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.

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.

They were just so competent they made me feel like they know what their doing and the fact that my daughter also felt comfortable with Dr. Chan gave me the security I needed. 
They were so hospitable in a way it was almost as if I walked into a 5-star hotel instead of an oral surgery office. JAIME

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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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