What to Do About a Tooth Growing in Upper Gums

A tooth growing through the upper gums in an unexpected spot is almost always one of two things: an ectopic tooth that has drifted off its normal eruption path, or a supernumerary tooth, meaning an extra one the body produced that was never supposed to be there. The first step is getting proper imaging so your dentist can figure out exactly what it is, where it’s heading, and whether neighboring teeth are at risk. From there, treatment can range from simply removing a baby tooth to clear the path, all the way to surgery combined with braces that may take two to three years.

Why a Tooth Ends Up in the Wrong Place

Teeth follow a remarkably predictable eruption schedule, but sometimes the process goes sideways, literally. Upper canines are the most common offenders in the upper jaw. One case series found that canines accounted for about 60% of ectopic tooth impactions in the maxilla, with most of the remaining cases involving premolars or molars in other jaw regions.¹ Supernumerary teeth, meanwhile, show a strong preference for the front of the upper jaw, often appearing just behind the central incisors.²

Several factors push teeth off course. Research on ectopic first molars found that children whose permanent molars were oversized relative to their jaw, or whose molars erupted at a steeper angle, were significantly more likely to develop irreversible ectopic eruption. A tendency toward a shorter upper jaw compounded the problem.³ In other words, big teeth trying to fit into a small jaw sometimes veer into places they shouldn’t be. When a permanent tooth erupts ectopically, it can also trap the baby tooth above it, preventing normal shedding. Studies have found ectopic eruption of a developing permanent tooth accounts for roughly 2% of cases where a primary molar is retained past its expected lifespan.⁴⁵

The bigger evolutionary backdrop matters too. Modern human jaws are substantially smaller than those of our ancestors, a shift linked to changes in diet and food processing over millennia. That reduction in jaw size didn’t come with a matching reduction in tooth number or tooth size. The result is more crowding, more malposition, and more teeth that simply don’t have room to come in straight.⁶

Getting the Right Imaging

If you or your child has a bump, a visible white edge, or simply a tooth that hasn’t appeared when it should have, your dentist will start with X-rays. A standard panoramic image gives a good overview and is often the first thing taken. But when it comes to pinpointing exactly where a misplaced tooth sits relative to the roots of other teeth, three-dimensional imaging with cone beam computed tomography (CBCT) is consistently more accurate. One study comparing methods for localizing ectopic upper canines found that CBCT correctly identified the tooth’s position in about 94% of cases, compared with roughly 83% for one conventional technique and 65% for another.⁷

CBCT also outperforms traditional X-rays when it comes to detecting whether an ectopic tooth is resorbing (eating into) the roots of its neighbors. A study involving dental faculty and residents found that CBCT was significantly better for locating the problem, assessing root damage, and planning treatment.⁸ This doesn’t mean every case needs a CBCT scan. Many straightforward situations are handled fine with standard films. But if there’s any question about the tooth’s exact position or whether adjacent roots are being damaged, three-dimensional imaging eliminates guesswork.

What Happens If You Do Nothing

A misplaced tooth in the upper gums isn’t always an emergency, but leaving it alone indefinitely carries real risks. The most common concern is root resorption of adjacent teeth: the ectopic tooth slowly dissolves the root of its neighbor, which can eventually loosen or kill the neighboring tooth entirely. This is one reason early detection matters so much.

Another risk is cyst formation. Dentigerous cysts are the most common developmental cysts in the jaw, and they form around the crowns of impacted or unerupted teeth.⁹ In extreme cases where teeth migrate far from their normal position, such as into the maxillary sinus, cysts were found in a high proportion of cases. One case series reported that all ectopic teeth found in the maxillary sinus were associated with a dentigerous cyst, and those cyst-associated teeth accounted for over 70% of all cysts in the series.¹ These cysts can expand silently within bone, and the longer they go undetected, the more damage they cause. For ectopic teeth that have traveled into the sinus, early surgical removal along with removal of any associated cyst is the standard approach.¹⁰

Beyond physical damage, there’s a psychosocial dimension that’s easy to underestimate. A visibly misaligned or protruding tooth in the front of the mouth can affect how adolescents feel about themselves. Research has linked the severity of malocclusion to psychosocial outcomes in teenagers.¹¹ This alone isn’t a reason to rush into treatment, but it’s worth factoring in when deciding whether to wait or act.

Interceptive Treatment for Children

In children, the simplest fix is often the most effective: removing the baby tooth that’s blocking the permanent tooth’s path. When a developing permanent tooth is erupting at an angle that traps the primary tooth above it, early extraction of that primary tooth can restore the eruption pathway and help preserve space in the arch for the permanent tooth to come in on its own.¹² This is a quick, low-cost procedure that can prevent a much more complex intervention later.

Timing matters here. If a dentist identifies ectopic eruption early, say during a routine check-up around ages 6 to 9, removing the baby tooth while the permanent tooth still has momentum to self-correct gives the best shot at a natural outcome. Wait too long and the permanent tooth may become fully impacted, meaning it’s stuck in bone and needs surgical help. Dentists often monitor the situation with periodic X-rays before deciding to intervene, because some ectopic eruptions do self-correct. But once it’s clear the tooth isn’t going to find its way on its own, pulling the overlying baby tooth is the logical first step.

When Surgery and Braces Are Needed

If an ectopic tooth is fully impacted, particularly an upper canine buried in the palate or behind other teeth, the treatment almost always involves a combination of surgery and orthodontics. The goal is to surgically uncover the tooth, bond a small bracket or attachment to it, and then use braces to slowly pull it into its correct position in the arch. This process typically takes two to three years from start to finish.¹³

There are two main surgical techniques, and your dental team will recommend one based on where the tooth is sitting:

Closed technique: The surgeon uncovers the tooth, bonds an attachment (usually a small bracket with a gold chain), then stitches the gum tissue back over the tooth. The orthodontist later uses the chain to gradually pull the tooth through the tissue and into the arch. The tooth moves under the surface until it’s close to its final position.
Open technique: The surgeon uncovers the tooth and removes enough overlying tissue to leave the crown of the tooth visible. The orthodontist can then bond a bracket directly and begin aligning it with a wire.

A Cochrane systematic review looked at the evidence comparing these two approaches for palatally displaced canines and found that neither technique has been conclusively proven superior across the board.¹³ In practice, many clinicians choose based on the tooth’s position: if it’s high up or deeply buried, the closed technique is often favored because it protects the tissue during the long traction process. If the tooth is closer to the surface, an open exposure may be simpler.

One thing clinicians have emphasized is that the amount of bone removed during surgery is less important than how the soft tissues and the periosteum (the membrane covering the bone) are handled. Careful tissue management during the procedure tends to produce better long-term results for the gum tissue around the tooth once it’s in place.¹⁴

For a supernumerary tooth that’s causing trouble, the approach is more straightforward. If the extra tooth is blocking or displacing a permanent tooth, it’s usually extracted surgically, and any displaced permanent teeth are then guided into position orthodontically. If the extra tooth is deeply embedded, not causing any symptoms, and not threatening other teeth, some dentists will recommend monitoring it rather than operating, especially in adults where the risk of the tooth causing problems may be low. Occasionally these ectopic teeth are discovered incidentally on imaging taken for an unrelated reason. Even in asymptomatic cases, CT scans help determine exact positioning and whether surgical removal is warranted.¹⁵

What Recovery Looks Like

After surgical exposure of an impacted tooth, you can expect swelling, discomfort, and some difficulty eating for a period that varies with the technique used and the tooth’s location. Research comparing the two surgical approaches found that the open technique tends to involve a longer recovery. Patients experienced more prolonged pain, took more pain medication, and had a harder time eating and opening their mouth compared with those who had the closed technique.¹⁶

Where the tooth sits also affects how rough the recovery is. Exposures on the cheek side of the jaw (buccal) tend to be more traumatic and involve longer recovery periods compared with exposures on the palatal side, regardless of whether the open or closed technique is used.¹⁷ This is something to discuss with your surgeon before the procedure so you can plan accordingly, especially if you’re scheduling it around school or work.

For simpler procedures, like extracting a baby tooth or removing a small supernumerary tooth, recovery is much faster. Most children bounce back within a few days with standard over-the-counter pain relief. The longer, more involved recovery applies mainly to impacted canines or other teeth that require flap surgery and bone removal.

Long-Term Health of the Moved Tooth

A natural question after all that work: does the tooth end up as healthy as one that came in on its own? The answer is encouraging, with a small caveat. A systematic review and meta-analysis examining the gum health of teeth that were orthodontically pulled into place found that these teeth had slightly higher gingival inflammation scores and marginally deeper probing depths compared with the corresponding tooth on the other side of the mouth. The differences were statistically significant but small, on the order of fractions of a millimeter.¹⁸

In practical terms, this means the gum tissue around a formerly impacted tooth may need a little extra attention during brushing and flossing, but it’s not a sign of disease. A randomized trial comparing standard traction with a newer corticotomy-assisted approach found that probing depths around the aligned canines didn’t exceed 2 millimeters in either group, which is well within the healthy range, and gum recession was minimal.¹⁹ Another study specifically measuring gingival health after surgical exposure and orthodontic traction of labially impacted maxillary canines reported low gingival index values overall, with no significant gum disease detected by visual inspection or probing.²⁰ The researchers noted that preserving the dental follicle during surgery helped produce better soft tissue outcomes.

So while a tooth that had to be surgically retrieved and orthodontically guided into position may not be in identical shape to one that erupted uneventfully, the difference is small enough that most patients end up with a fully functional, aesthetically normal tooth that lasts a lifetime with reasonable care.

Adults Versus Children

Everything discussed so far tends to go more smoothly in younger patients. Children’s bones are less dense and still growing, which makes orthodontic tooth movement faster and surgical access easier. The root of a tooth that hasn’t fully formed yet is also less prone to resorption during traction. In adults, the bone is more mature and the tooth root is fully developed, so the whole process takes longer and the biological response is slower.

That said, adult treatment is absolutely possible and often successful. The principles are the same: image, expose, bond, and pull the tooth into place. Adults may simply need more patience and should be aware that the orthodontic phase can extend beyond the two-to-three-year window typical in younger patients. Adult bone also doesn’t remodel as readily, which is one reason some clinicians have explored accelerated techniques like corticotomy-assisted traction, where small cuts in the bone around the impacted tooth stimulate faster remodeling and shorten treatment time. As noted, periodontal outcomes with these accelerated methods appear comparable to conventional traction.¹⁹

For adults who discover a deeply impacted or ectopic tooth incidentally, perhaps on a scan taken for sinus issues or an unrelated dental problem, the calculus is slightly different. If the tooth isn’t causing symptoms, isn’t threatening other teeth, and isn’t associated with a cyst, monitoring rather than immediate surgery can be a reasonable option. Your dentist and oral surgeon will weigh the risks of surgery against the risks of leaving it alone, and the answer isn’t always the same for everyone.

Endoscopic Removal and Newer Approaches

When an ectopic tooth has migrated far from its normal position, particularly into the maxillary sinus, traditional surgical removal requires making an incision through the gum and sometimes creating a window in the bone to access the tooth. Endoscopic procedures are gaining traction as an alternative for these unusual cases. Using a small camera inserted through the nostril or a minimal opening, the surgeon can visualize and remove the ectopic tooth with less tissue disruption.¹⁵ This approach is mostly relevant for teeth that have ended up in truly remote locations, not for the typical impacted canine or supernumerary tooth near the front of the mouth. But it’s worth knowing about if your dentist tells you that a tooth has wandered into your sinus, because a minimally invasive option may be available depending on the facility and the surgeon’s training.

1
PubMed Central. Management of rare ectopic teeth eruption: case series
2
Dental Update. Diagnosis and management of supernumerary teeth
3
American Journal of Orthodontics. Ectopic eruption of the maxillary first permanent molar: Etiologic factors
4
The Open Dentistry Journal. Retained Primary Molars and Related Reasons in Umm Al-Qura University, Makkah: A Retrospective Study
5
PubMed. Prevalence and local causes for retention of primary teeth and the associated delayed permanent tooth eruption
6
Bulletin of the International Association for Paleodontology. Tooth evolution and its effect on the malocclusion in modern human dentition
7
PubMed. Localization of ectopic maxillary canines — is CBCT more accurate than conventional horizontal or vertical parallax?
8
Pediatric Dentistry. Effectiveness of Impacted and Supernumerary Tooth Diagnosis from Traditional Radiography Versus Cone Beam Computed Tomography
9
PubMed Central. Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A case report and review of literature
10
PubMed Central. Ectopic tooth in maxillary sinus: Case series
11
Dental and Medical Problems. Association between malocclusion severity and adolescents’ psychosocial status
12
International Dental Journal. Eruption Failure Of Primary Molar With Ectopic Permanent Tooth
13
PubMed Central. Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth
14
American Journal of Orthodontics. The surgical exposure and application of direct traction of unerupted teeth
15
Radiology Case Reports. Incidentally detected ectopic maxillary tooth in an asymptomatic adult male: A rare case scenario
16
Journal of Oral and Maxillofacial Surgery. Patient’s Perception of Recovery After Surgical Exposure of Impacted Teeth: A Comparison of Closed-Eruption and Open-Eruption Techniques
17
Seminars in Orthodontics. Surgical exposure of impacted canines: Open or closed surgery?
18
Korean Journal of Orthodontics. Periodontal parameters in orthodontically tractioned teeth: A systematic review and meta-analysis
19
PubMed. Adult periodontal comparison after treatment of palatally impacted canines aligned by conventional or accelerated minimally-invasive corticotomy-assisted orthodontic traction: A randomized controlled trial
20
Annals of Punjab Medical College. Gingival Health after Surgical Exposure of Impacted Maxillary Canines with Orthodontic Traction