Extra Tooth Blocking Permanent Tooth

I'm a 13 year-old boy who has an extra tooth. My original permanent tooth is impacted. The extra tooth is growing normally in place of it. I have been told to have the extra tooth removed so that the real tooth can grow in its place. Do you think this is a good idea? If so, should I have general anesthetic or local anesthetic with laughing gas?

Question:

You have asked a very good question. Decisions regarding the treatment of impacted teeth must be made carefully and with the cooperation of the general dentist, the orthodontist, and oral surgeon. Careful notation of the position of the impacted tooth, its root formation, and its position in relationship to other teeth and structures should be assessed.

Since you are young, it is not likely the impacted tooth is ankylosed (i.e fused with the bone). It is likely the root is not fully formed. These advantages will make it easier to orthodontically extrude the impacted tooth. In fact, if root formation is still in progress, there is a natural eruptive force which can be used to guide the tooth into a functional position. If the root is extremely curved or if the tooth is ankylosed, moving the tooth may be difficult. An x-ray of the tooth will show the shape of the root.

If it is determined the impacted tooth can be properly positioned, the surgical exposure of the tooth must be carefully considered. Radiographs (i.e. x-rays) should be studied to determine if the impacted tooth is located facially (toward the face) or lingually (toward the tongue). In addition, its proximity to adjacent roots must be determined. The health of these adjacent teeth must be considered. Root damage to adjacent teeth can occur during removal of bone to expose the impacted tooth or when placing a wire or ligature to pull it into place. Bonded orthodontic brackets help minimize these risks because less bone removal is required. Threaded pins can also be used, although these are very technique sensitive. One other consideration in extruding an impacted tooth is the final health of the gum tissue surrounding the tooth. Proper surgical technique should also take this into consideration.

As you can see, removing the supernumerary (extra) tooth and extruding the permanent tooth can be somewhat complicated. This should not discourage you from having the procedure completed. The recommended treatment may be the best way to go. Another option is to have the impacted tooth removed and leave the supernumerary tooth in place. Some type of cosmetic dentistry, such as bonding or a veneer, can be done to improve the shape of the supernumerary tooth.

If you have the impacted tooth removed, and it is anticipated by the oral surgeon that either extensive bone removal or sectioning of the tooth will be required, you may choose general anesthesia. Otherwise, you may be fine using local anesthesia and nitrous oxide (i.e. laughing gas) for removal of the supernumerary tooth or removal of the impacted tooth. Part of the decision will depend on your comfort and anxiety level. If you are very nervous about the treatment, you may want to be more sedated. You should discuss the various sedation options with the person performing the surgery.

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