Teething in Children How to Detect and Treat It Safely

Have you noticed an extra tooth in your child's mouth, or observed crowded teeth and delayed alignment? This condition is medically known as hyperdontia or supernumerary teeth, and it is more common in children. It can affect tooth alignment, speech, chewing, and sometimes the appearance of the smile.In this article, we will explore the causes of extra teeth in children, their symptoms, potential complications, and treatment options—both surgical and orthodontic. We will also provide practical tips for parents to monitor their child’s dental health effectively and take timely action to ensure proper and healthy growth of the jaw and teeth.

Do extra teeth appear only in baby teeth?

No. Extra teeth can appear in both primary (baby) and permanent teeth, and in some cases, they may be hidden under the gums and not visible.

Are extra teeth associated with syndromes?

Sometimes, especially if multiple extra teeth appear. They can be linked to genetic syndromes that affect the growth of teeth, jaws, and sometimes other bones in the body.

When is the number of teeth considered “extra”?

Normal number of teeth for a child: 20 primary teeth
Normal number of teeth for adults: 32 permanent teeth
Any tooth above these numbers is classified as hyperdontia (extra teeth). Most cases involve only one or two additional teeth.

Is hyperdontia rare?

Yes, it is considered a rare condition, accounting for about 1–3% of all dental anomalies:

In permanent teeth: up to 3.8% of cases
In primary teeth (children): about 0.6%
Males are twice as likely as females to develop extra teeth in adulthood.

Are wisdom teeth considered extra teeth?

No. Wisdom teeth (third molars, appearing between ages 17–21) are part of the normal set of permanent teeth.
However, in hyperdontia, additional wisdom teeth may develop alongside other extra teeth.

At what age can extra teeth in children be treated?

Dentists usually recommend removing extra teeth around age 7 to prevent interference with the growth of normal teeth and jaw development.

Can hyperdontia be prevented?

No. Extra teeth in children cannot generally be prevented, as most cases are genetic or congenital.
However, early detection and proper treatment can reduce future risks and complications, such as:

Crowded teeth
Abnormal gaps
Bite problems

Can hyperdontia be treated with orthodontics?

Yes. In most cases, orthodontic treatment can be applied after the removal of extra teeth.

The primary treatment usually starts with surgical extraction of extra teeth.
After surgery, traditional braces or clear aligners can be used to align teeth and adjust the jaw.

When is orthodontics alone sufficient?

In some cases, if the extra teeth do not affect adjacent teeth or the bite, orthodontic treatment alone may be sufficient without surgery.

Factors affecting treatment choice

Child’s age at diagnosis
Location of extra teeth (front, back, or impacted under the gums)
Other issues like crowding or missing teeth

For example:

Impacted teeth may cause bite problems or tilting of surrounding teeth
Loss of teeth due to hyperdontia may cause adjacent teeth to shift, leading to gaps or misalignment

Stages of extra teeth in children

1. Infancy (0–1 year)

Extra teeth rarely appear at this stage.
If they do, they may cause:
- Difficulty breastfeeding
- Gum irritation or pain
Note: This stage is important for monitoring the eruption of the first normal teeth.

2. Early teething (1–3 years)

Extra teeth may begin to appear, usually upper front incisors (Mesiodens).
Common symptoms:
- Crowding of natural teeth
- Abnormal gaps or crooked teeth
- Minor chewing difficulties if extra teeth are posterior or prominent

3. Mixed dentition (6–12 years)

Baby teeth start falling, and permanent teeth erupt.
Effects of extra teeth:
- Delayed eruption of permanent teeth
- Crowding of new permanent teeth
- Misalignment or bite disorders

4. Adolescence (12–18 years)

Permanent teeth are complete, and the impact of extra teeth becomes more apparent.
Common problems:
- Crowding or crooked permanent teeth
- Need for braces or surgical removal of extra teeth
- Changes in smile appearance and sometimes jaw and chewing issues

Important notes

Most extra teeth appear in the upper front jaw.
Some extra teeth remain hidden under the gums and are detected via X-rays.
Early diagnosis by a pediatric dentist helps:
- Determine whether removal is necessary
- Prevent future misalignment and bite problems

Causes of extra teeth in children

Hyperdontia refers to the presence of more teeth than normal, and its exact cause is unknown. It is generally linked to genetic, congenital, or environmental factors.

1. Genetic causes:

Most cases are related to hereditary factors
If a family member has extra teeth, there is a higher chance the child may have them
Certain genes responsible for tooth development may cause extra teeth

2. Congenital syndromes associated with extra teeth:

Cleidocranial Dysplasia: Affects bone and tooth development
Gardner Syndrome: Associated with tumors and some extra teeth
Fabry Disease: Enzyme deficiency affecting skin, muscles, and nerves
Ehlers-Danlos Syndrome: Weak joints, easy dislocations/bruising, spinal and dental issues
Ellis van Creveld Syndrome: Short limbs, extra fingers, congenital heart and dental anomalies
Nance-Horan Syndrome: Dental anomalies and congenital cataracts
Rubinstein-Taybi Syndrome: Facial anomalies, short stature, dental, eye, heart, and kidney problems
Trichorhinophalangeal Syndrome: Bone, joint, facial, skin, hair, and dental anomalies

3. Environmental or acquired causes:

Maternal exposure to medications or toxins during pregnancy
Vitamin deficiency or poor nutrition
Trauma to the jaw or gums during tooth development, rarely stimulating extra teeth

Important notes

Extra teeth most commonly appear in the upper front jaw
Some cases remain hidden under the gums and are detected with X-rays
Early diagnosis is crucial for determining whether extraction or orthodontic treatment is needed to prevent bite and alignment problems

Symptoms of extra teeth in children

Appearance of extra teeth:

Abnormal teeth alongside normal teeth, usually in the upper front region, but may appear anywhere in the jaw

Crowding:

Extra teeth push normal teeth, causing misalignment, small gaps, or crooked teeth

Delayed eruption of normal teeth:

Extra teeth may block natural teeth from erupting in the correct position

Difficulty in chewing or biting

Extra teeth appearing in the premolars or molars can make chewing food difficult.

Speech problems

Extra front teeth may affect the pronunciation of certain sounds.

Changes in jaw or smile appearance

They can cause jaw expansion or crooked teeth, altering the appearance of the smile.

Occasional pain or inflammation

Extra teeth may press on the gums or cause inflammation, especially if partially erupted or hidden under the gums.

Types of extra teeth in children

By number:

Single extra tooth: Most common, usually upper front incisors.
Multiple extra teeth: Less common, more than one extra tooth appears.

By location in the jaw:

Front teeth (Mesiodens): Most common, located between upper front incisors.
Back teeth (Paramolars / Distomolars): Less common, behind premolars or molars.
Lower jaw: Rare, but can cause crowding of back teeth or bite problems.

By shape:

Supplemental tooth: Resembles a normal tooth and may integrate into the natural alignment.
Abnormal shape (Conical / Tuberculate / Odontoma): Small, conical, or incompletely formed, causing problems with eruption or jaw alignment.

By eruption status:

Erupted teeth: Visible in the mouth.
Impacted / Embedded teeth: Hidden under the gums, preventing normal teeth from erupting or causing jaw issues.

Important notes:

Most extra teeth appear in the upper front jaw.
Some may remain hidden and detected only via X-rays.
Early diagnosis helps determine whether surgical removal or monitoring is necessary.

Risks of extra teeth in children

1. Functional risks:

Crowding of natural teeth.
Difficulty in chewing, especially premolars or molars.
Speech difficulties, particularly sounds like “s, sh, th.”

2. Cosmetic and psychological risks:

Changes in the smile due to crooked teeth or abnormal gaps.
Lower self-confidence, social embarrassment when smiling or speaking.

3. Health risks:

Food accumulation and difficulty cleaning, increasing the risk of cavities and gum inflammation.
Movement of natural teeth to fill gaps, causing future orthodontic problems.
Delayed eruption of permanent teeth due to obstruction by extra teeth.

4. Syndrome-related risks (rare):

Some children have extra teeth linked to genetic syndromes like Ectodermal Dysplasia, affecting hair, skin, nails, and teeth.
General jaw or facial growth problems caused by extra teeth or their complications.

Important notes:

Early diagnosis reduces most risks.
Regular follow-up with a pediatric dentist is essential to determine if surgical removal is needed.
Cooperation between doctor and family ensures proper tooth alignment, oral health, and aesthetic outcomes.

Diagnosis of extra teeth in children

1. Clinical examination:

Compare the number of primary and permanent teeth to normal eruption for the child’s age.
Note any crowding or abnormal gaps between teeth.
Assess tooth shape for anomalies or syndrome-related small teeth.
Examine gums and jaw for extra or underdeveloped teeth.

2. Medical and family history:

Ask parents about extra teeth in family members (hereditary).
Review pregnancy and birth for exposure to infections, medications, or radiation.
Ask about congenital syndromes like Ectodermal Dysplasia affecting teeth, hair, or skin.

3. Imaging:

Panoramic X-ray: Identify location of extra teeth and hidden permanent teeth.
Periapical / Bitewing X-rays: Detect small or additional teeth in younger children.
3D CBCT scans: For complex cases to locate extra teeth precisely before treatment.

4. Differential diagnosis:
Ensure extra teeth are not caused by:

Normal delayed eruption.
Trauma to teeth or gums.
Nutritional deficiencies or vitamin insufficiency.

5. Follow-up diagnosis:

Some cases, especially hidden teeth, require monitoring for several months to see if they erupt naturally or need surgical removal.

Importance of early diagnosis:

Prevent tooth crowding, bite misalignment, and delayed eruption of permanent teeth.
Plan for timely removal or orthodontic treatment.
Ensure proper jaw growth, oral health, and aesthetic appearance.

Surgical treatment of extra teeth

1. Front extra teeth (incisors):

Risks: Crowding, difficulty chewing, speech problems, and aesthetic concerns.
Surgical treatment: Usually removed between ages 6–9 before permanent teeth erupt.
Sometimes removal occurs after evaluating jaw growth and permanent teeth positioning.
Post-surgery follow-up: Monitor permanent teeth and apply orthodontics if necessary.

2. Back extra teeth (molars / premolars):

Risks: Crowding, delayed eruption, chewing difficulties.
Surgical treatment: Remove after X-ray location is determined.
Prefer removal before permanent molars erupt to prevent bite issues.
Follow-up: Monitor permanent teeth eruption and apply orthodontics if needed.

3. Hidden extra teeth (Supernumerary unerupted teeth):

Risks: Block permanent teeth, fracture adjacent teeth, or distort the jaw.
Surgical treatment: Usually removed before or during eruption of permanent teeth.
For complex cases, CBCT scans are used to locate teeth precisely.

Post-surgery follow-up:

For normal teeth:

Monitor permanent teeth growth and positioning.
Apply braces if alignment issues arise.

For syndrome-related extra teeth:

May require staged removal according to jaw and teeth development.
Usually requires long-term follow-up with a multidisciplinary team (pediatric dentist, orthodontist, oral surgeon).

General notes:

Early diagnosis ensures optimal timing for surgery and minimizes complications.
In some cases, removal may be postponed until jaw growth is complete.
Cooperation between doctor and family ensures the best functional and aesthetic outcome.

Orthodontic treatment for extra teeth

1. Front extra teeth (incisors):

Problems: Crowding, delayed eruption of permanent teeth, smile deformity, psychological impact.
Treatment:
- Sometimes a pre-extraction appliance is used to guide natural teeth.
- After removal, braces align incisors and improve the smile.
Recommended age: 6–12 years, depending on permanent tooth eruption.

2. Back extra teeth (molars / premolars):

Problems: Crowding or delayed eruption of permanent molars. Bite and chewing issues.
Treatment:
- Fixed or removable appliances to guide teeth into proper position.
- Continuous follow-up to adjust gaps.
Recommended age: 8–14 years.

3. Hidden extra teeth under the gums:

Problems: Prevent permanent teeth eruption or misalign bite.
Treatment:
- Appliances guide natural teeth after extraction.
- Sometimes jaw expanders are needed for severe crowding.
Recommended age: 6–12 years, depending on permanent teeth eruption.

4. Syndrome-related multiple extra teeth:

Problems: Severe crowding, jaw or facial deformities.
Treatment: Long-term plan with a multidisciplinary team coordinating surgery and orthodontics.

Orthodontic treatment plan:

Gradual removal of teeth causing crowding or eruption problems.
Use of fixed or removable appliances to align teeth and correct bite.
Regular follow-up with pediatric dentist, orthodontist, and oral surgeon.

General notes:

Orthodontics is usually part of a comprehensive plan including surgical removal if needed.
Early diagnosis and planning ensure the best functional and aesthetic outcomes.
Continuous follow-up is required to ensure proper jaw growth and teeth alignment.

Comprehensive table for orthodontic treatment of extra teeth (Hyperdontia)

Type of extra teeth	Appropriate age for orthodontics	Type of appliance	Notes / Follow-up
Front incisors	6–12 years	Small fixed or removable appliances to guide teeth	- Remove extra teeth before braces if needed - Monitor teeth alignment after extraction - Adjust smile and gaps between incisors
Back molars / premolars	8–14 years	Fixed or removable appliances to expand jaw and guide teeth	- Remove extra teeth if needed - Monitor eruption of permanent teeth - Adjust bite for better chewing
Hidden teeth under gums	6–12 years	Guiding appliances or jaw expanders	- Surgical removal of extra teeth - Guide natural teeth into proper position - Monitor jaw growth to prevent deformities
Multiple / syndrome-related teeth	6–14 years (case-dependent)	Comprehensive plan: fixed & removable appliances	- Gradual removal of extra teeth - Monitor bite and permanent teeth alignment - Multidisciplinary team: orthodontist, pediatric dentist, oral surgeon
Random or sudden extra teeth	According to permanent teeth eruption	Customized appliance	- Individual evaluation - Remove unnecessary teeth - Continuous follow-up for proper permanent teeth growth

General follow-up notes:

Orthodontics usually follows extraction if teeth cause crowding.
Early diagnosis ensures proper planning for each type.
Regular check-ups every 4–6 weeks in the early phase to adjust appliances and monitor jaw growth.
Some cases may require additional surgery before or during orthodontic treatment for optimal results.