Dr. Hussein Albeedh Associate Consultant, Orthodontics Dental Center International Medical Center My son is 9 years old and is complaining of delayed eruption of one of his upper incisors, what are the possible causes and available treatment options? Delayed eruption of the upper front teeth can have a negative impact on the patient's general well being and life style as they are considered the “social six teeth”. The upper incisors tend to erupt around 7-9 years of age. The lowers on the other hand erupt around the age of 6-8 with some individual variations between patients. Any delay in the eruption pattern can be a part of the normal dental development and in most cases does not require any dental intervention. However, if the tooth does not erupt within 6 months of the contra-lateral one in the same jaw then it is advisable to examine the patient clinically and radiographically by an Orthodontist. Possible causes of delayed eruption are: • Supernumerary teeth (extra teeth or tooth-like structures) • Primary teeth that have not exfoliated and preventing the eruption of the permanent teeth • Previous dental trauma • Dental crowding and lack of adequate spacing • The presence of other dental pathology such as cysts • Abnormal shape of the crown or the root of the tooth It is therefore imperative that we examine patients at an early age to reach a definitive diagnosis and monitor the case accordingly. In most cases, the course of action is as simple as extracting the retained baby tooth and wait for the permanent tooth to erupt. However, in other more demanding cases we might consider a surgical exposure of the impacted tooth and remove any pathological factors that may hinder its eruption such as dental cysts. In these cases we can also attach orthodontic appliances on the teeth in order to guide and align the impacted tooth with braces. The process of orthodontic alignment can take anything from 12-24 months depending on the severity of the case and the position of the impacted tooth in the jaw. We also have to highlight that tooth impaction is quite common with canine teeth and not only incisors. Unfortunately, many of those patients are unaware of this condition as they were not examined early by an orthodontist and the general dentist may have not noticed this condition. Untreated impacted canines can lead to dental spacing and unwanted tooth movement of the adjacent teeth. Other possible serious consequences include the development of dental cysts and root resorption of the adjacent teeth. The alignment therefore of these teeth is a crucial process that should only be carried out by as specialist orthodontist.
