Finding a tooth erupting in an unusual location, such as high on the gum line or on the roof of the mouth, requires professional attention. This phenomenon, where a tooth appears outside of its normal position in the dental arch, is a relatively common developmental issue. These teeth often signal an underlying condition that can affect the alignment and health of surrounding permanent teeth. Addressing this situation promptly prevents potential complications and determines the correct course of action.
Understanding Abnormal Tooth Eruption
The presence of a tooth in the upper gums is most often categorized as either a supernumerary tooth or an ectopically erupted tooth. Supernumerary teeth, medically known as hyperdontia, are those that exceed the normal count of 20 primary or 32 permanent teeth. This excess tooth structure is frequently found in the upper jaw, with up to 90% of cases occurring in the maxilla, often near the midline.
A specific type of supernumerary tooth is the mesiodens, a cone-shaped extra tooth that develops between the two upper central incisors, often positioned palatally. Ectopic eruption refers to a tooth that develops and emerges along an abnormal path or in an incorrect location. This includes teeth that erupt into the palate, the nasal cavity, or the maxillary sinus.
A related concept is an impacted tooth, which is a fully formed tooth prevented from erupting into its proper position, often by a physical block. These teeth are not necessarily extra, but their inability to emerge can cause them to press against or displace adjacent structures. This displacement potentially leads to the formation of cysts or damage to neighboring tooth roots.
Common Causes of Teeth in the Upper Gums
The exact reasons for these dental anomalies are considered multifactorial, involving a combination of developmental and genetic influences. A leading theory suggests that the formation of supernumerary teeth is due to hyperactivity of the dental lamina, which is the band of tissue responsible for tooth development. This overactivity results in the creation of an extra tooth bud, leading to the development of an additional tooth.
Genetic factors play a significant role, as supernumerary teeth are more common in individuals with inherited syndromes, such as Cleidocranial Dysplasia or Gardner syndrome. Local factors within the mouth also contribute to the problem. Physical obstruction from a cyst, an odontoma growth, or lack of space due to dental crowding can force a tooth to deviate from its normal path.
Early trauma to the primary teeth can affect the underlying permanent tooth bud, causing it to shift position and erupt ectopically. While a single supernumerary tooth can occur sporadically, multiple extra teeth often associate with a broader genetic condition. These underlying causes dictate the treatment plan and the potential for recurrence.
Immediate Action and Dental Assessment
Upon noticing a tooth growing in an abnormal position, the immediate action is to schedule an appointment with a dental specialist. A general dentist will likely refer the patient to a pediatric dentist, an oral surgeon, or an orthodontist specializing in complex eruption issues. Early diagnosis is important because the longer the abnormal tooth remains, the greater the risk of complications, such as delayed eruption of permanent teeth or root damage.
The initial assessment involves a thorough clinical examination, followed by specialized diagnostic imaging to visualize the hidden structures of the jaw. Standard panoramic and periapical X-rays are routinely used to locate the tooth but only provide a two-dimensional view. For precise surgical planning, a Cone-Beam Computed Tomography (CBCT) scan is often necessary, as it provides a detailed three-dimensional image.
The CBCT scan allows the dental team to determine the exact orientation of the abnormal tooth, its proximity to vital structures like the nasal cavity, and its relationship to neighboring tooth roots. This detailed imaging assesses whether the extra tooth is causing root resorption—the breakdown of an adjacent tooth’s root—or if it is blocking the path of a permanent tooth. The treatment decision hinges on the data gathered from this comprehensive assessment.
Treatment Options for Ectopic Teeth
Treatment for a tooth growing in the upper gums is highly individualized, based on the tooth’s type, location, and potential for complications. If the supernumerary tooth is small, non-symptomatic, and not interfering with the alignment of other teeth, the specialist may recommend careful observation. This “watch-and-wait” approach involves regular clinical check-ups and follow-up X-rays to ensure the tooth remains stable and does not develop a cyst or cause damage.
Surgical extraction is the most common treatment option when the abnormal tooth is causing pain, infection, or actively blocking a permanent tooth. The procedure involves accessing the tooth, which may be deeply embedded in the palatal bone, and carefully removing it while minimizing trauma to surrounding tissues. Extraction is also necessary if the extra tooth is causing root resorption of an adjacent tooth, which can lead to the loss of a healthy permanent tooth.
For an impacted tooth that is not supernumerary, such as an upper canine positioned too high, treatment involves surgical exposure and orthodontic management. This technique requires the oral surgeon to uncover the crown and bond a small attachment, such as a gold chain, to it. An orthodontist then uses braces and specialized appliances to gently guide the tooth into its correct position within the dental arch. This combined approach aims to preserve the permanent dentition and achieve a functional, aligned smile.