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EXTRA AND TOO FEW TEETH....WHAT TO DO?
Often a parent will enter the office and declare their child has a 'second row of teeth' or be referred by a general dentist for missing teeth. In either case, long-term treatment planning is all important.
Extra teeth:
Typically this condition is due to 'supernumerary' or extra teeth, but these unusual teeth are typically located in the midline of the upper jaw near the nasal area. Treatment is simple when there is a small root or the tooth is not located near a major blood vessel. I typically send the child to an oral surgeon for removal as soon as the extra tooth is located, usually by a digital panoramic x-ray. The other place extra teeth are typically found is in the area of the third molars and extraction is again the treatment of choice.
The situation where the parent thinks there are extra teeth due to two rows of lower or upper teeth is almost always the laterals erupting to the back side of the baby teeth and can be corrected by repositioning. In twenty five years of practice, I have never seen an 'extra' set of teeth. I've seen an extra lateral or two, never a whole set.
Sometimes there are two teeth fused together like Siamese twins. This is always tough to work out and requires lots of planning and discussion of options. The choices are so varied, it is mostly a unique decision for each patient.
Missing teeth:
From the stand point of treatment planning, missing teeth are a big problem. Why? Because the teeth work together as a set of gears and if one "tooth" of the set is missing, things don't fit correctly.
Upper laterals and second bicuspids are the most commonly missing teeth. I typically move the back teeth forward in these cases to give a totally natural set of teeth and it works out really well. Substitution of the upper cuspid for the lateral is a common treatment plan.
The worst tooth to be missing, in my experience, is a lower incisor when there is no crowding to compensate for with the loss of a tooth. It throws off the "fit" or occlusion and is very difficult to work out satisfactorily.
In rare cases, multiple teeth are missing all over the mouth and this is where long term planning again plays an important part. Unless there is a way to close spaces and balance the bite, bridge work or implants may be necessary. In some of these cases there just isn't any other way to achieve a balanced bite.