A child has twenty teeth in the oral cavity during primary dentition, whereas tooth count increases to twenty-eight after the eruption of permanent teeth except for third molars. There may be instances in which the number of teeth may be more.
They can be single, multiple, unilateral, bilateral, and can be in any region of the arch. These extra teeth are termed Supernumerary teeth, which can occur in both deciduous and permanent dentition with predominance in the maxilla compared to the mandible and are more frequently seen in males.
Though the etiology of Supernumerary teeth is not clear, there are few theories about their formation. One school of thought suggests hyperactivity of dental lamina that may be the causative factor behind it, while according to some supernumerary teeth is heredity.
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Atavism is another theory that essentially is an evolutionary throwback that proposes a reversion to an ancestral human dentition with more teeth.
Their location, orientation, shape, and position have been termed Mesiodens, which are present between two central incisors. Distomolars are located distal to the third molar, while Paramolars are located buccally or palatally to molars.
Sometimes their position is unpredictable and is diagnosed on radiographs as impacted teeth adjacent to roots of permanent teeth (as shown in IOPA (1) impacted supernumerary tooth adjacent to the distal surface of the root of erupting 44).
For a definitive diagnosis, a paediatric dentist needs a comprehensive clinical and radiographic evaluation of the patient.
Mesiodense may pose esthetic changes (Fig:-1) in the smile zone of the patient either by causing malalignment of primary/ permanent teeth if erupted and Midline diastema, crowding, Dentigerous cyst if remain impacted, root resorption of adjacent teeth where erupted Paramolars usually do not cause any problem except for difficulty in cleaning and caries.
Early identification and a proper treatment plan can effectively reduce the chances of potential complications in the supernumerary tooth as related problems range from simply cosmetic issues to pathologic changes in the surrounding bone. Hence the management should be comprehensive rather than solely focused on the Supernumerary.
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