What is Hyperdontia: Types, Causes, Symptoms, Treatment, Diagnosis

Hyperdontia is an oral condition where people have an excess number of teeth growing anywhere in their mouth. These additional teeth are referred to as supernumerary teeth. Although there is no age bar, gender or race specific reason for hyperdontia to develop, it is more commonly observed among those having Cleft lip or Gardner’s Syndrome and children affected by Down syndrome. Research studies reveal that having supernumerary teeth for any person without having any kind of syndrome is not normal.

The standard number of primary teeth in a person is 20 and permanent teeth 32. A person having hyperdontia often have it in permanent teeth instead of deciduous teeth, popularly known as temporary teeth or baby teeth. Hyperdontia can occur in any portion of the dental arch, but they are most commonly found around the permanent anterior incisors, located in the maxillary arch. The next most common area for such occurrence is the maxillary and mandibular fourth molars which are more commonly impacted as wisdom tooth. The occurrence of hyperdontia is somewhere between 1% to 4% of the total population with a male to female ratio of 2:1; majority of the cases being limited to a single tooth. There have been marked instances of people having up to 30 supernumerary teeth, but that is rarely observed.

The classification of extra teeth by researchers and experts has been made based on their location and morphology. The classification of hyperdontia has been made as under –

Paramolar Hyperdontia: It refers to the growth of additional molar growing adjacent to the molars. It is generally observed outside the arch of the normal dent, beside the tooth. The additional tooth will be undeveloped in size.

Mesiodens Hyperdontia: This is the most common type of hyperdontia where the additional tooth is found in between the two central incisors on the upper front. This can be further classified into-

• Eumorphic: This is similar to a normal looking incisor.
• Dysmorphic: Dysmorphic mesiodens has different shapes and sizes and can be distinguished from the adjacent tooth. It can be further sub-classified into:
  • Tuberculate: Here the tooth is cusp or tubercle in shape and may be invaginated. The root does not develop as early as the permanent incisor. Such additional tooth generally occurs in pairs.
  • Conical: Here the extra tooth is part of the permanent tooth which is small in size and shaped like peg. The development is along with the permanent incisor or before its occurrence and can hinder the normal growth and development of the permanent incisor.
  • Odontoma: This is a tumor in the odontogenic region and is considered by experts as some form of malfunction. It is characterized by several forms of tissues.
  • Distomolar: It is the occurrence of an additional molar behind the third molar and is quite rare in nature.
  • Supplemental Tooth: Although similar in appearance to a regular tooth the size is relatively small in comparison to the adjacent tooth.

There is usually no symptom for hyperdontia as the discovery of such an unusual medical condition is by accident when there is a checkup with the dentist for any of the following reasons:

Crowding of the Tooth: Every person’s gum line is designed in such a way that it can hold the natural number of teeth. Any extra teeth will result in overcrowding leading to displacement and deformation of the alignment.

Non-eruption of Permanent Tooth: For some children, it can be seen that the primary teeth do not fall off as they should in the normal course of time. Or there might be hindrance in getting the maxillary central incisor after the falling of the primary incisor. Due to the eruption of the supernumerary teeth there might be problem in the eruption of the tooth adjacent to it.

Displacement of the Permanent Teeth: There is a high chance of the permanent teeth getting displaced from their normal position, which can be slight or prominent leading to feelings of uneasiness and discomfort.

Issues Related to Speech: Due to more than the normal teeth count in the mouth there might be problems in normal speaking. This can adversely affect the learning ability of children suffering from such disorder and might have different speaking tone or communication.

Abnormality in Facial Appearance: A proper set of teeth plays a major role in the facial appearance of a person. There might be abnormalities in the facial appearance of those suffering from hyperdontia adversely affecting the self-confidence of the person.

There might be certain rare cases when such supernumerary teeth can lead to resorption of dental roots adjacent to such teeth or dentigerous cysts.

Even after years of research done in his field, the cause of hyperdontia cannot be linked to a single reason and is connected to a number of congenital defects. Some researchers are of the opinion that there are two common causes of hyperdontia resulting from the following sources:

• Environmental Factors (though it is yet to be known which natural element triggers such condition).
• Genetic Factors where children born from parents with supernumerary teeth are known to inherit such condition.

The occurrence of supernumerary teeth is often associated with a number of syndromes such as –

• Ehler-Danlos Syndrome: This is a rare hereditary syndrome that is associated with a group of connective tissue disorder responsible for causing complications in normal teeth formation.
• Cleidocranial Dysplasia: This is when the person is born with partial or no clavicle bone. This medical condition is responsible for increasing distance between the eyes, hearing impairment, susceptible to infections frequently and cleft mouth.
• Cleft Lip or Palate: In such cases the supernumerary teeth occurs as small and conical, located on either side of the palate or cleft lip.
• Down Syndrome: The problem of supernumerary teeth occurrence is common among those children suffering from Down’s Syndrome that is a genetic chromosomal disorder.
• Gardner Syndrome: this is another general syndrome where the child has enlarged and multiple polyps in the bowel, multiple benign tumors in the jaws and occurrence of skin cysts.

Scientists and researchers have established the fact that faster the diagnosis of Hyperdontia better will be the prognosis. The knowledge of the clinician in identifying the location of the primary and permanent dentition will help to diagnose hyperdontia at an early stage and avoid further complication. The diagnosis of hyperdontia can be possible as early as the second year of birth and on wards as suggested by experts.

In primary dentition, mesiodens often have normal shape and erupt naturally which is the reason for it being overlooked. Another major reason for it being overlooked is the lack of care given by the caregiver. It is common for the anterior primary mesiodens to erupt normally before its detection, which could often be mistaken with fusion anomalies or germination.

In case of permanent dentition, the diagnosis is much easier following eruption of the anterior teeth. However, in order to identify the supernumerary teeth, a lot of radiographic and clinical examinations are required to be undertaken. Periapical radiographs and panoramic maxillary occlusal are mostly recommended to assist the diagnostic process. Despite panoramic radiograph being the most effective screening tool, clarity in the midsection is still restricted. Also, with the help of parallax technique, the buccolingual position of the mesiodens that are unerupted can be evaluated.

In majority of the cases, the patient consults a doctor when any of the issues associated with hyperdontia is observed. However, experts suggest not to waste time in observing the symptoms and immediately get in touch with a physician in case of any abnormality in the growth pattern of the teeth. Once the problem of hyperdontia is diagnosed then there are multiple ways by which such complication can be cured. Some of them are summarized as under –

Teeth Extraction: This is one of the easiest and common techniques followed to cure hyperdontia. Local anesthesia is applied to the patient so that no pain is experienced during the extraction process.

Endodontic Treatment for Hyperdontia: This treatment for hyperdontia is similar to the treatment of root canal. The doctor will undertake this treatment process only if the supernumerary tooth fuses with that of the permanent tooth. In this treatment procedure, the tissue around the melded tooth is removed only after completion of development cycle of the root, after which the fused tooth is removed surgically. Surgery is the best option in this case as the roots of the tooth are joined with the adjacent ones.

Orthodontic Treatment to Treat Hyperdontia: The supernumerary tooth will affect the normal alignment of the adjacent tooth. Therefore, the post extraction process, if required, orthodontic measures like use of dental braces are undertaken to restore the normal alignment of the permanent teeth and to strengthen the same.

Wait and Watch Process: This involves investing substantial time in observing the progress of the supernumerary tooth and the effect it has on the adjacent teeth. The doctor will monitor the development of the additional tooth by way of taking x-ray and have a wait and watch attitude. Orthodontic tooth removal or other measures will be undertaken only if the additional tooth poses any serious threat to the alignment of the permanent teeth.

Above all, it is highly recommended to parents not to wait for the baby teeth of their child to fall off to approach an orthodontist as prevention is better than cure. It is necessary to take the child for regular checkups at frequent intervals and in case of any abnormality in the growth of teeth it is better to take preventive measures beforehand rather than wait for the situation to become more complicated. A medical professional is the best person to provide valuable suggestion in such matter and prevent the situation from getting more serious. Therefore, it is better to leave the matter to the experience and expertise of the professional.