We have two sets of teeth during our lifetime. These are primary (baby) teeth and adult teeth. People typically have 20 primary teeth and 32 adult teeth.

It’s also possible to have an extra, or supernumerary, tooth. The most common type of extra tooth is called a mesiodens.

A mesiodens appears at the front of your upper jaw (premaxilla) between or behind your two front teeth (incisors). It’s typically conical in shape and occurs more often with adult teeth than with baby teeth.

Mesiodens is rare. While its prevalence can vary by location and community, it’s estimated to affect between 0.15 and 1.9 percent of the general population. It’s also more common in men than in women.

When a mesiodens is present, it’s important that it’s treated in a timely manner. This is because leaving it can potentially cause dental problems later on.

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Mesiodens, also known as supernumerary tooth. Varun Pratap Singh, Amita Sharma, Sonam Sharma, via Wikimedia Commons.

The exact cause of mesiodens is still unknown. It’s possible that genetics, environmental factors, and changes during dental development may all play a role.

Additionally, the occurrence of mesiodens has been associated with a variety of health conditions, such as:

  • cleft lip and cleft palate
  • Gardner’s syndrome, a rare genetic disorder that causes growths to appear on various parts of the body
  • cleidocranial dysplasia, a rare genetic condition that leads to unusual development of the bones and teeth
  • orofaciodigital syndrome, a rare genetic condition that impacts the development of the mouth and teeth as well as facial features, fingers, and toes

It’s also possible for multiple mesiodens to appear, although this is less common. When this happens, it’s called mesiodentes.

Having a mesiodens can lead to a variety of potential dental complications. Let’s explore some of them.

Interference with other teeth

One of the main complications of mesiodens is interference with surrounding teeth. This can happen in a variety of different ways, including:

  • delayed eruption of surrounding teeth
  • displacement of surrounding teeth
  • increased crowding in the area of the mesiodens
  • misalignment of teeth (malocclusion) or problems with bite
  • formation of a diastema, or space, between your two front teeth
  • dilaceration of surrounding teeth, which is where the root or crown of a tooth has an abnormal bend
  • root resorption of surrounding teeth, which is where the root structure of the tooth is dissolved

Interference of a mesiodens with surrounding teeth can lead to the necessity of future dental or orthodontic treatments. That’s why it’s important to identify and treat a mesiodens as early as possible.

Cyst formation

A cyst is a sac of fluid that forms in the body. When a mesiodens remains un-erupted (impacted), it can lead to the formation of a type of cyst called a dentigerous cyst.

Generally speaking, a small dentigerous cyst won’t cause symptoms. However, if the cyst begins to get larger, it may cause problems like swelling or displacement of surrounding teeth.

Eruption in the nasal cavity

In some cases, the mesiodens may erupt in the nasal cavity instead of the mouth. This is very rare.

When a mesiodens erupts in the nasal cavity, it can cause several problems. These can include pain, swelling, and nasal obstruction.

Mesiodens are typically found during early childhood. In fact, they’re often detected during routine dental examinations and X-rays.

Mesiodens are typically associated with adult teeth instead of baby teeth. As such, they may often, but not always, be observed around the time that these teeth are coming in. This can begin as early as age 6.

A mesiodens that’s erupted into the mouth can be detected by a dentist during a dental examination. You may even notice it on your own, prompting a visit to the dentist.

However, about 79 to 91 percent of mesiodens remain impacted. Some signs that an impacted mesiodens may be present include crowding, misalignment of teeth, and delayed eruption of surrounding teeth.

When a mesiodens is impacted, it can be found through use of dental X-rays. Your dentist may collect X-ray images from several different angles to diagnose a mesiodens.

Management of mesiodens typically involves extraction. However, in some situations, such as if a mesiodens is a baby tooth and isn’t causing complications, a dentist may recommend watching it instead.

During an extraction, your dentist will carefully remove the mesiodens. There are two types of extraction:

  • Simple. In a simple extraction, a tooth is removed without any incisions. The dentist will typically use a tool to grip the tooth and loosen it. This type of procedure can often be carried out at your dentist’s office.
  • Surgical. In more complex situations, such as an impacted tooth, a surgical extraction is needed. This is done by an oral surgeon and will involve an incision and stitches. Since most mesiodens are impacted, it’s likely that they’ll need to be removed surgically.

Generally speaking, extraction is carried out shortly after diagnosis rather than waiting until a child is older. This is to prevent the mesiodens from causing future complications with surrounding teeth.

However, early removal of a mesiodens is associated with its own risks. Extraction can potentially damage the area where surrounding adult teeth will come in. When this happens, the eruption of these teeth may be delayed.

Because of this, your dentist will continue to carefully monitor your teeth following the extraction of a mesiodens. This is to make sure that other surrounding adult teeth come in properly.

It’s also not uncommon for people with a mesiodens to need additional orthodontic treatment following extraction. This is typically to correct alignment, positioning, or spacing of the surrounding teeth.

The cost of an extraction can vary and is highly dependent on your location. According to the Consumer Guide to Dentistry, the average costs can range from $130 to 400.

A simple extraction of a tooth that’s already erupted can cost between $100 to $250. Surgical extraction of teeth that are still impacted costs more, between $180 and $400, but deeply embedded teeth may drive the cost up to $600 or higher.

Many dental insurance plans will cover an extraction if it’s considered to be medically necessary. Contact your dental insurance provider prior to an extraction to get an idea of how much you may be responsible for paying.

Most of the time, mesiodens are detected and treated during childhood. However, it may be possible that a mesiodens remains diagnosed or untreated into adulthood.

If you can’t see the mesiodens in your mouth, you may be able to identify it if your front teeth have:

  • grown in at an abnormal angle or position
  • a noticeable gap between them
  • misalignment
  • crowding
  • not grown in at all

If you suspect that you may have a mesiodens, make an appointment with a dentist. They can perform a dental examination and X-rays to help determine whether a mesiodens is present.

Because mesiodens are typically diagnosed and treated at an earlier age, it’s possible that you may need more extensive dental or orthodontic procedures to help correct any dental issues that have occurred due to a mesiodens.

A mesiodens is an extra tooth that’s located behind or between your two front teeth. It’s typically identified during early childhood around the time that adult teeth are beginning to come in.

When left untreated, a mesiodens can lead to dental complications. This often interferes with nearby teeth, causing crowding, misalignment, and delayed eruption.

Mesiodens is typically treated using an extraction shortly after diagnosis. It’s possible that additional dental or orthodontic treatments may be needed after mesiodens removal.

See a dentist if you believe that you or your child has a mesiodens. Prompt diagnosis and treatment can help to prevent future dental complications.