Multiple supernumerary teeth without any associated systemic condition or syndrome: a case report Aylin Baysan Serpil Djemal Dental Update 2024 38:8, 707-709.
Authors
AylinBaysan
BDS, MSc, PhD, MFDS RCS(Ed), FHEA
Clinical Lecturer and Honorary Specialist Registrar, Adult Oral Health, The Institute of Dentistry, Barts and The London, Queen Mary's School of Medicine and Dentistry, London
A 49-year-old Black African male, originally of Nigerian origin, was referred by his dentist regarding a bad taste in the mouth. He was seen in a general restorative clinic at Barts and the London NHS Trust. Clinical examination did not reveal any relevant abnormalities. A panoramic tomography, however, showed the presence of multiple supernumerary teeth, which were located in the maxillary right and left premolar and molar regions, and the mandibular left premolar region. The family's history was non-contributory. The patient was unaware of the supernumerary teeth and, as far as he knew, there were no other members of his family with a similar problem.
Clinical Relevance: A decision regarding the appropriate management of supernumerary teeth should be considered carefully since surgical removal of the teeth may cause damage to adjacent structures, including bone. In this respect, it is interesting and rare to find multiple supernumerary teeth in individuals with no other associated diseases or syndromes elucidated by clinical and historical enquiry.
Article
Although the first report of supernumerary teeth appeared between AD 23 and 79, the aetiology of supernumerary teeth is still not clearly understood. They may occur singly, multiply, unilaterally or bilaterally, and in one or both jaws.
Multiple supernumerary teeth are usually associated with cleidocranial dysplasia, Gardner's syndrome and cleft lip/palate.1 It is, however, rare to find multiple supernumeraries in individuals with no other associated disease or syndrome.2
Interestingly, the maxillary region has the highest frequency of occurrence, being 12 times (66.7%) more likely to contain supernumeraries, followed by the mandibular premolar region with 4 times (22.2%), whilst the maxillary premolar and mandibular anterior regions have an occurrence rate of 5.6%. The conical and tuberculate types of supernumerary teeth were found in the midline region, whilst the supplemental supernumerary teeth were more in the mandibular premolar region with 12 (70.6%), followed by maxillary midline 4 (23.5%) and the lower incisor region (5.9%).3 In the literature, a ratio of 2:1 was reported in favour of males with supernumerary teeth when compared to females.4
There is one study reporting multiple supernumerary teeth without any associated syndromes in the Nigerian population. Unweni and Osunbor suggested that genetics had a part to play in the aetiology of multiple supernumerary teeth.5 These authors reported the occurrence of supernumerary teeth associated with two brothers and one of the affected brother's daughter in a Nigerian population. This may suggest an autosomal dominant mode of inheritance, although the evidence is sparse.
Case Report
A 49-year-old Black African male, originally of Nigerian origin, was referred by his dentist regarding a bad taste in his mouth. The patient was seen in a general restorative clinic at Barts and the London NHS Trust. Medically, the patient had well-controlled hypertension and was an irregular dental attendee.
Clinical examination revealed a moderately restored dentition. His plaque control was poor, with inflamed gingivae and periodontal probing depths of 2 to 4mm, with immediate and profuse bleeding on probing.
The following teeth were present with no obvious signs of dental disease: UR1–6, UL1–8, LR1–7 and LL1–7.
Figure 1. A panoramic tomograph showing supernumerary teeth in the maxillary right and left premolar and molar regions, and the mandibular left premolar region.
5–10% horizontal bone loss around the maxillary and mandibular teeth.
Figure 2. UR5 and UR9,10 supernumerary teeth.Figure 3. UL5 and UL9,10,11 supernumerary teeth.Figure 4. LL5 supernumerary tooth.
Careful questioning concluded that no other members of his family were aware of any supernumerary teeth and, furthermore, the patient was unaware of his supernumerary teeth and the potential sequelae that could ensue.
The following diagnoses were made:
Generalized mild chronic periodontitis;
Multiple supernumerary teeth;
Overhanging restorations UR6 and LR6.
After careful discussion with the patient, the following was advised:
Extensive oral hygiene instruction;
Non-surgical periodontal treatment for periodontal pockets of 4 mm and above;
Monitor the overhangs UR6 and LR6;
Monitor the supernumerary teeth.
Discussion
It has been stated that approximately 75% of supernumerary teeth are impacted and asymptomatic. Interestingly, most of these teeth are diagnosed coincidentally during radiographic examination.6 Supernumerary teeth are not necessarily accompanied by malocclusion, as seen in our case. An unerupted supernumerary tooth may be found by chance during routine radiographic examination, with no discernible effect upon adjacent teeth. Extraction of these asymptomatic supernumerary teeth may not always be necessary, since dental complications associated with the surgical removal of impacted teeth include periodontally compromised adjacent teeth, damage to adjacent teeth, root fracture, neuropathy, sinus involvement and osseous defect.7 However, follow-up procedures regarding these patients are recommended.
The exact aetiology of supernumerary teeth is still unknown, although many theories have been suggested. The localized and independent hyperactivity of the dental lamina is the most accepted cause for the development of supernumerary teeth.8 It is suggested that supernumerary teeth are formed as a result of local, independent, conditioned hyperactivity of the dental lamina. According to this theory, the lingual extension of an additional tooth bud leads to a eumorphic tooth, whilst the rudimentary form arises from proliferation of epithelial remnants of the dental lamina induced by pressure of the complete dentition.8 Heredity was also believed to be an important aetiological factor in the occurrence of supernumerary teeth. Many published cases of supernumerary teeth mentioned recurrence within the same family.9 Sedano and Gorlin emphasized the possibility of an autosomal dominant trait with lack of penetrance in some generations.10 In this respect, Bruning et al suggested the possibility of sex-linked inheritance to explain the existence of a sex predominance of males over females.11 Human tooth eruption is known to be a dynamic interaction between genetics and the local environment, which are being affected by each other. Therefore, the most recent data available in the literature confirms that the supernumerary traits have a strongly hereditary component, without following a simple Mendelian pattern. This has led some authors to consider environmental factors and to conclude that hyperdontia is a disorder with a pattern of multifactorial inheritance originating from hyperactivity of the dental lamina.12 In our case, it is uncertain if there is a hereditary component, as our patient was unaware of the presence of these supernumerary teeth, and he was unable to recall any associated presentation within his family.
Conclusion
This is an interesting case presenting a Black African male patient with no dental complications with respect to the presence of supernumerary teeth. These supernumerary teeth were not associated with any syndromes or diseases. The importance of taking a panoramic tomograph to investigate these unerupted supernumerary teeth should be borne in mind. A treatment decision for reviewing these patients can be considered without any invasive procedures if these teeth are asymptomatic, hence if there is no associated pathology and if they have been found by chance. Extraction is not always the treatment of choice for these supernumerary teeth.
