Tuesday, October 02, 2007

Gemination and Fusion of teeth

Gemination is where a developing tooth splits into two separate teeth. Fusion is where two developing teeth merge into one tooth.

The appearance between the two can be similar, you just have to count the teeth to see if you have an extra one or a missing one. I see a lot of this kind of thing on the top and bottom front baby teeth. It can present a problem if they do not or cannot fall out at the right time and interfere with the eruption of the permanent teeth.

Gemination or Fusion can be total or partial. Here is an photo showing partial-gemination of a baby lateral incisor. You can see this "tooth" has two roots and two crowns but are both joined together, kind of like "siamese" teeth.

55 comments:

Anonymous said...

Yes, I agree with you. Tooth gemination and fusion is one kind of tooth abnormality. However, this problem can be treated by means of our new dental technologies.

Your friendly Naperville cosmetic Dentist

bushra said...

hello doc,,i m a student of BDS final year,,facing some problum in orthodontics,,specially in growth n development,,,m doing it from pakistan lahore,,plz send me mail at,,,,{raw_nusherwani@hotmail.com}

Dr. Dean Brandon said...

It's ok to ask in this forum if you don't mind. If it is a private matter, you may contact me at my office which is linked on the main page. (Alabama Pediatric Dental Associates).

Daniel said...

Where most people have two upper front teeth, my 2yr old has three. It came in well and hasn't (yet) interfered with other teeth. Should this be addressed now or is it best to wait until later? In either case, what treatment is normal in such cases?

chrysamom said...

I am a worried mother of an 18 month old son has a two fused baby teeth. What is the chance that his permanent teeth will also be fused? Is there anything I can do at this point or in the future?

Dr. Dean Brandon said...

Fused baby teeth do not necessarily mean fused or missing permanent teeth. An x-ray will tell later on. I would not worry too much.

Bob said...

My 10 year old has a permanent tooth fusing with its predecessor baby tooth. Is there any7way to correct this other than surgery in cutting out the stubborn baby tooth?

helen k said...

Hi,

I had a fused baby tooth when I was younger (it appeared that I had 5 teeth in my front bottom row)

and now that I am 19 I only have 3 in my bottom row.

What happened?

Thanks,
Helen

Dr. Dean Brandon said...

Gemination, Fusion etc. of baby teeth does not mean you will have the same problem with permanent teeth. I have seen similar things to what you mentioned.

Anonymous said...

My son is 27 months old and he has a fused tooth on the bottom left of his mouth. The incisor and main tooth. It's grown together the dentist said. I'm not worrying though- I'll wait until it's time to fall out and see how it goes.

RMH said...

My 4 1/2 yr old son had his first x rays and our dentist believes the two central incisors are fused with its respective lateral incisor. Another dentist saw the x ray and said there is possibly an extra tooth. There is talk of a panoramic x ray. When should this be done (now or wait until he is older). What are the possible treatments for such possibilities and at what age can these procedures be done?

Dr. Dean Brandon said...

See that frequently--you can get a lot on info from those little x-rays--pan is good, but sometimes they cannot hold still in there or it won't show as much--still not a bad idea. I usually am in no rush on treatment.

Anonymous said...

My 3 1/2 year old's two back bottom molar are "crumbling" away, according to our pediatric dentist. On the x-ray it looks like jagged rocks that taper off toward the back of her throat. She is not in pain, they don't have any decay, and the dentist said the remains of the teeth are in there tight for now. He doesn't have an explaination for this. All her other teeth appear healthy. She also gets canker sores frequently, about 1 every three weeks. She was adopted from Guatemala, so I'm wondering if something was missing from teh mother's diet during pregnancy. Or could there be a diffiency in my daughter's diet? Any ideas?

Dr. Dean Brandon said...

See my post on Dental Hypoplasia

ThreeTimeMommy said...

My 12 month old has a second tooth that came along with one on his front teeth. They are smaller than his other teeth and seem to share a root. My primary care provider took a look at him and said that she believes they share a root,but not to worry as they are his baby teeth and will fall out eventually. Worry wart that I am, I am curious as to what things may evolve for him, and as a parent what should I keep an eye out for. He has had a difficult time cutting teeth and only has his upper and lower front (8 in total). Should I bring him to a dentist? He refuses to sit still so I doubt an X-ray will be possible. And with him being only 12mts old should I just wait and watch?

Dr. Dean Brandon said...

Though I doubt you will have any problems, the American adademy of pediatric dentistry recommends seeing children for thier first visit about one year of age. Seems like they could answer a lot of your questions..

Jarred, Angela, and Nathan said...

My 18 month-old seems to have gemination in several of his front teeth. His pediatrician told me that after she saw it in him, she did some reading and learned that it was somehow linked to a heart problem though it was still nothing to worry about (he had a heart defect at birth, Transposition of the Great Vessels). It seems really hard to believe. Can you confirm this?

Dr. Dean Brandon said...

Heart defect and teeth?--could be, but I have not read this. Probably just an a tren but not a direct correlation. I see gemination in kids with no health disorders or problems all the time.

Anonymous said...

Hi doc - my question is can baby teeth that are fused or geminated cause MORE pain coming in than regular teeth? Thanks for your response! Caryn

Dr. Dean Brandon said...

My experience is that teeth do not cause pain when they come in or if they stay too long. It's just that they often do not fall out when they need to, so the dentist frequently has to take them out.

pcblogger said...

My son is 8 months old and 3 teeth broke through at the same time. At least it looked like 3 teeth at first. Now it looks like 2 teeth. One looks like a large tooth with a "V" shape half way down the middle. Could this be what happened? I am scared this is a symptom of something worse. I will send a pic if you want.

Dr. Dean Brandon said...

If it is gemination, it's not a big deal and can be delt with, so do not panic. Get your pediatric dentist to take a look. There is usually nothing to be done at such a young age. You may also want to look up about enamel hypoplasia which is another developmental anomoly we see all the time. I think I have seen three or four cases of gemination or fusion just this week!

Anonymous said...

Dear Dr. Brandon, please, I NEED some advice! Just found out on the x-ray that my 7 year old son has NO permanent central incisors at the bottom (his lateral bottom incisors are coming up behind the milk teeth, which are all in place). The dentist suggested to extract all 4 (!) bottom milk incisors to make room for the 2 permanent coming incisors. Would not it be better to remove just 2 lateral milk incisors to make room for permanent ones, and leave the central milk incisors in place and hope they last, since there are no permanent teeth to substitute them?
It must be genetic - my husband still has 2 of his milk teeth (under veneers now) at age 56...Thank you in advance! Your blog is very helpful indeed!
-Anastasia

Dr. Dean Brandon said...

I saw two kids today that had congenitally missing permanent teeth! I cannot say what is best for you, but it kind of depends on how much room is there and the longer term situation re: orthodontics, etc. It is not so simple sometimes. You can always get the opinion of a Pediatric Dentist.

Anonymous said...

Hello Dr. Brandon--Sadly, tomorrow our 16-month old son will probably have to have three teeth pulled, as they are either fused or geminated and two of the three have severe caries. It's hard to think about our beautiful boy getting his teeth pulled. We have read that general anesthesia for little ones is linked to learning difficulties later, especially if the child has more than one surgery. So, we are opting to pull the teeth rather than risk his ability to learn. Our dentist said it's common for these teeth to get decay as they have different angles and hard-to-reach crevices. One is his left top incisor and the two teeth next to that. Will there be any long-term effects from this loss, other than a long wait for more teeth? We are working out a better teeth care routine, and hope that his permanent teeth are normal.Thank you for your insights and comments.

Dr. Dean Brandon said...

Front teeth lost or removed early usually do not have any adverse consequences other than appearance. Back teeth-that's different. See my other related posts for more details. One could have more problems If front baby teeth are Not treated, as there is potential for damage to permanent teeth.

Anonymous said...

my son was missing an lower incisor he had only 3....recently he lost one of the 3 and now my son has a permanent doubletooth growing in....what can be done about this? it looks to have started moving his 3rd in a crooked position...the dentist said we would cross this bridge when it came time....could it disrupt the positioning of his permanent teeth still to come??? Is there anything that can be done to correct the abnormal look of his tooth???

Dr. Dean Brandon said...

I cannot say as each case is different. Often orthodontics is used in conjunction with other things. Also, you often have to do one thing now, and the next thing later on after more growth.

Anonymous said...

Hi, My son (now 7 years) has two geminated front incisors. They are quite wide with a line down the middle. He has the normal number of teeth. The geminated teeth are very straight and look nice. I find them fascinating and can't wait until they fall out so I can have a better look! I just wondered whether this is something which is hereditary? I have not come across it in any other family members.

Dr. Dean Brandon said...

It is not definate (that I know of) whether this is hereditary ar developmenal. I do see many patients with missing or extra teeth that the parent reports they have something very much like it. Those things and gemination and fusion are related anomolies. Some disturbance in tooth formation can cause maldevelopent of teeth as well. Of course, it really doesn't matter what caused it the treatment is the same.

Anonymous said...

I urge all you parents who are noticing these geminated teeth in your children to follow your dentist's and this dentist's advice as early as is necessary. I am 47 years old. I had a geminated baby tooth (lower left incisor area). When the baby tooth came out, only one tooth replaced it, and I had a gap there. I had absolutely no trouble with it until now, as an adult, the gap is WIDENING. The two teeth surrounding the gap are spreading apart, and now it looks as though a whole tooth could fit in there. So now it looks like I lost a tooth, and will have to have an implant or something put in there to improve my smile.

Anonymous said...

hello,doc.
I'm worry about my daugther's tooth gemination case.
She just turn 8 years ol and she still with all the baby tooht.
The problem is with the 2 front tooth, on the ray x instead of coming 4 they are 2 big tooth fusioned ,should I remove then and wait until the permanent show up < the dentist told me that she will problably nee and implant,since they are super big and only 2,what should I do ? thanks susan m

Dr. Dean Brandon said...

I can't tell you what to do. I do remember one case from about 20 years ago--fused permanent teeth made them quite large. An orthodontic consultation might help determine how to line everything up.

jlynn3186 said...

Hi, I am trying to gain some understanding of what to expect with my 7th old daughters situation. Her dentist confused me. She has two teeth fused together. Upon xrays they discovered she did not have permanent teeth below them. Will she lose the fused tooth and have to deal with missing teeth or will it stay in like a permanent tooth? What options do we have to make it look normal?

jlynn3186 said...

My daughter is 7 and has a fused tooth. Xrays discovered she does not have teeth below them. Will she lose these tooth and have to deal with missing teeth or will it stay in like a permanent tooth. What options to we have to make it as normal as possible.

Dr. Dean Brandon said...

From a dentist's standpoint, the real concern is the missing permanent tooth. Orthodontic treatment is usually used to move teeth together to close spaces left by a missing tooth. Baby teeth will not naturally "fall out" unless there is something underneath to dissolve the roots and push it out, so to speak. Although sometimes fused teeth fall out due to adjacent teeth pushing them out. Occasionally, we leave baby teeth as long as possible, usually in the back, but occasionally in the front, if there is no significant natural crowding or something else that would make moving the teeth together not work so well.

I see fusion in front baby teeth a lot. It is usually not a significant orthodontic or developmental issue except for the missing permanent tooth (if not present), that can be dealt with later. Often we remove the fused tooth at an appropriate time.

Anonymous said...

I had a conjoined tooth when i was little and i lost it and only one tooth grew back.. what should i do there is a huge gap where the other tooth shouldve gone.

Dr. Dean Brandon said...

That is an orthodontic (braces) question. So, ask your pediatric dentist or orthodontist.

Susannah said...

Hi. I have a tooth fusion of the lower front incisors on the left side - the baby ones were the same. I am 46 and have never had any problems - they just look like 2 incisors close together. I am just interested to know what the prevalence of this is. Thanks

Dr. Dean Brandon said...

I see fusion or gemination, gosh probably twice a week. I don't have numbers on incidence. It's not common, but it's not rare.

Sheryl Wilson said...

My 18 month old has gemination per the dentist visit today. She suggested putting composite on it and closing it up. Is this necessary? I don't want to put him through the stress of confining him, gas and shots to do this if its not necessary... any information is appreciated. Thanks.

Dr. Dean Brandon said...

Partial gemination is where the tooth tried to split into two teeth, but didn't quite make it. There may be a little groove there that I sometimes recommend to seal up to reduce the chance of a cavity and sometimes it makes it look better. Each case is different. Sometimes just a little hand holding is all that is needed as this is often a quick easy procedure.
Ask the dentist if it's ok to wait an just observe it--if there is already decay, then he will likely recommend treatment.

Anonymous said...

Hi Dr. Dean Brandon,
My daughter had 2 extra front baby teeth when she was little. They were seperate from eachother, and fallen out individually. X-rays showed she would have an extra adult tooth, but did not know if it would be a tooth with-in a tooth or front and back. Her front teeth have came in. She has a wider, thicker front tooth. as well as an attached tooth sideways in the back of that front tooth. It looks like a the letter T. We were refered to an orthodontist. The orthodontist said she does in fact have a tooth within a tooth (gemination) that makes her front tooth wider and thinker. and a third tooth attached all contected to one root. which makes the letter T when you look up in her mouth. My concern is that the orthodontist recommended us back to her primary dentist to sand down the third tooth for now until she is aournd 12, before he removes the third attached tooth, and smooths out the front tooth that has the tooth within a tooth. Can a gemination involve more than 2 teeth with one root? The orthodontist said he doesn't want to take the risk of sanding the third tooth down and hitting the root because he does not do root canals. Is there any advice or suggestions as to reading material? I have never heard of this,and not sure I want my 8 yr old possibly having a root canal at this age. Thank you!

Dr. Dean Brandon said...

Sounds more like something we call a "Talon Cusp". Google that and I bet the "T" look will fit. That is just a larger than normal lingual cusp. It interferes with how the teeth bit together sometimes. They are correct to be cautious about just removing the cusp outright as there is often a pulp horn (t he nerve) in there. If that were exposed, there is the possibility of having to do a root canal. Some adjustment is ok so long as it is in the outer layer of enamel. Each case is different, but I know complex.

mandie said...

Not really a question but something a little odd for you. My 10 year went to the dentist and is now being referred to the orthodontist. His x-rays showed his right front tooth is actually a complete fused tooth with two roots. On the back of this tooth and the other front tooth he has talon cusps. On the tooth that is infused he actually has two very defined talon cusps that are separated in a Y. And now he has an extra tooth coming in above all his other teeth on the left hand side. He is prone to vascular malformations and so there is some thought that this may all be connected. Too odd for me to even comprehend.

Sunny said...

My son has a dentist appointment in a week but it appears he has two fused front teeth. I can floss about half way up one set of them, the other seems to be one giant tooth. He has so much space on the sides. I thought they would spread out, but the appear to be fused together. He is eight years old and these teeth are his permanent teeth. Is there any type of treatment for this? Is there any chance they are just very crowded?

Dr. Dean Brandon said...

Well, it's less common in permanent teeth, but orthodontics can help along with either adding or taking away tooth structure within the limits of each situation.

Anonymous said...

I just found out that my 8 year old son has a "siamese" tooth in his permanent tooth. Apparently, the "siamese" part is the one that has emerged first. The normal part has not yet come done. What can we expect? As he matures, can this be fixed?

Concerned Parent

Dr. Dean Brandon said...

Treatment of these kinds of things is very individual to the child and the tooth involved. No two cases are alike. Ask your Pediatric Dentist. Sometimes things can be dome, but it may take more growth to know the best path to take.

Arnab Santra said...

Sir, is there any chance of root gemination only? There are so many examples of incomplete gemination that arrest after crown formation. But i have not found any example which shows root gemination only. Please help in this regard.

Dr. Dean Brandon said...

Well, I have seen cases of weird root formations, multiple roots, two three, etc. especially in bicuspids. Other than that, I am not sure.

Anonymous said...

My 18 month old has tooth gemination in his front incisor. It looks like there was a hole in the tooth where the two are fused together and now the hole seems to have "broken" through the bottom portion of the tooth - so now there is a "v" shaped gap in the actual tooth. Is it ok to leave it like that or will it get a cavity easier.

Dr. Dean Brandon said...

Well, if it's changing, I'd get the pediatric dentist to look at it. It might just be a small chip, but things can develop into a cavity. Not likely that, but I'd get it looked at. It's harder to brush these kinds of teeth, and the anatomy is altered. Most I see do not decay, but occasionally, I will place a small easy to do filling there to eliminate the groove or pit if it's deep.

Parimala said...

My son is 20 months old. Our family dentist is having a doubt whether 4 teeth in front is fused to 2 teeth in both upper and lower jaw. Is there any possibility like. I am really worried will it affect the permanent teeth or will there be any other problem because of it.
Both the teeth looks little bigger than normal but no demarcation/ split is seen. Please advice

Dr. Dean Brandon said...

Fusion can be complete--no demarcation. The simplest way to determine things is to just count the teeth. Your pediatric dentist can help you in this case too. Just because the baby teeth have this condition, does not necessarily mean the permanent ones do. Otherwise just bush and treat thin like any other teeth. Sometimes kids just have large teeth.