Impacted Teeth
An impacted tooth is one that fails to erupt into the dental arch within the expected developmental window. Because impacted teeth do not erupt, they are retained throughout the individual’s life Time unless extracted or exposed surgically. Teeth may become impacted because of:
• Adjacent teeth
• Dense overlying bone
• Excessive soft tissue
• Genetic abnormality
• Inadequate arch length and space (Most often)
The most often impacted teeth are:
1. Wisdom Teeth
The wisdom teeth (third molars) are frequently impacted
because they are the last teeth to erupt in the oral cavity. Mandibular third molars are more commonly impacted than their maxillary counterparts.
2. Canines
The second most common teeth to be impacted are the maxillary canines
Because these teeth play a more important role in your mouth, Your doctor is more likely to recommend treatments that encourage these teeth to erupt instead of removing them.
Complications
• Cavities
• Decay
• Infection
• Crowding of nearby teeth
• Gum disease
• Absorption of bone or adjacent teeth
• Cyst, which can damage roots of nearby teeth or destroy bone
• Pericoronitis
Pericoronitis is an infection of the soft tissue that covers the crown of an impacted tooth and is usually caused by the normal oral microbiota.
Pericoronitis can present as a mild infection or severe infection. In its mildest form it is just a localized tissue swelling and soreness where as in severe forms the swelling is slightly larger even sometimes creating Trismus (difficulty opening the mouth).
Symptoms
Most commonly the individual complains of food getting lodged beneath the gums and a soreness that is usually confused with throat infections. In slightly milder forms a swelling is visible and mouth opening becomes difficult in severe cases. Pain is invariably present.
Management
Impacted teeth might be extracted or left alone, depending on the dentist and the situation.
Extraction might be contraindicated and might be simple or surgical, often depending on the location of the teeth.
In some cases, for aesthetic purposes, a surgeon may wish to expose the canine. This may be achieved through open or closed exposure.
Surgical procedure
1-Wisdom tooth
Before any tooth removal, your dentist will take x-rays. The tooth and surrounding tissue is numbed using local anaesthetic injected into the gums. Some patients that are particularly anxious about the procedure may also receive some form of sedation.
If the wisdom tooth is covered over by gum tissue, the dental surgeon will cut into your gum with small incision. They may need to remove bone around your tooth using a small handheld drill.
The dental surgeon may also use the drill to divide the tooth into sections to avoid it breaking unpredictably during the final extraction stage.
If a wisdom tooth breaks then each piece has to be removed separately and it may require further drilling and a deeper incision into the gum tissue.
2-Maxillary canine
Each patient with an impacted canine must undergo a comprehensive evaluation of the malocclusion.
The clinician should then consider the various treatment options available for the patient. Including the following:
• No treatment if the patient does not desire it.
• Auto transplantation of the canine
• Extraction of the impacted canine
For this procedure, clinician should localize canine by using intra & extra oral radiography or CBCT / CT.
The proper localization of the impacted tooth plays a crucial role in determining the feasibility of as well as the proper access for the surgical approach.
In some cases the access is from the palatal side and in some cases from the labial side and rarely from both sides.
Surgical exposure of the canine and orthodontic treatment to bring the tooth into the line of occlusion. This is obviously the most desirable approach.
First of all should be determine the position of the impacted canine by using oral radiography
The proper localization of the impacted tooth helps to have the proper access for the surgical approach and the proper direction for the application of orthodontic forces.
Recovery
• Apply an ice pack to your check after procedure to reduce swelling for 10 minutes each time.
• Bite down the gauze pad to reduce bleeding for 3 to 4 hours.
• Take any medications as prescribed.
• Rest and relax for the first 24 hours.
• Don’t use a straw for the first 24 hours.
• Don’t smoke
• Don’t rinse for 24 hours after the tooth extraction. And split only gently.
• Use pillows to prop your head up when you lie down.
• Brush and floss your teeth like normal, but avoid the extraction site.
• The day after the procedure, eat soft foods, such as yogurt pudding, and applesauce.
• After 24 hours, rinse out your mouth with normal saline (salt water)
• As you heal aver the next few days, you can slowly reintroduce other foods into your diet.
Complications
• Dry socket
Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain and a foul mouth odor.
Your dentist will treat the dry socket by placing medication in the socket.
• Paresthesia
Paresthesia is a rarer complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness of the tongue, lip, or chin that can last a few days, weeks, months or may even be permanent.