As our baby teeth are replaced by permanent teeth around the age of four or five, teeth can get stuck or impacted as they try to break through the gum. These impacted teeth either come in partially or not at all, remaining trapped in the gum tissue or bone. The most likely teeth to become impacted are:

Third Molar (Wisdom Tooth):

Because your wisdom teeth are the last teeth to emerge, usually between 17 to 21 years old, they are the most likely to become impacted and the most common to extract. There is usually no need to retain your wisdom teeth and they are simply extracted if there is no room for them in the mouth.These are removed during a common procedure called a wisdom tooth extraction. However, if other molars are impacted, then an orthodontist may need to shift the impacted tooth using braces.

Canine (Cuspid):

As the last of the “front” teeth to develop, your canines are the most likely to become impacted and cause symptoms. Most people’s canines will emerge around 13 years old and close the space left between your upper front teeth. If your canines do not emerge at this age, then you should seek immediate treatment to avoid associated problems.Located between the incisors and molars, the cuspid is an important part of your bite and are the first teeth to touch when your jaws close, aligning the rest of your teeth into a proper bite.

While any of your other teeth can become impacted, the canines and third molar are the most likely to require treatment to prevent troublesome symptoms.


Causes of Impacted Canines

  • Natural overcrowding of other teeth that have already emerged within the mouth
  • The canines attempt to come in at an angle toward the neighboring tooth and are unable to erupt properly
  • The canines attempt to come in at a right angle rather than straight up like the other teeth
  • The canines stay trapped in the jawbone rather than erupting through the gum line even though they are positioned properly within the jawbone
  • Orthodontic treatment has created less space in the mouth, and the canine is unable to properly erupt
  • Genetics that cause a hereditary condition, which makes some patients more susceptible to impacted canines

Signs of Impacted Canines

  • Red or swollen gums – if the gums are visibly red or swollen in the area of your canines, they may be impacted.
  • Tender gums – impacted canines often cause the gums to be tender to the touch. If you notice that your gums hurt when you brush your teeth or when you eat or drink, your canines may be impacted.
  • Gums that bleed easily – when canines are impacted, the gum tissue near the impaction is prone to bleeding easily. If brushing causes your gums to bleed more than normal, talk to our doctors to find out if you have impacted canines.
  • Pain or swelling in the jaw – if you are experiencing new discomfort or swelling in the jaw areas near your canines, they may be impacted.
  • Bad breath – impacted canines often cause patients to experience bad breath that they cannot seem to get rid of. This is because impacted teeth create tiny cuts in the gums as they attempt to erupt. These tiny cuts collect food debris and bacteria, resulting in persistent bad breath.

When Should I Seek Treatment for My Impacted Teeth?

The best time to treat impacted teeth is after your permanent teeth have come in or if you experience any painful symptoms related to your impacted tooth. San Francisco patients who are over 40 are more likely to experience fusion of the impacted tooth. In this case, the tooth will remain in a fixed position despite the efforts of an orthodontist and Oral and Maxillofacial Surgeon.

Recent studies have shown that treatment for any impacted teeth aside from wisdom teeth should start at a younger age. San Francisco patients should be referred to an orthodontist or Maxillofacial Surgeon if their dentist suspects any potential eruption problem.

How Do You Treat Impacted Teeth?

Although assisting the impacted tooth to erupt is the preferred treatment method, certain cases will require that an impacted tooth be removed and replaced with a crown affixed to a dental implant or fixed bridge.

Treatment for the impacted tooth can be used on any impacted tooth in the upper or lower jaw. Factors that affect the approach to impacted teeth are:

  • Location: 60% of impacted teeth are located on the roof of your mouth. The remaining are trapped in an elevated position above the roots of neighboring teeth or the facial side of the dental arch. Incisors and canines (anterior teeth) are the easiest to erupt because they are small and have single roots.
  • Fit: If your tooth has room to erupt then the dentist will apply techniques to remove any baby teeth or growths blocking eruption.
  • Timing: The sooner your impacted tooth is diagnosed and treated, the less invasive and more successful treatment will be.

Treatment for impacted teeth may need to be performed by an Oral and Maxillofacial Surgeon for more complicated cases.


What Happens If the Impacted Tooth Will Not Erupt When Proper Space is Available?

When impacted teeth fail to emerge spontaneously, an orthodontist and Oral Maxillofacial Surgeon partner to treat your impacted tooth. Most San Francisco patients initially require an orthodontist to place braces to create space for the tooth. After this space has been created, an Oral and Maxillofacial Surgeon will expose and bracket the impacted tooth. During this surgical procedure:

  • The gum surrounding the impacted tooth will be lifted to expose the hidden tooth.
  • Any baby tooth blocking the permanent tooth may be removed during this procedure.
  • An orthodontic bracket will be bonded to the exposed tooth. The surgeon will temporarily attach a small gold chain on the bracket through the orthodontic arch wire.
  • In most cases, the gum tissue will be re-positioned and sutured, leaving only the chain visible. Some cases require the impacted tooth to remain uncovered, and the gum tissue will be sutured above the tooth or a window in the gum will be created.

After healing from this surgery, the patient will visit the orthodontist for a follow-up appointment. Over a series of visits, the tooth will be moved to its proper place in the dental arch. Because this procedure spans up to a full year, the process is slow and gentle.

Once the tooth is in its final position, the condition of the surrounding gum is evaluated to ensure that it is healthy and strong enough to function normally. In some cases, particularly when an impacted tooth needs to be shifted further, some minor gum surgery may be required to protect the tooth.

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Exposure of Impacted Tooth Treatment

Oftentimes, a tooth is impacted because it does not have enough room to erupt properly. To create the needed space, our doctors will recommend you to an orthodontist for treatment. Typically, this orthodontic treatment will consist of braces and spacers that will be used to move the existing teeth into positions that allow room for the impacted tooth to come in.

Once space has been made, you will return to our office to have a simple surgical procedure called exposure and bracketing to bring your impacted tooth into place. This procedure is done in-office under local anesthesia, where our doctors will create a small incision into the gums to expose the impacted tooth. They will then attach an orthodontic bracket to the tooth and a chain to the bracket. You will then return to your orthodontist, who will attach the chain to an orthodontic wire that will be slightly adjusted periodically to help pull the impacted tooth into its proper place over time.

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Recovering From Impacted Tooth Surgery

The surgical procedure to expose and bracket an impacted tooth is common and carries minimal risks. After your surgery, you may experience:

  • Limited bleeding from surgical sites.
  • Some discomfort.
  • Swelling.
  • Pain.

San Francisco patients are frequently able to manage their pain with over-the-counter medication such as acetaminophen and ibuprofen. Ice packs can be applied to minimize swelling during the first 24 hours after surgery; however, within 2-3 days you should return to normal.


Restrictions on Food and Activity

Because chewing may cause your mouth discomfort, you should maintain a soft, bland diet until you have healed. There is no specific timeframe or food recommendation after this, aside from avoiding food such as crackers and chips because their pointed edges could irritate you during healing.


Follow-Up Visits

After 7-10 days of healing, you will have a follow-up appointment with your surgeon to check that you are healing well. During this exam, your surgical site will be evaluated, and the surgeon will provide you with additional information. If your impacted tooth has been bracketed, then you will continue to follow-up with your orthodontist as your tooth erupts.

As always, Dr. Michael Chan, Dr. Kirsten Rittenbach, & Dr. Brian Yang are available if any problems should arise after surgery. Simply call our office at (415) 776-6710 if you have any questions.

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