Impacted Canines

The primary teeth, also called baby teeth, erupt between the ages of 8 to 30 months and shed between the ages of 6 to 12 years. The secondary teeth, also called permanent teeth or adult teeth, erupt from the age of 6 to 25 years. Impaction can occur during the growth of the secondary teeth when one or more teeth ceases to erupt and remains underneath the gum line, either partially or completely. This is commonly seen in canine teeth (long, pointy teeth in the upper and lower jaw). When canines fail to erupt completely through the gums it is referred to as an impacted canine.

Causes

The common causes of canine impaction are:

• Inheritance
• Mismatched size and shape of teeth
• Problems in the number and alignment of teeth
• Early loss or removal of baby teeth

Complications

Canine impaction can cause a sufficient gap in the teeth affecting their function and appearance. Some impacted teeth may push into the adjacent teeth and damage them. Rarely, a cyst can develop around the crown of the impacted canine and push and displace the adjacent teeth.

Diagnosis

The impaction of canines can be detected at an early age of 8-9 years. The doctor will diagnose canine impaction through inspection and palpation (examiner feels the size and shape of the teeth by touch). To confirm the diagnosis, the doctor will order X-rays. This evaluates the position of the impacted canine and condition of the gums. X-rays provides clear evidence to determine the best treatment option.

Treatment

An impacted canine that doesn’t cause any problems does not need any treatment. The treatment option depends on the type and severity of the alignment of canines. Your doctor may prescribe pain killers to relieve pain and discomfort. You may also be advised to rinse your mouth with warm salt water to soothe your gums. There are various surgical procedures for the treatment of impacted canines.

• Exposure: The surgery is performed under general anaesthesia and comprises of a small cut in the palate to expose the crown of the tooth. Based on the requirement of space for the canine to grow, the adjacent teeth may be extracted and an orthodontic bracket (a device which helps to align teeth in a proper position), might be introduced. Exposing and aligning the impacted canines will prevent future impairments and make the smile aesthetically pleasing.
• Removal: If the canine is buried in a position that is difficult for realigning and is causing problems to the adjacent teeth, your doctor will recommend the removal of the tooth. This is performed under local or general anaesthesia.  If there is a noticeable gap, a denture or bridge may be used.
• Transplantation: This procedure is generally preferred if surgical exposure of the teeth is not a suitable option for treatment and if there is sufficient space between the teeth. Your surgeon will remove the baby canine and the impacted permanent canine. The impacted tooth is then carefully placed in the right position. The transplanted tooth will be braced for 2-3 weeks to set it correctly.

Post-operative care

After surgery, you may feel pain, bleeding and discomfort at the surgical site, for which your doctor will prescribe medications. Swelling can be reduced by applying ice packs. You will be advised to follow a soft and bland diet, until you are comfortable chewing