Impacted Teeth in Children: When a Tooth Does Not Erupt as Expected

The development of permanent teeth generally follows a fairly regular pattern, but not everything always happens at the expected time. A baby tooth may remain in place longer than usual, or a permanent tooth may erupt on one side of the dental arch while the corresponding tooth on the other side is still missing.

In some cases, the permanent tooth is present but cannot reach its correct position in the mouth. It remains trapped inside the bone or beneath the gum. This condition is known as dental impaction.

Children often experience no pain, and the problem may be discovered during a routine orthodontic check-up. The lack of obvious symptoms is one of the reasons why monitoring dental development is so important: it helps distinguish a normal variation in eruption timing from a genuine difficulty that may require attention.

At Renata Bakaj Orthodontic Studio in Lugano, the development of permanent teeth is assessed by considering the child’s age, the amount of space available in the dental arches and the relationship between the developing teeth.

What Does It Mean to Have an Impacted Tooth?

A tooth is considered impacted when it has developed but is unable to erupt normally into the mouth. In other words, the tooth is present but remains hidden or appears only partially.

Impaction may be complete, when the tooth remains entirely inside the bone or beneath the gum, or partial, when only part of the crown becomes visible.

Not every impacted tooth has the same clinical significance. Much depends on which tooth is involved, its position, the child’s age and the amount of space available in the dental arch.

Upper canines are among the teeth most carefully monitored during growth because they follow a relatively long eruption path before reaching their final position. However, incisors, premolars and second molars can also experience eruption difficulties.

Which Signs May Attract a Parent’s Attention?

There is no single sign that allows parents to identify an impacted tooth with certainty. Often, the first noticeable feature is simply a delay compared with the other teeth.

A permanent tooth may fail to appear while the other teeth in the same area have already erupted. In other cases, the corresponding tooth on the opposite side may have been visible for several months. A baby tooth that remains in place while the surrounding teeth are being replaced may also deserve further evaluation.

Parents may sometimes notice unusual spaces, movement of nearby teeth or crowding that appears to prevent the permanent tooth from following its normal path. These signs do not automatically confirm impaction, but they may indicate that an orthodontic assessment would be useful.

It is important to remember that eruption timing is not identical for every child. A difference of several months may fall within normal individual variation. For this reason, the child’s age alone is not enough: the entire sequence of dental development must be considered.

Why Can a Tooth Remain Trapped?

There can be several causes of dental impaction, and more than one factor may be present at the same time.

One of the most common situations is a lack of space. If the dental arch is narrow or the permanent teeth are relatively large, the emerging tooth may not find a clear path. Existing dental crowding can also alter its direction.

Sometimes the tooth is positioned abnormally from the beginning or encounters an obstacle during eruption. A retained baby tooth, an extra tooth or another local abnormality may interfere with its path. In some cases, there may also be a family predisposition.

Understanding the cause is essential because treatment does not depend only on the fact that the tooth is impacted. Its precise position, direction and relationship with the surrounding structures are equally important.

How Is an Impacted Tooth Diagnosed?

The assessment begins with a clinical examination. The orthodontist observes which teeth have already erupted, which baby teeth are still present, how the dental arches are developing and whether there are differences between the right and left sides.

In some cases, gently examining the gum may make it possible to feel the tooth beneath the tissues. When its exact position needs to be determined, a panoramic X-ray may be recommended. This examination provides an overview of dental development and shows the relationship between the impacted tooth and the neighbouring teeth.

Three-dimensional imaging is not required in every case. It is reserved for situations in which more detailed information is needed about the tooth’s inclination or its proximity to roots and other anatomical structures.

Why Can Early Diagnosis Be Helpful?

Identifying an eruption difficulty early does not automatically mean that treatment must begin immediately. In some children, monitoring may be all that is needed because the tooth may still have the conditions required to erupt naturally.

An early diagnosis does, however, reduce the risk of missing the most favourable moment to act. If there is not enough space, it may be possible to create it while the dental arches are still developing. If a baby tooth is blocking the eruption path, the orthodontist can assess whether and when it should be removed. If the permanent tooth is angled or displaced, following its development over time makes it easier to plan the next steps accurately.

Early diagnosis cannot always prevent the need for a more complex procedure, but it may provide more treatment options and reduce the risk of discovering the problem only when the permanent dentition is almost complete.

What Can Happen If the Tooth Does Not Erupt?

An impacted tooth may remain symptom-free for a long time. The absence of pain, however, does not necessarily mean that the situation should be ignored.

Depending on its position, the tooth may contribute to the movement of nearby teeth, interfere with the bite or create an aesthetic concern, particularly when an upper incisor or canine is involved.

A retained baby tooth may appear stable for many years, but it may not be able to function throughout adulthood. Over time, it may become worn, lose stability or fail to fit correctly within the permanent dentition.

For this reason, continued monitoring is important even when immediate treatment is not required.

Which Treatment Options May Be Considered?

There is no single treatment for every impacted tooth. In some cases, regular check-ups and observation are sufficient, especially when the child is still young and the tooth has a reasonable chance of erupting spontaneously.

When space is limited, the orthodontist may work on the dental arch to create more favourable conditions. If an obstacle is present, it may need to be removed before checking whether the tooth resumes its natural eruption path.

If the tooth cannot erupt on its own, combined treatment may be recommended. Once adequate space has been created, the tooth may be surgically exposed and gradually guided into the dental arch using controlled orthodontic traction.

This is a progressive process that must respect the surrounding tissues and the roots of neighbouring teeth. Only when the position is particularly unfavourable, or when recovering the tooth is not considered the best option, may a different solution be evaluated.

The Particular Case of Upper Canines

Upper canines are among the permanent teeth most likely to experience eruption difficulties. They have a relatively long path to follow and must enter an area of the dental arch where the available space may already have been occupied by other teeth.

Their role is not only aesthetic. Canines contribute to the shape of the smile, help guide certain movements of the lower jaw and support the stability of the bite.

An upper canine that is not yet visible is not automatically impacted. Eruption timing varies from one child to another. However, the persistence of the baby canine, a clear difference between the two sides or an abnormal position detected on an X-ray may justify closer monitoring.

Monitoring Growth Without Acting Too Early or Waiting Too Long

The purpose of an orthodontic assessment is not to start treatment as early as possible. It is to understand whether development is progressing harmoniously and to identify the moment when treatment may genuinely be useful.

At Renata Bakaj Orthodontic Studio in Lugano, the position of the permanent teeth is evaluated together with the growth of the dental arches, the available space and the function of the bite.

Every child develops at a different pace and has different anatomical characteristics. The appropriate approach may therefore range from simple monitoring to a more structured orthodontic treatment. What matters is having an accurate diagnosis and avoiding unnecessary delays when signs deserve attention.

FAQ – Frequently Asked Questions About Impacted Teeth in Children

How Can You Tell Whether a Tooth Is Simply Late or Truly Impacted?

It is not possible to determine this by looking at the mouth alone. Eruption timing varies, and a delay of several months may be completely normal.

The orthodontist evaluates the order in which the other teeth are appearing, compares both sides of the dental arch and checks whether any baby teeth remain in place. When the delay appears significant, an X-ray can confirm whether the permanent tooth is present, where it is located and whether an obstacle is blocking its path.

In some cases, comparing examinations performed several months apart is particularly useful because it shows whether the tooth is continuing to move towards the dental arch.

Can an Impacted Tooth Erupt Spontaneously?

Yes, this is possible in some situations. The likelihood depends on the child’s age, the tooth’s position and inclination, the space available and the presence of any obstacles.

A developing tooth that is correctly oriented and has enough space may still complete its eruption naturally. If it is severely angled, located far from the dental arch or blocked by other teeth, spontaneous eruption becomes less likely.

For this reason, it is not advisable either to intervene automatically or to wait without follow-up. Monitoring helps determine whether the tooth is progressing and when treatment may become appropriate.

Do Impacted Teeth Always Cause Pain?

No. Many impacted teeth cause no symptoms and are discovered during a routine orthodontic examination.

Pain may occur when the tooth is partially erupted and the surrounding gum becomes inflamed, or when its position places pressure on nearby structures. Even in these cases, symptoms alone cannot identify the cause.

The absence of pain therefore does not rule out an impacted tooth. When a permanent tooth does not appear within the expected developmental sequence, its position should be checked.

If a Baby Tooth Does Not Fall Out, Does This Mean the Permanent Tooth Is Impacted?

Not necessarily. A baby tooth may remain in place simply because the permanent tooth has not yet completed its eruption path.

The situation deserves closer attention when the matching tooth on the opposite side has already erupted, or when the other teeth in the same area have already been replaced.

A retained baby tooth should not automatically be extracted before the position of the permanent tooth has been assessed. In some cases, removal may encourage eruption. In others, it must be coordinated with space creation and the overall orthodontic plan.

Is Treatment for an Impacted Tooth Always Lengthy?

Treatment duration varies significantly from one case to another. If it is enough to create space and wait for spontaneous eruption, the process may be relatively straightforward.

When the tooth must be guided orthodontically, the timeframe depends on its distance from the dental arch, its inclination, the patient’s age and the individual biological response. Orthodontic traction must be gradual: applying excessive force does not make the process faster or safer.

Once the diagnostic examinations have been completed, the orthodontist can explain the different phases and provide a more realistic estimate based on the specific case.

Does Early Diagnosis Always Prevent Surgery?

No, not always. Early identification may increase the possibility of creating space, removing obstacles and encouraging a more natural eruption, but some teeth still require combined orthodontic and surgical treatment.

The main advantage of early diagnosis is that it allows the treatment to be planned at the most suitable time and reduces the risk of damage or unwanted effects on neighbouring teeth.

The goal is not to avoid a procedure at all costs, but to choose the least invasive and most predictable solution for the individual child.