Impacted Third Molar (Wisdom Teeth)
An impacted tooth is one that is unable to erupt into function and becomes stuck. Impacted third molar (wisdom) teeth often cause issues such as painful infections. Wisdom teeth are typically extracted if they cause problems since they are not usually necessary for function. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. Cuspid teeth are important for the dental arch and play a key role in the bite, as they have strong biting capabilities and the longest roots of any human teeth. They are meant to be the first teeth to touch when the jaws close, guiding the rest of the teeth into the correct bite.
Typically, the maxillary cuspid teeth are the last of the front teeth to come in, usually around age 13. When these teeth are impacted, efforts are made to help them erupt into their proper position in the dental arch. This technique can be used for any impacted tooth in the upper or lower jaw, but it is most commonly used for the maxillary cuspid teeth. About 60% of impacted eyeteeth are located on the palatal side of the dental arch, while the rest are either stuck in an elevated position above the roots of adjacent teeth or are on the facial side of the dental arch.
Early Recognition Of Impacted Eyeteeth Is The Key To Successful Treatment
The likelihood of an impacted eyetooth not erupting naturally increases with age, even if there is space available in the dental arch. The American Association of Orthodontists recommends that all dental patients undergo a panoramic x-ray and dental examination at age seven to assess tooth count and identify any potential issues with adult tooth eruption. It is crucial to determine if all adult teeth are present or if any are missing.
Your general dentist or hygienist typically performs this examination and will refer you to an orthodontist if any problems are detected. Treatment may involve braces to create space for proper tooth eruption, or referral to an oral surgeon for extraction of baby teeth or adult teeth blocking the eyetooth's eruption path. The oral surgeon may also need to remove any extra teeth or growths obstructing adult tooth eruption.
If the impacted eyetooth's eruption path is cleared by age 11-12, there is a good chance it will erupt naturally. However, if the tooth remains impacted by age 13-14, it is unlikely to erupt on its own. In older patients, particularly those over 40, the tooth may be fused in place and extraction may be the only option. Replacement options such as a dental implant or fixed bridge can be considered in these cases.
What Happens If The Eyetooth Will Not Erupt When Proper Space Is Available?
If the eyeteeth do not erupt spontaneously, the orthodontist and oral surgeon will collaborate to facilitate their eruption. Treatment plans will be tailored to each individual case, but typically involve a joint effort between the orthodontist and oral surgeon. The orthodontist will usually place braces on the teeth, creating space for the impacted tooth to move into its correct position in the dental arch. If the baby eyetooth is still present, it will be left in place until the space for the adult eyetooth is ready. Once the space is prepared, the patient will be referred to the oral surgeon to expose and bracket the impacted eyetooth.
During a simple surgical procedure in the surgeon's office, the gum covering the impacted tooth will be lifted to reveal the hidden tooth. If a baby tooth is present, it will be removed at the same time. The oral surgeon will attach an orthodontic bracket to the exposed tooth, with a gold chain connected to it. The chain will be guided back to the orthodontic arch wire and temporarily attached. After surgery, the patient will return to the orthodontist for a rubber band to be attached to the chain, applying a gentle force to move the tooth into its proper position over time.
The goal is to erupt the impacted tooth rather than extract it. Once the tooth is in its final position, the gum around it will be evaluated for strength and health. In some cases, minor gum surgery may be necessary to ensure the gum tissue remains healthy during normal function. These principles can be applied to any impacted tooth in the mouth, with early identification leading to treatment at a younger age.
If both maxillary cuspids are impacted, both sides of the dental arch will be prepared simultaneously. Impacted anterior teeth are easier to erupt than posterior molars due to their size and root structure. Early intervention is key, with the general dentist or hygienist referring patients to the orthodontist for evaluation. In some cases, the oral surgeon may need to remove over-retained baby teeth or extra teeth blocking eruption. By addressing impacted teeth early, the need for extensive treatment later on can be minimized, resulting in shorter treatment times for the patient.
What To Expect From Surgery To Expose & Bracket An Impacted Tooth
The surgery to expose and bracket an impacted tooth is a simple procedure done in the oral surgeon's office. Most patients receive laughing gas and local anesthesia, but IV sedation is an option for those who prefer to be asleep. The procedure takes about 75 minutes for one tooth or 105 minutes for both sides. If only exposing the tooth is needed, the time is cut in half. Bleeding and discomfort are common after surgery, but can be managed with Tylenol or Advil. Swelling can be reduced with ice packs, and a soft diet is recommended initially. Follow-up appointments will be scheduled to monitor healing and activate the eruption process with your orthodontist. Contact Wisdom Oral Surgery & Dental Implants at 408-723-4080 with any questions or concerns.
