Teeth Growing in Your Gums - Can an Aligner Fix Hyperdontia?

Teeth Growing in Your Gums - Can an Aligner Fix Hyperdontia?
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Teeth Growing in Your Gums - Can an Aligner Fix Hyperdontia?Clinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. What Is Hyperdontia?
  2. Dental Issues Caused by Hyperdontia
  3. Causes
  4. How Common is It?
  5. Will I Need Surgery?
  6. Treatment Options
  7. Can It be Treated with an Aligner or Braces?
  8. References

Hyperdontia (having extra teeth on the upper or lower jaw) can affect someone at any age and can cause a number of dental problems. Also called supernumerary teeth (ST), any excess teeth may require removal or at least monitoring for some time. Braces, aligners, and surgery may be an option for some patients with this condition.

If your child has hyperdontia, you should take them to a dentist as soon as possible. Early detection and treatment can prevent disruption to their dental development.

What Is Hyperdontia?

Unless you have a missing tooth, you should have 16 teeth on both the upper and lower jaw, if you’re an adult. Hyperdontia is a condition in which an adult has have more than more than 32 teeth in their mouth. Children who have this condition have a good reason for having it: they are still retaining extra baby teeth (primary teeth).

There is a bit of randomness about having too many teeth. There’s no consistent pattern about which teeth are extra, or supernumerary. They can be canines or molars. And hyperdontia can develop in any part of the lower or upper arch.

Sometimes the additional tooth grows out through the gum, where it’s conspicuously visible. It may be unsightly, with an abnormal shape or size.

In other cases, the supernumerary remains under the gum and can only detected by an X-ray or by another imaging technique. Sometimes the person does not even know they have an extra tooth, although often the condition produces pain and discomfort when the tooth grows and crowds into other teeth.

Dental Issues Caused by Hyperdontia

Too many teeth can cause several dental or teething problems, whether the extra ones come through into the mouth or are buried under the gum.

Issues include:

  • Failure of other teeth to come in
  • Permanent displacement of teeth
  • Crowded teeth
  • Dental cysts
  • Other tooth damage
  • Obstruction of necessary dental procedures
Some Teeth May Fail to Come In (Erupt)

A tooth is considered impacted if fails to erupt or break through the gum. When extra teeth develop in an awkward position, they can cause this problem.

For example, upper central incisors (the two front teeth on the upper jaw), normally erupt at 6-7 years old. They come in before the two upper lateral incisors (one on the immediate left and the other on the immediate right of the central incisors).

In one type of hyperdontia, the patient has fully developed upper lateral incisors, but the adjacent central incisors fail to erupt due to dental impaction.

Impacted teeth can cause several teething issues, including displacement and malocclusion (misalignment).

Permanent Teeth May be Displaced
A supernumerary baby tooth that hasn’t erupted may force a permanent tooth to grow in the wrong direction, such as sideways or forward. This occurs because both teeth are developing in the same area of the dental arch.
Crowded Teeth
Your jaw can comfortably accommodate 32 teeth at most. Any extra teeth may cause overcrowding in your mouth.
Dental Cysts
Cysts or small fluid-filled bumps may form over the impacted tooth. The gum tissue around an adjacent normal tooth or the supernumerary tooth itself can also be affected.
Tooth Damage
When a tooth fails to erupt due to the presence of a supernumerary, it may develop some structural defects. These may include a deformed, short, or underdeveloped root.
Obstructing Potential Medical Treatments

Hyperdontia patients may not qualify for certain medical procedures, such as alveolar bone grafting.

This surgical procedure involves adding bone to the gum ridge in cleft lip and cleft palate patients. It closes splits on the upper lip and roof of the mouth in children born with this condition.

For a child with both hyperdontia and cleft lip/palate, the former must be treated before bone grafting can begin to repair the cleft condition.

Possible Causes of Hyperdontia

It’s not clear what causes supernumerary teeth, but there are several theories. These include:

  • Split tooth bud
  • Hyperactive dental lamina
  • Genetics
Splitting of the Tooth Bud
Also known as dichotomy of the tooth bud, this theory links ST to the splitting of a tooth bud into two teeth in the first stage of development.
Hyperactive Dental Lamina
A band of tissue called dental lamina develops in the jaw, giving rise to a tooth bud. Hyperactivity in this tooth formation phase can create two instead of just one tooth bud, causing ST.
Genetics

Hyperdontia tends to run in some families. As per this theory, a child whose relatives have ST is at a higher risk of developing the anomaly.

Other conditions linked to ST include:

  • Cleft lip and palate: This condition must be treated to pave the way for healthy teeth formation in a child.
  • Gardner syndrome: This inherited disorder may cause cysts, lesions, and soft tissue tumors on various parts of the body.
  • Cleidocranial dysplasia: Also genetic, this condition causes weakness in teeth and bones.

However, having any of these disorders along with ST doesn’t necessarily mean one caused the other.

How Common is Hyperdontia?

How common ST is generally varies by factors like gender and ancestry. Here are some statistics on the disorder’s prevalence rate:

  • 1 to 3 percent of the Caucasian population has ST
  • 3 percent of Asians have ST
  • For every female with ST, two males have the anomaly
  • Mesiodens, which affects the front upper teeth (central incisors), is the most common type of ST
  • People without associated disorders like Gardner syndrome rarely have more than one ST
  • ST is five times less common in adult teeth than baby teeth

Will You Need Surgery?

Surgery is the primary medical intervention for ST, but it may be unnecessary or unviable for some patients. Your dentist may recommend this procedure to achieve either or both of the following:

  • Extract the supernumerary tooth
  • Expose the impacted tooth if it fails to erupt

Sometimes, it’s best not to remove the ST right away. Instead, your dentist will recommend periodic evaluations.

The problematic tooth may be removed later if potential complications are discovered.

Treatment Options for Supernumerary Teeth

Your dentist will probably use a CT scan or X-ray to assess the characteristics of your ST and the teeth/tissue around it. This information enables them to determine whether you’re candidate for surgery.

Surgical Extraction

Removal of the supernumerary tooth may be necessary if:

  • The ST has impacted a central incisor, preventing its eruption
  • Displacement of central incisors has occurred
  • There’s an associated disorder/disease
  • To allow a cleft lip/palate patient to have alveolar bone grafting
  • The impacted tooth is severely damaged

Surgical Exposure

Normally, ST removal allows the impacted tooth to erupt. If eruption doesn’t occur, the tooth may require surgical exposure.

General steps for this procedure include:

  • Your orthodontist creates arch space if there’s none at the site of the impacted tooth. Distalizing appliances may be used to achieve this by shifting adjacent teeth.
  • After space has been made, the surgeon injects numbing medication into the site of surgery.
  • Incisions are made into the arch to expose the tooth’s crown.
  • Brackets are attached (bonded) onto your teeth.
  • An orthodontic bracket is attached to the crown.
  • Elastic traction is applied. This eventually forces the impacted tooth to properly erupt into the dental arch.

Before agreeing to this treatment, consider:

  • Dental alignment and traction may take up to three years to produce the final outcome you desire
  • Lengthy surgery and orthodontic treatment may increase your costs
  • Consider removal rather than surgical exposure if the unerupted tooth is severely deformed and unsalvageable
  • Your surgeon may not recommend the surgical exposure of deeply buried teeth if it may harm otherwise healthy dental tissues or structures

Can Hyperdontia be Treated with an Aligner or Braces?

Braces and aligners can be part of your overall ST treatment plan. You may need them to correct teeth misalignment due to ST.

References

Supernumerary Teeth -An Overview of Classification, Diagnosis and Management. Journal of the Canadian Dental Association.

Eruption Charts. American Dental Association.

Management of Developing Anterior Malocclusion Due to Supernumerary Tooth with Preventive and Interceptive Approach: A 1½ Year Case Study. International Journal of Clinical Pediatric Dentistry.

Surgical Exposure and Orthodontic Alignment of Impacted Teeth. A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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