A mesiodens is an extra tooth that develops in the mouth, beyond the typical number. It is most commonly found in the upper jaw, positioned between or behind the two front teeth, known as the central incisors. As the most common type of supernumerary tooth, a mesiodens adds to the usual count of 20 primary (baby) teeth and 32 permanent adult teeth.
Appearance and Common Location
A mesiodens is often small, conical, or peg-shaped, meaning it’s wider at its base and narrows towards the top. While this conical form is most frequently observed, a mesiodens can also appear tuberculate with multiple cusps, or even resemble a normal tooth.
Its primary location is in the upper jaw, precisely in the midline between the two upper central incisors, often on the palatal or lingual side (towards the roof of the mouth or tongue). Although this is the most common site, a mesiodens can be found in other less typical positions. The tooth may be fully erupted and visible, or it may remain impacted within the bone or gum tissue, which occurs in a significant majority of cases, estimated between 79% and 91%.
Potential Issues and Treatment
A mesiodens can lead to various dental complications. These include delayed eruption or impaction of permanent teeth, and displacement or rotation of adjacent teeth, which can cause crowding or an improper bite. Other issues are the formation of a gap between the front teeth (diastema), or the abnormal bending of a tooth’s root or crown (dilaceration). A mesiodens can also contribute to the development of cysts or, less commonly, root resorption of neighboring teeth, where the root structure begins to dissolve. Aesthetic concerns may also arise from a visible extra tooth or misalignment.
Diagnosis involves a thorough clinical examination by a dentist, often supplemented by dental X-rays. X-rays are especially useful for identifying impacted mesiodens not visible in the mouth. Early detection is recommended to prevent or minimize complications.
The primary treatment for a mesiodens is surgical extraction. The timing of removal is a consideration; early extraction during the mixed dentition stage can encourage spontaneous eruption and alignment of permanent teeth, potentially reducing the need for extensive orthodontic treatment. However, if the mesiodens is a baby tooth and not causing immediate issues, observation might be recommended instead of immediate removal.
The extraction procedure can be simple if the tooth has erupted, or more involved for impacted mesiodens. After extraction, further dental or orthodontic treatments, such as braces or clear aligners, may be necessary to correct any remaining crowding, spacing, or misalignment, ensuring proper tooth alignment and a healthy bite.