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Supernumerary Teeth

Tooth Supernumerary

Supernumerary teeth imply the presence of additional teeth apart from the normal number and distribution and may occur during both deciduous and permanent dentition. It may appear at any site in the oral cavity either as single or multiple units, at one or more locations simultaneously. They are associated with numerous genetic conditions and are frequently an incidental finding, but they may cause complications which necessitate their removal, which is the primary treatment strategy.


Presentation

Patients may not present with any complaints, and the finding of additional teeth may be incidentally discovered during physical examination [13]. However, in patients with symptomatic development, inspection of the oral cavity will reveal the presence of additional teeth. Sometimes they may be asymptomatic; however, they may be often accompanied by local swelling, redness, and sometimes local tissue destruction, which may result in pain. However, close inspection of the oral cavity may not initially reveal the presence of supernumerary teeth, particularly if the tooth did not erupt, which further challenges the physician to make the diagnosis. However, signs such as the ectopic eruption of otherwise normal teeth, rotation of teeth for an unknown reason, or a wide diastema observed on physical examination should alert the physician to investigate the cause of such events. If the supernumerary tooth is visible in the mouth, then the patient may complain of food lodgement, bad breath or difficulty in cleaning that area. Most of the times, patient complain of aesthetic issues in the presence of supernumerary teeth like mesiodens.

Physician
  • A general physician was consulted who confirmed that there was no associated syndrome. Family history did not reveal any positive findings.[ncbi.nlm.nih.gov]
  • However, close inspection of the oral cavity may not initially reveal the presence of supernumerary teeth, particularly if the tooth did not erupt, which further challenges the physician to make the diagnosis.[symptoma.com]
Turkish
  • CONCLUSIONS: The prevalence of supernumerary teeth in Turkish children was 2.7% in this study.[ncbi.nlm.nih.gov]
Anemia
  • One of the patients was also suffering from Fanconi's anemia. Despite the similarities (aggressive periodontitis accompanied by supernumerary teeth) in the previous reports, we do not agree with the earlier results.[ncbi.nlm.nih.gov]
Short Stature
  • A family with the clinical diagnosis of supernumerary teeth, short stature and craniofacial dysplasia was examined. Molecular genetic analysis found that mutation occurred in the RUNX2 gene.[ncbi.nlm.nih.gov]
Disturbance of Growth
  • We also observed disturbed cranial growth and suture activity in the Il11ra null mutant mice, in which reduced size and remodeling of limb bones has been previously described.[ncbi.nlm.nih.gov]
Hepatosplenomegaly
  • Zimmermann-Laband syndrome is a rare autosomal dominant disorder that is characterized by gingival fibromatosis, ear, nose, bone, and nail defects, and hepatosplenomegaly.[ncbi.nlm.nih.gov]
Malocclusion
  • The prevalence rate of ST was higher in Class III malocclusions (5.2%) and was a rare finding among Class II malocclusions (0.1%). The occurrence rate of ST was higher in maxilla (78.5%) than in mandible (21.5%).[ncbi.nlm.nih.gov]
Dental Caries
  • Impacted teeth may be associated with periodontal disease, dental caries, odontogenic cyst and tumors, pain of unerupted origin, jaw fracture, and resorption of root of the adjacent tooth.[mjmsr.net]
  • Conclusion: Advanced dental caries is the most common cause behind tooth extraction. Keywords: Caries, Periodontitis, Restoration failure, Tooth extraction, Oral hygiene. (JPMA 62: 812; 2012).[jpma.org.pk]
  • Dental caries was observed in 36 and 46 and 55 was mobile. A supernumerary tooth was found in the place of maxillary left central incisor [Figure - 5] and [Figure - 6]. The following was the dentition observed during clinical examination.[jisppd.com]
  • This increases the chances of dental caries. So speak to your dentist about the best way to maintain optimal oral hygiene. If you do notice extra teeth erupting in your child’s mouth, it is time to head to the dentist.[momjunction.com]
Anterior Open Bite
  • On examination class I malocclusion with severe crowding of upper anteriors, anterior open bite of 5 mm, cross bite with upper right posteriors, upper midline shift to right by 5 mm and two supernumerary teeth placed buccally in between 16 & 17 and 26[ncbi.nlm.nih.gov]
Prognathism
  • The oral findings commonly seen with Sotos syndrome include: premature eruption of teeth; high, arched palate; pointed chin; and, more rarely, prognathism.[ncbi.nlm.nih.gov]
High Arched Palate
  • The oral findings commonly seen with Sotos syndrome include: premature eruption of teeth; high, arched palate; pointed chin; and, more rarely, prognathism.[ncbi.nlm.nih.gov]
Eruptions
  • Many complications can be associated with supernumeraries, like impaction, delayed eruption or ectopic eruption of adjacent teeth, crowding, development of median diastema and eruption into floor of the nasal cavity.[ncbi.nlm.nih.gov]
Ankylosis
  • Tooth impaction involves factors such as lack of space in the alveolar process, trauma, ankylosis, and mechanical barriers such as abnormal frenum, supernumerary teeth, tumors, and local cysts.[ncbi.nlm.nih.gov]
  • Its removal may solve the problem but if you are not having any troubles with your hyperdontia, you better leave it as it is to avoid complications of supernumerary teeth extraction such as severed blood vessel and nerve, maleruption, ankylosis, fractured[emedicalhub.com]
Advanced Bone Age
  • Abstract Sotos syndrome is a genetic disorder characterized by early and excessive growth, acromegalic features, mental retardation, advanced bone age, and a distinctive facial appearance.[ncbi.nlm.nih.gov]
Pointed Chin
  • The oral findings commonly seen with Sotos syndrome include: premature eruption of teeth; high, arched palate; pointed chin; and, more rarely, prognathism.[ncbi.nlm.nih.gov]

Workup

They can be identified by clinical examination by a dentist if the tooth has erupted in the mouth.

The diagnosis of supernumerary teeth is achieved through the use of X-rays of the oral cavity, where additional teeth may be clearly observed. OPG provides a good view of all teeth and is the initial radiographic procedure of choice. Alternative methods include the use of 3D-CT scan, which is somewhat more expensive, but perhaps more efficient in diagnosing additional teeth. In any case, a detailed radiographic workup is necessary to confirm the diagnosis.

When supernumerary teeth are observed in patients, a detailed family history should be obtained, since it has been hypothesized that various genetic diseases are in connection with the development of additional teeth [14].

Treatment

Before definite treatment is established, the localization and identification of all supernumerary teeth should be determined (whenever one additional tooth appears, the occurrence of more should be excluded before starting treatment) , as well as the status of the surrounding tissue should be accessed. If the additional teeth cause no complications and no discomfort to the patient, treatment may be postponed, and regular monitoring is sufficient. However, if potential complications such as the formation of cysts, migration to other sites such as the nasal cavity, and subsequent bone destruction are present, then surgical treatment should be initiated as soon as possible [15]. A series of radiographs may be required to assess the location of the supernumerary impacted tooth and for deciding the surgical approach.

Extraction of additional teeth is usually indicated, and early extraction is proven to be of benefit, as it prevents the potential injury to the surrounding tissue. More importantly, tooth extraction in early stages may lead to auto-correction of rotated and displaced teeth, although an increased risk of interfering with adjacent roots of other teeth is present with early tooth extraction. Another indication for early surgery is the normal tooth eruption limited by the presence of an additional tooth. It is established that up to 90% of impacted permanent incisors erupt within 18 months after additional tooth removal, which provides sufficient proof to indicate early surgery.

Post-operative care is equally important in the treatment process, including regular follow-up of patients and observation of the behavior of teeth after extraction of supernumerary teeth.

Prognosis

Supernumerary teeth usually present as aesthetic, but sometimes as a functional issue, and may be debilitating for the patient. However, surgical treatment is effective in resolving the issue of additional teeth, but the surgical approach to this condition must be conducted carefully, to determine how to remove additional teeth without causing post-operative complications.

Etiology

The exact mechanism of occurrence of supernumerary teeth is not yet understood, and several theories have been proposed, while a combination of environmental and genetic factors has been suggested to play a key role in the development of this condition [4] [5] [6]. Several genetic syndromes have been associated with this occurrence, including cleft lip and palate, Cleidocranial dysplasia, Gardener syndrome (also known as familial colorectal polyposis), Fabry disease, and many other, implying a genetic component in the pathogenesis [7] [8].

Supernumerary teeth can be classified according to chronology, location, morphology and their orientation [9]. Chronologically, they are classified into pre-deciduous, similar to permanent teeth, and post permanent or complementary teeth; in terms of morphological classification, they are divided into conical, supplemental, tuberculate, and odontoma; topographic distribution divides supernumerary teeth into paramolars, mesiodens, distomolars, and parapremolars. Orientation implies whether teeth are vertical, transverse, or inverted, and these guidelines enable somewhat easier classification of supernumerary teeth [10].

Epidemiology

Prevalence rates of supernumerary teeth are established to be between 0.8% and 3.6% [11], and this disorder is encountered in males more commonly, with a 2:1 ratio, for reasons that are not yet understood. Supernumerary teeth much more frequently occur during the permanent dentition period rather than in the deciduous period [11].

Sex distribution
Age distribution

Pathophysiology

The appearance of supernumerary teeth occurs for unknown reasons, but when they do appear, they can potentially cause significant damage to the surrounding structures [12]. In a certain number of cases, they may remain unerupted, and cause minimal damage, but in some cases, they may also induce displacement and rotation of adjacent teeth, as well as crowding, and eruption into the floor of the nasal cavity, which may result in tissue destruction and the development of follicular cysts.

Prevention

Prevention of this condition cannot be performed at the moment, as the cause and the mechanism of occurrence have not been identified.

Summary

Supernumerary teeth are defined as those that appear in addition to the fixed number of teeth that are present during deciduous or permanent dentition. Their location can be anywhere in the oral cavity and may appear either as single or multiple teeth, both unilaterally and bilaterally. They are a rare occurrence [1] and are associated with several genetic syndromes, such as cleft lip and palate, Fabry disease, and many others, which links the development of this disorder to a genetic cause. A substantial number of cases are undiagnosed, because they may not erupt and be not visible, and are often an incidental finding on X-rays. It is more prevalent among males because of unknown reasons. The appearance of supernumerary teeth more commonly occurs during the process of permanent dentition [2]. The presence of extra teeth can be asymptomatic, but patients often report misalignment or rotation of their teeth, and depending on the level of the eruption, they can cause damage to the surrounding structures, or they can cause extensive focal swelling and necrosis [3]. The diagnosis is confirmed by radiographic techniques, such as X-ray techniques including the orthopantomogram (OPG), and three-dimensional computed tomography (3D-CT). Treatment primarily involves surgical removal of additional teeth. However, surgical treatment follows certain guidelines in terms of optimal timing and initiation of treatment, guided by imaging results.

Patient Information

Supernumerary teeth is the term for the presence of an increased number of teeth than regular, and they may appear during both deciduous and permanent dentition. Most patients have one additional tooth, but two or more teeth may appear as well, and they can appear in different locations simultaneously. It is still not understood why supernumerary teeth appear. A combination of genetic and environmental factors has been proposed in the pathogenesis model of supernumerary teeth. Between 0.5 and 3% of children in certain studies have been established to have additional teeth, and it has been noted that this syndrome develops more commonly among males. Patients with supernumerary teeth are usually asymptomatic, as the additional teeth may not cause any complaints, but the majority of patients report some degree of discomfort, and most common symptoms include pain, swelling, as well as rotation of regular teeth. Depending on the level of tooth eruption, the patient may have minimal changes in the oral cavity, or sometimes, local redness, swelling, and tissue destruction may occur. In addition to the discomfort, the supernumerary teeth may cause aesthetic problems that may be prominent as well, which can be a sole indication for treatment in some patients. Physical examination of the oral cavity may reveal an additional tooth, but this may be difficult if the tooth eruption has not occurred yet. For these reasons, a definite diagnosis of supernumerary teeth is confirmed by performing an X-ray of the entire oral cavity, usually called the orthopantomogram, which gives a clear view of all the teeth, and physicians may easily identify the additional tooth. Another technique which might be used is three-dimensional computed tomography, which is more expensive but provides a better view of the oral cavity and the soft tissues.

Treatment of supernumerary teeth is primarily surgical, but surgical treatment should be carefully evaluated through a full workup, and evaluation of adjacent tissue, since these teeth may cause local tissue injury, and sometimes even protrude to adjacent structures and cause bone destruction. However, surgical treatment provides maximal efficacy in resolving this condition.

References

Article

  1. Yusof WZ. Non-syndromal multiple supernumerary teeth: Literature review. J Can Dent Assoc. 1990;56:147–9.
  2. Rajab LD, Hamdan MA. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Pediatr Dent. 2002;12:244–54.
  3. Brook AH. Dental anomalies of number, form and size: Their prevalence in British school children. J Int Assoc Dent Child. 1974;5:37–53.
  4. Smith JD. Hyperdontia: Report of a case. J Am Dent Assoc. 1969;79:1191–2.
  5. Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dent Child. 1995;62:262–5.
  6. Brook AH. A unifying etiological explanation for anomalies of human tooth number and size. Arch Oral Biol. 1984;29:373–8.
  7. Scheiner MA, Sampson WJ. Supernumerary teeth: A review of the literature and four case reports. Aus Dent J. 1997;42:160–5.
  8. Grimanis GA, Kyriakides AT, Spyropoulos ND. A survey on supernumerary molars. Quintessence Int. 1991;22:989–95.
  9. Garvey MT, Barry HJ, Blake M. Supernumerary teeth- an overview of classification, diagnosis and management. J Can Dent Assoc. 1999;65:612–6.
  10. Shah A, Gill DS, Tredwin C, Naini FB. Diagnosis and management of supernumerary teeth. Dental Update. 2008;35:510–20.
  11. Kinirons MJ. Unerupted premaxillary supernumerary teeth. A study of their occurrence in males and females. Br Dent J. 1982;153:110.
  12. Jensen BL, Kreiborg S. Development of the dentition in cleidocranial dysplasia. J Oral Pathol Med. 1990;19:89-93.
  13. Scheiner MA, Sampson WJ. Supernumerary teeth: a review of the literature and four case reports. Aust Dent J. 1997;42:160-5.
  14. Vichi M, Franchi L. Abnormalities of the maxillary incisors in children with cleft lip and palate. ADSC J Dent Child. 1995;62:412-7.
  15. Primosch RE. Anterior supernumerary teeth -assessment and surgical intervention in children. Pediatr Dent. 1981;3:204–15.

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Last updated: 2019-07-11 21:20