What This Guide Covers
This guide explains supernumerary teeth, which are extra teeth that develop in a child's mouth beyond the expected number. You will learn what causes them, how they are found, and when treatment is needed.
Children normally develop 20 primary (baby) teeth and later 32 permanent (adult) teeth. A supernumerary tooth is any tooth that forms in addition to those counts. These extra teeth can appear anywhere in the mouth, though they show up most often in the upper jaw near the front teeth. [3]
This guide is written for parents and caregivers. It covers diagnosis, treatment options, costs, and when to see a pediatric dentist who specializes in children's dental development. Whether your child has already been diagnosed or you are learning about the condition for the first time, this information can help you prepare for conversations with your child's dental provider.
Understanding Supernumerary Teeth
Supernumerary teeth are extra teeth that form due to disruptions in normal tooth development. They affect roughly 1% to 3% of the general population, with a higher rate in boys than in girls. [3]
Types and Classification
Supernumerary teeth are classified by their shape and by where they appear in the mouth. Understanding the type helps a dentist predict potential complications and plan treatment. [3]
The most common type is the mesiodens, a small extra tooth that grows between the two upper front teeth (central incisors). Published estimates vary, but the mesiodens accounts for roughly 50% to 80% of all supernumerary teeth depending on the study and population examined. [2] [7] [8] A 2011 review by Parolia et al. in the Journal of Clinical and Diagnostic Research reported a range of approximately 50% to 80%. [7] A 2019 review by Anthonappa et al. in the Journal of Clinical and Experimental Dentistry found the proportion closer to 45% to 67%. [8] The mesiodens may erupt into the mouth or stay buried in the bone. Even when it remains hidden, a mesiodens can block the normal eruption path of permanent front teeth. [1]
Other types include the paramolar, which appears near the back molars, and the distomolar, which grows behind the last molar. Some supernumerary teeth look like normal teeth in shape and size (called supplemental teeth). Others are cone-shaped or oddly formed (called rudimentary teeth). [3] A child can have a single extra tooth or, less commonly, multiple supernumerary teeth.
Causes and Risk Factors
The exact cause of supernumerary teeth is not fully understood. Researchers believe they result from excess activity in the dental lamina, the tissue layer that forms tooth buds during fetal development. [3] Several theories exist, including the idea that a developing tooth bud splits into two or that the dental lamina produces an additional bud on its own.
Genetics play a role. Supernumerary teeth are more common in children who have a family member with the same condition. They also appear more frequently in children with certain genetic syndromes. Cleidocranial dysplasia, a condition affecting bone and tooth development, is one well-known example. Gardner syndrome, which involves growths in the intestines, is another. Trichorhinophalangeal syndrome, a rare disorder affecting hair, facial features, and bone growth, has also been linked to dental anomalies. [4]
Boys are roughly twice as likely as girls to develop supernumerary teeth. [3] The reason for this difference is not yet clear. Environmental factors have not been proven to play a significant role.
Potential Complications
Many supernumerary teeth cause no symptoms at all. However, some can lead to problems that affect a child's dental development if left untreated.
The most common complication is delayed eruption, which means a permanent tooth cannot break through the gum because the supernumerary tooth is blocking its path. This is especially common with the mesiodens, which can prevent upper front permanent teeth from coming in on time. [1] Other complications include crowding of nearby teeth, displacement (where adjacent teeth are pushed out of alignment), and root resorption (damage to the roots of neighboring teeth). [3]
In rarer cases, a fluid-filled sac called a dentigerous cyst can form around an unerupted supernumerary tooth. [3] This is one reason why regular dental checkups and X-rays are valuable. Catching the problem early typically leads to simpler treatment and fewer complications.
What Parents Need to Know
Early detection through routine dental visits gives your child the best chance of avoiding complications from supernumerary teeth.
Age and Timing of Detection
The American Academy of Pediatric Dentistry recommends that children have their first dental visit by age one. [5] Supernumerary teeth are most often discovered between ages 5 and 10, when permanent teeth begin to replace baby teeth. A parent may notice that a permanent front tooth has not come in when the opposite side has already erupted. This delay is one of the most common signs that triggers further investigation.
Some supernumerary teeth are found earlier if they erupt visibly into the mouth during the baby tooth stage. Others are not discovered until a routine panoramic X-ray (a single image that shows the entire mouth) is taken, often around age 6 or 7. In some cases, a supernumerary tooth is found incidentally on an X-ray taken for another reason, such as a cavity check.
Signs to Watch For
Parents should be aware of a few key signs that may point to a supernumerary tooth. These include a permanent front tooth that has not erupted when the matching tooth on the other side has, an unusual gap or spacing between the upper front teeth, a small extra tooth visible behind or between other teeth, and swelling or a bump on the gum above the front teeth.
Not all of these signs guarantee a supernumerary tooth is present. Other conditions can cause similar symptoms. A pediatric dentist can perform the right tests to determine the cause. [5]
How Supernumerary Teeth Are Diagnosed
Dental X-rays are the primary diagnostic tool. A periapical radiograph (a small X-ray that captures a few teeth and the surrounding bone) can reveal a hidden supernumerary tooth in a specific area. A panoramic radiograph (a wide-angle X-ray of the entire jaw) gives the dentist a broader view and is useful for screening. [3]
In more complex cases, a dentist may order a cone-beam computed tomography scan, often called a CBCT or 3D scan. This creates a detailed three-dimensional image that shows the exact position, size, and angle of the supernumerary tooth relative to nearby structures. National clinical guidelines recommend advanced imaging when the position of the extra tooth is difficult to determine from standard X-rays. [1]
What to Expect During Diagnosis and Treatment
The process typically begins with X-rays and a clinical exam, followed by a treatment plan that may involve monitoring, extraction, or a combination of both.
The Initial Evaluation
At the first appointment, the pediatric dentist will examine your child's mouth and review any X-rays. If no recent images exist, the dentist will take new ones. The dentist looks at the location, shape, and orientation of the supernumerary tooth and checks whether it is affecting nearby permanent teeth. [1]
The dentist will explain the findings to you in plain terms. Together, you will discuss whether the supernumerary tooth needs to be removed or whether monitoring at regular intervals is a safe option.
Monitoring (Watchful Waiting)
Not every supernumerary tooth requires removal. If the extra tooth is deeply embedded in the bone, not close to the roots of other teeth, and not blocking the eruption of permanent teeth, the dentist may recommend periodic X-rays to track it. [3] This approach avoids unnecessary surgery, especially in very young children.
During monitoring, your child will have follow-up X-rays at intervals set by the dentist, typically every 6 to 12 months. If the supernumerary tooth begins to move, cause displacement, or show signs of cyst formation, the plan can be updated to include removal.
The Extraction Process
When removal is needed, the approach depends on whether the supernumerary tooth has erupted or remains buried in the bone. An erupted supernumerary tooth is typically a straightforward extraction similar to removing a baby tooth. An unerupted (impacted) tooth requires a minor surgical procedure to uncover and remove it. [1]
For younger children or complex surgical cases, the procedure is often performed under general anesthesia or conscious sedation. This keeps the child comfortable and still during the surgery. The pediatric dentist or oral surgeon will discuss sedation options with you beforehand. [5]
After extraction, the dentist may place a space maintainer or begin orthodontic treatment to guide the blocked permanent tooth into its correct position. National clinical guidelines for unerupted upper incisors recommend that, following removal of a mesiodens, the permanent tooth should be given 6 to 12 months to erupt on its own before considering further surgical exposure. [1]
Recovery After Extraction
Most children recover within a few days. Soft foods, cold compresses, and age-appropriate pain relief (as directed by the dentist) are the usual recommendations. Mild swelling and discomfort are normal for the first 24 to 48 hours.
A follow-up visit is typically scheduled one to two weeks after surgery. The dentist will check healing and may take another X-ray to confirm the treatment site looks healthy. Longer-term follow-up monitors whether the permanent tooth erupts as expected.
Cost Factors for Diagnosis and Treatment
Costs for diagnosing and treating supernumerary teeth vary by location, provider, and case complexity.
A panoramic X-ray typically costs between $100 and $250. A CBCT (3D) scan may range from $150 to $500. A simple extraction of an erupted supernumerary tooth may cost between $150 and $400, while a surgical extraction of an impacted tooth can range from $300 to $800 or more. If general anesthesia or sedation is needed, the anesthesia fee may add $200 to $800 depending on the duration and setting. [6]
Many dental insurance plans cover X-rays and medically necessary extractions for children. Coverage details vary widely, so contact your insurance provider before the procedure. Ask the dental office for a pre-treatment estimate, which is a written projection of costs and expected insurance payments. Some pediatric dental offices offer payment plans for families without full coverage.
When to See a Pediatric Dentist or Oral Surgeon
A general dentist can identify a supernumerary tooth, but a pediatric dentist or oral surgeon is typically the right choice for treatment in children.
You should seek specialist care if your child has a permanent front tooth that has not erupted and the corresponding tooth on the other side came in more than six months ago, if an X-ray at a general dentist has revealed a supernumerary tooth, if your child has a known genetic condition associated with extra teeth (such as cleidocranial dysplasia), or if a cyst or unusual swelling appears on the gum above the front teeth. [1] [3]
A pediatric dentist has two to three years of additional training beyond dental school focused on treating children, including managing developmental dental conditions. An oral surgeon may be involved when the extraction is surgically complex or when general anesthesia is required. In many cases, these specialists work together to plan and carry out treatment.
If your general dentist recommends a wait-and-see approach but your child's permanent tooth still has not appeared after 12 months, requesting a referral to a pediatric dentist for a second opinion is reasonable. [1]
Find a Pediatric Dentist Near You
If your child has been diagnosed with a supernumerary tooth, or if you have noticed signs like a delayed permanent tooth or unusual spacing, a pediatric dentist can provide an accurate diagnosis and a clear treatment plan. Use the pediatric dentistry directory on this site to search for a qualified specialist in your area.
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