Impacted Canines (Eyetooth)
An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections, among a host of other problems (see Wisdom Teeth under Procedures). Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.
Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eye teeth are found in the middle of the supporting bone, but are stuck in an elevated position above the roots of the adjacent teeth, or are out to the facial side of the dental arch.
Call 831-372-2882 with any questions or concerns.
Early Recognition Of Impacted Canine Is The Key To Successful Treatment
The older the patient the more likely an impacted canine (eyetooth) will not erupt by natural forces alone, even if the space is available for the tooth to fit in the dental arch. The American Association of Orthodontists recommends that a panoramic x-ray, along with a dental examination, be performed on all dental patients at the age of seven to count the teeth and determine if there are problems with eruption of the adult teeth. It is important to determine whether all the adult teeth are present or if some adult teeth missing.
This exam is usually performed by your general dentist who will refer you to an orthodontist if a problem is identified. Treating such a problem may involve an orthodontist placing braces to open spaces allowing for proper eruption of the adult teeth. Treatment may also require referral to Dr. Bhaskar for extraction of over-retained baby teeth and/or selected adult teeth that are blocking the eruption of the all-important eyeteeth. Dr. Bhaskar will also need to remove any extra teeth (supernumerary teeth) or growths that are blocking the eruption of any adult teeth.
If the eruption path is cleared and the space is opened up by age 11-12, there is a good chance that the impacted eyetooth will erupt with nature’s help. If the eyetooth is allowed to develop too much under the surface (by age 13-14), the impacted eyetooth will not erupt by itself, even with the space cleared for its eruption. If the patient is older (over 40), there is a much higher chance that the tooth will be fused in position. In these cases, the tooth will not budge despite all the efforts of the orthodontist and Dr. Bhaskar to erupt it into place. Sadly, the only option at this point is to extract the impacted tooth and consider an alternate treatment to replace it in the dental arch (crown on a dental implant or a fixed bridge).
What Happens If The canine Will Not Erupt When Proper Space Is Available?
In cases where the eyeteeth will not erupt spontaneously, the orthodontist and Dr. Bhaskar will work together to get these teeth to erupt. Each case must be evaluated on an individual basis, but treatment will usually involve a combined effort between the orthodontist and Dr. Bhaskar. The most common scenario will call for the orthodontist to place braces on the teeth (at least the upper arch). A space will be opened to provide room for the impacted tooth to be moved into its proper position in the dental arch. If the baby eyetooth has not fallen out already, it is usually left in place until the space for the adult eyetooth is ready. Once the space is ready, the orthodontist will refer the patient to the oral surgeon to have the impacted eyetooth exposed and bracketed.
In a simple surgical procedure performed in the surgeon’s office, the gum on top of the impacted tooth will be lifted up to expose the hidden tooth underneath. If there is a baby tooth present it will be removed at the same time. Once the tooth is exposed, Dr. Bhaskar will bond an orthodontic bracket to the exposed tooth. The bracket will have a miniature gold chain attached to it. Dr. Bhaskar will guide the chain back to the orthodontic arch wire where it will be temporarily attached. Sometimes the surgeon will leave the exposed and impacted tooth completely uncovered by suturing the gum up high above the tooth, or making a window in the gum covering the tooth. Most of the time the gum will be returned to its original location and sutured back with only the chain remaining visible as it exits a small hole in the gum.
Shortly after surgery (1-14 days) the patient will return to the orthodontist. A rubber band will be attached to the chain to put a light eruptive pulling force on the impacted tooth. This will begin the process of moving the tooth into its proper place in the dental arch. This is a carefully controlled, slow process that may take up to a full year to complete. Remember, the goal is to erupt the impacted tooth and not to extract it. Once the tooth has moved into the arch in its final position, the gum around it will be evaluated to make sure it is sufficiently strong and healthy to last for a lifetime of chewing and tooth brushing. In some circumstances, especially those where the tooth had to be moved a long distance, there may be some minor “gum surgery” required to add bulk to the gum tissue over the relocated tooth so that it remains healthy during normal function. Your dentist or orthodontist will explain this procedure to you if it applies to your specific situation.
Exposure and Bracketing of an Impacted Cuspid
These basic principals can be adapted to apply to any impacted tooth in the mouth. It is not that uncommon for both of the maxillary cuspids to be impacted. In these cases, the space in the dental arch will be prepared on both sides at once. When the orthodontist is ready, Dr. Bhaskar will expose and bracket both teeth in the same visit so that the patient only has to heal from one surgery. Because the anterior teeth (incisors and cuspids) and the bicuspid teeth are small and have single roots they are easier to erupt if they get impacted than the posterior molar teeth. The molar teeth are much bigger teeth and have multiple roots making them more difficult to move. The orthodontic maneuvers needed to manipulate an impacted molar tooth can be more complicated because of their location in the back of the dental arch.
Recent studies have revealed that with early identification of impacted canines (or any other impacted tooth other than the wisdom teeth), treatment should be initiated at a younger age. Once the general dentist or hygienist identifies a potential eruption problem, the patient should be referred to the orthodontist for early evaluation. In some cases the patient will be sent to the oral surgeon before braces are even applied to the teeth. As mentioned earlier, the surgeon will be asked to remove over-retained baby teeth and/or selected adult teeth. He will also remove any extra teeth or growths that are blocking the eruption of the developing adult teeth. Finally, he may be asked to simply expose an impacted eyetooth without attaching a bracket and chain to it. In reality, this is an easier surgical procedure to perform than having to expose and bracket the impacted tooth. This will encourage some eruption to occur before the tooth becomes totally impacted (stuck). By the time the patient is at the proper age for the orthodontist to apply braces to the dental arch, the eyetooth will have erupted enough so that the orthodontist can bond a bracket to it and move it into place without needing to force its eruption. This saves time for the patient and means less time in braces (always a plus for any patient)!
What To Expect From Surgery To Expose & Bracket An Impacted Tooth
The surgery to expose and bracket an impacted tooth is a very straight forward surgical procedure that is performed in the oral surgeon’s office. For most patients, it is performed using laughing gas and local anesthesia. In selected cases it will be performed under IV sedation if the patient desires to be asleep, but this is not always necessary for this procedure.
You can expect a limited amount of bleeding from the surgical sites after surgery. Although there will be some discomfort after surgery at the surgical sites, most patients find Tylenol or Advil to be more than adequate to manage any pain they may have. Within two to three days after surgery there is usually little need for any medication at all. There may be some swelling from holding the lip up to visualize the surgical site; it can be minimized by applying ice packs to the lip for the afternoon after surgery. A soft, bland diet is recommended at first, but you may resume your normal diet as soon as you feel comfortable chewing. It is advised that you avoid sharp food items, like crackers and chips, as they will irritate the surgical site if they jab the wound during initial healing. Dr. Bhaskar will see you seven to ten days after surgery to evaluate the healing process and make sure you are maintaining good oral hygiene. You should plan to see your orthodontist within 1-14 days to activate the eruption process (applying the proper rubber band to the chain on your tooth). As always, your doctor is available at the office and can be contacted after hours if any problems should arise after surgery. Simply call Monterey Oral Surgery at 831-372-2882 if you have any questions.
Monterey Oral Surgery
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My daughter got her wisdom teeth pulled with this wonderful team and doctor. No pain or swelling after and the after care was so impressive.. I would recommend them to anyone!!
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We are lucky to have The Best Oral Surgeon Ever right here in Monterey! I've had several (many) implants placed and every single procedure has been painless and perfect. My case hasn't been easy by any stretch of the imagination; he's had to work hard to find solutions to some difficult spaces with very little to work with ... Thanks Dr Bhaskar, for making my "Smile"! Bhaskar's Stars are Six (6)
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Patient Review from Sherryl S
I am a person that has a lot of anxiety going to any dental office. His receptionist is very warm and welcoming. The staff is very good at returning phone calls and answering all questions. Dr. Bhaskar called me after surgery which made me feel he is very caring. I would highly recommend this office for any type of oral surgery.
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Dr. Bhaskar honors his patients, staff, and himself through his insistence on quiet, efficient, effective, disciplined and competent performance of the jobs they're all there to do.
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Patient Review from Kristi J
Dr. Bhaskar and his staff were incredibly professional, friendly and gentle. I worried for years about this procedure, knowing I would have to do it at some point in my future - what a waste of worry that was! The procedure was quick and painless and I was comfortable throughout it all. The healing process was a breeze and am so glad to be rid of that troublesome tooth once and for all! Thank you Dr. Bhaskar and staff. I will recommend you to others!
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Patient Review from Klaudia R
I was so incredibly scared of my last wisdom tooth removal. But it all went easy, smooth and pleasant. Everyone is extremely friendly, the office is well organized and Dr. Bhaskar did a fantastic job. Thank you so much! Highly recommendable!
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Dr.Bhaskar placed 2 implants in June 2016. Everything went great, no pain, no swelling..... very easy. Loved the office, staff was great.
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I love Dr. Baskar! Great experience and couldn't be happier with my new Dental Implants. Yay!!
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Dr. Bhaskar took care of my children's (all four!!) wisdom teeth removal. All four did great. The office is nice, staff is soooooo kind and Dr Bhaskar is the best!
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Professional, efficient and kind. The yellow after care flow sheet was particularly helpful.
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Patient Review from Kristen C
Dr. Bhaskar has performed fairly extensive oral surgery on my husband, Paul, over the last couple of years, with a perfect outcome. Dr. Bhaskar's competence, demeanor and attentiveness made us feel calm and well cared for. Paul had multiple issues that needed to be addressed over a lengthy period of time, under the care of multiple professionals. Dr. Bhaskar communicated with the other dental experts and together they planned for excellent, sequential, efficient care. We greatly appreciate the care received by Dr. Bhaskar and his skilled staff, and highly recommend him. Thank you, Dr. Bhaskar.
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Had my wisdom teeth removed by Dr Bhaskar, everything went great! Loved the office, the staff and Dr Bhaskar.
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Patient Review from Makayla T
The reason why I give this practice a five star review is because Dr. Bhaskar is one of the best oral surgeons. My whole experience was great. The receptionist was very friendly and the assistants made me feel at ease. After the surgery Dr. Bhaskar even called that evening to check on me. I have to admit that I was scared to have my wisdom teeth pulled but Dr. Bhaskar and his staff made it super easy and smooth!!!
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Patient Review from Makayla T
Great with the patients
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Patient Review from Barbara K
Dr. Bhaskar put an implant in me quite a while ago, and I've had no problems. He also pulled the wisdom teeth on my three children. They all recovered with minimal discomfort.
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The office is very professional. I was impressed with the doctor and his staff. My outcome is great.
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Patient Review from Paul P
I saw Dr Bhaskar for the extraction of a molar tooth. After our first meeting, we decided to place an implant at the time of the extraction. Everything went very well, no pain or problems. The crown was placed 10 weeks later and it has worked perfectly!!! I highly recommend Dr. Bhaskar.
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