Impacted Canines in Teens: Why a Permanent Tooth May Not Erupt Normally

An impacted tooth is one that is blocked and cannot erupt on its own, as opposed to one that is simply running behind. After wisdom teeth, the upper canine is the tooth this happens to most often, in something like one to three percent of people, and it happens to girls two to three times as often as boys.

If you are reading this because your teenager still has a baby canine, or a gap where a canine should be, here is the part worth knowing up front. By the teenage years the tooth is usually already stuck, and the question shifts from preventing that to bringing it in. The check that does the most good happens years earlier. This page covers both.

Impacted is not the same as late

A late tooth is on its way and taking its time. An impacted tooth has a physical reason it cannot arrive: no room, an obstruction, or a path that has taken it somewhere it cannot erupt from.

The two look identical from the outside, which is why they get treated as the same thing and are not. Sorting late from blocked is what an examination and, when warranted, an image are for. If your child’s situation is that a tooth simply has not shown up yet and nothing else stands out, that is a different question with its own answer.

Why canines specifically

Upper canines have the hardest job of any tooth in the mouth. They begin forming high in the upper jaw, well above where they will eventually sit, and they travel farther than any other tooth to reach their position. They also arrive late, usually around ages eleven to twelve and typically earlier in girls, by which point the arch is largely full and there is less margin for error.

A long path plus a late arrival plus limited room is a reasonable summary of why this tooth gets into trouble more than its neighbors.

Canines are worth the attention they get. They sit at the corner of the smile, they carry a disproportionate share of the visible arch, and they guide the bite during side-to-side jaw movement. They are among the teeth you would least want to lose.

What gets in the way

Not enough room

Of everything on this list, plain lack of space is the likeliest explanation.

The path itself

A canine can drift off its route and end up angled across the root of the neighboring lateral incisor, or positioned toward the palate rather than the cheek side. Most impacted upper canines end up on the palate side.

Something in the position

An extra tooth or another obstruction sitting in the eruption path can stop or divert it.

A small or missing lateral incisor

This one is less intuitive. The lateral incisor’s root appears to act as a guide for the canine coming down past it. When that tooth is unusually small, peg-shaped, or absent, the canine loses part of its guidance, and dentists treat a peg lateral as a reason to look more carefully at the canine on that side.

What families sometimes notice

Often, nothing. That is the central difficulty with this tooth and the reason the professional check matters more here than parental observation.

When there is something to see, it tends to be one of these:

• A baby canine still firmly in place well past the age its replacement should have arrived
• The permanent canine in on one side while the other side has nothing
• A firm bulge on the roof of the mouth behind the front teeth
• A lateral incisor that looks tipped, rotated, or unusually small
• A space that is not closing, or one that closed up and left no room
• An older teenager whose orthodontic treatment has stalled on one tooth

Pain is not usually part of it. Impacted canines are typically silent, and so is the complication that makes them worth catching.

The check that matters most, and when it happens

Around age eight or nine, a dentist can begin feeling for the canine high in the gum above the baby canine, where a firm bulge appears as the tooth approaches. Feeling that bulge is a strong indication the tooth is on a normal course. Not feeling it is where the timing gets interesting.

The classic study on this examined schoolchildren between eight and twelve. At age ten, nearly three in ten had canines that could not be felt, but by eleven that had dropped to about one in twenty, and lower still afterward. Most of the children whose canines were not palpable at nine or ten went on to erupt normally.

That single finding drives current practice. A canine you cannot feel at eight or nine is not alarming and usually does not justify imaging, because the tooth simply has not arrived in the neighborhood yet. A canine that still cannot be felt at ten or eleven, or one that can be felt clearly on one side and not the other, is the point at which an image genuinely changes what happens next. Published guidance is consistent that radiographs before about ten years of age usually do not tell you enough to be worth taking.

If your child is younger than that, the useful thing is not to demand an X-ray. It is to make sure someone is actually palpating for the canines at checkups from age eight or nine onward, and to ask.

The reason waiting has a cost

The complication that drives urgency is not the canine. It is the tooth next to it.

An upper canine sitting against the root of the neighboring lateral incisor can resorb that root, dissolving it from the outside. Studies using three-dimensional imaging have found some degree of root resorption in a large share of adjacent lateral incisors, with published estimates running from roughly a quarter to over half depending on the population and how the images were read. Most of what turns up is slight. But the pooled analysis of these studies also found that close to a third of the resorption identified was severe, so this is not a finding to wave off as uniformly minor.

Two features of this matter for families. It is usually silent: no pain, no looseness, nothing your teenager would report. And it is progressive while the canine stays where it is. That combination is the honest argument against an indefinite wait-and-see approach, and it is more persuasive than anything about how the smile will look.

None of that means every child with a late canine needs three-dimensional imaging. Those scans deliver more radiation than an ordinary dental film, so they are reserved for the questions ordinary films cannot answer, and the standard for children is the least imaging that resolves the question in front of us.

What can actually be done

The options narrow with age, which is the practical reason this article keeps pointing backward in time.

In the mixed dentition, removing the baby canine

When an upper canine is identified as off course during the mixed dentition, taking out the baby canine on that side can be enough to let the permanent tooth correct its own path. The trials behind this found the canine came in correctly in roughly two thirds of children treated this way, against roughly four in ten in children who were not. Those are meaningful odds, and they are the best argument for finding this early.

Later, the same approach still helps

Diagnosed between about eleven and sixteen, and provided the canine is not lying horizontally, removing the baby canine reduces the severity of the impaction, and reported figures put eruption at around three quarters of cases. Later is not the same as too late.

Making room

Where crowding is the limiting factor, creating or holding space can be part of what allows the tooth through, and expansion of the upper arch during the mixed dentition has been shown to improve the odds for palatally positioned canines.

Exposing and guiding it in

When the tooth will not come on its own, the standard approach is to surgically uncover it and attach an orthodontic attachment, then move it into position over months. This involves coordination with an orthodontist and sometimes an oral surgeon. The reassuring finding here is that the long-term gum and bone health of canines brought in this way is comparable to canines that erupted normally. The evidence is not strong enough to say which surgical technique is best, which is a real gap rather than something to gloss over.

Occasionally, other paths

A canine that cannot reasonably be brought in may be left and monitored, or removed with the space closed orthodontically or restored later. These are less common and they are decisions made with a full picture, not defaults.

Where early guidance of the developing bite is part of the plan, our early start orthodontics page explains what that involves, and dental X-rays covers how imaging decisions are made for children.

What earlier identification does and does not buy

Finding an off-course canine early improves the odds, shortens what is needed, and reduces the chance the neighboring tooth is damaged in the meantime. That is well supported.

What it does not do is guarantee an outcome. Some canines come in on their own once the baby tooth is out. Some need exposing and guiding regardless of how early they were spotted. Some are in a position that limits what any approach can achieve. A dentist or orthodontist who tells you at the outset exactly how it will end is telling you more than the evidence allows.

If your teenager is already past that window

Not too late, and worth assessing rather than leaving. The options are narrower and the treatment is generally longer, but a canine identified at fourteen still has real paths available, and the question of whether the neighboring incisor has been affected is worth answering either way. Bring it up rather than assuming the moment has passed.

Quick answers

Does an impacted canine hurt?

Usually not, and that is the problem with it. Impacted canines and the root resorption they can cause in the tooth next door are typically silent. Absence of pain is not evidence that nothing is happening, which is why this is one of the findings that gets picked up on examination rather than reported by a patient.

Can we just leave the baby canine in place?

Sometimes for a while, but not as a permanent plan. A retained baby canine has a root that will resorb in time, and its long-term outlook is usually limited regardless of how solid it looks now. It can buy time while a decision is made, which is different from being the decision.

Is a 3D scan necessary?

Not in every case. Conventional films are often enough to establish where the canine is and to plan around it. What tips the balance toward three-dimensional imaging is the question of the lateral incisor root, because ordinary films are poor at showing whether resorption has started and how far it has gone. When that is the concern, a flat image can miss what matters.

Will braces be needed either way?

For a canine that has to be exposed and guided into place, yes, because orthodontic mechanics are how the tooth is moved. For a canine that corrects its own path after the baby tooth is removed, not necessarily, though many children in that situation turn out to need orthodontic treatment for separate reasons.

My other child had this too. Is it genetic?

There is a familial pattern, and having one child with an impacted canine is a reasonable prompt to make sure siblings are being checked by palpation from age eight or nine. It is not deterministic, and a family history is a reason to look rather than a reason to expect it.

Ask us to check

If your child is around eight to eleven and you want to know whether their canines are on course, ask us to palpate for them at the next visit, or send the question through our contact page and we will make sure it is on the chart. It takes moments, it is the highest-value check in this whole article, and it is easy to skip if nobody raises it.

If you have a teenager with a baby canine that never came out, call us at 317-580-9199 and we will work out what is actually going on. Our Indianapolis address is 9240 N. Meridian St., Suite 250, and the schedule runs Monday through Thursday.