Impacted Tooth: Preventing and Remedying a Dental Inclusion

What is called a dental inclusion? What are its causes and repercussions? How to detect and treat it effectively? Explanations.

What is a dental inclusion?

An impacted tooth is a permanent tooth that fails to come out and remains "enclosed" in the bone of the jaw, under the gum. Dental inclusion is both uncommon and frequent: not all teeth are indeed exposed in the same way to this anomaly.

Clinical observations unambiguously show that wisdom teeth are the most concerned by this phenomenon; it also happens that the upper canines are affected. Finally, this condition can also concern the incisors, but the cases remain very rare: less than 1% of the diagnoses made, against up to 15% of the population for wisdom teeth.

Multiple causes for the same problem

Several factors can be advanced to explain the origin of a dental inclusion.

It can result from a poor alignment of the teeth, responsible for a lack of space which prevents the tooth from coming out and keeps it impacted, or from the presence of a cyst or an ankylosis of the dental germ. With regard to this last situation, ankylosis is characterised by the destruction of the periodontal ligament under the effect of a bony bridge: the root is then welded as one piece to the alveolar bone.

Moreover, certain dental inclusions are explained by the presence of supernumerary teeth: these extra teeth are encountered more often within the permanent dentition than in the temporary dentition (milk teeth).

Although the incisors are not very affected by inclusion, it is useful, at this stage, to dwell on the most commonly identified supernumerary tooth: the mesiodens. This is an additional tooth located between the two central incisors of the upper jaw (maxilla).

• When it is impacted between the roots of the two incisors, it can cause a late eruption or a malposition of these 2 incisors.
• In other cases, it has come out on the arch and can prevent the eruption of an upper incisor or divert its normal trajectory.

From the point of view of cause and effect, the mesiodens remains to this day unexplained. The currently favoured hypothesis evokes the lamina (dental-generating tissue), which would abnormally prolong its activity in the palatal vault, hence the appearance of these additional teeth.

Finally, it should be known that an old impact suffered by a milk tooth (leading in passing to a damage of the dental germ) can explain an inclusion. The rupture of the eruptive dynamic (normal eruption of the permanent dentition) is then the direct consequence and constitutes, as such, a serious anomaly.

Prevention is better than cure

A possible dental inclusion will be detected thanks to a panoramic X-ray, which it is recommended to have carried out in children between 6 and 12 years old. If management by Health Insurance proves necessary, it is better to anticipate: full reimbursement of care is no longer possible beyond the child's 16th birthday. The treatment will vary according to the form of the impacted tooth and the cause of the inclusion.

Orthodontic care will be necessary to create the space essential to the emergence of the impacted tooth, allowing it to erupt naturally or surgically (release then traction of the impacted tooth).

Let us recall that a dental inclusion requires specific management: it is therefore advised to approach your dentist in Cannes as soon as possible to know the procedure to follow.