Saturday, January 20, 2007

Mesiodens, or Extra Tooth

A Mesiodens is the most common supernumary (extra) tooth. It is located in the maxilla in the midline (hence the special name which means "middle tooth"). They can be well formed or just little clumps of tooth like stuff. A related phenomenon is the odontoma. They are often discovered on a routine x-ray or perhaps if the teeth are not erupting in a normal manner. Most of the ones I have seen kind of look like teeth with a small crown and a root of some kind. If they form right side up like a regular tooth and are fairly well formed, they may erupt like normal teeth. If it is upside down it definately will not erupt normally. (The second radiograph seen here shows two inverted mesiodens in a young child. Can you see them?) Mesiodens can interfere with the normal eruption of the teeth leading to crowding or impaction. There can actually be more than one up there. I have even seen some teenagers with this funny looking pointed tooth coming in on the palate behind the incisors.

Treatment: Well, if it's an extra tooth, you want to eventually get it out of there. I usually wait till I see if it is interfering with the normal eruption of the permanent incisors, or shows some other sign that there is trouble. If it's not causing an immediate problem, you can wait a while, usually till the child is 6 to 8 years old to deal with it so long as you are monitoring the situation. If it will erupt on it's own, then we can just extract it like a normal tooth (doesn't happen very often). If it does not or you can just tell that it's going nowhere, it needs to be surgical removed, hopefully "timed" correctly. I don't like to do it too soon as I don't want there to be any damage to the developing tooth buds from the surgical procedure. Eventually, you do need to have them removed. Once it is removed it is likely the new teeth will erupt in a fairly normal pattern.

58 comments:

Anonymous said...

what if the permanant tooth has not erupted? Will the child need braces to fix this?

Dr. Dean Brandon said...

If an extra tooth is present, (any extra tooth), that usually means there will not be enough room for the teeth to line up properly without treatment. Sometimes teeth do not erupt on their own (often cuspids that are ectopic) and need orthodontic treatment to help them come in properly. If it's just an incisor that is slow to erupt (and there is no extra tooth there interferring or something else), then you can sometimes just make a surgical exposure "window"in the thick gum tissue to aid proper eruption.

Anonymous said...

My almost 5 year old son appears to have an extra tooth coming in in front of his right front baby tooth, and another seen via xray in front of the left (which is the type that probably wont erupt). The oral surgeon wants to wait until closer to when his adult teeth will be coming in to get them out. I'm fine with waiting, but now the one that was barely poking through is erupting more-- should I bring him back in? Should I have the one that is coming in pulled when it comes out and continue to wait on the other?

Dr. Dean Brandon said...

If things are changing, it's never a bad idea to get it looked at as circumstances may change previous plans. Sometimes a change in appearance (like the eruption of the tooth or something) may change the treatment needs. For instance, once a tooth is erupted, it is usually easier to remove and would avoid any concerns a more invasive surgical removal might entail. Still, sounds like you have things well looked after with the advice you are getting.

Anonymous said...

My 3 year old has an extra tooth growing behind one of her front teeth. This is not "front facing" and is growing sideways on and is now pushing her front tooth forward. Should this be removed? If it is removed, would it be likely that it will re-appear when her adult teeth come through? I do not want to put her through the unnecessary stress of tooth removal if it can be avoided. Thanks

Dr. Dean Brandon said...

Most of the time I don't remove extra teeth unless I have to, which is usually later on when the new teeth are trying to come in.

What you discribe might be a talon cusp which is part of the back of the tooth (kind of a bump sticking out) and can interfere with the "bite". I don't know, I'd get it checked out so you will know for sure.

Anonymous said...

My 12 month old son has a raised ridge-like area running from top to bottom on the front side of his maxillary central incisor. It has caused his gun line to form in an inverted 'v' shape over the tooth Could this be a 'talon cusp'? If not, what else do you think it might be? Is there anything that will need to be done?

Dr. Dean Brandon said...

Sometimes teeth can try and split into two teeth, that's called "gemination". Sometimes they don't quite make it and it looks funny, kind of wide with a line down the middle. "Fusion" looks the same but if you count the teeth there is one less tooth than there should be.

I'm not quite sure if that is what you have--it's just something I see from time to time.

Anonymous said...

what if the extra middle tooth is behind the upper incisors but not touching or pushing, at least quarter inch space from the normal teeth. Should I wait for the permanent teeth coming in, then remove the Mesioden?

Dr. Dean Brandon said...

I can't tell you what to do, but I usually like to get them out as soon as they erupt. If it is not erupted yet, then I will wait and observe for a while to see if it interferes with the eruption of the "normal" permanent teeth. If not then I can usually get them out later on.

Anonymous said...

I am (almost)35 snd my last molars(both sides, last upper tooth) have not come down. I have had xrays, they are up there but my baby teeth are solidly in my gums. They are pushing down causing the baby teeth to go sideways but are otherwise not bothering me. I also have very mild TMJ and an overbite, which also doesn't bother me much. One dentist suggested it "might" help to have them removed but there is no real way to tell. Any thoughts on when I should be concerned about these teeth?

Anonymous said...

Based on an x-ray the dentist informed me that my 2 1/2 son has this "extra" tooth and that it is placed in such a manner that it will grow upwards (towards the nose) vs. downwards eventually erupting. IN this case will it have to be surgically removed? And when is the right timing for this? and Should i get a second opinion?

Dr. Dean Brandon said...

Usually needs to be removed. timing can be variable. Most of the time, I wait a few years.

Anonymous said...

When my son was 5yrs., we discovered he had an extra tooth coming in the middle of his 2 top front teeth. It prematurely pushed out his baby tooth, and then was promptly removed by his dentist. His 2 permanent teeth have come in, and 1 is totally sideways! What can we do for him at this age to fix the problem? He is already being teased by other children.

Dr. Dean Brandon said...

Just as for any "crooked" tooth, some form of orthodontics might be needed. Ask your dentist.

Anonymous said...

My 16 month old daughter has what a dentist said to be a mesioden. The tooth is visible, coming out very close to the back of her front two teeth (splitting th eteeth apart)but the dentist says that I should wait a year for an x-ray and see what happens. Does that mean it could possible fall out on its own? What are the pros and cons of removing it now?

Dr. Dean Brandon said...

I do not know your specific situation, but it does not surprise me that someone would wait with such a young child. It has to do with age/cooperation/ability to deal with surgical procedures and possible sedative medications. I often will wait on some things till they are a little older.

Anonymous said...

I'm actually 20 years old and I have an extra tooth above my two front teeth. I have had braces and my adult teeth are all lined up and healthy. My doctors always have advised me to wait because they do not know which direction it is moving and if it does not move, the extra tooth will not cause a problem. I have been going for x-rays every few years and have not noticed any changes. Should I be concerned? Please advise - I'm scared.

Dr. Dean Brandon said...

I wouldn't be overly scared, but it is good that you are getting it followed by a dentist regularly.

miffy1 said...

My 10year old son has a mesiodens approx 1/4inch behind his front (permenant) teeth. My dentist has been a little vague regarding what to do next. It is fully exposed and looks like a normal tooth, it isn't causing a problem yet, but it does make his tongue sore. Should we push to have it removed? or should we wait until all his permenant teeth are through? - we are still waiting for canine's and premolars to come through although his molars are through.

Anonymous said...

My 5 year old (6 in Feb) has a tooth growing behind one of her two front teeth. Only a little of it is showing at present. How long do you recommend we wait to have it removed?

Dr. Dean Brandon said...

I can't say what to do in your case, but if I can see it and get hold of it (and the other teeth are ok), then I get it out as soon as I can. If it is impacted or unerupted, then it is a little more complicated.

silent tears said...

wat nerve block should be given to extract a fully erupted mesio dens??

Dr. Dean Brandon said...

Usually, you can infiltrate above the area on the facial(the anterior superior alvoelar, I think) and then block the nasopalatine nerve on the palate.

Anonymous said...

My 5 year old daughter has an extra tooth in the upper front of her mouth. It has already pushed her baby tooth out and has grown into it's spot. It is a smaller than normal tooth. I would like to wait to have it extracted until she is older and the permanent tooth is closer to coming in. However her dentist insists that it be pulled immediately and became quite aggitated with me when i argued with him over this. He is telling me that it has the root of a permanent tooth and it is not going to fall out on it's own. He also said it will mess up the permanent tooth that is supposed to come into that spot. Is this true? Should I get a second opinion?

Dr. Dean Brandon said...

If it is an extra supernumary tooth, it may need to be removed at some point. I cannot say when. I have had situations where I did recommend removal of an extra tooth to allow better eruption of the unerupted permanent teeth. Sometimes it is ok to wait too. I would suggest making sure you fully understand the recommended treatment and the risks or consequences of postponing treatment and have confidence in the recommendations.

It's always ok to get a second opinion.

Anonymous said...

I have an extra tooth which has come out at the side of my mouth under my tongue. ocassionally it cuts my tounge because it is sharp. it has taken a few years to grow sufficiently to enable it to be removed. my previous dentist said it could be removed. my new dentist tells me that it is holding up the two teeth above and if they are removed i may end up losing the other two teeth. there is a history of additional teeth in my family and most of my siblings have had additional teeth removed without any complications. any advice would be helpful at this stage. I am an adult in my 40's

Dr. Dean Brandon said...

Sounds like you may have more going on than just an extra tooth. Periodontal disease can make a situation where "support" of other teeth is an issue. Having said that however, most of the time having an extra tooth is not a big deal. Yes, there can be complications, but they are usually manageable.

Anonymous said...

My 9 year old daughter had 4 extra teeth removed 6 months ago from her top front area. when we went back to the orthodontist for a 6 month check up it now appears that she has 2 additional teeth and her adult teeth have not moved at all. Our orthodontist says he has never seen anything like this. now he wants to put braces on her and have the additonal teeth removed and place chains on the adult teeth to pull them into place. the 2 adult teeth appear to still be up under her nose near her sinus. I am afraid that another surgery would be hard for her. She has only lost 2 teeth on top naturally. all of her top teeth are crowded Any ideas.

Anonymous said...

Hello Dr. Brandon,

My 7 year old son has an inverted mesiodens behind his upper incisors, and a recnt CT scan confirmed location and orientation. It clearly needs to be removed, as the dentist and the oral surgeon have both indicated that it has slowed the normal (timeline) loss of the baby teeth.

The OS also suggested that the referring dentist might also want to remove the baby incisors during surgery, though we would prefer to wait and let the permanent teeth push them out. What are your thoughts on this?

One last question, they'll be using a general anasthetic; any concerns there either?

Dr. Dean Brandon said...

I've seen something like that before. Just have to take the treatment process one step at a time. Sometimes supernumary teeth do form especially in weird syndromes like Cleidocranial Dysostosis. However, not unusual at all to have to "pull" down orthodontically impacted cuspids.

Dr. Dean Brandon said...

Re: 7 yr old:

Most of the time if a mesiodens is inverted it is not going anywhere. In other words the tooth will not erupt normally usually not at all. Also, sometimes extra teeth interfere with the normal eruption/exfoliation of teeth, so things don't just go the way it is supposed to. Get as much info from your dentist(s) as possible to be well informed about your particular circumstance.

Anonymous said...

Re: 7 yr old. Thanks!

Anonymous said...

Just today, my 6 1/2 y.o. boy had xrays which showed that he has a "mesiodent" (that's how the pediatric dentist spelled it). It is right in-between his 2 front baby teeth. There is a tiny little tip of it that has erupted behind his Right front baby tooth. I had just assumed that it was part of the permanent tooth coming through. I did notice it about a month ago, but it has not come through any more during that month than just the tiny tip. They showed me the xray & said that it HAS to come out pretty much ASAP because it was preventing the permanent teeth from erupting. They showed me how his right permanent front tooth is totally sideways & said that if nothing is done, there is roughly a 90% chance that he will LOSE this permanent tooth. They told me to find an orthodontic surgeon to have it removed. They also said that he would PROBABLY have to have braces due to the tooth being sideways; but that there was a CHANCE of the orthodontist being able to somehow move it? Does this sound reasonable to you? Also, I was in such a state of shock that I didn't think to ask what the reason is that he could lose that sideways tooth? I am only guessing, but could it have to do with the root twisting & "killing" the tooth? I'll also mention that they extracted his 2 front bottom baby teeth today because the permanent ones were about halfway in already right behind the baby ones & they told me that they had to extract the baby ones because they were preventing the permanent ones from coming in all the way. Geez, when I was a kid, we just let them come in & I have never even had to have braces! I know things change in medicine over time. This was our first visit to this pediatric dentist & I just want to make sure they are doing the right thing by my children. I am shocked, confused & scared right now. Please advise & thank you!

Anonymous said...

Please help me! I was looking in my 15 month olds mouth and I saw something soft and white in the roof of his mouth right behind his two front teeth. It was hanging and I thought it was food at first so I got some of it out, but then I noticed it was stuck in his mouth and it was all the way in his gums and it looks like it may be connected to a root or something under there. I have no idea what it could be and I am scared. He eats and drinks, but I am waiting for my vehicle to get shipped back from overseas and I don't have a way to get hime to a dentist. Please help me so I can feel a little bit at ease until I can get him to the dentist. Thanks!

Dr. Dean Brandon said...

I can't really say. Could be an Epstien's Pearl which would go away after a while. See your dentist to be sure.

Dr. Dean Brandon said...

Re 6 1/2 yr old,

A mesiodens can impede or interfere with the normal eruption of a permanent tooth. I don't know but it s usually possible to allign teeth that have been diverted from their normal position.

Anonymous said...

When my daughter (now 2 years old) first started growing her top front teeth, I noticed that her #2 tooth grew in pointed and slightly twisted. After that she continued to grow a normal #2 tooth next to it. At first I though it was strange but it didn't seem to be causing any trouble. Now all of a sudden it seems that it is pushing her 2 front middle teeth outward & twisting to where they are starting to cross each other. This all happened rather quickly. Should I be concerned?

Caroline said...

My 6yo boy, and my 4yo girl BOTH have an extra tooth like this! My son has just lost his as his first tooth. I must get them to the dentist as they haven't been much (hard to get one in the UK!), as I would presume it is the occurence of them as adult teeth that may be more problematic?

Dr. Dean Brandon said...

Yes, an extra permanent tooth is harder to deal with than an extra baby tooth.

alex14 said...

I am 19 years old,
And i noticed that i have an extra tooth starting to come through, right behind my front two teeth it is very close about 2-4mm.I am worried that it is going to push my front two teeth out!
can you help please?

Dr. Dean Brandon said...

Unless something out of the ordinary is going on, a supernumary extra tooth is more likely to crowd thing up than push things out. Have a dentist get an x-ray and examination--may not be as bad as you think.

Dominique said...

Hi,

I have an extra tooth growing; my dentist discovered it in an x-ray about a year-and-half-ago. For the the past couple of years, the tooth caused a bump in my upper gums (left side), and a protrusion on the palate behind my incisors. It's never given me pain, but I have noticed in the past couple of weeks the bump on my gums has gotten bigger. I am very worried about the pain (most important) and cost of oral surgery. Do you know what the worst case scenerio would if I did not get surgery?

-In Dire Need Of Help,
Dominique Minor

Dr. Dean Brandon said...

If he advises getting it out, I think you should consider his advice carefully. Extra teeth seldom cause pain, but tend to disrupt or effect other teeth.

Anonymous said...

I am 50 yrs old and recently had 6 teeth rmoved from the front, during the xray two more teeth were found that never came down, one is laying sideways and the other is starting to show thru the gums,which means I can't wear a partial yet, but my question is should I have it taken out or wait to see how far ir comes down?

Dr. Dean Brandon said...

I am not a general dentist and haven't done an adult partial or denture in 20 years. I would think they might remove it prior to any partial or denture. A tooth that has been there that long would not likely move on it's own. Still, ask your dentist what his plans are.

Anonymous said...

My 4 year old has a mesioden and it came in between the two front teeth, as there was room for it. We are being referred to an orthodontist, but would it seem normal that we would leave this teeth until the front teeth are ready to come out on their own.

Dr. Dean Brandon said...

Sometimes it is fine to wait at that age. See what they say, but I've had many cases where you can leave an erupted supernumary for a while.

Anonymous said...

how do you know if the tooth has erupted?
and when you get an mesiodens out does the surgery hurt, how long will it take?

Anonymous said...

My 8 year old boy has an extra tooth that is upside down and is behind his two front teeth. His two front perminent teeth came out fine and are in right position. Nothing bothers him. I am worrying if it is necessary to get the extra tooth removed. I do not want him to go through the procedure if it is not necessary.

Anonymous said...

My 1 year old just had a black object immediately behind her top middle tooth. At first I thought that something had gotten lodged between her tooth and her gum but after they looked at her in the ER they said it didn't look like a foreign body but something else. I was going to take her to the surgeon tommorow to have him sedate her to get a closer look at it but after supper tonight I looked and it was gone. I am wondering if it could have been an extra tooth that her body simply expelled. When it was gone there was no hole, no blood, no swelling. Not a thing!

Dr. Dean Brandon said...

If it was black I doubt it was a tooth. I have no idea, but could have been a piece of food or debris. Physicians sometimes are not the best at looking at dental/mouth stuff. Good to have a Pediatric Dentist do a dental exam at one year of age.

Anonymous said...

My 10 month old daughter got her two upper and two lower teeth perfectly but the next set of teeth on the bottom(one on each side) have both come in and are completely sideways is this something that I should worry about and immediately take her to the pediatric dentist for or is it something normal? For your info she does not take a pacifier nor does she suck her thumb

Dr. Dean Brandon said...

A visit to the pediatric dentist would reassure you I think, that there is not much to worry about with rotated baby teeth.

Anonymous said...

My 4 month old has his upper left cuspid poking threw, and no other teeth yet. Should I be worried?

Dr. Dean Brandon said...

I don't know, but teeth come in at various times in little ones., sometimes out of order.

remember baby's first visit by one year of age, but sooner is ok too if you have a concern.

Anonymous said...

MY SON IS 6 1/2 AND HAS AN AN EXTRA TOOTH AND I HAVE BEEN TOLD IT SHOULD BE REMOVED BUT I WAS WONDERING IF MY DENTIST SHOULD DO IT OR AN ORAL SURGON WHICH WOULD YOU RECOMEND?

Dr. Dean Brandon said...

As a Pediatric Dentist I have done several of these, but if they look complicated or the situation obviously warrants being all the way asleep, then I will refer to an oral surgeon. I did one just the other week, but mostly I refer those out.