Mesiodentes is a supernumerary tooth between teeth 11 and 21 or 31 and 41. The supernumerary tooth usually prevents the adjacent teeth from erupting or restricts their growth. In most cases, the treatment of a mesiodens is inform surgical removal.
What is a mesiodens?
Various types of tooth crowding in the human dentition fall into the disease group of hyperdontonia. A mesiodens is one such tooth hyperplasia. Literally translated, the Latin term means “toward the middle of the dental arch.” In most cases, the supernumerary tooth is atypically shaped or vestigial and, in the case of mesodiens, is preferentially located between tooth 11 and tooth 21, i.e. between the upper central incisors. Less commonly, a mesodien is observed between tooth 31 and tooth 41. The frequency is estimated to be no more than two percent. In a 2:1 ratio, men are twice as likely to be affected by the phenomenon. In rare cases, a diagnosis of mesodiens may include multiple, supernumerary teeth. The mesiodens is also called a cone tooth and usually develops faster than its neighboring teeth. As a result, the supernumerary tooth is usually retained. The mesiodens only becomes dentally relevant when the eruption of the normal teeth is disturbed due to the supernumerary tooth. Despite its low prevalence, mesiodens is the most common type of hyperdontia.
Causes
There are three different theories regarding the etiology of mesiodentes. Some authors assume a phylogenetic reversion phenomenon. According to this theory, the mesiodens is an atavism and originates from human ancestors who, according to the theory, possessed three central incisors. Thus, the mesiodens occasionally occurs in humans by random expression of earlier genes. In the meantime, this theory is considered to be approximately disproved by embryological studies. The theory of dichotomy is based on the connection that tooth anlagen can divide in the course of the development and let arise in this way an additional tooth anlage. However, the hypothesis of tissue hyperactivity is now the most widely accepted. According to this hypothesis, the additional teeth are formed by hyperactivity of the lamina dentalis. Cell encapsulation of active cells is thought to be responsible for the extra tooth set. The theories are controversially discussed, so that research into the cause is not yet considered complete.
Symptoms, complaints, and signs
Mesiodens may be manifested in children by ectopic, asymmetric, or delayed eruption of one or both incisors. In principle, however, the mesiodens can also lie inverted. The root tip then points toward the oral cavity. The time of symptomatic manifestation of a mesiodens can vary. Mesiodentes can already occur in the primary dentition and are then called supplementary. When they first appear in the permanent dentition, they are called rudimentary mesiodentes. A mesiodent can take different forms. The most common forms are conical, tubular and molariform. The mesiodentes symptomatically displace the adjacent teeth, if necessary. However, this symptom is less common than delayed eruption of the adjacent teeth. Only in the rarest cases does the mesiodens erupt spontaneously.
Diagnosis and course of the disease
In most cases, mesiodentes are incidental findings. Almost always, the supernumerary teeth are detectable only radiographically. In adults, diagnosis usually occurs as an incidental finding within the OPG. The diagnosis is confirmed by two apical tooth film exposures in different projections. This imaging is mainly used to determine the position of the tooth in direct relation to the neighboring tooth roots. The alternative diagnosis of the mesiodens can be done by computer tomography. However, this alternative diagnosis is rarely used within dental practices because it is associated with higher radiation exposure and, moreover, most dental practices do not have CT equipment. The prognosis for patients with mesiodens is favorable.
Complications
Due to mesiodent, there is an extra tooth in the patient’s mouth. This has a very negative effect on the health of the other teeth, and in the process can lead to various complications and discomfort in the oral cavity.As a rule, this results in disruption of the growth of teeth and displacement of healthy teeth. Those affected therefore suffer from toothache and pain in the dentition. In many cases, this results in an asymmetrical arrangement of the teeth, so that the aesthetics of the patients are also significantly affected by this disease. Diagnosis of this complaint is relatively quick and simple, so that early treatment can also take place. As a rule, no complications occur and the supernumerary teeth can simply be removed. In order to avoid consequential damage, the treatment must take place at an early age. The life expectancy of the patient is also not affected by the mesiodentes. In children, the symptoms can lead to bullying or teasing. Usually, complications do not occur in adulthood if treatment takes place early on.
When should you see a doctor?
If pain occurs in the mouth or throat, a doctor should be consulted. If there are impairments in food intake, a loss of appetite or pain in the jaw, a doctor is needed. If there are sleep disturbances, headaches or a feeling of pressure in the head, there is an irregularity that needs to be examined and treated. If the symptoms increase in intensity over several days or weeks, a doctor should be consulted. If there is bleeding in the mouth or if pus comes out, there is cause for concern. If there is an unpleasant taste in the mouth or bad breath, a doctor should be consulted. If the patient wears braces or has dentures in the mouth that suddenly cause discomfort, a doctor should be consulted. Shifting of the teeth or a sensation of pain when pressure is applied should be investigated. The use of a painkilling medication should always be discussed with a doctor. The person concerned is at risk of various side effects and complications, which must be ruled out in good time. Since generally occurring pain in the area of the teeth has an increasing character and no spontaneous healing is to be expected, a visit to the doctor is recommended already at the first signs of an irregularity. If teeth can be felt or observed to be breaking through gradually and slowly in unusual places in the jaw, a visit to the doctor is required.
Treatment and therapy
In cases of spontaneously erupted mesiodentes, the supernumerary teeth are usually extracted. However, because mesiodentes rarely achieve spontaneous eruption, surgical removal is the more common treatment option. If spontaneous eruption does not occur, surgical intervention is the only treatment option. The choice of the right timing determines the treatment success of the removal. If mesiodentes are removed too early, permanent teeth in growth could be damaged at their roots during surgery. If removed too late, cyst formation is considered a risk. In addition, if removal is delayed, the mesiodens could resorb the adjacent tooth roots. If the supernumerary tooth does not prevent the neighboring teeth from erupting and does not pose an obstacle to orthodontic treatment, dentists usually wait until surgical removal. This is usually done when the growth of the roots of the neighboring teeth has come to an end. During the waiting period, regular X-ray examinations of the supernumerary tooth are performed. Many mesiodentes remain symptom-free throughout their lives. Despite this, mesiodentes should be surgically removed no later than the completion of root growth, otherwise patients face a lifelong fear of tooth cyst formation.
Outlook and prognosis
The prognosis of mesiodentes is favorable. In a large number of affected individuals, no medical care is needed. Provided that no complaints occur, the affected person can spend a lifetime with the majority of the existing teeth without health disorders. If no abnormalities occur, usually only an incidental finding clarifies the presence of the extra teeth in the jaw. If complaints occur, such as pain or crookedness of the teeth, only medical treatment can provide relief. Otherwise, the prognosis worsens and an increase in health impairments can be expected over the lifespan. As soon as the affected person seeks medical care in these cases, removal of the affected teeth is initiated.Although the surgical procedure is generally associated with risks, it is a routine procedure that is usually trouble-free. Within a few days or weeks after the surgical removal of the excess teeth, the patient can expect to be free of symptoms. If the wound heals without any problems, no further impairments will occur. Recurrence of the disease is not possible. If there are disturbances in the wound healing process, the otherwise normal healing process is prolonged. Rest and protection are necessary to enable recovery. Consequential diseases or psychological stress do not occur.
Prevention
The causes of mesiodentes have not been conclusively determined, but remain controversial to this day. Since the cause has not been established beyond doubt, no promising preventive measures for mesiodentes can exist. Regular monitoring for mesiodentes can facilitate early detection. However, this control is done by X-ray imaging, which is associated with high radiation exposure. Since mesiodentes is rather rare, this step is also hardly worthwhile.
Follow-up
Mesiodentesis can lead to many complications or discomforts, so the affected person should definitely see a doctor for this disease. Thereby, an early diagnosis has a very positive effect on the further course and can thereby also prevent further complaints and complications. As a result of the disease, most of those affected suffer from an additional tooth, which is located in the oral cavity and can make it much more difficult to take in food and liquids. If the disease is not detected at an early stage, it also causes displacement of the milk teeth and fixed teeth, so that aesthetic complaints can also occur. Especially in adolescents and in children, this can lead to bullying or teasing. The disease can be treated relatively well, so that no further complications occur with successful treatment. In this case, the life expectancy of the affected person is also not limited by the disease.
What you can do yourself
The therapy of a supernumerary tooth is almost always inform of a surgical intervention. The patient can contribute only little to the improvement. However, it is important that the disorder is detected in time, as a mesiodent can often interfere with the development of adjacent teeth or delay their eruption and negatively affect jaw aesthetics. Parents should always take a delayed eruption of the front teeth as an opportunity for a thorough dental examination. If mesiodentes is indeed present, determining the timing for surgical removal is a critical issue. A second opinion should always be sought here. If removal is performed in childhood, there is a risk of damaging the roots of the teeth in the surgical area, which are still growing. On the other hand, late removal increases the risk of cyst formation as well as the risk of the mesiodentes resorbing the roots of neighboring teeth. Provided that the mesiodentes does not impair the development of the neighboring teeth and does not interfere with orthodontic treatment that may be necessary for other reasons, it is possible to wait for the time being. However, the supernumerary tooth must be constantly monitored. The patient should therefore actually attend all preventive examinations recommended by the dentist.