In the most common scenario, baby teeth begin to emerge between four and six months, eventually filling your child’s gummy mouth before making way for erupting permanent teeth (starting around age seven). Somewhere in between no teeth and a full set of teeth, we may experience cavity, orthodontics, and other oral health challenges. In some rare cases, these challenges are exacerbated (or exaggerated) by an ankylosed tooth. Here’s what you should know.
What causes tooth ankylosis?
The alveolar bone is the bone that holds the tooth sockets. Every tooth – deciduous and permanent – comes through the tooth socket.
Tooth ankylosis occurs when one of two things takes place:
- The deciduous tooth decides to stick around, fusing to the alveolar bone
- The permanent tooth fuses to the bone
In children, the most common ankylosed tooth is the second deciduous molar in the mandible (lower jaw). The first stage of an ankylosed tooth is partial resorption of the tooth’s roots into the alveolar bone.
This causes the tooth to fuse to the bone. Because the tooth is now fused to the bone, it cannot be shed to make way for permanent teeth. As the alveolar bone continues to grow with the child, the deciduous tooth seems “submerge” and the permanent tooth becomes impacted.
For adults, an ankylosed tooth is most often caused by damage to the periodontal ligament that causes the tooth roots to detach from the alveolar bone before fusing to it. This damage can be caused by trauma, either from an accident or from prolonged low-grade oral health issues.
Symptoms and risks of ankylosed tooth
Tooth ankylosis affects deciduous teeth far more often than permanent teeth (at an estimated rate of ten to one). It is easy to understand the risk of an ankylosed tooth in children. No space for a permanent tooth to erupt can cause impacted teeth that require surgical extraction.
Ankylosed teeth can also cause an increased risk of cavity, malocclusion, and other periodontal diseases in children. Tooth ankylosis can also hinder the success of orthodontic treatments, as the affected tooth will not move at all.
Adults with tooth ankylosis may have teeth that are functional but aesthetically imperfect. The impact of ankylosed teeth most often affects the cosmetic nature of the teeth. In most cases, an adult ankylosed tooth is not a singular cause for removal, but if the tooth needs to be removed for other reasons it can be significantly more challenging than a simple extraction.
There are no concrete answers as to what causes an ankylosed tooth. Many people with ankylosed teeth have family members with the same condition, suggesting at least a small genetic risk factor. Other causes can include:
- Trauma, either minor over time or a significant one-off occurrence
- Inflammation
- Infection
Symptoms of tooth ankylosis include:
- A smaller number of teeth
- Abnormalities in the tooth enamel
- A larger mandible
- Abnormalities in the other teeth
Oddly, between five and 29% of people with tooth ankylosis also have a permanently curved pinky finger. In addition to taking a look at the pinkie finger, dentists will make a diagnosis with a clinical examination that includes X-ray. The best way to determine if an ankylosed tooth is present is to see it, and X-ray is the way to go.
What should I expect with ankylosed tooth extraction?
There a few common ankylosed tooth treatments available, depending on the timing and location of your ankylosed tooth.
1. Deciduous with a permanent tooth behind it
In general, your dentist will opt to extract an ankylosed tooth that is a baby tooth when there’s a visible permanent tooth behind it.
A space maintainer can help maintain the alignment of erupting adjacent teeth.
2. Deciduous, but without a permanent tooth behind it (but the patient is very young)
If a young patient with no permanent teeth waiting in the wings is diagnosed with an ankylosed tooth, the dentist may want to take a “wait and see” approach before extraction and a space maintainer.
3. Deciduous tooth in an older child with no permanent tooth behind it
Older children experiencing tooth ankylosis with no permanent teeth (and with none on the horizon) may do best with a tooth extraction and dental restoration (e.g., dental implant) when they get older.
4. Permanent tooth with early onset tooth ankylosis
Luxation is the medical term for dislocation. If a permanent tooth has ankylosed, it is possible to dislocate it to see if the fused bone will then heal properly. If not, the tooth will appear to be completely resorbed into the alveolar bone.
Because this is suboptimal, the tooth should then be extracted and restored with a dental bridge or implant.
5. Permanent teeth with a late onset tooth ankylosis
For any ankylosed tooth in adults, it is possible to luxate the permanent tooth. This is a dislocation of the tooth from the tooth socket, with the hope that the tooth heals back into its correct position.
If it does not, and the tooth does not appear to be submerging, a dental crown or other restoration can help.
6. Deciduous or permanent ankylosed tooth that appears to be “submerged”
Unless such a tooth is threatening immediate damage or misalignment of bite, this type of ankylosed tooth is generally left undisturbed and monitored for changes over time. It may be necessary to extract the tooth at a later date, but your dentist will not want to perform an unnecessary extraction.
An ankylosed tooth extraction is usually surgical in nature, as the tooth is firmly affixed to the bone. Your dentist will discuss the whole procedure beforehand to answer any questions and soothe any of your fears about the procedure. The goal is a pain-free experience that restores the health and function of your teeth.
Every mouth’s anatomy is different. AZ Dentist, a family dentist in the Phoenix area, has experience with ankylosed teeth and can offer individualized treatment for all of your family members. Get in touch today!