A child’s teeth are growing in two rows: is it necessary to do something?

Normally, a person grows 52 teeth over a lifetime: 20 milk teeth and 32 permanent teeth. Supernumerary teeth are “extra” dental units that appear in addition to some incisors, canines, premolars or molars. In various medical sources, the phenomenon is called hyperdontia, supradontia or polyodontia. A superset can include 1–2 teeth or reach several hundred dystopic structures, be true or false.

Supernumerary teeth: causes of anomaly

The main cause of polyodontia is a violation of the formation or development of tooth germs. Doctors are considering several theories for this phenomenon:

1. Heredity – hyperdontia develops as a result of genetic abnormalities that can be transmitted from parents to children. In this case, the pathology should manifest itself in the patient’s closest blood relatives.
2. Splitting of the root germ of the tooth in the embryonic period of development. Usually observed after the mother becomes ill during pregnancy. Characteristic of single supernumerary teeth (1–2 pcs.).
3. Failure during the embryonic period of tooth formation with the formation of multiple dental buds (up to several hundred). It is observed when the mother lives in unfavorable environmental conditions, during treatment with dangerous drugs, taking drugs, or alcohol abuse.

In more rare cases, polyodontia develops as a result of odontoma, a benign tumor in the area of ​​the jaw arches. The disease is typical for children and young people during the period of active growth of tooth germs. Such a tumor structure may contain several tens or even hundreds of highly deformed dentin-enamel formations.

Provoking factors in the prenatal period:

• malfunction of genes - primarily the Msx1 gene (responsible for the formation of tooth germs);
• viral infections;
• taking teratogenic and potentially dangerous drugs;
• smoking, drug use, alcohol use;
• poor environmental conditions;
• exposure to radiation - not only direct exposure, but also increased general background radiation in the place of residence/work.

Reference! Some scientists consider the presence of supernumerary teeth as an atavism.
Thus, it has been scientifically proven that various species of the genus Homo could boast a set of teeth of 36–44 pieces. However, this theory does not explain in any way the appearance of multiple rudiments covering all spaces of the sky (a typical example is an Indian boy who had to remove 230 supernumerary units).

Symptoms of pathology

The main symptom is the presence of teeth beyond the natural set. They can have different positions, shapes and numbers. The process of teething of abnormal teeth is often accompanied by pain, fever, and inflammation of areas of the oral cavity. If measures are not taken in a timely manner, complications may develop:

• redness and swelling at the site of the impacted tooth;
• problems with chewing food and digestion;
• injuries to the mucous tissues of the oral cavity;
• violation of the position of the main teeth (dystopia) and the formation of malocclusion;
• various speech defects - mainly problems with the pronunciation of hissing sounds;
• loosening of adjacent normal teeth;
• deformation of the jaw bones.

In young children and adults, the pathology has its own nuances. They are associated with age-related characteristics of the body and affect the subsequent development of maxillofacial structures. Statistics on the spread of pathology in children and adults:

• 60% of cases are children and adolescents during the period of replacement of milk teeth with permanent ones;
• 35% of cases are adults;
• 5% of cases are small children during the period of growth of baby teeth.

Reference! Supernumerary teeth, as a rule, have a standard structure, sometimes with a smaller crown size. Less common are deformed formations of a teardrop-shaped, lumpy, chisel-shaped form.

Location

The eye teeth or canines are found in pairs on the upper and lower jaws. They occupy an intermediate position between the front and back teeth, adjacent to the lateral incisors and molars (in the primary dentition) or small molars (in the permanent dental set).

The formation of primary eye teeth begins in the second month of embryogenesis. Like other teeth, they originate from the dental lamina of the oral epithelium, but penetrate into the developing bone tissue somewhat deeper than the others. The development of permanent canines and the entire set of molars begins a little later (at about 4 months of intrauterine development), but occurs identically to the formation of baby teeth.

The canines are characterized by the following features that distinguish them from other teeth:

1. The presence of a single fairly long root, which is somewhat compressed on the sides.
2. A massive crown with 2 cutting edges converging at an acute angle.
3. The crown has a somewhat flattened shape, in which the labial and lingual surfaces meet at the cutting edge.
4. The upper canine is slightly larger than the lower one, it has a longer cutting edge and wider contact surfaces.

Such features in the location and structure of the eye teeth allow them to perform their main function well: holding food and tearing it into pieces.

Features of polyodontia in children

Possible symptoms of hyperdontia in childhood:

• intrauterine formation of teeth (a child is born with several teeth);
• the appearance of teeth in the first months, weeks and even days of life;
• delayed eruption of baby teeth.

This has unpleasant consequences:

• problems with feeding the baby - he does not latch onto the nipple well and sucks weakly;
• swelling of the mucous tissues can spread to the nasal area and cause breathing problems;
• poor closure of the dental arches causes severe salivation;
• a prolonged increase in temperature to 38C is possible.

Hyperdontia is especially harmful during the period of speech formation. Teeth located outside the general row prevent the tongue from taking the correct position when pronouncing most consonant sounds. Without eliminating the pathology, any speech therapist will be powerless.

In addition to true hyperdontia, children (less often adults) can develop the so-called false form of the disease. It is characteristic of the period of tooth change and develops during the eruption of molars next to the milk teeth that have not yet fallen out. This is a fairly common phenomenon that usually goes away on its own as the dentition finally forms. In some cases, orthodontic treatment may be required.

Digital haderup system

Haderup's system is simpler. It resembles the notation using the Zsigmondy-Palmer method, but instead of angles, the segments are indicated by the signs “ ” and “-”. The sign “ ” denotes the upper jaw, and the sign “-” denotes the lower jaw. In this case, the location of the sign relative to the number makes it possible to determine the segment.

The right side of the jaw has a sign after the number, the left - before the number. The system is more convenient than that of Zsigmondy-Palmer, since the use of signs reduces the likelihood of error compared to multidirectional angles.

Features of polyodontia in adults and adolescents

In adults, after complete replacement of complete teeth, the presence of additional units can lead to additional pathologies:

• chronic rhinitis, sinusitis when the wall of the maxillary sinuses is perforated by the roots of supernumerary impacted structures;
• interdental caries - due to teeth fitting too closely to each other.

Retention and dystopia

Adults are characterized by 2 main types of supernumerary teeth:

• Dystopic teeth are the name given to teeth with deviations in the direction of growth. The peculiarities of the formation of supernumerary units very often lead to dystopia. This is due to the fact that the space on the dental arch line is limited, and the roots of normal teeth simply push the “intruder” towards the cheek or palate.
• Impacted teeth – impaction occurs when a tooth loses its growth impulse and remains embedded in the jawbone. Impacted teeth can cause the adjacent normal teeth to become loose and cause them to shift and change the bite. Often cause pain.

On a note! According to statistics, hyperdontia accounts for up to 2% of cases of dental problems. Of these, 70% are associated with the appearance of single supernumerary teeth, 25% with a couple of such formations, and only in 5% complex multiple complexes of 3–4 or more teeth can be found.

Diagnostic methods

The main indication for diagnosis is the presence of an “extra” tooth in the patient’s oral cavity or obvious signs of its eruption (painful tubercle or swelling in the gum or palate). All of these signs can be identified through a routine visual examination, during which the dentist evaluates the condition of the oral cavity. To confirm the diagnosis and carry out differential diagnosis, an X-ray examination is performed - an orthopantomogram. If it is necessary to examine the dentition in several planes, computed tomography (CT) is additionally prescribed.

On a note! The patient may not be aware of the presence of impacted supernumerary teeth. In this case, hyperdontia is detected only by the results of an X-ray or CT scan of the maxillofacial region.

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Do supernumerary teeth need to be removed?

There is no clear answer to the question of what to do with “extra” teeth. Much depends on the shape, position and quantity. The following are subject to mandatory removal:

• baby teeth that interfere with normal growth and formation of permanent teeth;
• strongly dystopic structures - located on the palate or at a large angle to the lateral side of the gums;
• impacted formations that put pressure on the adjacent roots of normal teeth and provoke periodic inflammatory processes of soft tissues.

If the additional tooth does not cause discomfort and does not disrupt the development of the dentition, removal may not be necessary. Moreover, such a superset can play the role of a strategic reserve in case of damage to nearby normal teeth.

How does the removal work?

The removal procedure can be simple or complex. In the first case, the doctor is dealing with a fully erupted tooth, the root of which is not intertwined with the surrounding structures. Simple removal steps:

• The oral cavity is prepared - treated with antiseptics, anesthesia is given.
• Grasp the crown with forceps (in some cases, an additional incision of the mucous tissue is required to facilitate access).
• The elevator destroys the retaining ligaments.
• The root is freed and the tooth is removed.
• Clean the hole from tooth fragments and bones.
• Apply stitches (if necessary) and a healing bandage.

Complex extraction is prescribed in the case of impacted, semi-impacted or dystopic teeth with complex root shapes. The procedure is carried out with a deep incision of soft tissues, in especially severe cases - with opening of the jaw bone to gain access to the roots. The latter option is relevant for deep bone occurrence, position in close proximity to the cranial sinuses and orbits, as well as for irregularly shaped roots and a high risk of damage to complete teeth. A complex removal operation is performed by a dental surgeon.

Price

Our Center operates a case payment system, which guarantees patients no overpayments for additional services associated with implantation.

The implant installation case includes:

• cost of Nobel Biocare implants;
• doctor's work;
• consumables and superstructures;
• anesthesia;
• CT diagnostics before and after surgery;
• fixation of bone regeneration stimulators (up to 0.25 cm³) to the neck of the implant for simultaneous bone tissue growth in conditions of slight atrophy;
• antibiotics and painkillers at home;
• visits according to schedule.

The case for installing crowns and bridges includes:

• fixation of abutments;
• taking impressions;
• manufacturing, installation of crowns or bridges.

Sinus lifting and guided bone regeneration, if necessary, are paid separately.

Orthodontic treatment

Depending on the situation, it is used after tooth extraction or instead of it. In children, it is used to stimulate the loss of baby teeth and eliminate false hyperdontia, as well as to facilitate and accelerate the eruption of a normal set. In addition, orthodontic treatment with the installation of braces, mouth guards, dental plates or other auxiliary structures can straighten crooked teeth and return them to their proper place.

Before prescribing treatment, the dentist carefully evaluates the condition of the complete and supernumerary structures and, depending on the overall picture and prognosis for the future, can use both formations or leave the strongest and most durable tooth (not necessarily complete).

Bone tissue

As mentioned above, the jaw bones consist of spongy and cortical bone tissue. Cortical tissue is bone plates, 95% consisting of various mineral salts. These plates are arranged tightly, which is why the cortical bone is hard and durable.

Spongy tissue, on the contrary, is softer, since, for the most part, it consists of soft tissue, has a cellular structure, and the bone plates in it form partitions.

Bone tissue is made up of different types of cells, and each cell performs its own functions. Thus, osteoblasts are responsible for the formation of new tissue, and osteoclasts, on the contrary, for the destruction of old tissue, stimulating the renewal of bone tissue. Osteocytes are the main cells of bone. Interstitial cells are a kind of “lining” of bone.