Impacted Canines
An impacted canine is an adult upper eye tooth that is stuck in the jaw and cannot come in on its own. It is the second most commonly impacted tooth after wisdom teeth. Early detection, ideally with a dental X-ray around age 7 and close monitoring through ages 11 to 12, gives the best chance of the tooth erupting naturally. If it does not, the orthodontist creates space and the oral surgeon uncovers the tooth and attaches a small bracket so braces can guide it into place.
Key takeaways
- Upper canines normally come in around age 12 to 13 and are key to a healthy bite.
- About 60% of impacted eye teeth sit on the palate (roof of the mouth) side.
- If space is cleared by age 11 to 12, many canines erupt on their own.
- After about age 13 to 14, an impacted canine usually needs exposure surgery to erupt.
- Treatment is a team effort between your orthodontist and the oral surgeon.
Why The Canine Matters
The upper canines have the longest roots of any teeth and are among the strongest biting teeth. They are designed to be the first teeth to touch when the jaws close, guiding the rest of the bite. They also shape the corners of the smile. Every effort is made to bring an impacted canine into its proper position rather than remove it.
Why Do Canines Become Impacted?
- Crowding or not enough space in the upper arch
- A baby canine that stays in too long
- Extra (supernumerary) teeth or growths blocking the path
- The canine developing in an unusual position or angle
- Family history; impacted canines can run in families
The Right Age To Act
| Age | What usually happens | What parents can do |
|---|---|---|
| Around 7 | Adult teeth are forming | Dental examination and panoramic X-ray to check that all adult teeth are present and positioned normally |
| 9 to 11 | Canine position becomes clearer | Orthodontic monitoring; removal of baby canines or blocking teeth if recommended |
| 11 to 12 | Canines should be erupting | If space is cleared by now, there is a good chance the tooth erupts on its own |
| 13 to 14 | Development is nearly complete | Impacted canines usually need exposure and bonding to erupt |
| Adults | Canine may become fused in place | Exposure may still work in younger adults; in older adults, removal and a tooth replacement may be needed |
A classic study by Ericson and Kurol found that removing the baby canine early helped many palatally displaced adult canines erupt normally. Your orthodontist will decide whether this approach suits your child.
How Is An Impacted Canine Treated?
- Orthodontic space. Braces are placed to open space in the arch for the canine.
- Imaging. Panoramic X-rays and, when needed, 3D cone beam CT imaging show the tooth's exact position and its relationship to neighbouring roots.
- Exposure and bonding. In a short procedure, the oral surgeon lifts the gum, uncovers the tooth, and bonds a small orthodontic bracket to it, often with a tiny gold chain attached. The chain is connected to the braces.
- Guided eruption. Over the following months, the orthodontist applies gentle force to pull the canine into place.
Exposure is commonly done with local anesthetic, and IV sedation is available for patients who are anxious. The surgeon will tell you how long your child's appointment is expected to take.
Recovery After Exposure Surgery
Recovery is usually straightforward:
- Some bleeding or pink saliva for 24 hours; bite on gauze for 30 minutes if needed.
- Ice packs on the face for the first 24 hours only, 20 minutes on and 20 minutes off.
- Soft foods and plenty of fluids on the day of surgery, then a normal diet as soon as comfortable.
- Gentle cleaning after meals as instructed.
- If a surgical pack was placed, leave it alone; if it falls out, do not worry.
- If a chain was attached, contact your orthodontist to schedule a follow-up to activate it.
Most children return to school within a day or two. Detailed instructions are on our exposure of an impacted tooth page.
What If The Canine Cannot Be Brought Down?
In some older teens and adults, the canine is fused to the bone (ankylosed) and will not move despite orthodontic force. In these cases, the tooth is removed, and the space can be restored later with an implant or a bridge once growth is complete. See dental implants.
Impacted Canine Care In Waterloo Region
Our office at 96 Union Street East in Waterloo works with orthodontists across Waterloo, Kitchener, Cambridge, Guelph, and Stratford to treat impacted canines. Most families are referred by their orthodontist, who coordinates the timing of braces and surgery. Learn more on our impacted canines page or call +1 (519)-743-7811.
Sources
- Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. European Journal of Orthodontics, 1988.
- Impacted canines and exposure of an impacted tooth, Dr. Kevin J. McCann Oral & Maxillofacial Surgery.
FAQ
What Age Is Best For Impacted Canine Treatment?
Early action gives the best results. If the canine's path is cleared by about age 11 to 12, it often erupts on its own. After age 13 to 14, exposure and bonding is usually needed.
Is Impacted Canine Exposure Surgery Painful?
The area is numbed with local anesthetic, and sedation is available. Afterward, most children have mild soreness for a few days, managed with over-the-counter pain relief as directed.
How Long Does It Take For An Exposed Canine To Come Down?
It varies by position and age, but orthodontic eruption usually takes several months. Your orthodontist will monitor progress at regular visits.
Can An Impacted Canine Damage Other Teeth?
Yes, occasionally. An impacted canine can press on the roots of neighbouring teeth. Imaging helps detect this early so treatment can be planned.
Does My Child Need A Referral?
Most patients are referred by their orthodontist or dentist, which allows us to review X-rays and coordinate with the braces plan.
This article is general patient education and does not replace an examination, diagnosis, or the written instructions from your own surgeon or dentist. If you have heavy bleeding, trouble breathing or swallowing, or rapidly spreading swelling, call the office or go to the nearest emergency department.