anaesthetic)
What happens if I have an impacted canine?
Usually your dentist or orthodontist will diagnose the problem.
They will notice that the tooth is not growing normally, will
feel for the bump of the tooth in your palate or gum below your
nose and will take some X-rays to check its existence and position.
Often the dentist will refer you to an orthodontist and/or an
oral and maxillofacial surgeon for an opinion on the best ways
of handling the problem.
What can be done surgically for impacted canine teeth?
There are several options for the surgical treatment of impacted
canines. Your dentist will explain the options for you which might
include:
-
Removed and discarded - This can be the treatment
of choice if the buried tooth is in a poor position for orthodontic
re-alignment, or shows signs of causing problems to adjacent
teeth.
Removal of the tooth involves a minor operation, which can
be done under local or mostly under general anaesthetic.
If there is a gap to fill where the canine tooth should be,
it might be necessary to use a false tooth of some kind (denture
or 'bridge')
-
Exposed before orthodontic treatment - If part of
the tooth is exposed to the mouth it can allow an orthodontist
to move it into correct alignment. This can be an option only
if the buried tooth is in a reasonable alignment and the patient
is prepared to wear an orthodontic fixed appliance for at
least two years.
The exposure of the tooth involves a small operation in the
palate of the mouth, which is often performed under general
anaesthesia. During this operation, some gum and bone overlying
the tooth is removed so that the crown of the tooth is exposed.
Sometimes, other teeth will need to be extracted to make space
for the canine - your orthodontist will explain this to you.
The oral and maxillofacial surgeon might place a dressing
over the tooth, which is held with stitches that are removed
after two to three weeks. An orthodontist then starts treatment
to align the tooth.
-
Transplantation - Your oral and maxillofacial surgeon
might suggest transplantation of the buried tooth if it is
in a position where exposure followed by orthodontic treatment
is not possible but there is adequate space between the other
teeth. This entails an operation to remove the deciduous tooth
if it is present, to remove the canine and replace it as carefully
as possible in the correct position. The replaced tooth will
need to be splinted for two to three weeks.
The success rate of this procedure remains variable. If it
is unsuccessful, the transplanted tooth does not function
like a normal tooth and might have to be removed later on.
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