Hyperdontia in children is a rare condition in which extra teeth are grown in the mouth. Usually, children have 20 deciduous teeth (primary teeth), while adults have 32 permanent teeth. As children grow, the primary teeth are gradually replaced by permanent teeth. Some children may get extra teeth on the upper or lower jaw, called supernumerary teeth. These can be permanent or primary, depending on when they get (1).
Hyperdontia is a developmental problem, and there is a 3.8% incidence rate in children (2) (3). The incidence rate is twice as frequent in boys as in girls. Keep reading this post to know the causes, types, and effects of hyperdontia in children.
Types Of Hyperdontia
The following is the classification based on the shape.
- Conical: This tooth is small and peg-shaped (wider base and narrower top) with normal roots.
- Tuberculate: This tooth is barrel-shaped and has a rudimentary root. It often occurs in pairs.
- Supplemental (eumorphic): This can be described as duplication of a tooth. The supplementary tooth is similar to the tooth near it.
- Odontome: This tooth has no defined or regular shape. It appears more like a disorganized and diffused mass of dental tissue.
The following are the types of extra supernumerary teeth based on location.
- Mesiodens: The supplementary tooth is located between two central incisors. It is the most common type of supplementary tooth.
- Paramolar: The supplementary molar or extra tooth grows buccally or palatally (towards the back of the mouth) to one of the molars.
- Distomolar: The tooth grows posterior or distal (behind) the third molar.
- Parapremolar: The extra tooth grows in the premolar region.
The extra teeth can appear as a single tooth, as well as multiple teeth. However, multiple supplementary teeth are rarely seen and are mostly associated with conditions such as cleft lip or palate and Gardner syndrome (1).
Symptoms Of Hyperdontia In Children
The main symptom is the growth of extra tooth or teeth near a primary or permanent tooth. Your child might even complain about an extra tooth in the mouth. A doctor can determine the type of supernumerary teeth by examining the location and morphology (shape) of the extra tooth or teeth.
Causes Of Hyperdontia In Children
The causes of hyperdontia are not well understood. However, the condition has been associated with factors including genetic conditions, familial tendency, and overactive dental lamina (the part that initiates tooth formation) (1) (4) (6).
- Cleidocranial dysplasia: This genetic condition affects the development of bones and teeth. Individuals with cleidocranial dysplasia often display the development of supernumerary teeth and retention of primary teeth (7).
- Cleft lip and palate: This condition is a birth defect and occurs when a baby’s lip or palate of the mouth (upper part of the mouth) does not form properly during pregnancy. This results in an opening in the upper lip and is likely to result in hyperdontia (8).
- Gardner syndrome: This rare genetic disease causes multiple colorectal polyps and various types of tumors (benign and malignant). This disease can increase the risk of developing supernumerary teeth, along with other dental problems (9).
- Ehlers-Danlos syndrome: This genetic group of disorders affects connective tissues supporting blood vessels, skin, bones, and other organs. This condition can cause loose joints and other life-threatening conditions (10). Dental abnormalities is one of the many symptoms of the condition.
- Down syndrome: This is a genetic condition where an individual has an extra chromosome number 21 (11). This syndrome is characterized by distinct facial features, intellectual disability (mild to moderate), and birth defects, including the probability of having hyperdontia.
- Fabry-Anderson syndrome: This hereditary disorder causes the accumulation of a certain type of fat in the cells of the body. It may cause several signs and symptoms, like hyperdontia, pain in hands and feet, dark red spots on the skin, hearing loss, and decreased ability to sweat (12).
How Is Hyperdontia Diagnosed?
Supernumerary teeth are detected through X-ray and examination of the mouth. Healthcare practitioners may also thoroughly evaluate family and medical history, along with clinical examination (5). The presence of supernumerary teeth can be suspected if there is no eruption of permanent teeth (5).
Treatment Of Hyperdontia In Children
Early diagnosis and appropriate treatment are necessary to avoid complications in the case of hyperdontia. The treatment options may vary depending on the location and type of supernumerary teeth and its effect on the neighboring teeth or tissues. Treatment options include (5).
- Extraction or removal: Clinicians may suggest extraction or removal of the supernumerary tooth in the following cases.
- There is a complication associated with it.
- There is a delay in the eruption of a permanent tooth.
- There is an increased risk of infection since extra teeth may make it difficult to maintain oral hygiene.
- There is misalignment, displacement, or rotation of a neighboring tooth.
- Extra teeth cause aesthetic (appearance) or functional issues.
- Endodontic therapy (root canal): If a supernumerary tooth has fused with a permanent tooth, then the doctor may recommend root canal treatment.
- Clinical follow-up or frequent observation: In some cases, doctors may not extract the supernumerary tooth but keep it under observation until the eruption of the adjacent teeth. If the child does not face any problems, such as pain, and there is no risk of future complications, like infection, then the doctor might let the extra tooth or teeth remain in the mouth.
Complications Associated With Hyperdontia In Children
- Failure of eruption: Supernumerary or extra tooth interferes with the normal eruption of the permanent tooth.
- Displacement or rotation: Supernumerary tooth may cause displacement or rotation of a permanent tooth.
- Overcrowding: Growth of extra teeth results in crowding, causing aesthetic or functional problems.
- Diastemas: These extra teeth may also create a gap or space between teeth (usually in the front teeth of the upper jaw).
- Development of odontogenic cyst: Supernumerary teeth can cause the formation of jaw cysts or tumors.
- Root resorption of neighboring (adjacent) teeth: Although rare, supernumerary teeth may cause root resorption (breaking down leading to loss) of neighboring teeth.
- Eruption in the nasal cavity: Sometimes, the extra tooth may erupt in the nasal cavity and can be seen as a white mass in the nasal area.
Hyperdontia in children is not a common condition. It may lead to issues with speech, mastication, and aesthetics. Your child’s dentist will mostly diagnose the condition during your regular dental check-up. A physical examination can help a dentist diagnose the presence of supernumerary teeth. The condition may run in families. If there is a tooth that constantly pinches your tongue or cheeks, it is recommended to see a dentist as soon as possible. Dental extractions are the best treatment for most cases.
2. Meighani G. and Pakdaman A., Diagnosis and management of supernumerary (mesiodens): a review of the literature; Journal of Dentistry
3. American Academy of Pediatric Dentistry, Management considerations for pediatric oral surgery and oral pathology (Reference manual): The Reference Manual of Pediatic Dentistry
4. Kirtaniya B. C. et al., Review of Supernumerary Teeth and their Management in Children; International Journal of Oral Health and Medical Research
5. Parolia A. et al., Management of supernumerary teeth; Journal of Conservative Dentistry
6. Demiriz L., Durmuslar M.C., and Misir A.F., Prevalence and characteristics of supernumerary teeth: A survey on 7348 people; Journal of International Society of Preventive & Community Dentistry
7. Cleidocranial dysplasia; Genetic Home Reference, U.S. National Library of Medicine
8. Facts about cleft lip and cleft palate; Centers for Disease Control and Prevention
9. Gardner syndrome; Genetic and Rare Diseases Information Center, National Center for Advancing Translational Sciences
10. Ehlers-Danlos syndrome; Genetic Home Reference, U.S. National Library of Medicine
11. Downs syndrome; Centers for Disease Control and Prevention
12. Fabry disease; Genetic Home Reference, U.S. National Library of Medicine