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Causes and Treatment of Supernumerary Teeth

Supernumerary teeth also known as hyperdontia, is the condition where more than normal number of teeth are present. When the extra tooth is present in deciduous dentition that is the primary dentition or in permanent dentition than these specific extra teeth are called as supernumerary teeth. By definition the supernumerary teeth are the extra teeth present in the oral cavity. These can be found in any region of the oral cavity.

Causes for Supernumerary Teeth

There is no specific cause of the supernumerary teeth. Many theories are given to explain their presence. Some says that these are there because of the abnormal division of the tooth bud but another theory says that it is because of the hyperactivity of the dental lamina. Dental lamina is the dental tissue which forms the tooth buds to form the teeth. If the dental lamina shows hyperactivity then extra teeth are formed which are known as the supernumerary teeth. Hereditary is also considered to be one of the main cause of supernumerary teeth.

What is the incidence of Supernumerary Teeth

The incidence of supernumerary teeth is more common in adult permanent teeth as compared to deciduous teeth. It is 0.8% in deciduous teeth and 2.1% in permanent teeth. These can be unilaterally present or bilaterally. It can be single or multiple. Normally it is single but multiple supernumerary teeth are present in cases of cleft lip and palate, cleidocranial dysplasia or Gardner’s syndrome. The incidence of supernumerary teeth in cleft lip and palate cases is around 22%. While in cleidocranial dysplasia cases it is 22.2% in maxillary region and 5 % in molar region. The supernumerary teeth can be present in one jaw or both the jaws. In deciduous teeth the incidence of supernumerary teeth is equal in males and females but in case of permanent teeth the incidence of supernumerary teeth is twice in males as compared to the females.

Multiple supernumerary teeth present in cleidocranial dysplasia

Multiple supernumerary teeth present in cleidocranial dysplasia

 

Classification of Supernumerary Teeth

Supernumerary teeth can be classified according to the location and the morphology. The supernumerary teeth present in the front teeth are called Mesiodens. The deciduous teeth are normally conical and straight but the permanent teeth can be differentiated into different shapes. They can be classified into four types according to the morphology. These are:

  1. Conical Supernumerary Teeth
  2. Tuberculate Supernumerary Teeth
  3. Supplemental Supernumerary Teeth
  4. Odontoma, This can be complex composite odontoma and compound composite Odontoma

Conical Supernumerary Teeth

They are normally peg shaped and are present between the front teeth and are known as the Mesiodens. They develop ahead or with the formation of root but some times they are impacted and lie inverted in the palate. Rarely do they cause hindrance in the eruption of the permanent teeth but they can cause the rotation or the displacement of the permanent teeth.

 
 X-ray showing inverted and conical Mesiodens

X-ray showing inverted and conical Mesiodens
 

Tuberculate Supernumerary Teeth

As the name implies they have more than one cusp or tubercle and are mostly present palatally to the central upper incisors. Their root formation is delayed and they are usually paired. It is very rare that they erupt and they can cause the delayed eruption of the incisors.
 
Supplemental Supernumerary Teeth

It is the duplication of teeth in normal series. Mostly it is found in lateral incisor, molar and premolar region. Most of the deciduous teeth are supplemental and are never impacted.

Odontoma

It can be complex composite odontoma i.e. the diffuse mass of dental tissue which is totally disorganized. Other is compound composite odontoma which has some resemblance to the normal anatomical structures.

 
 X-ray showing complex composite odontoma

X-ray showing complex composite odontoma


Problems Encountered by Supernumerary Teeth

There are many problems associated with supernumerary teeth. The main problems with supernumerary teeth are listed below.

1.      Movement of the teeth

The presence of the supernumerary teethcauses the displacement of the adjacent teeth. When they are removed the teeth come in to alignment.

 2.      Hindrance in the eruption of the teeth

Some times the supernumerary teeth are so placed that it causes the hindrance in the eruption of the normal teeth. The teeth fail to erupt. In such cases, when X-ray’s are taken to find the cause, the presence of supernumerary tooth is the cause and extraction of supernumerary tooth solves the problem.

 
Supernumerary teeth causing hindrance in the eruption of the teeth

3.      Failure in eruption of front teeth

Supernumerary teeth can sometime become cause for failure of eruption of front teeth.
 
4.      Crowding of the teeth

The supernumerary teeth also cause crowding as they are the extra tooth or teeth. When extracted this takes care of the crowding.

 5.      Development pathology in relation to Supernumerary teeth

Few pathological conditions are found in relation to the supernumerary teeth like cyst formation. Dentigerous cyst formation is the most common pathological condition found in case of supernumerary teeth.

 
 Dentigerous cyst in relation to the supernumerary tooth

                    Dentigerous cyst in relation to the supernumerary tooth

6.      Alveolar bone grafting

If alveolar bone grafting has to be done and there is supernumerary tooth present then that has to be extracted and then one has to wait for healing. It causes problems where alveolar bone grafting has to be done like in case of cleft lip and palate where as such incidence of supernumerary teeth is very high.

 7.      Resorption of roots of adjacent teeth

Some times the position of the supernumerary teeth is such that it causes the Resorption of the roots of the adjacent teeth. In such cases the supernumerary teeth has to be extracted as soon as possible.

 8.      Implant site preparation

Some times when the site is being prepared for the implant and there is a supernumerary tooth present, it has to be extracted and bone grafting has to be done.

Diagnosis of the Supernumerary Teeth

Most of the times, the supernumerary teeth are asymptomatic. They are diagnosed by chance. But if some teeth are impacted or there is displacement of the teeth then anterior occlusal X-ray and the periapical X-ray is taken to diagnose the presence of the supernumerary teeth.

Treatment and Management of the Supernumerary Teeth

Management part depends upon the location of the supernumerary tooth and its affect on the teeth. If it is asymptomatic and is not causing any problem like there is no displacement of teeth. There is no hindrance in the eruption of the teeth and no pathology is involved then the supernumerary teeth are not extracted. But there are certain conditions where the supernumerary tooth has to be extracted.
 
Conditions where extraction of supernumerary tooth is indicated:

 

  1. When the eruption of the teeth is delayed

  2. Displacement of the teeth is there which cannot be explained.

  3. When major orthodontic alignment of the teeth is planned like braces treatment has to be done. In such cases if any supernumerary tooth is present which is not visible or asymptomatic even then it is extracted.

  4. Some alveolar bone grafting procedure is planned like in case of cleft lip and cleft palate.

  5. When implant site has to be prepared for putting the implant.

 

 User Comments on -  Causes and Treatment of Supernumerary Teeth


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Posted By : Vane on 22-Jan-2013 03:46 PM
This article is very informative I really enjoyed reeding it. Thank you
 


Posted By : Dr.Ritz on 15-Nov-2012 12:16 AM

Hi HARLEY,Tooth behind adult tooth can be supernumerary tooth.Supernumerary tooth is also called as extra tooth.Supernumerary teeth present can cause movement of teeth, hindrance in eruption of teeth,failure in eruption of teeth,crowding of teeth and developmental pathology.Supernumerary teeth need to be removed only if they interfere with the oral health and dental function.In some cases, the extra teeth may be manageable with routine dental care.You have to undergo a thorough clinical examination.Hope that helps.Good luck!!

 


Posted By : harley on 11-Nov-2012 09:49 PM
i have two on my bottom jaw behind both wisdom teeth. i dont like to go to the dentist only recently have i decovered them i did not have them before but i do now. i figured out because i had a wisdom tooth crowned after repeating the toostie roll sucker commertial 5 times
 


Posted By : Ingrid Brouwer on 29-Apr-2012 03:30 AM
I have known about my supernumerary teeth for a long time and can't do anything about them I am now over 50 and it's too hard to have them out as they would have to break mya jaw to get them out. They cause me a lot of pain and I can't get screw in teeth as they are in the way. My own teeth are really bad because they get pushed around by the other teeth. What will become of me. Dentists don't like dealing with me as they can't really help me. I feel like a freak and will probably end up eating soft food with no teeth at all. I am so depressed and in pain. Please can somebody help me other than having to break my jaw
 


Posted By : Kella on 27-Feb-2012 04:01 AM
I had a very rare case of supernumerary teeth, I had two when I was younger at the age of 7. I had 1 hour of surgery trying to get them out of the nerve system of my mouth. After the surgery I lost felling of my lips and cheeks, But it came back a year later. Now I have to get a other surgery for my wisdom teeth, and they have to put a plate round my ("I" tooth) because it is collapsing. When I soon go into uni I want to become a doctor or dentist.
 


Posted By : Dr. Mayura on 06-Feb-2012 06:33 AM
Very good, informative and to the point.
 


Posted By : Picky reader on 20-Jul-2011 08:21 PM

This is a very informative piece of writing on supernumerary teeth. It is very easy to understand.

 

 
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