Hindawi Publishing CorporationInternational Journal of DentistryVolume 2012, Article ID 745265, 5 pagesdoi:10.1155/2012/745265Research ArticleSupernumerary Teeth in Indian Children: A Survey of 300 CasesAmita Sharma1and Varun Pratap Singh21Department of Pediatric Dentistry, College of Dental Sciences, BPKIHS, Dharan, Nepal2Department of Orthodontics, College of Dental Sciences, BPKIHS, Dharan, NepalCorrespondence should be addressed to Varun Pratap Singh, varundc@gmail.comReceived 11 July 2011; Revised 19 December 2011; Accepted 10 January 2012Academic Editor: Preetha KanjirathCopyright 2012 A. Sharma and V. P. Singh. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.The aim of this investigation was to study children with supernumerary teeth who visited the Department of Pedodontics andPreventive Dentistry, Government Dental College and Hospital, Rohtak, Haryana, India. Only children with supernumerary teethwere included in the study while patients having supernumerary teeth with associated syndromes were excluded. Supernumerarieswere detected by clinical and radiographic examination. The results indicated that males were aected more than females witha sex ratio of 2.9 : 1. Single supernumerary tooth was seen in 79% of the patients, 20% had double, and 1% had three or moresupernumeraries. Premaxillarysupernumerariesaccountedfor93.8%ofthecases. Conical shapedsupernumeraryteethwerethe most common type (59.7%). Majority of supernumeraries remained unerupted (65%). Fusion of supernumerary tooth witharegulartoothwasobservedin4%ofthepatients. Taloncusp, anassociateddental anomaly, wasseenin5%ofthecases.Simultaneous hypodontia occurred in 2.3% of patients with supernumeraries.1. IntroductionSupernumerary teeth (hyperdontia) may be dened as extrateethmore than twenty in the deciduous dentition or morethan thirty-two in the permanent dentition [1]. The etiologyof supernumerary teeth is not well understood. Several the-orieshavebeenput forwardtoexplaintheanomaly. Onetheory suggests that supernumeraries are formed as a resultof local, conditionedhyperactivityof dental laminawhileanother theory proposes dichotomy of tooth bud. Heredityplays an important role in the occurrence of supernumeraryteethbut does not followasimpleMendelianpattern. Afamilial tendencyandsex-linkedinheritance(malesbeingaectedtwiceas frequentlyas females) has beendemon-strated [24].Supernumerary teeth occur in 0.3 to 3.8 percent of dif-ferent populations andappear tobe onthe rise. Out ofthese 90 to 98 percent occur in the maxilla with a particularpredilection for the premaxilla. Supernumerary teeth may besingle or multiple, unilateral or bilateral, erupted or impact-edandinoneorbothjaws.Multiplesupernumeraryteethare rare and usually seen in association with cleft lip/palate,Cleidocranial dysplasia, Gardnerssyndrome, andsoforth[5, 6].Supernumerary teeth may be classied according to theirform/morphology (supplemental or rudimentary includingconical, tuberculate, andmolariformtypes) andlocation(mesiodens, paramolar, and distomolar). Detection of super-numeraryteethis best achievedwithathoroughclinicaland radiographic examination. Many complications canbeassociatedwithsupernumerarieslikecrowding, delayederuption, impaction, abnormal diastema, cystic lesions, ec-topic eruption, root resorptionof adjacent teeth, andsoforth. An early diagnosis allows an early intervention, a morefavourable prognosis, and minimal complications [7].The purpose of this study was to investigate the charac-teristics of supernumerary teeth among children who report-edtoourspecialtyclinicandcomparethedatawithothersimilar studies.2. Material and MethodA survey was performed on 21,824 patients (11,218 femalesand 10,606 males) attending the Department of Pedodontics2 International Journal of DentistryTable 1: Distribution of supernumerary teeth by dentition and sex.Denotes statistically signicant values (P < 0.01).Type of dentition Male Female Total P ValueDeciduous 15 5 20 0.002Mixed 142 39 181 0.001Permanent 67 32 99 0.017Total 224 76 300 0.002Table 2: Distributionof supernumerary teethby number perpatient.Number of teethper patientNumber of patientsPercentage ofsupernumerary teethOne 237 79.0Two 60 20.0Three or more 03 01.0Total 300 100.0Table 3: Type of supernumerary tooth.Type Number PercentageSupplemental (Eumorphic) 70 18.2Rudimentary (Dysmorphic): Conical 230 59.7Tuberculate 55 14.3Molariform 30 07.8Total 385 100.0andPreventiveDentistry, GovernmentDental CollegeandHospital, Rohtak, Haryana, India over a period of six years.Out of the total population, 300 children with ages rangingfrom 4 to 14 years were diagnosed with supernumerary teethin dierent regions of the dental arches. Reasons for visitingincluded caries, malocclusion, lack of eruption of permanentteeth, androutinedental checkup. Thecharacteristicsofsupernumerary teeth were noted and diagnosis made duringclinical and radiographic examination with help of occlusal,periapical, and panoramic radiographs. The horizontal shifttechnique was used to determine the sagittal position of theimpactedsupernumeraryteeth. Surgical removal of teethwhen and where indicated further conrmed the character-istics of supernumeraries. Patients with syndromes known tobe predisposed to supernumerary teeth such as Cleidocranialdysplasia, Gardners syndrome, clefts of lip, and palate werenot included in the study. All the radiographs were reviewedin a negatoscope and interexaminer discrepancies weresolved by mutual consensus. The Pearson chi-square test wasused to determine potential dierences in the distribution ofsupernumeraryteethwhenstratiedbygender. Pvalueofless than 0.01 was considered statistically signicant.3. ResultsOut of 300 patients, 224 were male, and 76 were female, thesex ratio was 2.9 : 1 (Table 1).The total number of supernumerary teeth was 385among the 300 patients. Majority of the patients had singleFigure1: Radiographicappearanceof aneruptedsupplemental21alongwithanuneruptedtuberculatesupernumerarytoothinmaxillary central incisor region.Figure 2: Two unerupted normally oriented conical supernumer-ary teeth causing failure of eruption of 11 and 21.supernumerarytooth(Table 2)whichwasconical inform(Table 3).Supernumerary teeth located in the premaxilla were 361(93.8%), andout of these, 293(81.2%) supernumerarieswere located in the central incisor region (Figure 1), of which88 (30.0%) were in midline (mesiodens). Sixty-eight super-numerary teeth were seen in maxillary lateral incisor region(18.8%). The remaining teeth were located inpremolar(3.6%), canine (1.0%), and mandibular incisor (1.5%)regions. Alarge percentage of supernumerary teeth remainedunerupted (65%), while 35% were partially or fully erupted(Figures 2 and 3).Rotation/displacement of adjacent permanent teeth wasthe most frequently found complication. Three cases ofdentigerouscystassociatedwithsupernumeraryteethweredetected (Figure 4).In 4%of the patients fusion of supernumerary tooth withthe adjacent normal tooth occurred. Talon cusp, an associ-ated dental anomaly was seen in 5% of the cases (Figure 5).Talon cusp on supernumerary teeth was observed in 2%of the patients (Figure 6).Sevenpatients withsupernumerary teethwere foundhavingsimultaneouslycongenitallyabsentteeth(excludingthirdmolars), that is, concomitant hypohyperdontia wasobserved in 2.3% of the cases (Figure 7).International Journal of Dentistry 3Figure3:Bilateralunerupted(inverted)conicalmesiodentesob-served during radiographic examination of fractured anterior teeth.Figure4: Maxillaryocclusal radiographshowingtwoimpactedsupernumeraryteeth. Oneontherightsideisassociatedwitharadiolucency having sclerotic border suggestive of dentigerous cyst.Figure 5: Occlusalradiograph showingtalon cusp on 12and 22;fusion of 22 and supplemental supernumerary 22.4. DiscussionTable 4providesanoverviewofstudiesdoneonsupernu-merary teeth in dierent populations. Supernumerary teethmost commonly involved the premaxilla which has also beenestablishedas the predominant locationby others [2, 5,1113]. Supernumeraries appearedina variety of forms(sizeandshape). Most commonwasconical, followedbysupplemental, then by tuberculate and molariformtypeFigure6: Awell-developedmesiodenswithtaloncusp: atypicalsuperimposed inverted V-shaped radiopaque structure.Figure 7: Panoramic radiograph showing bilaterally erupted sup-plemental mesiodentes; fusion of 61 and 62 and missing 22.(Table 3). Koch et al. reported 56% conical, 12% tubercular,and 11% supplemental and 12% other congurations amongtheir patients [14]. In this study, 35% of the supernumeraryteeth were erupted which is higher than that reportedin Mckibbens study but comparable to Lius study [2,12]. Fewauthors have reportedaround20%of eruptedsupernumeraries [13, 15].Theassociationof taloncuspwithotherodontogenicanomalies reported in the literature includes peg-shaped lat-eral incisors, supernumeraryteeth, anddens invaginatus,megadont[16,17].Veryfewcasesoftaloncusponsuper-numeraryteethhavebeenreported[18, 19]. Concomitanthypohyperdontia is a rare condition of mixed numericvariationinhumandentition. It is usuallymentionedasindividual case reports in the literature [20]. Its prevalenceinorthodonticpatients(includingthirdmolars)hasbeenreported to be 0.4% [21, 22]. In the present survey on Indianchildren, ahighincidenceof other dental anomalies liketalon cusp and concomitant hypodontia were seen to be asso-ciated with supernumerary teeth while Celikoglu et al. foundnosuch associateddentalanomaliesinTurkishpopulation[23]. Dentistsshouldtakecognizanceof associateddentalanomalies during the examination for supernumerary teethso that a comprehensive treatment can be rendered.Furthermore as supernumerary teeth are often associatedwithdelayederuptionor impactionof permanent teeth,early removal is recommended to facilitate the spontaneouseruption of impacted permanent teeth [24]. In one interest-ingstudyAshkenazi etal. demonstratedthatspontaneous4 International Journal of DentistryTable 4: Summary of various studies carried out on supernumerary teeth in dierent populations.Authors Sample size Country Age MethodTypes ofsupernumeraryincludedMale : FemalePresent study300 childrendiagnosed withsupernumeraryteethIndia 414 YerasClinicalExamination andradiographsAll 2.9 : 1Tyrologou et al.(2005) [8]97 children withdiagnosedmesiodensSweden 315 yearsClinical examinationand radiographsMesiodens 2 : 1Huang et al.(1992) [9]152 children withdiagnosedsupernumeraryteethJordan 515 yearsClinical examinationand radiographsAll 2.2 : 1Liu (1995) [2]112 children withdiagnosedsupernumeraryteeth in thepremaxillaryregionsTaiwan 414 yearsClinical examinationand radiographsIn the Premaxillaryregion.2.8 : 1von Arx (1992)[10]90 patients withanterior maxillarysupernumerarySwitzerland 610 yearsClinical examinationand radiographsIn the AnteriorMaxillary region2.6 : 1eruptionofpermanentteethdependsonvariousvariableslikeapexdistanceof theimpactedtoothrelativetoits-nal position, extent of vertical impaction, morphologyofsupernumerary teeth, angle of impaction relative to midline,and time of surgery. However the authors recommended im-mediate orthodontic traction at the time of removal of su-pernumerary teeth [25].References[1] C. Schulze, Developmental abnormalitiesof theteethandjaws, in Thomas Oral Pathology, R. J. Gorlin and H. M. Gold-man, Eds., The CV Mosby Co., St Louis, Mo, USA, 6th edition,1970.[2] J. F. Liu, Characteristics of premaxillary supernumerary teeth:a survey of 112 cases, ASDC Journal of Dentistry for Children,vol. 62, no. 4, pp. 262265, 1995.[3] A. H. Brook, A unifying aetiological explanation for anoma-lies of human tooth number and size, Archives of Oral Biology,vol. 29, no. 5, pp. 373378, 1984.[4] M. J. Kinirons, Unerupted premaxillary supernumeraryteeth. Astudy of their occurrence inmales andfemales,British Dental Journal, vol. 153, no. 3, p. 110, 1982.[5] M. M. Nazif, R. C. Rualo, and T. Zullo, Impacted supernu-merary teeth: a survey of 50 cases, The Journal of the AmericanDental Association, vol. 106, no. 2, pp. 201204, 1983.[6] R. E. 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Rakocz,Postoperative prognosis of uneruptedteethafter removalofsupernumeraryteethorodontomas,AmericanJournalofOrthodontics and Dentofacial Orthopedics, vol. 131, no. 5, pp.614619, 2007.Submit your manuscripts athttp://www.hindawi.comHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oral OncologyJournal ofDentistryInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014International Journal ofBiomaterialsHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Case Reports in DentistryHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oral ImplantsJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Anesthesiology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Radiology Research and PracticeEnvironmental and Public HealthJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014The Scientifc World JournalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Dental SurgeryJournal ofDrug DeliveryJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oral DiseasesJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational andMathematical Methods in MedicineScienticaHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PainResearch and TreatmentHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Preventive MedicineAdvances inHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014EndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014OrthopedicsAdvances in