Excess teeth. Hyperdontia - when there are a lot of teeth in the mouth. Supernumerary tooth in a child

Supernumerary teeth are one of the developmental anomalies dental system when the number of teeth in the mouth exceeds the norm. The norm is 20 teeth in the milk bite and 32 in the permanent one. Usually, such additional formations are located in the anterior part of the dentition, but there are times when several more erupt near the distant teeth.

How do they look

More often they are cut into upper jaw. Their shape can be completely different. They can look almost the same as ordinary teeth, or they can be a cluster of several tooth-like formations or look like drops. Often they are soldered with permanent ones. Most often, the phenomenon of overcompletion can be found in, and much less often in dairy. Usually they erupt when the front permanent incisors appear, that is, at 7 - 8 years. They may call inflammatory changes in surrounding tissues, for example.

They can be in the dental arch, and can be in front of the dentition, or behind it. Often such a tooth is located between the central incisors of the upper jaw, and when it is removed, it remains between the teeth, which must be treated with orthodontic methods. It happens that due to the presence of supercompleteness, the main teeth do not have enough space for a normal arrangement in a row, and their crowding is observed. But if the human jaw itself is large, then there is no negative effect on the bite.

Sometimes these teeth can be impacted, that is, located in the jaw. Such supernumerary teeth are found only on an x-ray. The photos illustrate how they look, as well as the malocclusion they lead to.

If there is an overpopulation in the anterior dentition, there may be a delay in the eruption of permanent incisors. In this case, the child is given an orthopantomogram, that is, an x-ray of all teeth. If the cause of the delay was indeed the rudiments supernumerary teeth, they are removed.

Supernumerary teeth: causes

If a person has supernumerary teeth, it is rather difficult to name the reasons for their appearance. There are several hypotheses for such an anomaly:

Some scholars consider them atavism. Proponents of this hypothesis suggest that the appearance of an extra tooth in oral cavity- this is an echo of the time when our ancestors had 6 incisors. But this theory cannot explain why supernumerary teeth appear not only in the anterior, but also in the far part of the jaw.
There is also an opinion that such teeth appear due to the fact that the embryonic plate split into large quantity parts than usual. This hypothesis may explain their appearance in the far part of the dentition, but at the same time, some people have both hyperodontia (extra teeth) and hypodontia (some rudiments are missing). For example, in the anterior section, a person has 2 additional “incisors”, while there are no premolar rudiments. This hypothesis cannot explain this fact.
There are doctors who believe that negative impacts on the mother's body in the first trimester of pregnancy, when the laying of tooth germs occurs, affect the development of this anomaly.

"Extra" teeth in babies

Supernumerary teeth in children with a milk bite are not as common as in children with permanent teeth. It happens that a child has such a tooth immediately after birth. Of course it is removed. After all, it injures both the mucous membrane of the child himself and the mother's nipple during breastfeeding.

When an extraction occurs in a child, one can hope that the bite will recover on its own. But if the removal was performed on an adult, then orthodontic treatment is necessary. If the baby's supernumerary tooth is in place of a permanent one that has not yet erupted, an X-ray examination is performed and the condition of both teeth is assessed. If the supernumerary root is well developed, and the tooth itself is healthy and looks like a normal one, and at the same time the permanent one begins to erupt already with a defect, then the supernumerary one is left. The defective permanent is then removed.

An additional tooth has appeared: to remove or treat?

If an extra enamel organ that has appeared in the anterior part of the dentition looks like an incisor or canine, and does not disturb the bite, it is left. Supernumerary teeth are also susceptible to caries and its complications. Treatment of caries in this case is carried out in the usual way. After boron treatment and cavity preparation, the defect is filled filling material and illuminate.

Fate additional formations depends on their influence on the whole bite as a whole. If they interfere with the development of a normal bite, then they must be removed. In the case when the supernumerary formation is located close to the growth zone of the complete one, then it is not necessary to immediately remove it. You need to wait until the root of the complete one is fully formed. If you remove the additional one earlier, the growth zone may be damaged. ordinary tooth and then it will erupt already with a defect or not erupt at all. But, if the growth zones overlap each other, then the supernumerary must be removed without delay.

It often happens that a supernumerary tooth is retained, that is, it is located inside the jaw. But even in this position, he can provide Negative influence on the dentition.

Removal in this case is a rather complicated procedure, not only because of the location inside the bone. The number and shape of its roots can be very unusual. Often there are difficulties in removal due to the depth of occurrence. X-ray helps to determine its exact location. Several x-rays in different projections.

Stages of extraction of an impacted supernumerary tooth

If, after the examination, the doctor advised to get rid of impacted supernumerary teeth, the extraction takes place in this way:

First of all, the doctor does anesthesia, most often local. Sometimes this operation is done under anesthesia.
Based on the radiograph, the doctor determines the position of the tooth and cuts out a mucoperiosteal flap to create an access.
Dentist peels off mucosal flap from the bone, exposing the periosteum.
Then, using a burr, the doctor creates a small “window” in bone tissue, that is, implements the approach.
When the approach is formed, the doctor pulls out the impacted teeth, and puts medicine in the hole for the speedy healing of the bone.
The mucoperiosteal flap is placed in the same place, and the doctor sutures it.
The last step is advice to the patient on care. postoperative wound(rinse with solution, careful hygiene oral cavity).
When severe pain or swelling should see a dentist immediately.

Thus, sometimes a supernumerary tooth is not superfluous and can even take its place in the dentition. But in most cases it will need to be removed. To determine further fate such a tooth, you need to consult an orthodontist.

Nature has made sure that each person has a certain number of teeth. There are 20 teeth in the milk bite, they have their own terms of formation, eruption and loss. Permanent teeth can be from 28 to 32. Wisdom teeth, of which 4, are no longer included in the standard set, and their absence or, conversely, eruption is not considered a pathology.

But what if the child has more or less teeth in any of the bites? How should parents act? What can offer modern dentistry? MedAboutMe will talk about it on International Dentist Day!

Supernumerary teeth are called those that are redundant. Most often they can be seen in a permanent bite on the anterior group of teeth: instead of 4 anterior incisors, 5 erupt. Of the total number of dentoalveolar anomalies, 3-5% are assigned to the share of supernumerary teeth.

Today, dentists cannot specify exact reason appearance of supernumerary teeth. There is an assumption that this is due to our ancestors, and such teeth are considered atavism - a manifestation of signs of distant ancestors.

The study of the nature of this phenomenon led to the conclusion that most often an extra tooth is formed on the upper jaw and is a representative of incisors or canines, less often premolars. Supernumerary teeth can be complete and meet all standards and requirements. But more often these are underdeveloped tooth-like formations: individual tooth crowns that do not have roots and growth zones, conglomerates. Sometimes supernumerary teeth can be soldered with normal, permanent ones.

Their location can also be different. But more often, the teeth come out of the dentition, have a rotation of the crown and do not participate in the process of processing food, and can also influence the formation of a permanent bite in a child. Incorrect positioning and eruption of teeth can cause bite pathologies - crowding of teeth, dystopia of complete teeth (teeth come out of the dentition). In some cases, the appearance of a supernumerary tooth can cause a change in the shape of the dental arch.

In July 2014, a 22-year-old Saudi Arabian sought medical help after complaining of nasal congestion, nosebleeds, runny nose, and occasional purulent discharge. In the last 2 years young man worried about regular nosebleeds.

Careful medical research revealed a white bone mass resembling a tooth in the nasal cavity. A more detailed study made it possible to accurate diagnosis- eruption of a supernumerary tooth in the nasal cavity.

After surgical treatment- removal of a supernumerary tooth and granulation tissue, - nasal breathing was restored, the patient was no longer bothered by nosebleeds. This clinical case was described in the American Journal of Case Reports.

The tactics of treating children with supernumerary teeth of permanent occlusion almost always turns out to be radical - removal. But treatment is sometimes associated with some difficulties and will require a long study and the participation of several specialists at once.

If the crown of a supernumerary tooth is complete, correct, an X-ray image allows you to see the roots and the degree of their development, then the issue of removal is decided on an individual basis, often with the involvement of orthodontists. A tandem of doctors chooses a tooth to be removed, and the main selection criterion is possible consequences. Usually, a tooth is removed that has an incorrect location in the oral cavity, violates not only aesthetic, but also functional standards. Sometimes it is the supernumerary tooth that is more promising than the tooth included in the permanent set.

In order to decide on the treatment of children with supernumerary teeth, a long and thorough study will be needed: targeted x-rays, an orthopantomogram (an extensive picture of the child's jaws), a multi-specialist examination, and dental tests. Only after analyzing the data, the fate of each tooth is decided, which of them will have to be removed.

Children with supernumerary teeth need close attention of dentists. A schedule of preventive visits to the therapist and orthodontist is drawn up on an individual basis.

The Indian magazine The Times of India described a unique case. In December 2015, a 7-year-old boy went to the dentist, who complained of pain in his teeth throughout mandible. When examining a child, a tumor was revealed - odontoma, which is provoked by a violation of the development of dental tissues. The tumor itself had a large size of 5 × 3.5 cm. As Indian experts noted, this great amount cells in the thickness of the jaw, from which supernumerary teeth are formed.

A 7-year-old boy, whose name is kept secret, had 80 supernumerary teeth removed. If the operation would have been performed later, then this number could have been more, according to doctors' forecasts, about 200. There is a known case of the removal of 232 teeth in a teenager. By a strange coincidence, the operation was also carried out in India.

The birth of a baby with an already erupted tooth is considered a rarity. Statistics show that about 2,000 "toothy" newborns are born every year (data for 2012 - 2013). Learning it a rare occurrence made it possible to distinguish two types of teeth that erupt in utero.

According to statistics, in 95% of cases, teeth erupted in utero belong to the neonatal class. They are considered inferior: they have no correct form, underdeveloped enamel, sometimes it is completely absent. There are also no areas for growth and development. Such teeth quickly deteriorate, crumble and are affected by caries. Neonatal teeth are among the extra - supernumerary teeth, and in the thickness of the jaw, babies have a normal, complete baby tooth which goes through the full stages of its development.

In 5% of cases, a tooth erupted in utero is among the complete teeth. Their crown has the correct shape, there are growth zones, the tooth occupies the correct position and can fully perform its functions. The main criterion for determining whether it is supercomplete or complete is the absence of the germ of the same name.

Dentists cannot yet specify the exact reason why children are born with an already erupted tooth. There are only convincing theories related to hereditary predisposition, malfunctions endocrine system during pregnancy, taking certain medicines.

The main problem is not why this happened, but how to act and what to do with such teeth?

Doctors offer two solutions - remove and leave. How to choose between them? Today, dentists cannot come to a consensus and prefer to decide on an individual basis. It all depends on the type of the erupted tooth.

If the tooth is neonatal, defective, then more often it is removed as unnecessary and because of the risk of possible complications. It is more difficult to resolve the issue if the tooth turned out to be complete. It is not recommended to remove such teeth, moreover, parents and dentists should do everything to save it until the natural change.

These goals can be achieved through a range of preventive procedures:

complete oral hygiene
teeth saturation mineral components,
complete breastfeeding
preventive visits to the dentist.

Premature loss of milk teeth is one of the main and most common causes of permanent occlusion pathologies.

There is also back side medals - lack of teeth, dentists call this phenomenon adentia. Parents are looking forward to teething permanent tooth, but it's not there. Sometimes, baby teeth don't fall out, they go through their natural timing and don't even start to loosen. Usually, parents do not notice the difference between milk teeth and permanent ones, and such a "find" is only detected in the dentist's chair. Why is there a delay in eruption permanent teeth?

impacted teeth

The absence of permanent teeth in the oral cavity does not always indicate the absence of a permanent tooth germ. After contacting the dentist with such complaints, after examination, doctors can identify the so-called impacted teeth, which occupy wrong position in the thickness of the jaw and do not have the ability to erupt. The teeth themselves are horizontal position instead of vertical. Their development takes place in the thickness of the jaw, they are full-fledged. Sometimes impacted teeth can be supernumerary.

Contrary to popular belief, impacted teeth can be brought into the oral cavity, helping them to take the correct position, and subsequently fully erupt. This is achieved through some surgical procedures and orthodontic treatment.

The death of the rudiment of a permanent tooth

It is necessary to treat milk teeth in a timely manner, doctors do not get tired of talking about possible complications and consequences for the whole organism, and for the dentoalveolar system in particular. In children, during the period of preparation for a mixed bite, periodontitis will be especially dangerous - inflammation of the tissues surrounding the tooth in the thickness of the jaw, which is always a complication of caries. The focus of inflammation and a potential source of infection in the thickness of the jaw is dangerous not only for the whole organism, but also for the germ of a permanent tooth, which is actively advancing and preparing for eruption.

If the germ of a permanent tooth has moved close enough to the focus of inflammation, it can be involved in this process. In the absence of a timely measures taken, the germ of a permanent tooth can melt and die before it erupts. Such consequences are dangerous not only because the permanent tooth will not erupt, but also because it is a source of infection for the whole organism.

Reasons why a tooth germ may be missing

In addition to extra rudiments of teeth, their deficiency can also be recorded. As a rule, several teeth of the same group are missing at once, for example, incisors, canines, premolars. What could be the reason for their absence? One exact reason could not be established, as a rule, this whole complex causes acting at the same time:

heredity;
any negative impact during pregnancy. The rudiments of permanent teeth begin to form as early as the 20th week of pregnancy. disease, bad habits, taking certain medications, stress and many other reasons can affect their bookmark and further development rudiments of permanent teeth;
latest research dentists have shown that vitamin D deficiency in pregnant women can adversely affect the state of the germs and their subsequent development;
in some cases, the absence of tooth buds is combined with other anomalies maxillofacial region, for example, cleft palate and lips.

Whatever the reason for the absence of tooth germs, modern dentistry can solve any problem, carry out high-quality prosthetics and prevent various consequences.

The anomaly of supernumerary teeth or polyodontia (hyperdontia) is not as rare as it might seem at first glance. According to dentists, from 4 to 7 percent of the world's population suffers from it.

Such an anomaly can cause serious inconvenience: problems with diction, bite and eating. In this article, we will tell you what polyodontics is, name the main causes of its occurrence, describe the symptoms and diagnosis of the disease.

Polyodontia - what is it?

Polyodontia is the appearance of an excess number of teeth in the human dentition. Men suffer from this disease to a greater extent, although pathologies occur among women, often a similar disease appears in babies. A child is born already with a tooth, but the rest of the dental germs are also in place, in which case parents are advised to get rid of the "extra" tooth from the child.

Too many teeth are not uncommon. As a rule, only one supernumerary tooth grows, but there are two (about ¼ of all cases of polyodontia), three or more. It is worth noting that the third molars (“wisdom teeth”) should not be attributed to cases of polyodontia, although they do not appear in everyone.

The reasons

Why can an anomaly of supernumerary teeth occur? There are several reasons:

pathology of the development of tooth germs - similar processes develop in the fetus even in the womb. This is due to malfunctions in her body, which may be associated with adverse factors(for example, ecology). According to scientists, the tooth germ grows into several parts, which ultimately leads to the appearance of an anomaly in the child;
failures in the genetic code - it is believed that the first people had not four, but six incisors on each jaw. Scientists attribute this to the fact that in primitive times people used unprocessed meat food, this required a large number of teeth whose function is to bite off pieces of food. Over time and through evolution, human body stopped needing so many incisors. The appearance of extra teeth in some people in our time, according to experts, is associated with the rest of the elements. genetic code ancient people, but this is just a hypothesis.

However, there is no exact answer to the cause of the disease. The reasons given above are simply the most likely that science has proposed. Thus, the etiology of this disease remains rather mysterious.

Symptoms

The disease is characterized by several, but very obvious symptoms, they can be divided into children's and adults. For polyodontia in an adult, the following symptoms are characteristic:

the appearance of "extra" teeth in the sky and gums, they can be distorted in shape and structure;
violations of diction and bite;
location problems ordinary teeth: they can be turned to the sides, is very close to each other. This is due to wedging into the dentition of supernumerary teeth;
problems with chewing food, which lead to disorders of the digestive system;
frequent inflammation of the mucous membranes in the mouth, which occur due to their damage by supernumerary teeth.

Supernumerary milk teeth in children appear in the first few months of their life or immediately after birth. In this case, the following symptoms are characteristic:

difficulties with eating - the child cannot breastfeed normally, the young mother also suffers from constant bites from the baby;
digestive disorders, which are the result of disruptions in eating;
violation of salivation and swelling of the nasal mucosa;
fever and swelling in the area of teething.

Despite the speech problems that a child may develop over time, and other complications caused by polydontia, the child most painfully perceives ridicule from peers, this can cause serious psychological trauma. Children begin to smile less often so as not to show the anomaly once again, especially when communicating with unfamiliar people or peers. After a few years, these tendencies can develop into isolation and feelings of inferiority.

Kinds

There are several types of anomalies of supernumerary teeth. The classification is based on the location and type of "extra" teeth. So, experts distinguish: typical and atypical polyodontia, real and false.

The typical form is characterized by the location of supernumerary teeth inside the dentition. Sometimes they are very difficult to distinguish from ordinary ones and often they look like fangs. In this case, the teeth will be very tightly pressed against each other.
Atypical polyodontia - supernumerary teeth grow outside the aisles of the dentition, they can appear in the sky and in other places. In unique cases, they can cut through oral cavity.
True polyodontia is characterized by classic eruption and the shape of supernumerary teeth. The places of their appearance do not go beyond the aisles of the dentition.
The false form of the disease is characterized by an increase in the number of teeth in an adult due to incomplete loss of milk teeth. The latter can remain in the dentition for many decades after the supposed moment of their loss. It happens that the presence of such supernumerary teeth does not even interfere with the bite and does not cause any other forms of discomfort. Another symptom of a false form is fused teeth.
Impacted supernumerary teeth - they do not grow outward, but remain under the covering of the oral tissues. As a rule, patients do not feel any discomfort, but only discover them during a thorough examination or treatment of other teeth.

A photo

For a more detailed acquaintance with this problem, we suggest that you look at the photographs of the oral cavity of patients with an anomaly.

Diagnostics

Diagnostics does not special problems in almost all forms. As a rule, patients themselves report this disease, because it is not so difficult to notice that you have an extra tooth, especially if its growth causes serious problems with diction and bite.

If there are impacted supernumerary teeth, then the most in a suitable way their diagnosis is x-ray. In this case, the dentist can easily determine where and how many extra teeth you have.

If an X-ray cannot determine the exact location problematic tooth, then the doctor may prescribe a tomography. Early diagnosis of the disease will not allow it to develop and cause serious inconvenience.

How is polyodontia treated?

There are two main methods of treatment - extraction of problematic teeth and orthodontic measures. Removal is particularly difficult experienced dentists. At the same time, not only supernumerary teeth can be removed, but also those that were too negatively affected by the growth of the previous ones.

In a children's (milk) bite, all unnecessary elements of the dento-jaw structure must be removed, otherwise there may be pathological changes not only bite, but also the shape of the face. Removal of supernumerary teeth is carried out as follows:

An x-ray of the dentoalveolar system is performed to exact definition the location of the problematic tooth and all the nuances associated with its growth (computed tomography can be undertaken).
The patient is doing local anesthesia(In particularly difficult cases, the doctor may recommend general anesthesia).
The tooth element is removed. If there is impacted tooth, then the doctor opens the surface of the gums, as a rule, from the side of the tongue, and carves out the crown and root of such a tooth.
If the surgical incisions are of impressive size or of a complex nature, then the specialist can apply several stitches.

After the operation, the patient must undergo rehabilitation, which consists in taking drugs prescribed by a doctor and temporarily refusing certain types of food (too spicy or hot) and bad habits.

How much does it cost to remove supernumerary teeth? It depends on the complexity of the operation and many contributing factors(for example, the cost of anesthesia, examinations, consultations). The price can range from 2 to 20 thousand rubles.

Extra teeth are far from always removed, since a supernumerary tooth sometimes surpasses the healthy one located near it in many ways. In this case, the damaged “correct” tooth is removed, and the supernumerary begins to perform its functions.

If it does not fit well into the structure of the human dentition, then the doctor may advise orthodontic methods to correct the problem. The installation of special mouth guards and braces will help not only to introduce a supernumerary tooth into the dentition, but also to correct other bite problems.

Video: polyodontics world record - 232 teeth.

Dental problems always cause discomfort in a person. But there are anomalies when there are many teeth in the mouth. What is this disease and why does it occur? In a brief overview, we will describe in detail what hyperdontia is and what treatments currently exist.

Palatal hyperdontia in a child

What is the disease of extra teeth

Normally, each person has two sets of teeth: twenty dairy and thirty-two permanent. 2% of people have a rare pathology in which additional instances of canines or incisors appear. They differ in size and shape from ordinary ones, and the disease itself has acquired the name hyperdontia. The disease is more common in men than in women.

“Supernumerary teeth may not differ from others, but may look abnormal - in the form of drops or spikes, with a flattened or shortened crown part. Often they grow together with other crowns, intertwined with their roots.

What causes the anomaly? Scientists have not yet come to a consensus on what is the catalyst for this deviation.

There are two assumptions that explain the presence of such a pathology.

Atavism. At primitive people had more teeth than modern man. Doctors believe that the appearance of an extra copy is an attempt by the body to return the lost opportunity.

Separation of the tooth germ in the embryo. During the period prenatal development the fetus is disturbed, which leads to incorrect formation of jaw sets. Unfavorable conditions are infectious diseases or bad habits of the expectant mother, as well as poor ecology.

Often people do not even realize that there are extra teeth. But there are symptoms that warn of a problem:

speech defects (patients lisp);
difficult to pronounce sounds;
the appearance of a large gap;
injuries of the gums, tongue, palate;
crowding of neighboring teeth;
slowing down the eruption process;
broken bite.

Awl-shaped tooth - an anomaly of development

Depending on the area of location, teeth with hyperdontia are of several types.

Subulate. They grow in the upper part of the oral cavity, between the incisors. Sufficiently sharp ends often injure the tongue, gums, resulting in an infection and inflammation begins.
Fangs. Found in the upper jaw. Strongly intertwined roots with healthy specimens.
Premolars. Arise in the cheek area in the gaps between normal teeth. Located below and above.

An anomaly in the mouth is discovered only when the permanent set begins to erupt.

Extra premolars outside the dentition

And if a person prefers not to visit the dentist, then the pathology will become known in adulthood. During this period, it will be difficult to fix anything, as time has been lost.

Why is hyperdontia dangerous? As a result of mixing, the normal arrangement of the teeth is disturbed. This negatively affects the quality of speech. Patients often lisp or have difficulty making simple sounds. Healthy kits from pressure begin to turn around their axis, are arranged horizontally. The bite is broken, what does appearance less attractive person.

One extra tooth in the bottom row

An additional number of teeth leads to deformation of the roots. They become rough and do not settle down at the normal depth.

An extra set causes a delay in eruption, and the process itself takes place with severe complications:

the temperature rises;
swelling of the mucous membrane of the mouth and nose;
digestion is disturbed;
general weakness, as from a cold.

The second row appeared during the eruption of permanent teeth

Due to crowded teeth, patients suffer from permanent caries, and also, from inflammation and bleeding of the gums. Interdental spaces are difficult to clean at home, so food debris accumulates in them. Bacterial plaque gradually turns into stone, which threatens with discomfort and loosening of healthy specimens.

Treatment

With the timely detection of hyperdontia, therapy passes quickly and without any complications. The neglected form is also treated, but more physical and material strength will have to be spent to put the jaw in order. If an excess number of teeth has led to deformation and the appearance of malocclusion, then not only the surgeon, but also the orthodontist is engaged in deliverance.

Anomaly in the number of teeth is treated by removing excess specimens.

How earlier man get rid of pathology faster body will recover. Most often, the operation is performed in childhood. Adults for regeneration will require the correction of all defects. During this period, it is important to prevent infection from entering the wound, so disinfecting procedures are required. Rinses with antibacterial solutions provide maximum protection open wound from infection.

X-rays will help to understand the nature of the polydental disease in the mouth. If the rudiments are located deep from the place where the eruption will be, then the patient needs to undergo a massage to stimulate growth. The procedure is carried out both by hand and professional equipment. Remember: all manipulations are done only by a specialist, since the slightest mistake can harm.

If the tooth does not interfere and does not cause deformation of the main set of the jaw, then the doctor decides to leave an extra copy. It is important to monitor the anomaly for several years, so you should visit the dentist every six months, even if nothing bothers you.

Removal of extra teeth - a way to treat hyperdontia

“A person with such a pathology should know that the problem itself will not be eliminated. Only qualified doctors, such as a surgeon, dentist, orthodontist, can help. They select methods of treatment for each specific person individually.

Hyperdontia is an anomaly in the number of teeth that can cause disease and discomfort. Each person should be attentive to health and regularly show their mouth to a specialist. The sooner the pathology is detected, the sooner it will be cured. Our recommendations will help identify changes early.

Among the anomalies in the number of teeth, it is customary to distinguish: adentia (hypodentia); hyperdentia or supernumerary teeth.

Adentia

The congenital absence of one or more teeth is called hypodentia or adentia.

Among the reasons causing this dentoalveolar anomaly are noted infectious diseases(syphilis, tuberculosis, noma).

Some researchers regard the reduced number of teeth as a reduction of the dentoalveolar system in modern man and its adaptation to new functional needs.

Most authors associate a reduced number of teeth with disturbances in the laying of rudiments or their death during embryonic development, which can be facilitated by maternal illness, as well as parafunctional states. individual bodies or systems during pregnancy.

Currently, more and more importance is given to genetically determined information that leads to a malformation of the rudiments of teeth. Depending on the severity, they can manifest themselves in the form of violations of the shape, size, structure of hard tissues of the teeth, the absence of individual or groups of teeth and total absence tooth, both temporary and permanent. Such adentia, when there are no rudiments of teeth, is called " true adentia».

One of these diseases is ectodermal dysplasia (Fig. 67). Biggest Violations in the dentofacial region are observed with anhydrotic ectodermal dysplasia (AED).

Clinically, in the dentition, defects of the dentition of various lengths are determined, which can be combined with anomalies in the shape of the teeth.

Orthopantomography reveals that in the edentulous areas of the upper jaw, the structure of the bone tissue is disturbed (especially pronounced in the region of the tubercles), the alveolar process is underdeveloped or absent. Vertical Dimensions the bodies of the lower jaw are sharply reduced due to the underdevelopment of the alveolar process.

Treatment of such patients is usually prosthetic. The choice of prosthesis design depends on the age of the patient and the type of anomaly. In pediatric practice, fixed bridges are used only with one-sided reinforcement or sliding during the period of late removable and permanent occlusion. During the period of early removable and temporary occlusion, it is recommended to use removable plate devices or prosthesis devices that have their own design features.

Hyperdontia or supernumerary teeth

The process of occurrence of supernumerary teeth (SCD) is still not clear. Some authors put forward the hypothesis of atavism. Others - adhere to the hypothesis of splitting the tooth germ.
Still others consider the appearance of supernumerary teeth under the influence of one and the other factors.

Supporters of the atavism hypothesis explain the origin of supernumerary teeth as the appearance of an organ that disappeared in the process of evolution, that is, they consider the manifestation of supernumerary teeth as a return to the original number, when human ancestors had six incisors. This is why supernumerary teeth are more common in the anterior region of the jaws.

It should be noted that the atavism hypothesis can only explain the emergence of supernumerary teeth close to incisors and canines, but cannot explain why supernumerary premolars and molars sometimes develop.

Supporters of the hypothesis of splitting of the tooth germ explain the presence of supernumerary teeth by excessive productivity of the dental plate in the embryonic period.
This hypothesis can explain the appearance of supernumerary teeth in different parts of the dentition, however, it cannot explain the fact that hypo- and hyperodontia exist simultaneously in the same individuals. This hypothesis can also be confirmed by such a fact as macrodontia.

Some authors believe that the phenomenon of macrodontia has similar etiological factors with supernumerary teeth, namely, hyperproduction of the dental lamina in the embryonic period. Therefore, not only individual teeth can be duplicated, but also the entire dentition (Fig. 68).

The anatomical shape of supernumerary teeth is different - in most cases, cone-shaped, oval, multifaceted. Very rarely, supernumerary teeth have the correct anatomical shape(Fig. 69).

There are 6 main groups of supernumerary teeth, depending on the shape of the crowns: spike-shaped, tuberculate, chisel-shaped, cone-shaped, fused and split.

Fused teeth can have four types of fusion of complete and supernumerary teeth, taking into account its nature and length (Fig. 70).

The first type is the stratification or buildup of the supernumerary part in the form of additional tubercles.
The second type is the fusion of only the crown part of the teeth.
The third type is the fusion of only the root part of the teeth.
The fourth type is the fusion of teeth throughout.

There are indications of the location of enamel in the dentin of the teeth with a cavity enclosed in it. This formation can be mistaken for the enamel part of another tooth, that is, a "tooth in a tooth." It arises in the dentin from the same enamel organ as the enamel.

It has been established that supernumerary teeth, which have stopped in their development at the level of the crown of the tooth, very slowly approach the crest of the alveolar process and more often remain in a state of retention.

Supernumerary teeth with an unformed root, which has a wide apical opening with unfolded edges, have a great potential for eruption, its intensity depends on the degree of root formation.

The eruption of such teeth is difficult to predict, but they react quite actively to irritation of the alveolar process and, if periodontium is present, their eruption is expected.

In supernumerary teeth with a well-developed root and formed periodontium, eruption is very intensive.

AT last years the prevalence of supernumerary teeth has a pronounced upward trend. In Kyiv, Chernihiv and Kharkiv regions by 2002, the prevalence of supernumerary teeth had doubled compared to 1986.

This phenomenon is associated with changed environmental conditions, including an increased level of ionizing radiation.

Most researchers dealing with this problem note that supernumerary teeth create unfavorable conditions for the development of the dentoalveolar system and are the cause of its various anomalies.

In almost 98% of cases, supernumerary teeth cause deviations in the full development and function of the oral organs.

Among all disorders caused by supernumerary teeth, in 84% of cases they cause the formation of anomalies of the dentition. In the remaining 16% of cases - inflammatory-dystrophic changes in the surrounding tissues.

This is manifested by chronic gingivitis in the area of supernumerary teeth, changes in the periodontium of complete teeth, expressed in its uniform or uneven expansion.

Supernumerary teeth can contribute to the development of anomalies in the position of individual teeth, various deformations of the dental arch and occlusion in general, as well as disrupt the process of eruption of permanent teeth.

During the eruption of supernumerary teeth in the dentition, there is a shortage of space for permanent complete teeth, as a result of which they change their inclination, and the dental arch is deformed.

Supernumerary teeth are the cause of the diastema (Fig. 71).

Erupting into the dentition, supernumerary teeth cause the distal, medial, palatine, vestibular position of complete teeth. A supernumerary tooth may erupt outside the dental arch. In cases of their location on the palatine or lingual side behind the permanent teeth, the displacement of the latter occurs anteriorly and to the side.

If the supernumerary teeth erupt ahead of the permanent teeth, the latter are displaced orally. In cases where supernumerary teeth exert pressure on the permanent ones, the latter rotate around the axis.

Due to the presence of supernumerary teeth in the frontal area, permanent teeth are retained in the jaw. Especially dangerous is the persistent retention of permanent incisors in the presence of impacted supernumerary teeth. The root of a permanent tooth completes its growth and formation, and the tooth loses its tendency to erupt.

The most optimal for the treatment of anomalies of the dentoalveolar system caused by supernumerary teeth is the instrumental-surgical method. At the same time, the terms of treatment of patients with supernumerary teeth depend on the severity of the anomaly, the age of the patient, but on average they are higher than in the treatment of similar anomalies not burdened with supernumerary teeth.

In studies on medical tactics regarding supernumerary teeth, there are conflicting reports. Most experts believe that they should be removed.

Early extraction of supernumerary teeth promotes self-adjustment of the position of permanent teeth and usually does not require further orthodontic treatment. Self-regulation occurs within 3-4 months, mainly in cases where supernumerary teeth were identified and removed during the development of anomalies.

If, by the time of extraction, supernumerary teeth have caused significant changes in the position of permanent teeth, then it is necessary to carry out active orthodontic treatment.
Most often, supernumerary teeth are the cause of retention of permanent teeth. Especially dangerous is the retention of permanent teeth with a formed root, when the teeth lose their potency for eruption.

Significant difficulties arise in the treatment of retention of complete teeth, combined with retention of supernumerary teeth. In this case, supernumerary teeth are removed and the crown of the impacted tooth is exposed up to the neck (under local anesthesia).

After surgery, orthodontic treatment begins, namely, the imposition of a crown or mouthguard on the impacted tooth and an antagonist with intermaxillary rubber traction between them.

In the case of persistent retention of permanent teeth, due to the presence of impacted supernumerary teeth, it is proposed to remove them as the cause of the anomaly.

Supernumerary teeth that do not cause anomalies of the dentoalveolar system are subject to removal without subsequent orthodontic treatment.

Supernumerary teeth causing various changes in the jaws and dentition, are subject to removal with subsequent orthodontic treatment.

Supernumerary teeth, which caused the retention of complete teeth, are to be removed, followed by the use of replacement prostheses or stimulating plates, combined with orthodontic treatment and surgical intervention. All retained supernumerary teeth must be removed.

Removal of supernumerary teeth that erupt towards the dentition and do not cause changes in the bones and deformation of the jaws can be delayed until their full or partial eruption in order to avoid injury to the rudiments of the teeth and alveolar processes jaws.

This requires strict medical control over the development of impacted supernumerary teeth, especially when they are located deep in the jaws and have the wrong direction of growth. In these cases, in order to prevent anomalies of the dental system, it is necessary early detection and extraction of supernumerary teeth. However, other researchers believe that a supernumerary tooth should not be treated as absolute reading to removal.

In the case of anomalies in the position of the teeth, due to the presence of impacted supernumerary teeth, it is proposed to stimulate their eruption.

The supernumerary teeth with an irregular anatomical shape that have erupted into the dentition should be removed, and the supernumerary teeth with the correct anatomical shape, the formed root and periodontium, should be preserved, followed by moving to the site of the removed defective (caries and its complications) complete teeth.

In addition, it is proposed to remove supernumerary teeth that have erupted into the dentition, having an irregular shape and superficially located impacted supernumerary teeth.

Orthodontics
Under the editorship of prof. IN AND. Kutsevlyak