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Q. Can a supernumerary tooth cause tumor if left untreated?

Answered by
Dr. Mohammad Emranul Islam
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 25, 2021

Hi doctor,

My son is 11 years old, and I need your opinion about his case. He has a supernumerary tooth in between the tooth 28 and 29. I am overseas, and doctors here are only giving me one option: extraction under IV (Intravenous) sedation. I do not feel comfortable doing all that. I keep on asking the doctor in the case that I do not want to extract it. What is the worse that can happen? Anesthesia and sedation have its risk too. I do not get any response from the doctor regarding other options. They are not even monitoring it. So I would like to know in your experience, can this tooth grow, will it stay like that without causing issues, can he develop a tumor down the road? Just a bit more explanation, please, so I can consider my options.

#

Hello,

Welcome to icliniq. com.

I am sorry for the problems your son has.

There is a supernumerary tooth in between the lower right premolars. But it is in the early stage, and still, there is lots of time to grow. And your son is now only 11 years old. Probably that is why you fear to go for any surgical intervention. But you did not mention what problems your son has or why did you see the dentist. I assume it was discovered accidentally.

If you proceed with surgery, the procedure will involve removing the gingiva, creating a hole in the bone, and then removing the tooth, followed by stitching. So the doctor needs to sedate the child to do it smoothly.

But if you do not go for the surgery, it will grow and erupt. As there is no space above, it will erupt by tilting buccally (on the cheek side) or lingually (on the tongue side). The lingual eruption is common. In that case, your son may complain about the difficulty in speech or mastication, or his tongue may get injured by the sharp edge of the tooth. Sometimes it can push the adjacent premolars and cause occasional pain. And there are many cases where the patient has no complaints and is well adapted to it. But still, it will create minute spaces between teeth, difficult to reach by brush, and there will be food impaction leading to caries of the impacted tooth and the adjacent innocent teeth. So I always advise my patients to extract these impacted supernumerary teeth.

But in the case of your son, there is a way long time to get it erupted. And it is very easy to extract when it has erupted enough. So, in my opinion, you still have time to wait and observe it grow and erupt and remove it when it has grown enough. Then your son would be grown too. But do not hesitate when it has erupted. Development of cyst or tumor associated with the tooth is not so common but cannot be excluded. But if you keep track of its development, you can detect it earlier if a cyst or tumor is suspected.

I hope you can understand what I have said. Please let me know if you have any other questions.

Thank you for contacting us.

Hi doctor,

Thank you for your reply. Today, I saw an oral surgeon who told me to wait for a little to get bigger and said, let us observe it. He said when it grows a little, he can retrieve it easily. Instead, if we do it now since it is too small, it may require a more invasive approach. He says if we wait a bit, he can get it out easier by sedating him. So even if impacted, will it still grow?

How frequently have you seen root reabsorption in your practice? Is panoramic x-ray a good detection to keep track of how the tooth is growing?

#

Hi,

Welcome back to icliniq.com.

Thank you for the reply. I gave you the same impression. You can wait for 2-3 years and let it erupt. The more it comes out of bone, the easier it will be to extract it. And your son will be grown up too. Whether it is going to erupt or stay within the bone depends on the inclination of the tooth. Most commonly, it will erupt on the tongue side. It may also stay stuck in between the roots of the adjacent teeth. Then it may push the roots of the adjacent teeth and cause dull pain, but root resorption is unusual.

For subsequent follow-up, you can do the panoramic x-ray or the orthopantomogram. It is advised to do the follow-up x-rays from the same hospital or diagnostic center. Still, you did not tell me whether your son had any problem or why you saw a dentist.

Please let me know if you have any other queries.

Thank you again.

In my practice, I have seen lots of cases of an impacted supernumerary tooth. Most of them had multiple impacted or malposed teeth.

Hi doctor,

Thank you for your reply.

He does not have any problems. It was found accidentally in an x-ray, and it does not hurt. The only oral surgeon here I live has advised me to wait at least one year, so it grows a bit bigger, and he can extract it safely without any major intervention. He says that was his opinion, and we can monitor it every six months. The other oral surgeons are telling me to do it now because it can cause root resorption, but that involves a bigger intervention that I do not want to do to my son. I was glad that you had the same opinion, and also, based on your experience, we can wait for a little and get it out when it gets bigger. Do you see in the images (attachment removed to protect patient identity) of the 3D (three-dimensional) ultrasound I sent you? The supernumerary tooth is too close to one tooth, coming out almost in the middle of both teeth. Also, what is the clear circle around the circle where the tooth is present? Is it like a translucent thing in the x-ray?

#

Hi,

Welcome back to icliniq.com.

The circular thing in the x-ray is the primary tissue that forms the tooth. First the crown is formed, and then the root is formed. It is still a long time to go. The tooth will start to move to erupt when the crown is completely formed and the root formation starts. You can simply do a dental x-ray to see the prognosis.

Thank you doctor,

I have attached a file.

#

Hi,

Welcome back to icliniq.com.

I have seen the X-ray. Please send me the current x-ray and oral pictures of your son.

Thank you doctor,

What kind of oral pictures do you need exactly? I will be taking a new panoramic next week for the oldest child at his dentist appointment.

#

Hi,

Welcome back to icliniq.com.

Just tell him to open the mouth wide and take a right lower wisdom tooth pictures separately. Make sure to have a sharp, clear picture.

Thank you doctor,

I got these two pictures, and I will get X-rays by next week.

#

Hi,

Welcome back to icliniq.com.

The left molar picture is blurred and not clear. The right one is good. The wisdom tooth is partially erupted and covered by gums. It seems to be inclined and has to be removed. But it will be confirmed on an OPG x-ray. Let us wait till then.


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