What is the condition?

Teeth are considered impacted when they fail to erupt into the oral cavity within their expected developmental period and can no longer reasonably be expected to do so. Maxillary and mandibular third molars are the most likely teeth to become impacted, followed by maxillary canines, mandibular premolars, maxillary premolars and second molars. Some patients may also present with impacted extra teeth (supernumerary teeth).

The cause for most impacted teeth is idiopathic (unknown) and they most commonly occur in non-syndromic patients. However, some permanent teeth can become impacted due to systemic or local factors. Multiple impacted teeth are known to be involved in systemic conditions such as endocrine deficiencies, febrile disease, Down’s Syndrome, and irradiation. Local factors may include over-retained primary teeth, malpositioned tooth germs, small arches, supernumerary teeth, odontogenic cysts and tumors, abnormal eruption paths, and cleft lip and palate.

Why should I seek treatment?

Impacted teeth may be left alone and monitored if they are not causing symptoms or associated with pathology, and they can be reviewed periodically with dental radiographs if appropriate. You should seek treatment for these impacted teeth if you are considering braces treatment or experiencing signs and symptoms of pain, discomfort or swelling. Occasionally, pathological lesions (cysts and tumors) can develop around the impacted teeth, and these should be treated with surgical removal of the impacted teeth and pathological lesions.

What are the treatment options?

Impacted and buried teeth which are asymptomatic may be left alone, but there is a very small risk of formation of pathology lesions. Impacted teeth associated with pathological lesions (cysts and tumors), or where enough space cannot be created to accommodate them through braces or are causing symptoms, will be recommended for surgical removal.

Impacted teeth with the potential to be accommodated within the dental arch with braces can undergo surgical exposure and traction with a bonded gold chain to assist in their eruption. This will usually be discussed together with an orthodontist (braces specialist). There is still a risk that these impacted teeth may fail to erupt after traction treatment, and hence, they may require a second surgery to be removed.

Discuss with your surgeon to decide which treatment is best for you.

What to expect after treatment?

Painkillers and antibacterial mouthwash will usually be prescribed after surgery. Antibiotics may be prescribed if necessary. A small amount of bleeding and a short period of swelling and pain are expected sequelae after dentoalveolar surgery. You may have limited mouth opening for this period of recovery. A soft diet is advisable for 5 – 7 days after surgery.

If there is unexpected bleeding after surgery, you may insert and bite on a piece of moist gauze for 30 minutes to stop the bleeding. Profuse uncontrolled bleeding will need to be managed promptly.

For patients who underwent surgical exposure and traction with a gold chain, there is a small risk of the gold chain debonding from the tooth over time and may require a second surgery to rebond the chain if the tooth is still not yet exposed in the oral cavity.