• Reference Number: HEY-133/2023
• Departments: Oral Surgery, Dentistry and Max Fax
• Last Updated: 31 July 2023

Introduction

This information is designed to help your understanding of the condition where an upper canine tooth fails to erupt normally and what treatments are available to help remedy it. Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is exposure of impacted upper canine?

The upper canine, or eyetooth, normally comes into the mouth between the ages of 11 and 13. Sometimes teeth can develop in an abnormal position and the upper canine is the most common tooth to be affected in this way. Either one or both teeth may be affected. Often they will lie across the roof of the mouth behind the front teeth.

Why do I need treatment?

The upper canine has a long root making it a strong tooth and is an important tooth both for biting and in the development of a normal smile. Sometimes they may be left alone and will remain un-erupted for many years, possibly a whole lifetime.

They can, however, damage the roots of other front teeth or push them out of position. They can interfere with the orthodontic movement of other teeth. More rarely cysts can develop around them. Treatment is almost always provided as part of on-going orthodontic treatment to help the teeth to erupt normally into the mouth.

What does the treatment involve?

Helping the tooth to erupt into the mouth involves a relatively minor surgical procedure. This may be carried out under local anaesthetic (numbing injection in the gum) but often takes place under a “day case” general anaesthetic (put to sleep), going home the same day. Depending on the exact position of the unerupted tooth; generally one, or a combination of three possible procedures, will be carried out:

1. If the tooth lies near the outside of the arch of teeth (i.e. near the lip) the gum can be moved up and re-positioned, stitched in the new position exposing the crown of the tooth. Sometimes some thin soft bone will need to be removed from around the crown of the tooth.
2. If the tooth is in the roof of the mouth a small window of gum can be removed plus some bone if it is necessary from the palate. Sometimes an antiseptic pack is placed over the tooth, which is held in place by one or two stitches. This both protects the wound and helps to prevent the gum growing back over the tooth. It is usually left in the mouth for 2 weeks after which it is very simple to remove.
3. If the tooth is very deeply impacted then often the gum over it will be lifted up, the tooth exposed and a gold chain and bracket will be glued onto the crown. The gum is then put back and the chain is stitched to the outside of the gum where the orthodontist can use it to pull the tooth gradually into the correct position. Pulling can usually begin a couple of weeks after surgery when healing is complete.

Can there be any complications or risks?

There are risks associated with general anaesthesia, but this depends on your overall health. Risks vary with each patient. Your anaesthetist will discuss these issues with you, but it is important that you raise any concerns that you may have. Other problems are less common. Some discomfort is inevitable but can usually be controlled with simple pain relief medication. Severe pain is uncommon. Surgical complications may include bleeding, swelling and bruising this maybe to a greater or lesser degree.

How do I prepare for this operation?

Please read the information leaflet. Share the information it contains with your family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

You will be given a letter detailing where you should attend, fasting instructions and the time to report to the ward. Staff will greet you and show you around the ward. You will be seen by the doctor and possibly the anaesthetist. The type of anaesthetic you will be having is called a general anaesthetic. You will be prescribed pain relief medication to manage any pain you may suffer following the operation.

What will happen?

This procedure usually takes place under a day case general anaesthetic. Although you will be a sleep when you have the operation, you will be able to go home the same day.

While you are asleep the gum lying over the tooth will be removed or pushed back. Usually some of the bone surrounding the crown of the tooth also needs to be removed.  Once the tooth is exposed one of three things may happen under the same anaesthetic.  This will have been discussed with you prior to your surgery.

• A plate – An impression of the teeth is used to make a plate. This plate covers the roof of your mouth and is clipped on to your teeth. This plate will improve comfort and stop the gum from growing back over the tooth again. This is worn for 10 days and is easily removed.
• Bracket & chain – A small bracket is glued to the tooth. Attached to this is a chain that your orthodontist can use to pull the tooth into the correct position. The chain is usually stitched out of the way but it is quite delicate and therefore important to be careful when eating for the first few weeks after surgery.
• A pack – Sometimes a pack made from gauze soaked in antiseptic is stitched in place to keep the gum from covering the tooth again. It is normally removed after a week to ten days. If the pack comes loose you should contact the department.

What happens afterwards?

Before leaving the department to go home you will be given an advice sheet with aftercare instructions. A nurse will go through these instructions with you and your parent or guardian.

Any medications required will also be explained at this time. Follow up appointments will be made. You will be advised to refrain from education or work for between 2-7 days depending on the individual.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Maxillo-facial Department (01482) 674406

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.