April 6, 2000
Dear Dr. Mady: My son is 14 years old and he has a funny looking extra tooth that has grown in the front of his mouth. The real permanent tooth is still underneath and we do not think it is going to come in. What should we do about this? - Margaret in River Canard
Dear Margaret: It appears that your son has what is known as a supernumerary tooth or extra tooth. Occasionally these are developed and their presence can cause some of the normal permanent teeth to assume the wrong position.
These supernumerary teeth are rarely normal in appearance and are usually peg-shaped or conical and may even occur in the primary dentition. They do appear more frequently among permanent teeth.
Their most common position is in the upper front incisor area, where you describe your son's to be. These teeth usually erupt into the mouth just prior to the regular permanent incisors. This can ultimately cause deflection or block normal eruption of normal teeth.
The reason that such supernumerary teeth occur is not clearly understood, and in lieu of a better explanation, many dental professionals, for many years have believed that their formation and existence may be attributed to atavism. This merely means that these teeth may be an indication that there was an effort on the part of nature to restore in man, teeth which have been eliminated in the process of evolution.
It is also important to understand that several members of the same family occasionally have supernumerary teeth occurring in the same relative position, which may also be traced through several generations, upholding the laws of inheritance.
Any decision regarding the impacted tooth in your son's situation must be made carefully with the team of your dentist, an oral surgeon and an orthodontist. Because of his age, most likely the tooth in question is not ankylosed (bonded to the bone) and there is a good chance that it can be helped to erupt into position. The root itself may not be fully formed at this time and this can only help the situation.
If it is determined that the extra tooth can be extracted and the normal tooth can be properly guided into position, the tooth will have to be surgically exposed by an oral surgeon. After this an orthodontist can gain the access that he needs to begin extruding the tooth into position with some type of orthodontic appliance.
If you choose to go this way, the process can become very time consuming and complicated. Another option would be to have the impacted tooth removed and leave the supernumerary tooth in place. If in fact the shape of this extra tooth is undesirable it can be cosmetically treated with a porcelain veneer or crown to make it appear as the normal tooth. .
It sounds like either one of these treatment modalities will work for your son. It is important that you sit down with your treating dentist and review all the specific options for your particular situation. Some cases are much more complicated than they sound and you need to have proper informed consent and information before commencing any form of corrective treatment for your son. Good Luck!
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5