Supernumerary teeth in children

Supernumerary teeth, also known as hyperdontia, refer to the presence of extra teeth beyond the normal number in the primary or permanent dentition. These additional teeth can develop anywhere in the dental arches and can affect both the aesthetics and function of a child’s dentition. While not exceedingly common, supernumerary teeth are a significant clinical concern in pediatric dentistry due to their potential to disrupt normal oral development.

Types and Classification of Supernumerary Teeth

Supernumerary teeth in children are broadly classified based on their location, morphology, and occurrence:

1. Based on Location:

   • Mesiodens: Located between the two central incisors, this is the most common type of supernumerary tooth.

   • Distomolar (or fourth molar): Found distal to the third molar.

   • Paramolar: Located buccally or lingually to the molars.

   • Premaxillary supernumerary: Appears in the anterior maxilla, frequently affecting aesthetics.

   • Mandibular supernumeraries: Less common but may appear near the premolars or molars.

2. Based on Morphology:

   • Conical: Peg-shaped and usually small. Often erupts normally.

   • Tuberculate: Barrel-shaped with multiple cusps. Less likely to erupt.

   • Supplemental: Resembles a normal tooth, such as an extra lateral incisor or premolar.

   • Odontoma: A type of benign tumor composed of dental tissue.

3. Based on Occurrence:

   • Single: Most commonly seen in mesiodens.

   • Multiple: Frequently associated with syndromes like cleidocranial dysplasia or Gardner’s syndrome.

   • Unilateral or Bilateral: Can appear on one or both sides of the jaw.

Causes and Risk Factors

The exact cause of supernumerary teeth is not fully understood, but several theories and contributing factors are recognized:

• Genetic predisposition: A family history of supernumerary teeth can significantly increase the risk.

• Dichotomy theory: Suggests that a tooth bud splits into two, forming an extra tooth.

• Hyperactivity of the dental lamina: Overproliferation of cells in the dental lamina, which gives rise to tooth buds.

• Syndromic associations: Children with conditions like cleidocranial dysplasia, Gardner syndrome, and cleft lip/palate often present with multiple supernumerary teeth.

Symptoms and Clinical Presentation

Supernumerary teeth may be asymptomatic and discovered during routine dental exams or radiographs. However, they can lead to various dental problems, including:

• Delayed eruption of permanent teeth

• Malalignment or crowding

• Impaction of adjacent teeth

• Diastema (gap between teeth)

• Cyst formation around unerupted supernumerary teeth

• Aesthetic concerns, especially in the anterior maxilla

In some cases, children may present with a visible extra tooth, or parents may notice a delayed eruption of a permanent tooth, prompting a dental consultation.

Diagnosis

Early diagnosis is critical to prevent complications. Diagnosis typically involves:

• Clinical examination: Visual inspection of the oral cavity for extra or delayed teeth.

• Radiographic evaluation: Periapical, panoramic, and occlusal radiographs help in identifying the number, location, and orientation of supernumerary teeth.

• CBCT (Cone Beam Computed Tomography): In complex cases, 3D imaging provides detailed anatomical views to guide treatment planning.

Management and Treatment Options

The management of supernumerary teeth depends on several factors including the number, type, location, and impact on adjacent teeth.

1. Monitoring:

   • Asymptomatic, non-erupting, or non-obstructive supernumerary teeth may be monitored with periodic evaluations.

   • Close observation is preferred when the tooth does not interfere with eruption or alignment.

2. Extraction:

   • Indicated when the supernumerary tooth causes or is likely to cause complications such as delayed eruption, displacement of adjacent teeth, or formation of cysts.

   • Extraction is often recommended when the permanent teeth are still developing to allow for spontaneous alignment.

3. Orthodontic treatment:

   • Necessary when supernumerary teeth have caused displacement or spacing issues.

   • Braces may be used post-extraction to align teeth properly.

4. Surgical removal under general anesthesia:

   • Considered for young children or in complex cases where the supernumerary tooth is impacted deep within the jawbone.

Timing of Intervention

Optimal timing for intervention is crucial to minimize the risk of damaging the surrounding teeth or structures. In general:

• Early intervention (ages 6–7) is recommended for mesiodens to facilitate the eruption of central incisors.

• Delaying treatment until root development of adjacent teeth is complete may be preferred in other cases to avoid complications.

Complications of Untreated Supernumerary Teeth

If left untreated, supernumerary teeth can result in:

• Severe crowding

• Impaction of permanent teeth

• Malocclusion

• Developmental cysts

• Root resorption of adjacent teeth

• Oral infections or gum issues

Early detection and intervention can prevent these long-term complications and support proper dental development.

Preventive and Supportive Measures

While supernumerary teeth themselves cannot be prevented due to their genetic and developmental nature, proactive dental care plays a vital role in minimizing their impact:

• Routine dental visits starting from the eruption of the first tooth or by age 1.

• Radiographic screening if delayed eruption or unusual spacing is observed.

• Parental education on normal dental development milestones.

• Timely orthodontic referrals when malocclusion or crowding is present.

Syndromic and Genetic Considerations

When supernumerary teeth are part of a syndrome, a multidisciplinary approach is necessary. In such cases, pediatricians, geneticists, oral surgeons, and orthodontists must work together. Common syndromes associated with multiple supernumerary teeth include:

• Cleidocranial dysplasia: Characterized by delayed closure of cranial sutures, hypoplastic clavicles, and numerous impacted supernumerary teeth.

• Gardner’s syndrome: A genetic condition involving intestinal polyps and multiple supernumerary teeth.

• Cleft lip and palate: Often associated with dental anomalies including supernumerary teeth in the cleft area.

Conclusion

Supernumerary teeth in children are more than just an anomaly; they are a potential disruptor of the normal developmental and functional processes of the dentition. Their early identification through routine dental exams and radiographs is crucial. Management should be individualized, considering the type, location, and impact of the extra tooth or teeth. With timely intervention, including extraction and orthodontic correction when needed, children can achieve optimal oral health and functional dentition, minimizing future complications.