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1004.e2 Unerupted Teeth

Unerupted Teeth Client Education
Sheet
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defects in the eruptive process, genetic/
BASIC INFORMATION
coaxed into position (extrusion) if tooth,
traumatic displacement of the tooth bud or • Some unerupted teeth can be orthodontically
Definition surrounding bone, mechanical obstruction patient, and owner are willing.
Teeth that have not emerged into the mouth from adjacent structures, regional odonto- • If an operculum is present, dissect gingiva
are unerupted. The tooth appears to be missing, genic and nonodontogenic neoplasia to allow for tooth eruption (operculectomy).
and radiographic diagnosis is required. • The most commonly unerupted teeth in the • To prevent dentigerous cyst development,
dog are the mandibular first premolar and surgically extract unerupted teeth without
Synonyms third molar teeth. eruption potential. Curettage of the
Embedded teeth, impacted teeth • Endocrine abnormalities can prevent or slow extraction site is recommended to remove
the eruption of teeth. remnant odontogenic tissue. Postoperative
Epidemiology • Unerupted teeth can incite dentigerous cyst radiographs ensure complete removal of all
SPECIES, AGE, SEX formation: an epithelium-lined soft tissue is tooth structures.
Unerupted teeth occur more commonly in attached to the cementoenamel junction of • If a dentigerous cyst is present, the tooth
younger dogs and less commonly in cats. an unerupted tooth, with the crown protrud- and cyst are removed en bloc. If this is not
They may not be recognized until animals ing into the fluid-filled cyst, causing pressure possible, extensive curettage to remove all
have reached adulthood. resorption of alveolar bone, displacement of epithelial cyst lining is mandatory because
adjacent teeth, abscess, and fistulation. small islands of remaining epithelium can
GENETICS, BREED PREDISPOSITION lead to cyst recurrence or malignant trans-
Familial delayed eruption occurs in Tibetan and DIAGNOSIS formation. The debrided cyst cavity need
wheaten terriers, and toy breeds can have slower not be filled with osteopromotive materials;
eruption times. Because erupting teeth can be Diagnostic Overview natural bone remodeling likely is clinically
influenced by internal and external causes, a Dental radiography is necessary to differentiate adequate.
genetic link is suspected but difficult to prove. unerupted teeth from missing teeth. • Flaps should be closed with synthetic absorb-
Symmetrically unerupted or missing teeth are able suture material.
usually genetic in origin. Brachycephalic and Differential Diagnosis • Administration of antibiotics is not usually
toy-dog breeds appear to be predisposed to Edentulous region: necessary after the extraction procedure
impacted teeth due to crowding of teeth. • Partially erupted, ankylosed, embedded, and unless another medical condition or exten-
impacted teeth sive tissue trauma at the extraction site is
RISK FACTORS • Presence of an operculum (tough gingival present.
• Persistent deciduous teeth (p. 238) covering preventing tooth eruption) • Pain management: regional nerve block
• Regional trauma • Anodontia and hypodontia resulting from (0.2-0.5 mL of 0.5% bupivacaine) intra-
• Dental crowding a large variety of causes operatively, followed by carprofen 2.2 mg/
• Certain endocrine disorders • Fractured tooth ± retained tooth roots kg PO q 12h +/− butorphanol 0.2.-1 mg/
• Malnutrition • Previously extracted tooth kg PO q 6-12h (dogs); buprenorphine
• Canine distemper Edentulous region associated with soft-tissue 0.01-0.03 mg/kg oral transmucosal q 6-8h
swelling: +/− gabapentin 5-10 mg/kg q 8-12h (cats);
ASSOCIATED DISORDERS • Odontogenic tumor (e.g., compound or given postoperatively for 2-3 days.
Dentigerous cyst, root resorption, root dilacera- complex odontoma)
tion, pericoronitis, jaw fracture • Cyst (e.g., radicular, dentigerous) Chronic Treatment
• Abscess See Acute General Treatment above.
Clinical Presentation • Neoplasia
DISEASE FORMS/SUBTYPES Possible Complications
• Embedded teeth: unerupted teeth covered Initial Database • Inability to locate the unerupted tooth
in bone whose eruption is compromised by • CBC, serum biochemistry panel, urinalysis • Extraction of a healthy erupting permanent
lack of eruptive force (preanesthetic): generally unremarkable tooth
• Impacted teeth: unerupted or partially • Full-mouth (intraoral) dental radiography • Cyst recurrence
erupted teeth whose eruption is prevented • Regional trauma due to improper extraction
by contact with a physical barrier Advanced or Confirmatory Testing technique
CT scan: if associated cystic structure is large • Infection
HISTORY, CHIEF COMPLAINT and to define surgical margins and/or regions
Animals are sometimes presented for evaluation for debridement Recommended Monitoring
of missing teeth or swelling within the dental • Exam 1-2 weeks postoperatively to evaluate
arch, but most unerupted teeth are found TREATMENT extraction sites
incidentally on routine physical exam. • Cyst: exam with radiographs in 6 months
Treatment Overview
PHYSICAL EXAM FINDINGS Treatment goals are to preserve normal anatomic PROGNOSIS & OUTCOME
Most animals are in good health. Oral exam arrangement and structure, encourage complete
reveals an edentulous (toothless) region. tooth eruption or extract tooth if eruption is • Unerupted teeth with operculectomy: fair for
Permanent premolars are the most common impossible or impractical, and prevent cyst/ tooth eruption (depends on tooth eruption
unerupted teeth, but any tooth can be affected. abscess formation. potential)
• Extracted unerupted teeth: excellent for
Etiology and Pathophysiology Acute General Treatment extraction site healing
• Complications leading to abnormal tooth • No treatment if entire tooth is missing on • Dentigerous cyst: excellent if all cystic lining
eruption are many and varied: primary radiographs is removed
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