Hyperdontia In Children - Types, Causes, Signs And Remedies

Hyperdontia In Children

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Remember that moment when your little angel flashed his first toothy grin, with those tiny whites gleaming proudly? Wasn’t it the sweetest moment ever? But, what if you find that your kid has spurted one tooth too many? Like most concerned parents, you’ll probably rush to the dentist, who’ll tell you that your little critter has something called ‘hyperdontia’. And, before you say “Hyper what?” let’s look at some information that could help you learn more about the condition. Here, MomJunction has created a comprehensive knowledge bank on hyperdontia in children. Read on to find out more.

What Is Hyperdontia In Children?

Hyperdontia is a condition that causes extra teeth in children. It’s a rare condition, and about one to four percent children have extra or supernumerary teeth. Also, the number of boys with hyperdontia is higher than girls with the same condition.

While the thought of extra teeth can summon troubling images, there isn’t much your kid can do about it. All levity aside, it’s best to understand certain facts so that you accept your child’s extra teeth and then make an informed decision to treat the condition.

When your baby is born, he will not have teeth. However, by the time he is 36 months old, he will get his first teeth, which we call primary teeth. A child usually has 20 primary or baby teeth, and when he reaches the age of 12, he would have shed these milk teeth to get 32 permanent teeth. Of course, all 32 may not be developed. Remember wisdom teeth usually erupt later. But, by the time your kiddo is 21, he should have all his permanent teeth.

If your little one has more than 20 primary teeth or over 32 permanent teeth, he has hyperdontia [1]. The extra teeth can develop from separate tooth buds, or the bud of the permanent tooth can split into two, resulting in two teeth. Usually, hyperdontia will be visible when your child begins losing his baby teeth. These additional teeth can grow anywhere in your baby’s mouth – gums, behind the gumline, in front of the gumline, and even the roof of the mouth. Your kid’s one additional tooth may put you in a state of shock and panic. Just think about the parents of an 11-year-old girl in the UK who had 81 teeth! Now, doesn’t that make you feel better already!

Studies show children who have extra baby teeth generally tend to have a higher chance of having extra permanent teeth [2].

[ Read: Facts About Teeth For Kids ]

Types Of Hyperdontia In Children:

Dental health experts and researchers classify extra teeth based on their morphology and location. Different types of hyperdontia in children are as follows:

1. Mesiodens:

Mesiodens are the most common type of supernumerary teeth you will find in children. Here, the extra tooth develops between the two front upper central incisors. Within mesiodens, there are two more subclasses:

a. Eumorphic:

A eumorphic extra tooth is similar to a normal-looking incisor.

b. Dysmorphic:

A dysmorphic supernumerary tooth has different shapes and sizes, and hence, can easily be distinguished from the adjacent teeth. Dysmorphic teeth are further categorized as:

i. Conical:

Usually, the extra tooth is part of the permanent teeth. It is small in size and shaped like a peg. It can develop along with the permanent incisor or erupt before it. It can lead to displacement or rotation of the permanent incisor.

ii. Tuberculate:

Here, the extra tooth has a tubercle or cusp. It is barrel-shaped and may also be invaginated. The root does not form as early as that of the permanent incisor. Tuberculate supernumeraries usually occur in pairs.

iii. Supplemental:

Here, there is a duplication of teeth in the regular series, and the copy occurs at the end of the tooth series. The most common supplemental teeth are the permanent maxillary lateral incisors, but your child can also have supplemental premolars and molar. Supplemental teeth are present in primary teeth.

iv. Odontoma:

This particular subclass is not accepted by all researchers because any tumor in the odontogenic region is called odontoma. While experts agree that odontoma is a malformation, they do not agree it is neoplasm. The tumor has several types of tissue and hence, is also called composite odontoma. [3]

[ Read: Tooth Decay In Children ]

2. Paramolar:

As the name suggests, paramolar refers to an additional molar growing next the molars. It usually erupts outside the arch of normal dentition, to the side of the tooth. It will be rudimentary is size [4].

3. Distomolar:

When there is an extra molar growing behind the third molar, it is called distomolar. The occurrence of this type of supernumerary tooth is rare.

4. Supplemental Tooth:

Although smaller in size, this tooth is an extra tooth in normal dentition. It looks like a regular tooth, and it is the size that allows you to discern that there is something wrong with it. The tooth will be smaller in size compared to the adjacent teeth.

Causes Of Hyperdontia In Children:

Researchers still do not know the exact causes of hyperdontia in children. However, they do believe several factors, including genetics and environment, play a role. A child can also inherit supernumerary teeth. Children with the following syndromes can also have extra teeth:

1. Cleft Lip Or Palate:

Children born with cleft lip or palate usually have hyperdontia. The additional teeth are small, and conical. Usually, they’re located on either side of the cleft lip or on the palate.

2. Cleidocranial Dysplasia:

Cleidocranial dysplasia is when your child is born with partial or completely absent clavicle bone. This condition causes increased distance between the eyes, hearing loss, high roof of the mouth, susceptible to frequent infections, and cleft mouth. Children born with this condition usually have supernumerary teeth.

3. Gardner Syndrome:

This is another genetic syndrome that children can have. Gardner Syndrome results in large and multiple polyps in the bowel, several benign tumors in the jaw, and skin cysts. The syndrome also causes hyperdontia.

[ Read: Gum Disease In Children ]

Symptoms Of Hyperdontia In Children:

Your child will usually not have any symptom of hyperdontia. The discovery of supernumerary teeth usually is by accident when you approach the dentist for one of the following reasons:

1. Permanent Teeth Do Not Erupt:

You may notice that the primary incisors do not fall off as they should do. Or, your child may not get his maxillary central incisor after the primary incisor falls off. Due to extra teeth, even the other teeth adjacent to the supernumerary teeth may not erupt.

2. Displacement Of Permanent Teeth:

You may notice that your child’s teeth are getting displaced from their original position. This displacement can be mild or complete rotation of the teeth.

3. Crowding Of Teeth:

Remember, your child’s gumline and mouth are designed to hold just as many teeth as naturally possible. So if there are extra teeth, it will result in overcrowding of the teeth, causing the teeth to get deformed and displaced.

4. Speech Issues:

Due to the presence of too many teeth in the mouth, it will affect the ability of your child to speak clearly. Extra teeth can adversely impact your kid’s learning abilities as he will not want to talk since he sounds strange or has difficulties enunciating words.

5. Abnormal Facial Appearance:

Your child’s primary teeth also help define the facial appearance. With too many teeth in the mouth, his facial appearance will not seem normal. This can have a profound effect on your child’s self-confidence.

[ Read: Chipped Tooth In Children ]

Rare Symptoms:

On rare occasions, hyperdontia can lead to dentigerous cysts or result in the resorption of dental roots adjacent to the extra teeth.

Usually, parents approach a dentist when the baby teeth fall, and permanent teeth do not erupt in their place. This often prompts the dentist to perform a dental X-ray, and he then diagnoses hyperdontia. Other times, parents may approach a pediatric orthodontist when there is an alignment problem with the teeth, only to discover that their little one has extra teeth.

Treatment For Hyperdontia In Children:

You shouldn’t ignore hyperdontia in your little one. The extra teeth will not disappear, and your child needs a qualified and knowledgeable pediatric dentist to treat it.

“Hyperdontia does not go away on its own so treatment will be necessary to correct it,” explains Dr. Nanna Ariaban, a pediatric dentist in the U.S. “In rare cases, if left too long, the supernumerary teeth can fuse to permanent teeth, making it necessary for surgery to detach them.”

Dr. Ariaban goes on to explain the best course of treatment for hyperdontia in children. “Typically, I will recommend extracting the teeth before they cause any damage,” states Dr. Ariaban. She, however, emphasizes one thing. “Extraction depends on the location of the extra tooth and its relation to the other teeth. If we don’t foresee any problem from the extra tooth, it is sometimes possible to leave it, as long as we are certain no problems will arise in the future.”

Some ways to diagnose and treat hyperdontia in children are as follows:

1. Regular Dental Checkups:

You should ensure your child begins visiting a dentist by the time he is a year old. This way, the pediatric dentist can monitor his oral health and address hypodontia early. If you leave the extra teeth too long, they can cause more damage to the other teeth, primary and permanent.

2. Extraction:

As stated by Dr. Nanna Ariaban, extraction is an effective way to treat hyperdontia. When you consult the dentist, he will take a call. The dentist will remove the supernumerary baby teeth only if the teeth are loose and pose a risk for choking, as the tooth can enter the lungs. Otherwise, the extraction will take place when your baby’s permanent teeth start erupting.

If the dentist decides to extract the extra teeth in kids, you needn’t worry. He will give your little one general or local anesthesia to ensure there is no pain during extraction. In some cases, the dentist may have to cut the tooth and extract it in smaller pieces rather than the whole tooth in one go.

3. Orthodontic Approach:

Extra teeth can misalign the other teeth. If this is the case with your child, the oral health care practitioner will resort to orthodontic methods to ensure the misaligned teeth are in their proper place after the extraction of the extra teeth.

4. Endodontic Method:

This is a major oral surgery, and your dentist will resort to it only if the supernumerary and permanent teeth have fused. Here, the dentist will first remove the tissue around the root of the fused tooth and then surgically remove the fused tooth. This is because the roots are joined and the only way to remove the problematic tooth is through surgery. If you don’t remove the fused tooth, it will adversely affect your kid’s ability to chew and may also result in overcrowding and alignment problems.

[ Read: Oral Hygiene And Dental Care For Kids ]

The Treatment Protocol:

If the extra teeth are not causing your child any problem and the dentist feels they are not going to interfere with orthodontic tooth movement, he will adopt a watch-and-wait approach. This treatment plan will involve monitoring your kiddo’s teeth with the help of an annual X-ray.

The pediatric dentist will also warn you about possible complications, such as cysts and tooth migration that can damage the roots of the nearby teeth. If you think these complications are too much of a risk, you can opt to have the dentist remove your little angel’s supernumerary teeth.

On the other hand, if the roots of the extra teeth fuse with the permanent teeth, the dentist will wait until the root completes its cycle of development to extract the tooth surgically. This reduces the chances of damage to the roots.

Supernumerary Teeth In Children:

As stated earlier, supernumerary teeth in children can occur in any part of the dental arch. Children are most likely to have extra teeth in the upper arch along the anterior incisors. The next common supernumerary teeth are the maxillary and lower arch fourth molars. Usually, these extra teeth will be present as additional impacted wisdom teeth.

The common supernumerary teeth in children are a mesiodens. This tooth grows between the maxillary central incisors and is malformed and has a peg-like appearance [5].

Research shows hypodontia is prevalent in about 0.15 to 1.9 percent of the population, and it is more common in males than females [6]. The worrying part is that these extra teeth can grow in any part of your kiddo’s mouth. They may erupt or stay impacted, and can lead to numerous complications.

Some of the complications due to supernumerary teeth in children include:

  • Failure of eruption
  • Displacement or rotation of teeth
  • Crowding
  • Premature space closure
  • Dilacerations
  • Abnormal or delayed root development of the permanent teeth
  • Ectopic eruption
  • Formation of cysts

While we often associate supernumerary teeth with kids, researchers have found that these teeth are also present in adults with a similar frequency of 2.14 percent as in kids and younger teenagers [7].

In a survey comprising 18,155 infants, researchers found one out of 716 infants had natal teeth. These are teeth present at birth and are a type of supernumerary teeth. During the study, scientists also found that 61 percent of the test subjects had a pair of natal or supernumerary teeth. Out of these, 95 percent had primary central incisors, while five percent had supernumerary primary central incisors [8]. This research shows supernumerary teeth can not only be present in toddlers, older kids and adolescents, but also in newborn infants.

Extra Teeth In Children:

Don’t blame yourself if your child has extra teeth. These are things that you cannot control. Also, you shouldn’t panic about these additional teeth. Medical science has advanced sufficiently to treat conditions like extra teeth without leaving behind a trace. When treated by a qualified dentist at the right time, the extra teeth will not be of any consequence.

At least, you now know that your child is not a vampire with those additional incisors! The extra teeth in children can be present in the middle of the two front teeth in the upper dental arch, in the molar region or behind the wisdom tooth. Sometimes, the extra tooth can have the same shape as a normal tooth. On other times, the extra tooth may be present inside the jawbone, with no visible outward sign or symptom.

Extra teeth in children usually obstruct the permanent tooth from erupting. In such a case, the dentist will extract it. But, if this is not the case, the dentist will wait until the time is right for extraction. If the extra tooth is in the anterior part of the dental arch, it can lead to aesthetic issues as it will give your little one’s pearly whites an unsightly appearance.

Then there is the worry of dental decay. When your kiddo’s mouth is crowded with teeth, it will be difficult to brush them. 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. He is best placed to decide whether to extract the teeth or let them remain until the time is right. The treatment for extra teeth is tailored to each child. So what the dentist may offer one child may not be the right treatment for your child.

“While mesiodens are often detected in routine radiographs, the timing to remove such teeth is important. There is a need to balance the risk between damaging the developing permanent teeth and yet allow the adult incisors to spontaneously erupt into good positions,” explains Dr. Tabitha Chng, Associate Consultant in Pediatric Dentistry Unit, Department of Restorative Dentistry, National Dental Centre, Singapore.

In Conclusion:

Don’t wait until all the baby teeth fall off to approach an orthodontist to help your child. If you do, your kiddo will have limited treatment options. Typically, supernumerary teeth require extraction unless they don’t pose a problem to permanent teeth or cause any other complication. Your child’s dentist will be the right professional to answer your questions and clarify your doubts. Until then, you should dwell on this…

Researchers from the University of Sheffield have found that humans still have the genes that allow sharks to regrow their teeth.

“What it means is because we have the same genes to make teeth, we also have a regenerative program. We make two sets of teeth, but humans need more teeth, whether through loss or damage, so our second set is really quite valuable,” explains Dr. Gareth Fraser, the lead researcher from the university.

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