Exodontia.Info
Ectopic & Supernumerary Tooth
Removal
Warnings
It is quite common to have extra teeth (supernumerary
teeth
) or teeth in the wrong position (ectopic teeth) or
both.

The prevalence of
supernumerary teeth is reportedly
between 0.15 - 3.9%.  Most commonly, extra teeth are
found between the upper central incisors
(
mesiodentes) or in the region of the premolars
(
paramolars) or very occasionally, behind the wisdom
teeth (
distomolars).

Supernumerary Teeth.  80 - 90% of all supernumerary
teeth
occur in the upper jaw.  Half are found at the ‘front’ of
the upper jaw.  
Mesiodentes frequently interfere with the
eruption and alignment of the upper incisors.  They can
delay or prevent eruption, displace or rotate the erupting
central incisors or less commonly, ‘
bend’ (dilaceration) the
developing roots of the central incisors so that tooth
eruption is slowed / stopped, ‘eat away’ (
resorption) the
surrounding teeth, develop cysts around the crowns of the
extra teeth (
dentigerous cyst formation) and loss of tooth
vitality.  Rarely, the
mesiodens can erupt into the nasal
cavity.

Ectopic Teeth.  Ectopic teeth are teeth that develop in the
wrong position.  
Ectopic teeth are not rare.  In most cases,
ectopic tooth can be repositioned with braces.
This list is not exhaustive nor is it predictive.  The most
pertinent warnings have been included here.

You are to have an ectopic / supernumerary tooth / teeth
removed.  You can expect the following.

Ectopic +/- Supernumerary Surgery-Specific Warnings.

Numbness of the Lip, Chin +/-Tongue.  The nerves that
supplies feeling to the tongue, lower lip and the chin run risk
that when
bicuspid teeth squeezed out of the line of teeth
towards the tongue are removed, these nerves can be
crushed, bruised or stretched resulting in numbness (at the
worse end of the scale) to altered sensation (at the other
end of the scale) in the region of the lower lip, chin and/or
tongue.  This nerve bruising tends to be temporary (rarely
is it permanent) but ‘temporary’ can stretch from several
days to several months.  It is hard to predict who will get
nerve bruising and if it will be temporary / permanent and if
temporary, how long for.

Mouth-Sinus Communications.  Upper premolar & canines
are often in close proximity to the sinus.  In removing these
teeth, there is a chance that a communication can be made
between the mouth & the
sinus (this is sometimes not
evident at the time of operation but may develop 4 – 6
weeks afterwards).  If this communication persists or is left
un-repaired, every time you drink, fluid can come out of the
nose and you may develop a marked
sinusitis.  This
communication, if small enough, can spontaneously close.  
It can be assisted in this by ‘cover plates’ that prevent food
& fluids going into the sinus allowing the hole to close
naturally.  However, communications above a certain size
need to be surgically closed.

Surrounding Teeth.  The surrounding teeth may be sore
after the extraction; they may even be slightly wobbly but
the teeth should settle down with time.  It is possible that
the fillings or crowns of the surrounding teeth may come
out, fracture or become loose.  If this is the case you will
need to go back to your dentist to have these sorted out.  
Every effort will be made to make sure this doesn’t
happen.

In very rare instances, the surrounding teeth may
actually come out as well as the intended tooth.  Extra
teeth can be very hard to get at and in doing so, the blood-
supply to the surrounding teeth may be compromised.  If
this happens, these teeth can die (under go ‘
devitalisation’);
the teeth change colour (turn grey), become spontaneously
painful or become infected.  A tooth that is dying may not
be immediately obvious and may take several weeks to
become so.

General Surgical Warnings.

Pain.  As it is a surgical procedure, there will be soreness
after the tooth removal.  This can last for several days.  
Painkillers such as
ibuprofen, paracetamol, Solpadeine or
Nurofen Plus are very effective.  Obviously, the painkiller
you use is dependent on your medical history & the ease
with which the tooth was removed.

Swelling.  There will be swelling afterwards.  This can last
up to a week.  Use of an icepack or a bag of frozen peas
pressed against the cheek adjacent to the tooth removed
will help to decrease the swelling.  Avoidance in the first
few hours post-op, of alcohol, exercise or hot foods / drinks
will decrease the degree of swelling that will develop.

Occasionally, there is bleeding into the cheek.  The swelling
caused by this may take much longer to resolve; at the
same time, there may well be limitations to mouth opening.  
This also improves with time.

Bruising.  Some people are prone to bruise.  The bruising
can look quite florid; this will eventually resolve but can take
several weeks (in the worst cases).

Stitches.  The operation site will often be closed with
stitches.  These dissolve and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.  Often the chewing muscles and
the jaw joints are sore after the procedure so that mouth
opening can be limited for the next few days.  If you are
unlucky enough to develop an infection in operation site
afterwards, this can make the limited mouth opening worse
and last for longer.

Bleeding into Cheeks.  Swelling that does not resolve
within a few days may be due to bleeding into the cheek.  
The cheek swelling will feel quite firm.  Coupled with this,
there may be limitation to mouth opening and bruising.  Both
the swelling, bruising and mouth opening will resolve with
time.

Post-op Infection.  You may develop an infection in the
socket after the operation.  This tends to occur 2 – 4 days
later and is characterised by a deep-seated throbbing pain,
bad breath and an unpleasant taste in the mouth.  This
infection is more likely to occur if you are a smoker, or are
on the contraceptive pill, or on drugs such as steroids and if
bone has to be removed to facilitate tooth extraction.

Surgical Removal.  To facilitate the removal of teeth, it is
sometimes necessary to cut the gum and / or remove bone
from around the tooth.  If this is the case, you can expect
the extraction site to be sorer afterwards, the swelling to
be greater and more prone to infection.  Hence, stronger
painkillers are needed; use of icepacks mandatory and
antibiotics will probably be prescribed.  The bone grows
back to a greater extent.

Bony Flakes.  If a number of teeth are removed at one go,
the resulting gums may feel a bit rough.  Occasionally, bony
flakes (
sequestra) from the lining of the tooth sockets can
work their way loose out through the gums.  These can be
quite sore.  They often work their way loose without any
problems but may need to be teased out or even smoothed.


Useful Websites:

Wikipedia

Canadian Dental Association

National Maternal & Child Oral Health Resource Center,
Georgetown University


Useful Articles:

Australian Dental Journal 1998.  Supernumerary tooth in the
maxillary sinus. Case report

The Management of the Palatally Ectopic Maxillary Canine.
2004

Dental Update 2008.  Diagnosis and Management of
Supernumerary Teeth

Int J Oral Sci 2009. Case Report.  Impacted Lower 3rd
Molar Fused with a Supernumerary Tooth.  Diagnosis &
Treatment Planning Using Cone-Beam CT

J Oral Maxillofac Surg 2009.  Clinical Characteristics &
Complications Associated With Mesiodentes

Archives of Orofacial Sciences 2010.  Case Report.  
Maxillary Paramolar - report of a case and literature review
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Last Updated 24th November 2010