What is an impacted tooth?
An impacted tooth is a tooth that tried to erupt but was prevented from erupting by another tooth. It's packed into the jaw and can't get out because of another tooth, jawbone, or some other structure. It didn't erupt fully.
Most people, when they think about this, think about wisdom teeth. Sometimes the teeth are upright, and the wisdom tooth comes in at an angle, getting stuck on the other tooth, resulting in an impacted wisdom tooth. However, you can get impactions of other teeth as well.
What problems can occur with impacted teeth?
When you have an impacted tooth, if it's partially erupted and partially impacted, half of it's in and half of it's out, or if it's a normal adult tooth that should have erupted but didn't, you want to either get that out or allow it to erupt fully. It's when it gets half in and half out and food gets packed around it that it develops cavities, decay, gum disease, becomes painful, and food gets stuck, leading to infection.
When it's totally in the bone, it's safe. When it's out and erupted properly, it's safe. It's when it's half in and half out that it causes problems. Again, most people think about a wisdom tooth, but it can really happen to any tooth.
How are impacted teeth diagnosed?
Two of the better X-rays to diagnose and look at impacted teeth are the panoramic X-ray, which goes around the head and shows the full teeth and jawbones, and the next level above that is a 3D X-ray. If the impacted tooth is close to a nerve, you'd want to look at the nerve relationship to the tooth before taking it out. I have both of these X-ray machines at my office. We use a panoramic X-ray and a 3D X-ray machine to look at the condition of the impacted tooth and figure out how to safely treat it.
What are the treatment options for impacted teeth?
Whether it's removing it or sometimes you can remove half of it and leave the deeper half that's closer to the nerve in the jaw. It sounds kind of weird, but it works very well. Up to the age of 25, you'll get full healing after an extraction. After the age of 25, we recommend placing surgical packing or bone graft material in the site where the tooth was removed. Most people get their wisdom teeth out in the 16 to 25-year-old range so that they can get full healing without incurring the additional cost or expense of the bone graft. That's why we often like to take teeth out in that age range.
Do you perform extractions at Dulac Dental of Springfield?
I perform a lot of third molar impactions or wisdom teeth extractions at Dulac Dental of Springfield. If you prefer to be sedated, we can talk about our dental anesthesia clinics.
However, wisdom tooth impaction is not a difficult surgery to do. If you know what you're doing, it usually takes me 5 or 10 minutes. If you don't want to be put to sleep for the procedure, it's something I can easily do for you in my office. It is a procedure typically covered by dental insurance as it will cause problems if left untreated.
How do you treat front impacted teeth?
If it's a front tooth, we'll usually expose it and pull it in orthodontically. I do a lot of orthodontics in my office. I enjoy doing it. It's fun to do, and I do a lot of cases in conjunction with other orthodontics.
We have a laser in the office that cuts very slowly, almost one or two cell layers at a time. So there's not a lot of pain or discomfort or post-operative discomfort. It works great for bringing in an impacted tooth. If you're doing your orthodontic case with me, I'll do it that way. If you're doing it with an orthodontist in the area and you want your child's tooth brought in in a very atraumatic, non-bleeding way, give me a call and I can expose it with this laser.
And the cool thing about the laser is that you can set it to cut only gum, only bone, or to a level that cuts teeth. So if I put it at a lower setting, it doesn't matter how much I hit the tooth with it, it's never going to cut the tooth. And that makes it super safe when bringing in a tooth because otherwise you're in there with a burr, which is quicker, and you're drilling the bone, but if you go too deep, you're going to nick the tooth. So the laser, not only is it less traumatic, but it's safer and it's less risk to the tooth.
If you're doing an orthodontic case in conjunction with an orthodontist and you don't want to go to an oral surgeon who's just going to zip in there with a bur and maybe damage the tooth, give us a call. I can put the bracket on for you so you don't have to go back to the orthodontist. There's a lot I can do in my office to help you with your case.
But mostly, when we're talking about impacted teeth, we're talking about wisdom teeth. I love doing surgery. I love taking out impacted teeth. I did it in the Navy. I've been doing it for decades.
What sedation and anesthesia options do you offer at Dulac Dental of Springfield?
We recently partnered with an anesthesiologist, and I opened up a sedation clinic. So we can do full sedation and anesthesia at Dulac Dental of Springfield, the same as you can get at the oral surgeon. Very safe, very effective. This was a need in the area that was unmet. A lot of oral surgeons do sedation. But for special needs kids, I have a hygienist who has a child with autism. I have other children with autism. I have other special needs patients. And for their safety, these patients really need to be put to sleep under general anesthesia. And that service was either extraordinarily expensive or very hard to find.
And I took the opportunity to develop an anesthesia suite in my office and work with a great anesthesiologist. So we can put you to sleep, or if your child or yourself is unable to be safely put to sleep in the area and you need general anesthesia, where the machine is breathing for you for your safety, we have that availability also. So I work with a board-certified anesthesiologist. He comes in, he does the health assessment, he puts you to sleep, I do the dentistry, he wakes you up. So it's a very safe and convenient option for patients that before was very hard to find or was very expensive.
And I'm looking forward to being able to do more of these cases in my office. And also, I look forward to working with other dentists in the area. If you feel more comfortable with your dentist doing the case, and they just don't have a general anesthesia suite in their office, they're welcome to come in and do the case in my office as well. So I really do want to help people and help the community. And I think this is a good way to do it.
When is an impacted tooth a problem?
But back to impacted teeth. If you want your wisdom teeth taken out with sedation or anesthesia, we have it available. I do like doing these cases. When the tooth is half in, half out, that's when it's a problem. If it's totally in, it's not really a problem.
When should wisdom teeth be removed?
We usually take wisdom teeth out before the age of 25 if we're going to do it because up to the age of 25, you get full bone healing. Past the age of 25, we can do something called a bone graft, which is like surgical packing you put in the area to help the bone promote and develop fully. So it's like bone food, and bone minerals and collagen help stabilize the clot and help keep the gum out of the hole and help give all the bone food for the bone cells. Within six months, they'll eat it up and turn it into your natural bone.
But there's an extra cost for the graft. It's an expensive material. It's not that it takes long to place. We just pack it in there. But the material itself is expensive. So to save time and money, mostly money because the material is expensive, we usually do this before the age of 25. So in the 16 to 18 to 20, 22, 23 range, this is depending on the person. We'll typically evaluate the wisdom teeth, and I'll have this discussion with the patient about whether or not I think it's safe to leave them in or if they should come out.
Can impacted teeth develop cysts?
On rare occasions, impacted teeth do develop a cyst around them. As I was saying, the tooth develops in this little follicle or cyst, and it grows the tooth. The top of the tooth gets grown from the outside in, and then once the tooth erupts, that goes away. That's why teeth can't repair themselves, and that's why we have to do all kinds of dental crowns and fillings and stuff if they get a cavity. But this follicle, sometimes if it's kept down in the bone, on very rare occasion it will grow and start to cause an issue. So that's rare, but that's one indication for taking out impacted teeth.
And like I said, we usually do this at a younger age for healing reasons, but we can do it at any age and we can put you to sleep so we can do it comfortably in the office.
What are the different types of impactions?
Different types of impactions. If it's tilted forward, we call it a mesial impaction. If it's fully sideways, we call it a horizontal impaction. If it's down or back or sideways, you might call it a distal impaction. It doesn't really matter. But if you're googling and you're seeing about different types of impactions, don't worry about it. It doesn't really matter. We're going to get it out for you safely and effectively no matter what.
What do I do if I think I have an impacted tooth?
Give us a call at the office if you have concerns about impacted teeth, whether it's for orthodontic purposes or for wisdom teeth purposes. It's something I'm happy to do for you. Like I said, for the canines or orthodontic purposes, we have the laser. For wisdom teeth, we have the sedation. We can do them both together. Just know you'll get taken care of very well at my office with myself and my anesthesiologist.
If you have any questions about wisdom teeth, wisdom teeth impactions, want to set up a consult, or are worried about this for a friend or family member, please give our office a call at (703) 451-4500, or schedule below! Our staff would love to talk with you.