Why do you have teeth on the roof of your mouth?

What is an included tooth?

An included tooth is one that remains inside the maxilla or mandible (lower jaw) in whole or in part because its normal period of eruption has stopped or delayed. The teeth included in order of frequency are the wisdom teeth or third molars (eruption period between 18-25 years) and the canines or fangs (eruption period ranges from 9-10 years for the lower ones and between 11-12 years for the higher ones).

In the case of canines included in the maxilla, its incidence is 20 times higher than in the mandible and it is twice as frequent in women than in men, and in 8% of cases the inclusion is bilateral.

Causes

The eruption is a coordinated process and a local, systemic or genetic alteration can cause interruptions in it. Systemic reasons include endocrine deficiencies for example or feverish illnesses. The existence of local factors, one or a combination of several of them, are:

• Macrodontia: tooth larger than usual, preventing its eruption due to lack of space.
• Dental arch insufficient in length to accommodate teeth. It is an effect of the evolution of the human species: due to the increasingly soft diet, the volume of the jaws has been reduced and with it the number of teeth.
• Retention prolonged or early loss of the temporal canine with closure of the space by movement of the lateral incisor and the first premolar.
• Apical abscess: Infectious process due to caries of temporary teeth.
• Abnormal location of the dental germ, ectopy.
• Ankylosis of the temporary tooth: it is fused with the bone avoiding its fall.
• Premature root closure, does not migrate the tooth.
• Cystic formation.
• Disturbances in the sequence of tooth eruption.
• Mucous barriers-Scar tissue due to trauma or surgery, gingival fibromatosis or gingival hyperplasia, which make the tissue harder and prevent tooth eruption.
• Supernumerary teeth: Hyperodontia is defined as that condition for which supernumerary teeth appear, those teeth in addition to the normal number, which may be present in both jaws and may interfere with the eruption of both temporary and permanent teeth. They can have diverse morphology.
• Idiopathic (the cause is unknown).

Diagnosis

It's based on:

• Clinical evaluation.
• Absence of the permanent tooth or prolonged retention of the temporary one.
• Absence of a normal labial canine lump observed during palpation, presence of a lump on the palate.
• Migration or displacement of the lateral incisor.
• Radiographic verification.
• The precise location of the affected canines and the determination of their relationship to the adjacent incisors and anatomical structures is part of the diagnostic process and is essential for the successful evaluation of treatment.
• Periapical occlusal radiographs may be helpful, but orthopantomagraphy and about a Dental CT they are the tests of choice for diagnosis and treatment evaluation.

Complications

The presence of a tooth included in the palate can cause migration of neighboring teeth with loss of space in the dental arch, formation of cysts or tumors, reabsorption of the roots of neighboring teeth, infections particularly with partial eruption causing pericoronitis more frequent in molars and referred pain.

Treatment

The treatment will depend on the will of the patient, the existence of symptoms and the risk-benefit of the treatment.

The extraction of wisdom teeth or third molars is very common. However, in an included third molar, the location and the risks of its extraction must be assessed. The surgery will be more or less complicated depending on the degree of inclusion:

• Full inclusion
• Partial
• If the tooth is at the subgingival level.

Surgical

In surgery it is used. A small incision is made in the gum and osteotomy in case of total or partial inclusion, removing the bone until reaching the included tooth, removing the piece and suturing the wound.