Tags Posts tagged with "Children’s Dentistry"

Children’s Dentistry

Colored Dental Tooth Fillings
©Kukshinov/Shutterstock.com

“Your child has a cavity.”

Not many parents want to hear those words, especially if their child has dental anxiety.

Last summer, I saw a three year old child who needed to have a filling on one of his upper molars.

Green Colored FillingThe only reason he sat still in the chair long enough for us to remove the decay and get a filling put in was because we told him we were going to give him a yellow colored filling.

He loved tractors, and wanted it to be yellow like his toy tractor. When he was all done, we took a picture of it and gave it to him so he could show his friends and family.

I’ve found that giving children a colored filling (along with some other things we do to make the comfortable), helps them to sit in the dental chair and get their needed dental work completed.

Find out why baby teeth need to have fillings if they just fall out.

Colored Fillings

Pink Colored FillingColored fillings are made of the same composite materials as tooth-colored fillings, they simply have more exciting coloring added to them.

At our office, we have five colors to choose from: blue, green, yellow, orange, and pink.

To the right, you can see how the pink filling looks on a tooth – it’s what most of the girls end up choosing.  That filling, as well as the green one above, was placed to fill in a cavity that formed between the teeth, which is one of the more common places you can get a cavity.

While we can do a colored filling to repair most cavities in baby teeth, nobody has had us do one on a front tooth yet!

Supernumerary Teeth
Extra Teeth: Supernumerary Premolars | ©iStock.com/Watanyou

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.

Extra Teeth: Supernumerary Mesiodens Tooth

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?

Supernumerary Teeth: MesiodensWhen 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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Double Tooth Gemination and Fusion
©Rachel Inbar

Many parents wait with great excitement and anticipation for the eruption of their baby’s first tooth.  Sadly, baby teeth don’t always look quite right.  This can cause extreme worry among parents.  Pictured to the left is one such scenario of a baby’s two upper teeth.  The tooth on the left is a “double tooth” while the one on the right is normal.

Double teeth are two teeth that are joined together by dentin or even by the pulp.  If you’re not sure what dentin and pulp are, take a look at the layers of a tooth.

There are two scientific terms for teeth that appear to be two teeth stuck together as one tooth: gemination and fusion.

Teeth Stuck Together: What is Gemination?

Tooth Twinning / Gemination - Close Up ViewGemination is when one developing tooth has split off into two distinct teeth that remain attached to each other and develop together.  Gemination comes from the latin word geminus which means twin.  You can think of gemination as two “twins” that are permanently attached.

When you count the geminated tooth as one tooth, there are a normal number of teeth in the mouth.  Rachel’s son (shown in the pictures) was shown to have gemination because he has all of his other teeth when you count the “double-tooth” as one tooth.

Teeth Stuck Together: What is Fusion?

Fusion is when two different developing teeth have joined together to create one tooth.  You can think of it as two teeth fusing together.  Gemination and fusion look very similar.  Sometimes the only way to tell them apart is to count the number of teeth.

When you count the fused teeth as one tooth, the person will be missing one tooth.

How Common Are Double Teeth?

Tooth Gemination
The same boy pictured above, a year or so later.  This boy has gemination. He has all four upper incisors including the double tooth. If he only had three upper incisors including the double tooth, it would be fusion.

Gemination and fusion have been reported to occur in the baby teeth in anywhere from 0.5% to 2.5% of Caucasian children.  It is more common in Asian children, where it has been reported to occur sometimes in excess of 5% of Asian kids.

Gemination and fusion occur most commonly in the upper front teeth.  However, it can also occur on the lower teeth as well.  As a general rule, if a double tooth is located in the upper teeth, it is probably gemination and if the double tooth is found in the lower teeth, then it is probably fusion.

Above and to the right, you can see the same boy’s twinned tooth now that he has gotten a little older.

Can Gemination and Fusion Happen with Permanent Teeth, Too?

Gemination and fusion do occur in permanent teeth, although it is not nearly as common as in baby teeth.  It reportedly occurs in one out of every 250 people.

Can Gemination and Fusion Cause Any Problems?

Gemination and fusion in the baby teeth can cause crowding, atypical spacing between the teeth, and can cause problems with or delay the eruption of the permanent teeth underneath.

Because of this, when a double tooth is found, you should have your dentist monitor the permanent teeth underneath it to ensure that they come in normal.  Sometimes, your dentist will have to remove the double tooth in order to allow the permanent tooth to erupt normally.

Rarely, there are no permanent teeth located under fused double teeth.  Your dentist will be able to provide more information about the permanent teeth through a simple x-ray.

One thing to watch out for is the propensity for fused and geminated teeth to have deep grooves between the “two” teeth.  This groove can be very susceptible to developing cavities as it is hard to get a toothbrush all the way down in the crevice to clean it properly.  You may want your dentist to put a sealant in this groove to help prevent a cavity.

How Are Gemination and Fusion Treated?

Sometimes, your dentist will be able to shave down and smooth the double tooth so that it doesn’t appear very obvious to the casual observer.  I say sometimes because the anatomy of twinned teeth can be complex.  If the pulp (click here to learn about the different layers of the tooth) is too close to the surface, then the dentist won’t be able to shave down very much of the surface.

Very rarely, the dentist may be able to surgically divide the teeth.  This often works best with fusion because both teeth usually have their own separate pulp chambers and root systems.  In any case, when surgically dividing the teeth, both teeth will need to have root canal treatment performed on them, which can end up being quite costly.

When Rachel gave me permission to use the photos of her son, she told me the following:

In case you’re curious – no one really notices it at all, even though it was obvious to me that we’d be constantly bombarded with questions about it. Maybe when he’s a little older (he’s almost 2-1/2 now).

Since kids will most likely lose all of their front teeth by the time they’re 9, you may elect to do nothing about the double tooth unless it’s a huge cosmetic concern.  Shannon W, one of the commenters on Rachel’s original post said to just “enjoy it’s cuteness”…and that may very well be sound advice!

Conclusion & Further Reading

For the record, I got my facts (the statistics) about gemination and fusion from this book: Oral and Maxillofacial Pathology by Neville.  If you want to read more on double teeth, that book is an excellent source.

Do you have any questions or comments about double teeth?  Do you or your child have double teeth?  If so, what did you do, if anything, to treat it?

Please share your experiences in the comments section below, so we can all learn from them.  Thanks for reading!

Updated Photos

Here’s a photo that Rachel recently shared with me showing her son with the double tooth still doing well a few years later!

Double Tooth

And a closeup of the double tooth:

Double Tooth Closeup

Extra Pictures of Tooth Twinning

Here’s an image of Deb’s son showing:

Gemination Tooth Twinning

You can read about his experience in this comment and this follow-up comment below.

If you would like to submit photos of twinned teeth, you can use this comment form or send me an email OralAnswers[at]gmail[dot]com.  Thanks!

I want to thank Rachel Inbar for allowing me to use two pictures of her son with a “double tooth” for this article.  Rachel runs a fertility blog and allows couples to share their fertility stories online.