Introduction

During the course of your life, you will develop two sets of teeth. The first set of teeth develops in childhood and consists of 20 “baby” teeth. Around age six, these fall out and are replaced with 32 “adult” teeth—also known as your permanent teeth. However, some individuals end up with more than 32 teeth, a condition known as hyperdontia.

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Like most dental conditions, hyperdontia requires the proper diagnosis and treatment. Keep reading this guide from Flossy to find out everything you need to know about the causes, symptoms, and treatment options for hyperdontia. 

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The Structure of the Teeth

The typical adult has 32 teeth. It consists of the following types of teeth:

• Incisors: There are eight incisors in total. They are located in the very middle of the jaw, with four on top and four on the bottom. They are mostly used for biting. 
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• Canines: There are four canines in total—each surrounding the incisors. These “fang-like” teeth are incredibly useful for tearing into food. 
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• Premolars: These are the eight teeth located between the canines and the molars.
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• Molars: These are eight flat teeth located in the back of the jaw. They are best for “grinding” food.
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• Wisdom teeth: You can have a maximum of four wisdom teeth. Some adults have only two, while some have none at all. These were useful back when human jawlines were bigger but are usually removed in the modern age to prevent tooth overcrowding. 

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The tooth's visible part is called “the crown,” while the part inside the jawline is called “the root.” Each tooth is made up of the following parts:

• Enamel: This is the pearly-white part that covers the outside of the tooth. Because enamel is primarily made out of calcium phosphate, it is one of the hardest materials in the entire body. The enamel protects the inside of the tooth from external factors. 
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• Dentin: This is a yellow-ish part of the tooth that lies directly below the enamel. It contains microscopic tubes that transmit information between the enamel and the innermost parts of the tooth. These microscopic tubes make the teeth more sensitive to hot and cold temperatures if the enamel wears away.
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• Pulp: This is the softest part of the tooth that lies inside. It contains nerve endings, making it incredibly sensitive to outside elements if not protected by the enamel and dentin. The pulp is responsible for bringing oxygen-rich blood and other nutrients to the tooth. 
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• Cementum: This layer of connective tissue—similar in consistency to cement—attaches the root of the tooth to the gums and the jaw.
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• Periodontal ligament: This is the soft tissue that consists mainly of collagen protein. It helps to bind the teeth to the jaw bone. 

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What Is Hyperdontia?

If someone has more than the expected 20 primary teeth or 32 permanent teeth, they are said to have hyperdontia. The additional teeth are called “supernumerary.” These tend to be larger and more complex than regular teeth. Hyperdontia is five times more likely to occur in adulthood than in childhood.

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The most common supernumerary teeth emerge in the upper center of the jaw—behind the incisors. These are known as “mesiodens.”  However, supernumerary teeth can emerge anywhere in the gums or jaw.

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It is possible to have just one supernumerary tooth or multiple. They can be located on just one side of the mouth or on both sides. Furthermore, it is possible for supernumerary teeth to emerge on both the upper and lower jaw. 

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Most supernumerary teeth are asymptomatic. For this reason, many are discovered incidentally during routine dental X-rays. That said, supernumerary teeth can cause various aesthetic and functional complications. This includes crowding, rotation, displacement, delayed eruption, infections, and lesions. 

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Since most supernumerary teeth can lead to complications, it’s important to diagnose and treat them early on. Although there is some disagreement about removing supernumerary teeth, dental professionals believe that around six or seven years of age is the perfect time to remove supernumerary teeth.

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However, in many cases, supernumerary teeth are not diagnosed in time and end up being removed well into adulthood when they begin to cause dental complications.

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Types of Supernumerary Teeth

Supernumerary teeth are classified according to their shape and location. 

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A supernumerary tooth can have the same shape and anatomy as a nearby tooth. In this case, it is called “supplemental.” However, if it has an abnormal shape, then it is referred to as “rudimentary.”

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A rudimentary tooth may be further classified according to its shape. If it’s tube-like, then it is referred to as “tuberculate.” However, if it resembles the shape of a cone, then it is referred to as “conical.”

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A supernumerary tooth can also be classified according to its location. If it grows between incisors located in the upper jaw, then it is referred to as a “mesiodens.” If it grows behind the molars, then it is called “distomolar.” Last, if it grows next to the molars, it is called “paramolar.”

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Mesiodens teeth are the most common types of supernumerary teeth. 

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What Causes Hyperdontia?

Dental professionals are not sure what the exact causes of hyperdontia are. Most likely, the causes vary from individual to individual. They may be a combination of environmental stressors, physical trauma, or genetic influences. 

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Various inherited disorders can also trigger hyperdontia in individuals. Some of the conditions associated with hyperdontia include:

• Cleft lip and palate: This condition is marked by the irregular development of a baby’s lip or mouth. This is a condition that occurs during neonatal development and can increase the risk of supernumerary teeth developing along with “baby” teeth. 

• Garner’s syndrome: While this is a rare disorder, it can significantly increase the risk of supernumerary teeth. It is marked by the growth of benign tumors in various areas of the face and body. Down the line, it can also increase the risk of colon cancer.
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• Rubenstein-Taybi syndrome: This condition is characterized by distinctive facial features, including abnormalities of the teeth. This abnormality increases the risk of developing supernumerary teeth.
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• Trichorhinophalangeal syndrome: This condition leads to the malformation of the bones, which includes those of the face. If the condition affects the jawline, it can lead to supernumerary teeth in childhood.
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• Cleidocranial dysplasia: Like the above syndrome, this is another condition associated with the deformation of bones. Usually, it affects the entire skull, which includes the jaw bone.
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• Fabry disease: This condition is marked by a deficiency of the enzyme alpha-galactosidase A. The lack of the enzyme leads to a build-up of tissue in many areas, including the teeth.

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Various other genetic disorders can lead to the development of supernumerary teeth. In some cases, dental professionals can even aid in the diagnosis of those conditions by identifying supernumerary teeth. 

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How Common Is Hyperdontia?

The prevalence of hyperdontia varies from population to population. Currently, estimates range from 0.1% to 3.9% prevalence for a given country. Some researchers believe that countries with low socioeconomic levels have a higher prevalence of hyperdontia. However, there is currently no consensus regarding why this may be the case.

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However, there is evidence to support gender differences in the development of hyperdontia. Some studies have found that males are more likely to develop the condition. 

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However, just because males are more likely to develop supernumerary teeth does not necessarily mean gender is a risk factor. For this reason, researchers are still attempting to study the prevalence of hyperdontia before making any definitive conclusions. 

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What Are the Symptoms of Hyperdontia?

In many cases, hyperdontia does not cause any pain to the teeth, gums, or jaw. It may not present with any symptoms that are evident to the patient. In many such cases, the supernumerary teeth are only discovered with a dental X-ray performed for other purposes.

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In other cases, supernumerary teeth can lead to overcrowding along the gums and the jawline. This can not only lead to an uncomfortable sensation for the patient, but it can also lead to complications with other teeth that are not considered supernumerary.

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Depending on the location of the supernumerary tooth, it can make contact with other teeth. This can lead to the wearing away of the enamel, chipping, or cracking, all of which significantly increase the chances of developing serious dental conditions.

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Some supernumerary teeth may fail to erupt completely. In this case, they remain trapped in the gums; a condition referred to as “impacted” teeth. In many cases, this should not cause any discomfort. However, the impacted teeth can cause inflammation, leading to intense pain and various other dental conditions.

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How Is Hyperdontia Diagnosed?

It is difficult to diagnose hyperdontia in some cases, especially if the condition does not present any obvious symptoms. However, if the patient complains of any type of discomfort, then their dentist might suspect hyperdontia.

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In this case, they might first manually examine the patient’s mouth to identify where the supernumerary tooth has developed. If the supernumerary tooth has erupted or come to the surface, spotting it and removing it is fairly easy.

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However, impacted teeth—or those stuck in the gum or jawline—are harder to identify. In this case, they can only be identified using a dental X-ray. 

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How Is Hyperdontia Treated?

When the supernumerary teeth do not cause any pain, they create a hindrance to chewing food or pose a serious risk of dental complications; no specific treatment is required. 

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While some dentists may wish to remove the supernumerary tooth—even when it does not pose an evident risk of complications—many others might advise their patient to leave it alone and to come in for regular check-ups to ensure that nothing changes.

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However, in the majority of cases, dentists might advise their patients to remove the supernumerary tooth (or teeth). Even if it does not pose an evident risk of dental complications, it can still decrease overall dental health.

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For instance, some supernumerary teeth can lead to overcrowding, which can pose a problem with properly chewing food and in cleaning the spaces between the teeth. This contributes to discomfort and can increase the risk of tooth decay and gum infection.

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If the supernumerary teeth emerge in late childhood—when permanent teeth are coming in—they can obstruct regular teeth development.  This is another instance in which the dentist might recommend removal. 

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If the supernumerary tooth has emerged above the gum, then it can be removed like a regular tooth. However, if it is an impacted tooth, your dentist might need to make an incision in the gums to access it before removing it. 

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Takeaways 

Hyperdontia is a dental condition characterized by an extra tooth (or several) that emerges in addition to the 20 primary teeth in childhood or 32 permanent teeth in adulthood. While researchers are perplexed about its exact causes, it is likely a combination of environmental and genetic factors. 

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Hyperdontia does not necessarily cause dental complications. However, it can increase your chances of developing various conditions, such as teeth crowding, teeth cracking and chipping, tooth decay, and many others. For this reason, your dentist might recommend removing the extra tooth before it causes actual problems.

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If you have been diagnosed with hyperdontia, then you might be looking for the right dental professional to perform the tooth extraction. With Flossy’s network of dentists, we guarantee that you’ll be in the best hands—from the initial consultation to the main procedure to the follow-up appointment. 

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Schedule your appointment today!

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Our Sources: 

Before Agriculture, Human Jaws Were a Perfect Fit for Human Teeth | Smithsonian Magazine

Indications for surgical removal of supernumerary teeth in the premaxilla | NCBI

Prevalence of hyperdontia, hypodontia, and concomitant hypo-hyperdontia | ScienceDirect

Whole-exome sequencing analysis of supernumerary teeth occurrence in Japanese individuals | Human Genome Variation

Genetic background of supernumerary teeth | NCBI

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