Most extra teeth are never seen in the mouth. In a Madrid study of 518 people with supernumerary teeth, 78 percent of the extra teeth were still buried in the bone (Brinkmann and colleagues, European Journal of Dentistry, 2020). That is why parents usually first hear about one after an X-ray, often taken for a different reason, and why a dentist may want a closer look before deciding anything.
A tooth beyond the usual count
A supernumerary tooth is any tooth that forms in addition to the normal set of 20 baby teeth or 32 adult teeth. Some look like an ordinary tooth, such as an extra lateral incisor next to the normal one. Others are small and cone-shaped, peg-like or irregular. They can grow upright, sideways or upside down.
In children, the upper front region is where they are most often found, and boys are affected more often than girls. They also form further back, as extra premolars or extra molars; in the Madrid study, which included adults, extra molars were actually the most common type. The best-known front type, a mesiodens, has its own article: extra teeth and mesiodens in children.
A child can have an extra tooth without any other health issue. When there are several, a dentist may consider whether a wider developmental condition is involved, such as cleidocranial dysplasia or Gardner syndrome, both of which are known to be associated with multiple extra teeth.
Clues that lead to an X-ray
Because so many stay hidden, the signs are usually indirect:
- an adult tooth arriving well behind its partner on the other side
- a baby tooth that stays firm long after it would be expected to loosen
- a gap between the front teeth that is not closing
- teeth that are crowded, rotated or pushed out of the line of the arch
- a small or oddly shaped tooth appearing in the palate or beside another tooth
Our guide to when baby teeth fall out shows the usual timing, which helps judge whether a delay is worth checking.
What the imaging shows
A routine dental X-ray or an OPG, the panoramic image that shows all the teeth and jaws on one film, is usually enough to show that an extra tooth is present. It may not show exactly where the tooth sits from front to back, how close it is to the roots of nearby adult teeth, or which way it points.
When removal is being considered, or the picture is unclear, a 3D X-ray (cone beam CT) can answer those questions. It lets the dentist see the tooth from every angle, plan the safest approach and avoid damage to developing teeth. As with any X-ray, it should only be taken when the information will change the plan, with the dose kept as low as practical.
Lumi Dental has an in-house 3D X-ray unit that takes both OPGs and 3D scans, so imaging can usually be done at the same visit as the assessment.
Not every extra tooth needs to come out
An extra tooth that is sitting well away from the other teeth, not blocking anything and not changing, can often be left and checked with X-rays from time to time. In the Madrid study, around 40 percent of extra teeth were linked to some problem on X-ray, which also means many were not.
Removal becomes more likely when the extra tooth is:
- stopping an adult tooth from coming through
- pushing other teeth apart or out of line
- sitting where planned orthodontic treatment needs to move teeth
- showing signs of a cyst or affecting a neighbouring root
When an extra tooth is blocking an upper front tooth, removal does not always mean the adult tooth comes through on its own. A 2023 systematic review by Seehra and colleagues in the American Journal of Orthodontics and Dentofacial Orthopedics pooled 15 studies and found that a little over half of blocked incisors erupted after removal of the extra tooth alone. The proportion was higher when space was also created in the arch, and higher again when the tooth was gently drawn down with an orthodontic attachment. That is why some children have a short period of orthodontic treatment around the time of removal, as described in our article on early orthodontic treatment.
What it costs depends on the plan
Fees vary widely, because the work can range from monitoring with occasional X-rays, to a quick removal of an erupted extra tooth, to surgical removal of a buried one followed by orthodontics. Imaging is usually a separate item. An accurate figure follows an assessment and a written treatment plan with fees; see the current offers page or contact us to arrange a visit.
What parents ask us
Will my child need surgery?
Not always. An extra tooth that has come through can often be removed quickly under local anaesthetic. A buried one needs a small surgical procedure, and the right setting depends on the child's age, the tooth's position and how comfortable the child is.
Could my other children have extra teeth too?
There seems to be a family tendency in some cases, so it is worth mentioning at their check-ups.
Is it safe to leave an extra tooth in?
Often, yes, when it is not affecting anything. Regular reviews make sure it stays that way.
If your child has a tooth that is late, crooked or out of step with its partner, an examination and X-ray can show whether an extra tooth is part of the picture. Our guides on a child's first dental visit and white spots on teeth cover other common questions, or you can book a consult.
This article is general information and not a substitute for personal dental advice. Outcomes vary between individuals.
