Impacted teeth

                   IMPACTED TEETH

What is a Impacted teeth? 

An impacted teeth is the one whose normal eruption is impeded in the mouth and it fails to assume it's normal anatomical arch relationships.. Such a tooth does not gain it's position even beyond the chronological eruption date. 

Causes/Etiology-

Causes of  Impaction can be broadly divided into local and systemic causes. 

Local causes-

1) Irregularities in position of tooth especially when it buries under crown of adjacent tooth. 

2) Increased density of the overlying or surrounding bone. 

3) Increased density of the overlying mucosa due to chronic inflammation. 

4) Problem of space in the jaw due to Underdevelopment. 

5) Early extraction of deciduous predecessor followed by drifting of adjacent teeth. 

6) over retention of deciduous teeth. 

7) Infection of the bone. 

Systemic causes-

1) Heredity seems to play an important role. 

2)  Systemic conditions  that may interfere     with  the normal development of child can be   cause for impacted teeth.. E.g - rickets,     anaemia, tuberculosis, malnutrition and     congenital syphilis. 

3) certain rare condition where there are skeletal deformities. Like cleidocranial dysostosis. 

4) Cleft lip and cleft palate are the congenital fissures that may manifest impacted canines and third molars. 

Frequency of Impaction-

Frequency order of impacted teeth normally observed is as follows-

1) Maxillary third molar. 

2) Mandibular third Molars

3) Maxillary canines

4) Mandibular premolars

5) Mandibular canines

6) Maxillary premolars

7) Supernumerary teeth

8) Maxillary central incisors

9) Maxillary lateral incisors. 

Symptoms of Impacted teeth-

• red, swollen, or bleeding gums
• bad breath
• a bad taste in your mouth
• difficulty opening your mouth. 
• when chewing and biting or when opening your mouth pain occurs. 

Symptoms may come and go over weeks or months.

Diagnosis of Impacted teeth-

Diagnosis of impacted teeth enables a surgeon to plan his surgical procedures and also to assess the difficulties he is going to encounter during the removal of  tooth. 

It is framed on the basis of history, clinical examination and radiological examination. 

The various radiograph required for the purpose include 

a) Intraoral-  periapical, bitewing and occlusal radiograph. 

b) Extraoral-  lateral  jaw radiograph, postero-anterior view of mandible or maxilla and orthopantomographs.

COMPLICATIONS ASSOCIATED WITH IMPACTED TEETH

1) INFECTION

Infection of the mocosa Or bone with associated symptoms compel the removal of impacted teeth. Acute and chronic pericoronitis, alveolar abscess, periosteitis, osteomyelitis and even necrosis of jaw can take place. 

2) PAIN

Pain can be severe, excruciating and neuralgic type of pain involving both upper and lower jaw. Pain may be referred to ear, postauricular area or the whole area supplied by trigeminal nerve. 

3) FRACTURE OF JAW

Trauma of the jaw can cause a fracture especially in the area of body of mandible, in the canine region and angle of mandible whete mandibular third molar is impacted. 

4) TRISMUS

It is a sequelae to infection. At times patients avoid opening of mouth and even talking because of the discomfort experienced by the patients during movement of the jaw.

5) CHRONIC CHEEK BITING

A good number of partially erupted maxillary third molar teeth are directed towards buccal mucosa and hurt the mucosa producing a white patch or chronic ulcer in that area.

6) MALALIGNMENT OF OTHER TEETH

Mesially directed impacted third molar are known to cause mesial migration of teeth by pushing one or two incisiors out of the dental arch on account of pressure put on the teeth.

7) OTHER COMPLICATIONS

Complications encountered less often are ringing or buzzing sound in the ear, dimness of vision or pain stimulating glaucoma and symptoms of TMJ arthralgia.