Impacted Teeth
What is an impacted (un-erupted) tooth?
An impacted (un-erupted) tooth is a tooth that fails to fully pass through the gum tissues because something prevents its normal eruption into the mouth, such as dense soft tissue, bone, tooth malposition, cysts, or another tooth. If a tooth fails to emerge, or emerges only partially, it is considered to be impacted. Patients frequently develop problems associated with impacted wisdom teeth, which are the most common form of impacted teeth that need removal. (See “Wisdom Teeth” under Procedures).
The second most common teeth to become impacted are the maxillary cuspids (otherwise known as canines and/or eye teeth).
These teeth are the last of the “front teeth” to erupt and normally come into position around the age of 13. If an upper cuspid becomes impacted, every effort is made to help it to erupt into position because these teeth play a crucial role in the dental arch. They are designed to be the first teeth to touch when your jaws are closed together and help guide your remaining teeth into the proper occlusion (bite). They are the foundation of an esthetic smile and functional occlusion. Other commonly impacted teeth include the second molars, bicuspids, and the lower jaw cuspids.
Early Detection and Referral to an Orthodontist
Early detection of impacted teeth, other than wisdom teeth, is the key to successful treatment and may greatly reduce treatment time and complexity later on. In most cases your general dentist will identify the need for an orthodontic consultation during routine clinical and radiographic examinations around the age of 7 years old. They will refer you to an orthodontist for a consultation if a problem is identified such as:
- Extreme crowding.
- Too little space available causing an eruption problem of adult teeth.
- Extra or missing adult teeth.
- Unusual Growths that are blocking the eruption of certain types of teeth.
Referral to an Oral and Maxillofacial Surgeon
Once the need for orthodontic treatment is identified, braces and initial orthodontic treatment is begun to allow for proper eruption of the adult teeth. At this point, your orthodontist may refer you to our office for the extraction of primary (baby) or permanent (adult) teeth, supernumerary teeth (extra teeth) or growths that block the eruption of the impacted teeth.
Upon your initial visit to our office, you will be evaluated by our doctors on an individual basis and special radiographs will be taken to determine the position of the impacted tooth to the adjacent teeth. Occasionally, Cone Beam Volume Scan will be taken if the doctor feels it is necessary to further assess the position and overall stage of the dental development of the tooth before a definitive treatment plan can be finalized.
Treatment of an un-erupted tooth will consist of one or more of the following:
- Extraction of Teeth — Extraction of an “over retained” primary tooth (a primary tooth still in position with a permanent tooth trying to come into the same space) and/or permanent teeth that are blocking the eruption of the tooth to be brought into position.
- Extraction of Extra Teeth — Removal of “extra teeth” (supernumerary teeth) or growths that are blocking the eruption of the tooth.
- Surgical Exposure of the un-erupted tooth — Removal of gum tissue and bone overlying the tooth is removed to expose the impacted tooth underneath. This will create access for your Orthodontist to attach an orthodontic appliance to help the tooth erupt. Depending on the individual case, our doctors might place a periodontal packing (Barricaid) over the tooth where it will remain until your post-operative appointment. Following surgical intervention you will be referred back to your orthodontist where he/she will slowly move the exposed tooth into its proper position in the dental arch.
- Surgical Exposure of the impacted tooth and placement of an orthodontic bracket and chain to the exposed tooth — Elevation of gum tissue and removal of bone overlying the tooth is done to expose the impacted tooth underneath. Once the tooth is exposed, our doctors will bond an orthodontic bracket and chain to the exposed tooth. The chain will then be attached to the orthodontic appliance (previously placed by your orthodontist) where it will remain temporarily. Depending on the individual case, our doctors might place a periodontal packing (Barricaid) over the tooth where it will remain until your post-operative appointment. Following surgical intervention you will be referred back to your orthodontist where he/she will slowly move the exposed tooth into its proper position in the dental arch.
- Extraction of the un-erupted tooth — This normally occurs in cases where a tooth will not move despite the efforts of an orthodontist. If extraction of the tooth is the only choice for treatment, our doctors will discuss treatment options to replace the missing tooth in your dental arch.
- Leave the un-erupted tooth alone — If the tooth is left in place, our doctors will discuss treatment options and possible sequelae of leaving the tooth.
Will I Be Asleep During The Procedure?
You have several anesthetic options when undergoing surgical exposure of impacted teeth surgery.
- Local Anesthesia
- General Anesthesia (asleep)
- Intravenous Sedation
- Nitrous Oxide Sedation (laughing gas)
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In Our Patients Words
“The aftercare was top notch! The entire staff was familiar with my status and Dr. Ramsey was always within reach for anything I needed. I would deeply and whole-heartedly recommend this procedure, the offices of Dr. Ramsey and his staff to all of my friends and family"
Frank S.,
All-On-4 Patient -
In Our Patients Words
I had all 4 of my wisdom teeth taken out within an hour and was fine by the next day. The doctors and team are top tier.
James Sweet,
Wisdom Teeth Patient -
In Our Patients Words
Thanks for making a not-great experience not so bad! I appreciate your thoughtfulness and kindness, before and after the procedure. It made a huge difference for me, as I imagine it does for all your other patients. Thank you again.
Judy Lacourciere,
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In Our Patients Words
Thank you and your team for making what I thought would be a horrible experience a pleasant surprise with my upper implants. I'll be back this year for work on the lower teeth. If I or my family ever needs any type of oral surgery, we know where to go. Thanks again.
William H. Lovelace,
Dental Implant Patient -
In Our Patients Words
I had my wisdom teeth taken out last week by Fairfax Oral and Maxillofacial Surgery. The office was very professional, very personable and friendly. The procedure went really quickly and the pain/swelling I felt afterwards was minimal/minor compared to some of the horror stories I've heard of wisdom teeth extractions. The doctor walked me through the risks of having one of my impacted teeth removed and what the risks were of not having it taken out. The office also took care of billing my dental and medical insurances for the procedures and at the time of surgery, I just had to pay a deposit, which is MUCH appreciated from other practices that I had looked into where they wanted me to pay for the ENTIRE surgery and it was my responsibility to get my money from the insurance companies.
Kim N,
Wisdom Teeth Extraction Patient -
In Our Patients Words
My husband and I both came to the Fairfax Oral and Maxillofacial Surgery office to get our wisdom teeth surgically extracted. The doctors were great to work with and answered any questions we had.
Katie Proudfoot,
Wisdom Teeth Extraction Patient -
In Our Patients Words
After having a wisdom tooth removed, I developed severe pain a few days later. I called your office, got an immediate appointment and was seen by a dentist within hours. The pain continued and three days later I called again. I was immediately given an appointment and was seen by the doctor even before the time of the appointment! I want to commend your practice since in so many cases a patient is all but ignored when any follow-up is required. Getting immediate appointments and being seen within hours is something you can be very proud of. This is what makes America's medical care the best in the world.
Dave Stottlemyer,
Wisdom Tooth Removal Patient -
In Our Patients Words
Thank you all for making what I thought would be a horrible experience “forgettable”. If I or my family ever needs any type of oral surgery again, we know where to go. Thanks again.
M. Schutter,
Oral Surgery Patient -
In Our Patients Words
I had a wonderfully easy and comfortable experience with my procedure at Fairfax Oral and Maxillofacial Surgery. Dr. Theberge was my oral surgeon and helped me feel at ease with the whole anesthesia process (I was a little anxious). The staff was super friendly and helpful! They put a blanket on me and made sure I felt comfortable. The healing process was quick and I had no problems at all. Overall I highly recommend this office.
Heather G,
Oral Surgery Patient -
In Our Patients Words
Whether it's a complex facial injury that occurs to one of our players during a game or routine care requiring the specialized services of an oral surgeon, the doctors of Fairfax Oral and Maxillofacial Surgery have always been my first choice when any of the Washington Capitals or their family members need specialized care by an Oral Surgeon.
Thomas Lenz, Jr., DDS, PC,
Washington Capitals Team Dentist -
In Our Patients Words
I had a tooth extracted this morning. I was really dreading it. The doctor and his assistant were just great. They made the whole experience so easy for me. While I hope not to have to do this again anytime soon, if I did, I would immediately call your office for an appointment.
Catherine,
Wisdom Teeth Patient
