Embedded Tooth.. ??
Embedded Tooth refer to teeth that are unable to erupt normally into the mouth. These teeth can either be one of the 32 permanent teeth that should naturally erupt, or they may be extra teeth beyond the usual 32, embedded in the jawbone. Most commonly, impacted teeth are premolars or canines.
Why Remove Embedded Tooth?
Before teeth erupt, they are enclosed in the dental follicle. If the teeth erupt normally, this follicle will break and dissolve on its own. However, for impacted teeth and embedded teeth that do not erupt properly, the follicle remains and may expand into a cyst or tumor, which can damage adjacent teeth and jawbone. In rare cases, it may even develop into cancer, although this is uncommon.
Treatment Process
- The dentist evaluates the impacted tooth using X-rays.
- Local anesthesia is applied to the gums. The anesthesia can last for 2-4 hours, and if pain arises during the procedure, the dentist can administer more. In some cases, general anesthesia is provided for anxious patients.
- The dentist makes an incision in the gum and removes the embedded tooth.
- Some patients may require minor bone reshaping around the area.
- The wound is cleaned with saline and sutured closed.
Recovery
Swelling after surgery varies depending on the patient’s overall health. Recovery typically takes around 3 days. During this time, avoid spitting or rinsing your mouth. Use cold compresses to reduce swelling and inflammation for the first 2 days, followed by warm compresses to improve blood flow. Normal eating can usually resume after about one week.
Recommendations
Regular dental X-rays every 1-2 years are recommended to monitor embedded teeth. Since the protective dental follicle of an unerupted tooth expands slowly, early detection is key. If left unchecked, the adjacent teeth may shift, loosen, or cause facial swelling. Removing embedded teeth before complications arise is ideal, making it a minor surgical procedure.
- If the tooth is not deeply embedded: Removal is easier, especially in younger patients, as the roots and bone are not fully developed, leading to faster recovery.
- If the tooth is deeply embedded: Surgery can be challenging, potentially requiring bone removal and risking nerve damage. In such cases, it might be best to leave the tooth but monitor it closely with regular X-rays to track dental follicle.
- During orthodontic treatment: If embedded teeth are found during orthodontic treatment, removal is recommended to prevent obstruction of tooth movement.
Precautions
- Nerves – Deeply embedded teeth in the lower jaw may be near nerves, increasing the risk of nerve damage during surgery.
- Sinuses – Upper jaw teeth may be close to the sinuses, risking sinus perforation during removal, particularly for canines and premolars.
- Accidents – Embedded teeth can act as weak points in the jaw, increasing the risk of fractures in accidents.
Therefore, patients must consider together with their dentist how much risk they can accept.
Case Study
An elderly male patient in his 60s-70s was referred for a loose tooth and a shadow under the root seen on a small X-ray. The patient had multiple molar teeth extracted due to loose teeth but never had an X-ray taken due to a lack of facilities at that time.
A new X-ray revealed a horizontal dental follicle. While there was no visible swelling, the follicle had expanded, compressing the jawbone. The embedded tooth likely caused the loose tooth by pressing against the roots of normal teeth. The treatment involved extraction of the affected tooth and removal of the follicle, creating a large void in the jaw. This could lead to future complications if impacted by trauma due to the lack of bone support.
This highlights the importance of early detection and treatment of embedded teeth to prevent extensive damage and complex surgical procedures.
Dr. Chutikan Juengprasitporn
Oral and Maxilofacial Dentist
