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Extra Tooth: Mesiodens and Other Supernumerary Teeth
Has your child ever come up to you and told you that they have an extra tooth growing out of their upper jaw behind their permanent teeth? It's probably more likely that you've been told that your child has an extra tooth, or supernumerary tooth (we try to make up complicated words!) as dentists like to call it.
If so, you're not alone! It is estimated that supernumerary, or extra teeth occur in 2% of Caucasian children, with an even higher frequency in those of Asian descent.
Below you can see an x-ray of a child with a supernumerary tooth. The original x-ray is on the left, and I outlined the supernumerary tooth in green in the x-ray on the right.
This particular extra tooth is called a mesiodens. That means that it is right between the two upper middle front teeth. Only about 25% of these teeth actually erupt into the mouth. Most mesiodens teeth stay in the jawbone and never make it into the mouth.
What Causes Supernumerary Teeth?
Currently, it is believed that supernumerary teeth occur due to the continued growth of the tissue that forms teeth, known as the dental lamina.
Supernumerary teeth can be hereditary or they may be associated with one of two conditions: Gardner's Syndrome and Cleidocranial Dysplasia. Supernumerary teeth can also occur in people that don't have those two conditions and in those withouta family history of supernumerary teeth.
How Common Are Extra (Supernumerary) Teeth?
It is estimated that supernumerary teeth occur in 0.1-3.8% of Caucasians. They are even more common than that in people of Asian descent, although I couldn't find any hard numbers.
Supernumerary Teeth are twice as common in boys as they are in girls. Most supernumerary teeth form before the age of 20, although they are more commonly found with the permanent teeth rather than the baby teeth.
What are Supernumerary Teeth Called?
Extra teeth have a lot of names! They are classified based upon where they are located and what they look like.
If an extra tooth is located in the middle of the two front teeth, it is called a mesiodens. If the extra tooth is located around the molar area, it is called a paramolar. If the extra tooth is located behind the wisdom teeth, it is known as a distodens.
If an extra tooth is shaped like another "normal" tooth, it is called a supplemental tooth. If it is not shaped like a normal tooth, then it is known as a rudimentary tooth. Rudimental teeth are then classified based on what they look like:
- Conical Rudimentary Teeth look small or peg-shaped.
- Tuberculate Rudimentary Teeth appear to be barrel-shaped and have more than one cusp.
- Molariform Rudimentary Teeth look similar to premolar or molar teeth, but not enough to be called a supplemental tooth.
What Does a Supernumerary Tooth Look Like?
When I was out visiting my sister last summer, she told me that my nephew had to get an extra tooth removed. She told me I could even take a picture and put it up on Oral Answers.
You can see my nephew's supernumerary tooth to the right. It was a mesiodens, since it was growing right between his front two teeth. As you can see, the tooth doesn't really resemble any particular tooth, it just looks like a cylindrical piece of enamel.
Where Do Supernumerary Teeth Occur?
Almost all (around 95%) supernumerary teeth occur in the upper jaw. They mostly occur between the upper two front teeth. After that, you are most likely to find a supernumerary teeth behind the wisdom teeth.
Interstingly, supernumerary teeth don't always occur in the jaws. Neville's Oral Pathology textbook states, "Although most supernumerary teeth occur in the jaws, examples have been reported in the gingiva, maxillary tuberosity, soft palate, maxillary sinus, sphenomaxillary fissure, nasal cavity, and between the orbit and the brain. The eruption of accessory teeth is variable and dependent on the degree of space available."
As you can see, supernumerary teeth can pretty much occur anywhere in your head, although they are most likely to occur in your jaws like the rest of your teeth.
Do You Need to Have Supernumerary Teeth Removed?
Most dentists recommend removing supernumerary teeth because they can cause problems. Regezi's Oral Pathology textbook states:
The significance of supernumerary teeth is that they occupy space. When they are impacted, they may block the eruption of other teeth, or they may cause delayed eruption or maleruption of adjacent teeth. If supernumerary teeth erupt, they may cause malalignment of the dentition and may be cosmetically objectionable.
Because they can cause problems, it is generally a good idea to have supernumerary teeth removed.
Conclusion
If you have extra teeth, don't be alarmed! It is pretty common to have supernumerary teeth. You can work with your dentist to figure out what your options are for removing the tooth and aligning your smile correctly.
Have you had a supernumerary tooth? Do you have any questions about supernumerary teeth? I'd love to hear what you have to say in the comments section below. Thanks for reading!
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Hi, I'm Tom. I'm currently a 4th year dental student in the USA. I started this blog to help people take better care of their teeth. You can 
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my son has supernumerary teeth in his upper front, and it was removed by surgery, doctor said that there is one more teeth is alive as supernumerary ( very beggning stage), now ( after four months of surgery) this teeth came out in a different shape ( cross way instead of normal),
now i am living far from my city and here dentists are helpless to say any advice,
expecting your kind advice please
best regards
nizal
Hi Nizal - Is there a reason that the surgeon didn't take out both supernumerary teeth when the first one was removed? It sounds like this other supernumerary tooth will need to be extracted - most do need to come out.
I hope that helps - Thanks for your comment, Nizal. Let me know if you have any other questions.
I just returned from the Dentist with my 8 year old son. The Doc showed me my Son's x-rays. He has three extra teeth (all on the upper jaw, in the front) And, one of them is upside down....in addition, he has a fused front tooth (which we have been aware of). The Doc is unsure what to tell me, he wants to consult with other Dentists.
What are the odds of my Son having both conditions...and that he has not one extra but three extra teeth?
Is there more to this then coincidence? Am I fretting over nothing, or is there a direction I should be heading?
Thank You
SueAnn
Hi SueAnn - Supernumerary teeth and fusion occurring in the same person is very rare, but it does occur. I was able to locate a few case reports on it. You can use Google Scholar to search for "fusion supernumerary teeth" to find some.
Are the fused front teeth permanent or baby teeth? Do you know if the supernumerary teeth are rudimentary (stubs that don't look like other teeth) or supplemental (extra tooth that look like real teeth.) If they are supplemental, it may be possible to surgically bring them down and work with them rather than the fused teeth - just a thought.
I wouldn't fret over it. It is most likely a coincidence. There are some syndromes that are associated with extra teeth, but many times they occur on their own.
I hope that helps, SueAnn. Let me know if you have any other questions.
Hi I have a small nub extra tooth above my gum over my wisdom tooth. I realized it a couple weeks ago. I went to the dentist a couple years back and they said my wisdom teeth grew in fine and that I don't need them removed, now I'm a little older and I noticed the tooth, it doesn't hurt and its sharp. I'm practically touching it all the time now because I'm so fascinated with it. Should I get it removed? P.s I hate the dentist and I don't like needles or pain
Hi Sena - It may not be complicated to remove - it might have a very short root. If it is sharp, it probably is a good idea to get it removed. It may also get in the way when you're brushing your wisdom teeth.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Sena.
Hi Tom,
Thanks for all your information here.
Can you please let me know the typical age for a child to have the mesiodens ( 2 mesiodens which are between two up front teeth, one has been erupted, the other once is upside down) removed? Is it too early to remove the mesiodens at 6 years old? What's the risk and impact for this kind of oral surgery? Do we need to take a 3D x-ray before the surgery?
Thanks,
Jaz
Hi Jaz - I found the following in Pinkham's Pediatric Dentistry textbook (note that a diastema is simply a fancy dental word for a space between the teeth) - "A diastema caused by a midline supernumerary tooth or abnormality is managed by removal of the supernumerary tooth or the abnormality. The supernumerary tooth should be removed as early as possible without causing injury to the adjacent permanent teeth."
Reading that, I would say that the earlier is the better. A cone beam CT scan would help the oral surgeon/dentist be able to better locate exactly where the two mesiodens are. A conventional x-ray would only show a two-dimensional picture. There are risks with any surgery. We have a consent form that the patient signs before each surgery that goes into all of the bad stuff that could happen, but will most likely not happen (such as damage to adjacent teeth, nerve damage, sinus damage, etc.) Although it is generally safe, there are always risks with sedation as well.
I hope that helps - Let me know if you have any other questions. Thanks for your comment, Jaz!
My daughter is 9 years old. She hadn't lost her 2 front baby teeth. The last xray shows that she has three extra teeth (all above her front 2 teeth). And then it looks like she has her two permanent teeth above the three extra ones. Two of the extra teeth look pointed and one looks like it might be an extra incisor. We are having a CT scan to see if the permanent teeth have actual roots. In the meantime, she had the 2 baby teeth pulled today. The plan is to see if any of the three extra teeth erupt. If not, an oral surgeon will remove them. Both our pediatrician and dentist indicate they haven't seen this before. Apparently, having 1 extra tooth is more the norm vs. 3 extra. Obviously we are worried about what her teeth will look like long term. Any advice? We just want to make sure we make the right decisions.
I have a simular problem to Sena, A couple of months ago, behind my wisdom tooth I noticed something white. I touched it and it was hard. After a couple of days the gum closed up over it. Now it has reappeared again. It has'nt caused me any problems at all. Is it normal to grow another tooth at 50yrs?
Hi Tom,
I love all of the information here! I was at the dentist yesterday. He took xrays and showed me that right behind my upper right K9? (sharp pointy ones) and before my premolars, I have 2 extra teeth. I am 28 years old and have had many xrays before. Could these have started growing recently? Or would they have to have been there since childhood? Also he said what was happening was rare. But I didnt understand if it was because of where they were or because I had 2.
He said that he was pretty sure they aren't issues and wouldn't worry about them. We took xrays of the other side, but I won't get those results back until the 7th.
Would love to hear your thoughts.
Thank you,
Karyn.
Hi Karyn - I am fairly certain that they would have started growing along with all of your other permanent teeth. Supernumerary teeth in the premolar area are more rare than along the midline and behind the wisdom teeth, but not unheard of.
I'm really not sure what I would recommend in your case since the teeth don't appear to be causing any problems. Sometimes there can be problems with impacted teeth such as certain cysts and tumors, but those are fairly rare. Keep us updated on what happens. Thanks for sharing your experience, Karyn.
Hi Tom
Firstly, thanks! This has been the most helpful article on supernumerary teeth, that I have found.
I have a 17 month old toddler who has just been given a referral to a paediatric dentist, for what appears to be a supernumerary tooth coming through between his two top front teeth. We were told that it is unusual for a baby to have a supernumerary tooth.
So far my son has 7 baby teeth. Three along the bottom, four front teeth up the top. He has always had a decent size gap between his top front teeth (as with two of my other children when they were little) but we had noticed that one of his front teeth seemed to be being pushed to the side (His frenum is no longer directly in the centre of his front teeth) and then more recently we had noticed a very hard white bulge appearing between his front teeth, and so we took him to our dental nurse.
We have been told that there could be a wait of several months to be seen by the paediatric dentist (on a public waiting list, as we have public health care where I am from) and I am concerned that this tooth erupting through could permanently misalign his teeth and the adult teeth following through later. Any advice?
Hi Tom
An update from us. We now have one very large supplementary mesiodens, almost entirely through, between my son's two front teeth. My son's two front teeth have been pushed significantly apart, and his upper left and right laterals have been pushed aside and back behind his front teeth. We are still waiting to be seen by the hospital oral surgeon, and this could take up to 6 months. I have concerns with how quickly this tooth has erupted and shifted his other top teeth, so have made a private appointment with a dentist, to seek a second opinion on our situation.
Our last update.
We have seen a dental surgeon at our hospital, who took a very basic X-ray of his top teeth (no anaesthetic, so done quickly and I don't feel the detail was very good) to confirm our very large supplementary supernumerary. They have recommended leaving it where it is, and keeping an eye out for any others. We have been told that it shouldn't affect the eruption and placement of his adult teeth. But to see our dental nurse again if there were any more or any issues.
We were also told that while supernumerary teeth were relatively common in adult teeth, they were uncommon in baby teeth, and sometimes a sign of genetic and development issues (for example, Down Syndrome children often have supernumerary teeth). We were told to keep an eye on our son for any issues such as his skeletal development, but as he seems to have very good physical and mental development, that his tooth is likely to be a one off random event.
The update is mainly for your other readers, since you haven't been in to answer queries in a while Tom. You've certainly started a popular topic!
Hi Tom, Thanks for being here. I am 53 and have two supernumeraries located above molars close to bicuspids in maxilla region each side. They occasionally cause migraines, as they are doing now, and they are above fully developed teeth some in crowns over root canals. (Malnutrition of trace minerals molybdenum and vanadium, I suspect). I have adrenal fatigue and the extra pain is draining my energy for days on end. I am allergic to the sulfites in Novacaine and sulphonamide class of antibiotics. What are the steps and ball park costs to remove these pain causing hyperdontia? And where does a dentist get the alternative numbing chemicals and how much is the cost per shot (expecting 5-8 may be needed)?
Hi Tom,
I have a 10 years old son and recently we have notice that one extra tooth is growing in front of the other tooth. I would like to know, whether I need to remove it immediately and how long the surgical procedure will take and other further actions I need to take care? Is his growth will be impact on the extra tooth?
Thanks,
Hello,
I am 15, and my wisdom teeth are growing, but in my upper jaw on the right side, I have 'extra tooth tissue' as the dentist called it, it is pretty much a monster wisdom tooth at the back, it has caused me pain in the past and all of a sudden it has started to hurt again, and when I try to brush my teeth, the gum in between the abnormal tooth and the one in front bleed, because there is a gap from where the extra tooth tissue is coming through. Do you know what my extra tooth tissue is called, or some more information about this?
Hi Tom
My son has just turned 18. He has a sub mucous cleft. He had a mesiodens(?) surgically removed when he was 5.
We had an OPG done today and it revealed that he has extra wisdom teeth on his lower jaw. He has had these X-rays done in the past and they didn't reveal these extra wisdom teeth. Why would that be?
These two extra wisdom teeth look like balls on the X-ray.
Any ideas??
regards,
Leonie
Hey, Tom!
I have a few questions regarding my extra tooth.
I've had this supplemental tooth that sits caddy cornered to my bottom front three teeth.
It came in when I was six, (21 now)but my dentists never told my mother that it was something to worry about. Problem is now, its been pushing into the back of my bottom teeth, fighting for a front row seat . Because of this my orthodontist noticed that the fun has receded fairly low and may one day expose the root if I don't do something now. My questions are:
1. When pulling one or two of my teeth, do I have a choice? one of the normal bottom tooths gum line is lower than the other affected tooth (two teeth's gum lines are affected), but the extra tooth still has a good gum line. I'd like to remove the tooth most affected and let the extra move ib.c. Do you think I may have a possibility at requesting that be done? Would the tooth not be receptive to repositioning even with the aid of braces?
2.I've heard from others once the gums recede they stay as such, but could it possibly be different when you're young and extracting extra teeth that would otherwise free up the gums? If the gums do stay low, should I just pull both affected teeth to eliminate the problem? As I get older my gum lining is only going to get worse,right? I'd like to start with a clean slate in that case, so to speak.
3.could I get this tooth extracted at the same time I get all my molars pulled, so as to be efficient and get all the pain over with in one go? Also would pulling my molars help create space in my mount th so that I may not have to pull the supplemental tooth, thereby letting them all spread out appropriately in my mouth?
Wow, so apparently my extra tooth was like a one in a million chance, as a Caucasian female who's extra tooth wasn't like any of the ones described lol. mine was on the bottom and wasn't between my two front teeth but wasn't by my molars either, it was by my canines. Mine never grew in because it was caught forming on an x-ray when I got my braces off when I was like 14. By the time I had it removed by an oral surgeon about 3-6 months later it had formed roots and was on track to be shaped like a normal tooth that would have been there. I'm not sure if there still called canines on the bottom but it was one of those teeth. So glad I got mine removed when I did though because they said that if it would have come in (as it would have come straight up) I would have to be put back in braces.
i have the same problem... did you get put to sleep?
Hi,
My dentist wants me to get braces and get the surgery.... I'm kind of scared about this whole surgery stuff. I have two teeth near the first 3 teeth in the front. its inside my gum and is completely taking over on the 3rd tooth in the front. I have really bad head aches that make me go blind for a couple of minutes. My jaw clicks and pops and totally hurts. What should i do before i get the surgery?
Alyssa
I have an extra Supernumerary tooth in my bottom right of my mouth right in the middle... the surgeon said it can be dangerous bc of my nerves its been in there for a couple years its causing my teeth to be crooked and is in my gums? should i go for a second opinion i am very nervous... he also wants to pull wisdon teeth.. he said it is a possibility i could get nerve damage what should i do?
should i go see another surgeon for a second opinion im 21.. i dont want jaw problems , nerve damage or anything like that.. im rally nervous..
Pls help!mydoughter is 11moth ald(thoday) and I noticed extra tooth between front two. It is growing totally opositenthen normal ones. Will it aventualy fall down, and will there grow up anotherone just like that or everything then will be ok. Sorry for grammar mistakes, my english is bed I hope you understood me.
Hello Tom : My 8.5 year old son has a mesioden near the roots of E & F. His pediatric dentist referred us to an oral surgeon and both of them agree that it should be removed based on the review of the regular and panoramic Xrays. The surgeon is recommending a CT scan to help him determine the best direction to approach the removal. I undertand that CT scans are useful when planning a dental implant, but is a scan REALLY necessary for a simple procedure like removing a mesioden ? I am concerned with unnecessary exposure to radiation. Thanks very much for your feedback !
A month or two ago, my younger sister, 14, showed me that she has an extra tooth growing behind her upper two front teeth. I thought it was the weirdest thing. Three or four days ago, I have begun feeling an extra tooth and it is now slightly visible, but mine is growing behind my lower canine on the left side. We both have to wait until our dentist appointments, which could be in a few months. Maybe we'll have them taken out together!
I've got one that's like half a molar growing above and kind of off the side of another molar. Known about it for over 20 years. Although strange looking, it's never given me any trouble and no one can see it. One dentist just remarked "there's an interesting situation". I guess it just makes you that much more unique.
Me AND my husband are dentists ...!!!! and i actually removed my daughter's (7yrs.- 9months) mesiodens about a year ago... then when we had another periapical radiograph yesterday ...we found another suppernumerary one which overlaps the right upper central incisor ....the roots of both centrals are pretty well developing ....(about half the normal length of the roots ) ...should i go for surgical extraction ...or wait ...and make another radiographs on regular intervals for follow up.. i'm really confused ... thanks for consultation