Today aesthetics has become so important that everyone wants to get a perfect smile on their face. Nobody likes to have extra teeth in the mouth.

An extra tooth not only affects the aesthetics but may also damage the adjacent teeth, interfere with the eruption of a permanent tooth and affect the surrounding tissues and bone.

One common type of supernumerary tooth that grows between the front teeth is called as a Mesiodens.

Mesiodens often occurs during childhood and interferes with the eruption of permanent teeth in the front.

In most cases, a mesiodens also alters the alignment and impacts the dental aesthetics. It is necessary to detect it in its early stage to avoid a series of complications and treatments that may be required to align the teeth.

It is always best to consult a dentist at this time and get the extra tooth removed at an early stage. Let’s read on to understand the implications of a mesiodens on the overall dentition.

What is mesiodens?

As the name suggests, Mesiodens tooth is a supernumerary tooth that erupts between two teeth, most commonly between the central incisors in the front i.e. the midline of the upper jaw.

Generally, a mesiodens is a single supernumerary tooth, but in rare instances, two extra teeth may also present clinically.

Studies have shown that only 1% of the population is usually affected by mesiodens. (1)

How does it occur?

Two proposed theories may explain the occurrence of a Mesiodens –

  • Hyperactivity theory – This suggests an increased activity of tooth’s developing layer called dental lamina during the formation of the tooth bud may form an extra tooth.
  • Dichotomy theory – This phenomenon explains the splitting of a single tooth bud into two sections.

Who can have mesiodens?

Mesiodens rarely occurs in the oral cavity. The prevalence of its occurrence may vary from 0.09 – 2.2%.

It commonly occurs in young children but may persist in adults as well. Individuals from 4 – 20 years of age are often affected. Males have slightly higher predilection as compared to females. (2)

An occurrence of mesiodens is common in permanent dentition, and it commonly occurs as a single, unilateral supernumerary tooth but may sometimes occur bilaterally as well.

Mesiodens is also often associated with syndromes like cleft lip and palate and cleidocranial dysostosis.

Types of mesiodens

Mesiodens can be broadly classified into three types:

  • Supplementary – They erupt like a healthy tooth, most commonly in young children during the eruption of primary dentition.
  • Rudimentary – Unlike supplementary, these erupt in permanent dentition and do not resemble a healthy tooth. It differs in shape and size. It commonly presents in adults.
  • Inverted – As the name suggests the tooth is inverted at 180 degrees and the direction of eruption changes.

What are the complications associated with mesiodens?

  • Delayed eruption of front teeth, i.e., the central incisors
  • A spacing between the front teeth called as diastema
  • Change in the direction of the eruption of the adjacent permanent teeth
  • Dilacerations – formation of curved roots
  • Root resorption of adjacent teeth
  • Formation of cysts like a dentigerous cyst
  • An abnormal eruption of a tooth for example eruption in the nasal cavity

How is it diagnosed?

Mesiodens is an x-linked inherited oral condition. A dentist can diagnose the situation after a thorough medical history, oral examination and x-ray study.

Since it is a common occurrence among the children, regular dental check-ups are advised as soon as the first tooth starts to erupt and should be followed up for every six months.

Around 75% of the mesiodens don’t erupt and stay impacted in such situations; radiographs play a crucial role to identify a mesiodens. (3)

Radiographically a mesiodens can be diagnosed as –

Eumorphic

In this case, a mesiodens resembles a healthy tooth in shape and size. Eumorphic mesiodens most commonly erupts between the central incisors of the upper jaw.

In some cases, because of incomplete root development, they may erupt partially in the upper jaw.

Dysmorphic

In this case, a mesiodens has an abnormal shape and size. The representation of a dysmorphic mesiodens can vary as follows:

  • Conical/peg shaped – the most common type of occurrence (almost 70%)
  • Tuberculate – resembles a tubercle (may have more than once cusp)
  • Supplemental – presents as double the size of a healthy tooth

What is the treatment?

Treatment varies with the age group. Generally, in all cases, mesiodens are extracted to allow the permanent teeth to erupt in their original position.

  • In young children, the condition is left alone and only monitored every six months. In some instances, the mesiodens fall out on its own.
  • An unerupted mesiodens if identified, should be treated with a surgical extraction.
  • In adults, an extraction of the mesiodens may be followed by an orthodontic treatment to align the teeth and close the diastema.

Whatever the treatment may be, a follow-up appointment is as necessary as the procedure. It will help the dentist to update you about the eruption pattern and help you maintain the aesthetics of the teeth.

Take away message

Mesiodens may be a rare occurrence. However, it is mandatory to take care of your child’s oral health and get regular check-ups to allow the teeth to erupt properly.

Nobody likes to undergo an orthodontic treatment; early detection and appropriate treatment will help you to avoid unnecessary surgery.

Maintain good oral hygiene to avoid any oral complications like infections, plaque formation, etc.

Mesiodens not only affects the aesthetics but also impair the growth of the adjacent teeth and surrounding tissues. So, it is essential to keep a check on the oral condition.

If you notice increased spacing or delayed eruption of teeth, visit your dentist and get a consultation to stay informed about the dental problem.

Mesiodens is a supernumerary tooth that erupts between two teeth, most commonly between the central incisors in the front upper jaw.