Something behind...

I have here is a photo of an 8 year old girl's dentition. The parents were amazed, how come there's another tooth behind the left permanent maxillary central incisor? and then I said," that is called a supernumerary or accessory tooth. In Dentistry, some called it Hyperdontia.

Supernumerary teeth can be classified by shape and by position. The shapes include:

• Supplemental(where the tooth has a normal shape for the teeth in that series);
• Tuberculate (also called "barrel shaped");
• Conical (also called "peg shaped");
• Compound odontome (multiple small tooth-like forms);
• Complex odontome (a disorganized mass of dental tissue)

When classified by position, a supernumerary tooth may be referred to as a mesiodens, a paramolar, or a distomolar.

The most common supernumerary tooth is a mesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary central incisors.

Fourth and fifth molars that form behind the third molars are another kind of supernumerary teeth

Periapical Radiograph showing translucency within the left permanent maxillary central incisor, that is the supernumerary tooth of the child patient.

Since the supernumerary tooth is pushing the central incisor forward resulting to malalignment of the arch, extraction is the best solution.( as seen in the image below)

Extracted supernumerary tooth

Actually, what I have here is just a simple case, only one extra tooth is present. In some cases, they have more than one extra teeth just like what is shown below:

Image from a fellow dental blogger.

Got Extra Tooth

Everyday, I encounter different cases in my clinic. It could be a disease or an abnormality. Sometimes I encounter less number of teeth in a patient, but oftentimes, with extra teeth. 

There's nothing wrong with an extra tooth if it does not affect the aesthetics. But some of them causes crowding and malocclusion. I had this case few months ago, 12 year old boy with an extra front tooth, this is called MESIODENS. 

mesiodens /me·sio·dens/ (me´ze-o-dens) pl. mesioden´tes   a small supernumerary tooth, occurring singly or paired, generally palatally between the maxillary central incisors. (Source: Free Online Medical Dictionary)

Treatment Plan:

• Extraction of Mesiodens
• Closure of space caused by mesiodens and alignment of teeth by a fixed orthodontic treatment

Upper braces installed

Space closure by elastics

Space closed, leveling process ongoing

I'm now on the process of correcting the alignment of both the upper and lower teeth. I'm still on the first stage of treatment to this patient. I'll be posting the development soon.

Coolest Milk Tooth

A child patient was complaining of toothache pointing on the area of her upper right temporary first molar.  I did a dental examination and was found out that the area she was pointing shows a locally swollen gingiva (gums) surrounding a mobile, non carious tooth. I decided to extract it and was expecting an easy extraction because in the first place that was just a temporary tooth. During the procedure, I was surprised that the tooth was so difficult to remove,it's already mobile but there's something holding it, I suppose that was the permanent premolar succeeding it. I was so careful because thinking that I might destroy the succeeding permanent tooth below it. That was few minutes already, I'm sweating, my right hand holding a pedo forcep is hurt (expecting calluses again...). "What's wrong with this tooth," I said. After few minutes of trying, I got it! Over flaring roots anchored tightly on it's area. That was the strongest, coolest milk tooth I ever had. Hahahaha! 

Upper Right Temporary First Molar

The roots look like a King's crown, beautifully shaped.

Not so lucky?

 The parent thought this child is hopeless.Well,what do you expect in towns? Thank God! Dentistry is upgrading endlessly. Nothing is impossible today. The  Dentist said, "this is just a simple case...".Indeed, this is just a little ortho thing. This 10 year old boy has a deep bite, slightly crowded anterior teeth, unerupted canines but with class I molar relationship and a full permanent dentition. Lack of space is the main cause of this problem. Since the patient is growing,we don't need to extract some teeth to align them. The alveolar bones are on its growth peak during this age,all we need is something to initiate and guide the teeth to it's proper position. The trend says, Braces, we will install a Fixed Orthodontic Appliance. What I did here is a basic Fixed Orthodontic Treatment.

Upper Braces Installed

3 months later, lower braces installed

After 2 months

After 3 months

The patient's teeth are properly aligned. I'm now on the process of stabilization and closing the bite. I'll be posting latest photos soon.

Monster Teeth? (continuation...)

Within 7 months of monitoring, I've personally learned the effectiveness of T4k in children with mixed dentition. As seen below, we can obviously notice the corrected crossbite and improved arch form. The patient will continue using the appliance until all permanent teeth (except 3rd molars) are fully erupted,the appliance will guide the erupting teeth to its proper position. 

After 7 months of using T4K

This is one of the easiest cases I guess, All we have to do is buy this pre-made removable appliance and instruct the patient on how to use it. Monthly monitoring is important to see improvements.  

Monster Teeth?

A mother with her daughter came to my clinic so worried of the child's teeth. She said her daughter lost esteem at early age. She often smile and always teased by her classmates in elementary school. The child was just 7 years old,with mixed dentition (teeth are composed of temporary and permanent). I did a dental examination to her, no caries(cavities) noted, surrounding tissues are normal. But as seen in the picture, teeth are partially erupted, constricted look, the alveolar bones are narrow shaped.

7 year old child patient with anterior cross bite

I was thinking of a removable orthodontic appliance for the child. An appliance which is comfortable, that the patient may use until all temporary teeth becomes permanent and will guide her teeth in correct alignment as well as correcting the jaw pattern. The solution was T4K, pre -orthodontic trainer for kids. The child will wear the appliance every night as she sleeps for a target of 6-12 months. This rubber appliance was usually given to child patients with mixed dentition preferably ages 9 and below. 

We will see the results soon.