A tooth that appears to be pushed back, or set deeper into the mouth than its neighbors, is a common form of dental misalignment known as malocclusion. Dental professionals often describe this displacement as linguoverted or palatally displaced, meaning the tooth is tilted toward the tongue or the palate. While a single displaced tooth may seem like a minor cosmetic issue, it can signal deeper structural problems or result from acquired habits that affect overall oral health.
Developmental and Structural Causes
The positioning of a tooth is heavily influenced by the genetic blueprint governing the size of the jaw and the teeth themselves. A primary structural reason for a tooth being pushed backward is dental crowding, which occurs when the dental arch does not have adequate space to accommodate all the teeth. When the jaw is simply too small for the collective width of the permanent teeth, one tooth may be forced to erupt or shift out of the alignment, often toward the tongue, as it yields to the pressure of its neighbors.
This issue is often a manifestation of a tooth size and jaw size mismatch, an inherited characteristic where a person may receive a large jaw from one parent and large teeth from the other. This leads to insufficient arch length, causing teeth to overlap or be pushed into the incorrect position. In some instances, the tooth may develop in an incorrect location, a phenomenon called ectopic eruption. This is particularly noted with the canines, which may emerge outside the normal path, pushing nearby teeth out of the way or being displaced backward themselves due to a lack of guidance.
Acquired Factors and External Forces
A tooth that was once straight but has shifted backward over time usually points to non-structural or external forces acting upon it. One significant category involves chronic oral habits that apply sustained pressure to the teeth. For example, a persistent tongue thrust, where the tongue pushes against the front teeth during swallowing, can slowly move the teeth forward, which may cause a tooth behind them to be pushed backward in reaction.
In childhood, prolonged thumb or finger sucking can place external forces on the developing dentition, contributing to misalignment that pushes one or more teeth out of the arch. Sudden displacement can also occur due to dental trauma, such as a direct impact to the face from a sports injury. This force can physically knock the tooth backward, a condition known as luxation or intrusion.
Periodontal disease involves the progressive loss of the supporting bone structure around the teeth. When the bone and gum tissues weaken, the tooth loses its stable anchor, allowing minor forces from chewing or the resting position of the tongue to move it out of alignment. Furthermore, the loss of an adjacent tooth, such as a removed molar, can prompt the remaining teeth to drift or migrate into the newly created space. This movement can sometimes create a domino effect, pushing a single tooth at the front or side of the arch into a backward position.
Professional Correction Methods
Correcting a pushed-back tooth typically requires the controlled application of sustained force to guide it into the correct position within the dental arch. The most common solution involves orthodontic treatment, utilizing either fixed appliances, commonly known as braces, or a series of removable clear aligners. These systems work by exerting gentle, constant pressure to remodel the bone surrounding the tooth root, allowing the tooth to move safely.
If the displacement is due to severe crowding, the orthodontist may need to create space through techniques like interproximal reduction (IPR). IPR involves carefully removing a small amount of enamel from the sides of adjacent teeth. In cases of extreme space deficiency, the removal of a tooth may be necessary to allow the pushed-back tooth to be properly aligned.
If the underlying reason for the shift is active periodontal disease, that pathology must be addressed and stabilized before any tooth movement can begin. Once the tooth has been successfully moved into alignment, retention involves wearing a retainer. This device holds the tooth in its new position while the surrounding bone and ligaments stabilize, preventing the tooth from relapsing.