Exposure & Bracketing of an Impacted Tooth

An impacted tooth simply means that it is “stuck” and cannot erupt in order to properly function. Patients frequently develop problems with impacted third molar (wisdom) teeth. Wisdom teeth that do not erupt in the back of the jaw can develop painful infections, among a host of other problems. Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems.

The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid is a critical tooth in the dental arch and plays an important role in a person’s bite. Very strong biting teeth, the cuspids have the longest roots of any human teeth. 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 cuspid teeth are the last of the front teeth to erupt into place, usually coming in around age 13. If they come in properly, they cause any space left between the upper front teeth to close tight together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch.

Early Recognition of Impacted Eyeteeth is the Key to Successful Treatment

The older the patient, the more likely an impacted eyetooth will not erupt by nature’s 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 Panorex screening x-ray, along with a dental examination, be performed on all dental patients at around age 7 to count the teeth and determine if there are or will likely be problems with eruption of the adult teeth. This exam is usually performed by your general dentist who will refer you to an orthodontist if a problem is identified.

Treatment may involve an orthodontist placing braces to open spaces which will allow for proper eruption of the adult teeth. Another option may be referral to an oral surgeon for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the crucial eyeteeth. The oral surgeon will also need to remove any extra teeth (supernumerary teeth), growths, or cysts that are blocking eruption of any of the adult teeth.

It is extremely important to address issues of impacted teeth at an early age. The older the patient, the less likely it is the eruption will occur naturally. If the patient is an adult, the tooth may be fused into position, necessitating an extraction and an alternate treatment (such as a crown on a dental implant or a fixed bridge).

Other Impacted Teeth

These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch form will be prepared on both sides at once. W hen the orthodontist is ready, the surgeon will expose and bracket both teeth in the same visit so the patient only has to heal from surgery once. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots, they are easier to erupt if they get impacted than the posterior molar teeth. Because molars are much bigger, have multiple roots, and are located at the back of the dental arch, the orthodontic maneuvers needed to manipulate an impacted molar can be more complicated.

It is extremely important to address issues of impacted teeth at an early age. The older the patient, the less likely it is the eruption will occur naturally.

What to Expect From Surgery to Expose and 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 surgeon’s office. For most patients, it is performed with using laughing gas and local anesthesia.

You can expect a limited amount of bleeding from the surgical sites after surgery. Most patients find Tylenol or Advil to be more than adequate to manage any pain or discomfort they may have. There may be some swelling, which can be minimized by applying ice packs to the lip for the afternoon after surgery. Bruising is not common.

A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that patients avoid directly biting into food items such as sandwiches or apples. It is also advised that you avoid sharp food items as they will irritate the surgical site if they jab the wound during initial healing. Many patients find it helpful to cut their food into smaller bites before eating. Your doctor will see you 7-10 days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process by applying the proper rubber band to the chain on your tooth.

As always, your COFSC doctor is available at the office or can be paged after hours if any problems should arise after surgery.

If you have any questions, please do not hesitate to call us at 910-762-2618 or 800-638-9019.

It is extremely important to address issues of impacted teeth at an early age. The older the patient, the less likely it is the eruption will occur naturally.