Buried canine teeth

What are buried canine teeth?

Buried canine teeth, also called impacted canines, are canine teeth, the pointed teeth towards the corners of your mouth, that stay stuck under the gum in the jawbone instead of coming through as they should. Up to 3 in every 100 people are affected, and most of these buried teeth sit in the upper jaw, tucked in behind the roof of the mouth.

Symptoms of buried canine teeth

Buried canine teeth often cause no symptoms at all, which is why they're usually spotted by a dentist or orthodontist rather than by the person themselves. The main thing to look out for is a ‘baby’ canine tooth that hasn't fallen out by the time it should have, or an adult canine that hasn't come through by the expected age of 11 to 13.

Causes and who is at risk

No one knows exactly why some canine teeth become impacted. It's a fairly common problem, affecting up to 3 in every 100 people, most often in the top jaw.

Are there different types of buried canine teeth?

Buried canine teeth can affect the top jaw or the bottom jaw, though the top jaw is affected far more often. Within the top jaw, the buried canine is usually under the gum on the roof of the mouth rather than on the lip side of the jaw.

How are buried canine teeth diagnosed?

Your dentist or orthodontist will usually diagnose a buried canine using an X-ray alongside an examination of your mouth. This might come up because your adult canine hasn't come through by the expected age, or because your dentist spots a retained baby tooth or a buried tooth on a routine check-up X-ray.

A specialist will then assess where exactly the tooth is positioned, your age, and how much space is available in your mouth. All of this affects which treatment is likely to work best for you, and how long it might take.

How are buried canine teeth treated?

If it's caught early

If a buried canine is spotted while the baby canine tooth is still in place and before you turn 11, removing the baby tooth can sometimes help the adult canine correct its own path.

Leaving it alone

If the buried tooth isn't causing any problems, your dentist may suggest leaving it where it is, checking it occasionally with an X-ray. There's a small chance it could damage the roots of your front teeth, or that a cyst could develop around it, in which case the tooth would usually then need to be removed.

If your baby canine tooth is still in place, it will be kept for now, though it may not last a lifetime. If it's lost later on, you may be left with a gap that your dentist can help fill.

Surgery to uncover and align it

This is the option most people end up having. It involves a small operation, usually a day procedure, to lift the gum and, sometimes, remove a small amount of bone over the buried tooth. It can be done under general anaesthetic (medicine that puts you fully to sleep) or local anaesthetic (medicine that just numbs the area), and a local anaesthetic is often used alongside a general anaesthetic to keep you comfortable as you wake up.

A small gold chain or bracket is usually glued to the tooth, either during the operation or later on, and connected to a brace so your orthodontist can gently guide the tooth into place. Alternatively, a healing dressing, such as gauze, a soft paste, or a custom-made plate, may be used to hold a small ‘window’ open in the gum while the tooth comes through on its own. The gum is closed with dissolvable stitches.

Afterwards, you'll likely feel sore for a few days, so painkillers are advised. You'll be told to eat a soft, cool diet at first, most people are back to eating normally within a few days. Keep your teeth clean with a soft or baby toothbrush around the area, along with hot salt water or a Corsodyl mouthwash. You'll usually have a review appointment 1 to 2 weeks after the operation.

Moving the tooth into its final position with a fixed brace can take a long time, often more than 2 years in total, with full repositioning generally taking at least 6 months to a year depending on where the tooth started. It's likely to feel sore for 3 to 5 days each time the brace is adjusted, simple painkillers such as those you'd take for a headache should help. You'll still need to see your regular dentist every 6 months during this time.

As with any operation, there are risks. These include:

• infection, if the area becomes swollen, red or tender, you may need a course of antibiotics
• the bracket coming away from the tooth (de-bonding), which may need reattaching
• the tooth fusing to the jawbone (ankylosis) and failing to move, which may mean it needs to be removed after all
• nearby teeth feeling slightly loose for a time.

Surgery to remove it completely

Removing the buried tooth completely may suit you if you don't want to wear a fixed brace, your other teeth are straight with no gaps, the tooth is in a poor position, or it's already causing problems. You may need further dental or orthodontic treatment afterwards if this leaves you with a retained baby tooth or a gap.

Tooth transplant

In some cases, the buried tooth can be surgically moved to its correct position, a bit like a transplant. This option isn't chosen often and is only suitable in certain cases, there needs to be enough space between your teeth, and it has a lower success rate than the other options.

When should I see a dentist?

See your dentist or orthodontist for regular check-ups so a buried canine can be picked up early and monitored with X-rays if it's not being treated straight away. If you've had surgery to expose or reposition the tooth, contact your surgical team if:

• the area around the tooth becomes swollen, red or tender, this can be a sign of infection
• the metal bracket or gold chain comes away from the tooth
• nearby teeth start to feel loose or uncomfortable.