Removal of misplaced teeth is easily the commonest oral surgical operation – it may be the most common operation in all of surgery.
Teeth are extremely hard but sensate and vascularised structures. There are 32 in the adult human being, they may erupt in sequence and fulfil their role in life, or they may not. If they do not – most commonly with third molar teeth (wisdom teeth) then they may become jammed in some part of the jaw. These are ectopic teeth. Any tooth may become ectopic but wisdom teeth and canine teeth are the most common.
Philosophies differ as to whether or not a tooth in the wrong place should be removed or repositioned or not. This is influenced worldwide by the various healthcare-funding systems.
If a tooth is important to aesthetics and function (the canine tooth, particularly the upper canine tooth is such), then detecting its position and whether or not it is likely to move into its proper position naturally at the age of 12, is clearly important. If it is in the wrong place then a constructive combination of surgery and orthodontics (straightening of teeth) can correct this small natural aberration.
If a tooth is deeply buried in jaw bone and is causing no symptoms, then there is no evidence to support invasive and potentially harmful surgery to remove it. Quite wild suggestions about the long-term risks of leaving deeply impacted wisdom teeth alone (such as the infinitesimally small risk of developing tumours within an associated cystic cavity) are completely counterintuitive and entirely without supporting evidence.
It is, however, true that partially erupted wisdom teeth which are not causing symptoms currently, may become infected and require removal at a later age when the operation is more traumatic.
In this respect, substantial differences have emerged amongst different health providers and clinicians with recommendations and guidelines which are at times taken as absolute rules. They are not, they are recommendations which can be deviated from after a sensible discussion and agreement between surgeon and patient.
On our detailed page about the treatment of ectopic teeth, we outline in some detail what these interventions involve. This should help guide the individual making what can be a difficult decision about a surgical intervention, which has both postoperative symptoms and potential postoperative problems.
Next section: Ectopic (displaced) teeth