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 of warnings might seem excessive to some however the legal ruling in
the case of
Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them.  Others might say that there isn't enough information but
where do you stop?

The following list of warnings regarding the
removal of ectopic / supernumerary
teeth
is neither exhaustive nor is it predictive.  The most pertinent warnings have
been included here.

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 (
tooth avulsion).  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

New England J of Medicine 2011.  Images in Clinical Medicine.  Ectopic Tooth in
the Maxillary Sinus
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Last Updated 26th December 2014