Extra Teeth in Children: What Are Supernumerary Teeth?

A supernumerary tooth is an extra tooth, one beyond the standard set of twenty baby teeth or thirty-two permanent teeth. Most of them turn up in the upper front of the mouth, most are found on an X-ray rather than by looking, and most never erupt into the mouth at all.

Whether an extra tooth needs to come out depends on where it sits and what it is affecting. It does not follow automatically from the fact that it exists, and that distinction is the most useful thing on this page.

Where they show up

They turn up about five times more often in permanent teeth than in baby teeth. In the baby teeth they are rare, well under one child in a hundred. Once the permanent teeth start coming in, reported figures climb to around two in a hundred, though the estimates move depending on how a study was run and whether imaging was used.

Where they appear is far more consistent than how often. Most sit in the upper jaw, about half of those in the front, and nearly all of the front ones sit on the palate side rather than the lip side.

The one that gets talked about most has its own name. A mesiodens is an extra tooth sitting at the midline between the two upper front teeth. It is the single most common supernumerary, and it is the one most likely to interfere with something.

Extra teeth come in different shapes, from small cone-shaped ones to teeth that look like normal neighbors, and the shape affects how they behave.

How they usually get found

Not by looking in the mouth. During the early mixed dentition, the great majority of extra teeth in the upper front are still buried in the bone. Only about a quarter of mesiodens erupt into the mouth on their own.

So most are found one of two ways: on a radiograph taken for another reason, or because something visible prompted a look. The visible prompts are worth knowing:

• One upper front permanent tooth has come in and its partner on the other side has not
• An upper front tooth is late in a child whose other teeth arrived on schedule
• An upper baby front tooth will not come out
• A permanent front tooth is coming in at an odd angle or in an odd place
• A gap between the upper front teeth that behaves differently from the ordinary space most children have at that age
• An extra tooth that has simply erupted and is visible

None of those means an extra tooth is present. They mean it is one of the things worth ruling out, which is exactly how dental X-rays earn their place in this situation. A standard film can show that an extra tooth exists. Pinning down exactly where it sits, front or back relative to the permanent tooth, takes either two films taken from different angles or a three-dimensional scan, because that position drives everything about how it is handled.

What an extra tooth can do, and often does not

The honest version is that the range runs from nothing at all to a genuine problem.

At the harmless end, an extra tooth can sit in the bone indefinitely without affecting anything around it. Extra baby teeth in particular usually erupt, function, and fall out on their own without complications.

At the other end, an unerupted extra tooth can block a permanent front tooth from coming in, push it off course so it erupts in the wrong place or at the wrong angle, or crowd and space the teeth around it. Less often it can bend the root of the developing permanent tooth as it forms, or cause resorption of that root. Rarely, a cyst can develop around it.

Which end of that range a given tooth falls on is a question about position and proximity, and that is what the imaging answers.

One point that catches families off guard: when a child has an extra baby tooth, an extra permanent tooth follows in roughly a third of cases. That is not a reason to do anything now. It is a reason to keep watching as the permanent teeth develop.

Deciding whether it comes out

This is the section that most articles get wrong by making removal sound like the default.

When removal is usually the right call

An extra tooth that is blocking a permanent tooth from erupting, pushing one off course, or associated with a cyst is generally removed. An extra tooth that has erupted into the mouth and is not needed is generally removed too. Once an erupted mesiodens is taken out, the neighboring permanent incisor erupts on its own in about three quarters of cases.

When timing is the real question

For an unerupted extra tooth blocking an incisor, there is a window that works better than the alternatives. Removing it around ages six to seven, once the permanent tooth’s crown has finished forming but its root is still relatively short, leaves that tooth with enough of its own eruptive push to come in normally. Waiting much longer reduces the chance it will arrive without help, particularly once the root is fully formed. Some shapes, especially the small inverted cone-shaped ones, also migrate deeper into the jaw over time and become harder to remove later.

When waiting is the better decision

Operating on an unerupted extra tooth very early, while the child is still in the baby teeth, carries its own risk: the surgery itself can displace or damage the developing permanent incisor sitting right there. An extra tooth that is asymptomatic, well away from anything important, and not affecting the developing dentition is sometimes reasonable to leave alone and monitor with periodic imaging. That is a real option, not a fallback.

So the answer to “does it have to come out” is genuinely “it depends,” and what it depends on is position, effect, and where your child is in development. A parent asking the dentist to point at the image and explain which of those three is driving the recommendation is asking exactly the right question.

How removal actually goes

When an extra tooth is removed, it is a short surgical appointment. The area is fully numbed, and comfort and behavior options are discussed ahead of time based on your child’s age, the position of the tooth, and how they generally do with treatment.

Afterward, the follow-up matters as much as the surgery. The permanent tooth is checked at about six months to see whether it has started moving. If it has not come in after six to twelve months and there is enough room for it, the next step is usually uncovering it and guiding it into position with orthodontic traction, which is done with an orthodontist. There is more on how early guidance of the developing bite works on our early start orthodontics page.

What this is not a sign of

An extra tooth on its own is not a sign that anything is wrong with your child’s health. Extra teeth do appear more often alongside certain genetic conditions, and a child with several of them in unusual places may be looked at with that in mind. But a single mesiodens in an otherwise healthy child is a common, isolated developmental finding, and it does not carry a broader meaning.

It is also not caused by anything a parent did or did not do.

Quick answers

Is an extra tooth hereditary?

They do cluster in families, which is why dentists ask about family history when one turns up. Plenty of children with an extra tooth have no known family history of one, so it is a useful clue rather than a rule.

Can an extra tooth just be left alone forever?

Sometimes, yes. An extra tooth that is not blocking anything, not associated with a cyst, and not affecting the teeth around it can reasonably be monitored. What that requires is actual monitoring, meaning periodic imaging at intervals your dentist sets, rather than being forgotten about.

Will removing it fix the crooked tooth next to it?

Often it lets the neighboring tooth erupt, which is a different thing from making it straight. The extra tooth was the obstruction, not the alignment plan. Whether the tooth then arrives in a good position, needs guiding, or needs orthodontic work later depends on how much room is available and how far off course it had already gone.

Does my child need a 3D scan?

Not usually. The question an extra tooth raises is whether it sits toward the lip or toward the palate relative to the permanent tooth, and that can often be worked out by shifting the angle between two ordinary films. Three-dimensional imaging is held back for the cases where that approach leaves the position genuinely unclear, since the aim with children is to use the least imaging that answers the question.

My child has an extra baby tooth. Should we do anything now?

Usually nothing beyond keeping it clean and keeping an eye on it. Extra baby teeth generally erupt and fall out without causing trouble. The reason to note it is that an extra permanent tooth follows about a third of the time, so it changes what we look for over the next few years.

Come in and we will take a look

If you have spotted an extra tooth, or a front tooth that is arriving late or in an odd spot, call us at 317-580-9199, or send us the question through our contact page, and we will take a look. This is one of those findings where a single image usually answers the question, and knowing the answer is worth more than guessing at it.

We are at 9240 N. Meridian St., Suite 250 in Indianapolis, open Monday through Thursday. Our pediatric dentistry page sets out the range of care we provide from infancy onward.