The mesiodens is an extra tooth between teeth 11 and 21 or 31 and 41. The extra tooth usually prevents the neighboring teeth from erupting or restricts their growth. In most cases, the treatment of a mesiod takes place in the form of surgical removal.
What is a mesiodens?
Various types of excess teeth in the human dentition fall into the hyperdontonia group of diseases. The mesodiens is such a number of teeth. Literally translated, the Latin expression means “towards the middle of the dental arch”. In most cases, the supernumerary tooth is atypically shaped or atrophied and, in the case of the mesodiens, is preferably between tooth 11 and tooth 21, i.e. between the upper central incisors. See AbbreviationFinder for abbreviations related to Mesiodentes.
A mesodiens between tooth 31 and tooth 41 is observed less frequently. The frequency is estimated at a maximum of two percent. At a ratio of 2:1, men are twice as likely to be affected by the phenomenon. In rare cases, the diagnosis of mesodiasis can also include several supernumerary teeth. The mesiodens is also known as the tenon tooth and usually develops faster than its neighboring teeth.
As a result, the supernumerary tooth is usually retained. The mesiodens only becomes relevant in dentistry when normal teeth erupt because of the supernumerary tooth. Despite the low prevalence, the mesiodens is the most common type of hyperdontia.
Causes
There are three different theories on the etiology of Mesiodentes. Some authors assume a phylogenetic reversion phenomenon. According to this theory, the mesiodens is an atavism and descends from the human ancestors, who according to the theory possessed three central incisors. Thus, the mesiodens occasionally occurs in humans as a result of accidental expression of earlier genes.
In the meantime, this theory has been almost completely refuted by embryological studies. The theory of the dichotomy refers to the fact that tooth germs can divide you in the course of development and in this way an additional tooth germ can develop. However, the hypothesis of tissue hyperactivity is now the most widespread.
According to this hypothesis, the additional tooth formation is caused by hyperactivity of the lamina dentalis. A cell encapsulation of active cells should therefore be responsible for the additional tooth formation. The theories are controversially discussed, so that the investigation into the causes is not yet considered complete.
Symptoms, Ailments & Signs
In children, the mesiodens can present with an ectopic, asymmetric, or delayed eruption of one or both incisors. In principle, however, the mesiodens can also be inverted. The tip of the root then points in the direction of the oral cavity. When a mesiodens becomes symptomatic can vary. Mesiodentes can already occur in the deciduous dentition and are then called supplementary.
If they only show up in the permanent dentition, we are talking about rudimentary mesiodentes. A mesiudens can take different forms. The most common shapes are conical, tubular and molar. The mesiodens may cause the neighboring teeth to shift symptomatically. However, this symptom is less common than the delayed eruption of neighboring teeth. Only in the rarest of cases does the mesiodens break through spontaneously.
Diagnosis & disease progression
In most cases, mesiodentes are incidental findings. The supernumerary teeth can almost always only be detected by radiology. In adults, the diagnosis usually takes place as part of an incidental finding within the OPG. The diagnosis is confirmed by two apical dental film images in different projections. This recording primarily determines the position of the tooth in direct relation to the adjacent tooth roots.
The alternative diagnosis of the mesiodes can be done by computer tomography. However, this alternative diagnosis is only rarely used in dental practices, since it is associated with higher radiation exposure and most dental practices also do not have a CT device. The prognosis for patients with mesiodens is favorable.
Complications
Due to the mesiodentes, there is an extra tooth in the patient’s mouth. This has a very negative effect on the health of the other teeth and can lead to various complications and problems in the oral cavity. As a rule, this leads to disturbances in the growth of the teeth and the displacement of the healthy teeth. Those affected therefore suffer from toothache and pain in the teeth.
In many cases, this leads to an asymmetrical arrangement of the teeth, so that the aesthetics of the patients are also clearly affected by this disease. The diagnosis of this complaint is relatively quick and easy, so that early treatment can take place. There are usually no complications and the excess teeth can be easily removed.
In order to avoid consequential damage, the treatment must take place at an early age. The life expectancy of the patient is also not affected by the Mesiodentes. In children, the symptoms can lead to bullying or teasing. As a rule, there are no complications in adulthood if treatment is given early.
When should you go to the doctor?
If you experience pain in your mouth or throat, you should consult a doctor. A doctor is needed if there are problems with eating, loss of appetite or pain in the jaw. If you have trouble sleeping, a headache or a feeling of pressure in your head, there is an irregularity that needs to be examined and treated. If the symptoms increase in intensity over several days or weeks, a doctor should be consulted. If your mouth is bleeding or pus is leaking out, you should be concerned. If you have an unpleasant taste in your mouth or bad breath, you should consult a doctor.
If the person concerned wears braces or has dentures in the mouth that suddenly cause symptoms, a doctor should be consulted. Displacements of the teeth or a sensation of pain when pressure is applied should be examined. The use of painkilling medication should always be discussed with a doctor. Those affected are at risk of various side effects and complications that must be ruled out in good time. Since pain that occurs in the area of the teeth generally has an increasing character and no spontaneous healing is to be expected, a doctor’s visit is recommended at the first sign of an irregularity. If it can be felt or observed that teeth are gradually and slowly erupting in unusual places in the jaw, a doctor’s visit is necessary.
Treatment & Therapy
In the case of spontaneously erupted mesiodentes, the supernumerary teeth are usually extracted. Since mesiodentes erupt spontaneously only in the rarest of cases, surgical removal is the more common treatment option. If spontaneous breakthrough does not occur, surgical intervention is the only treatment option. Choosing the right time determines the success of the removal treatment.
If mesiodentes are removed too early, permanent growing teeth could be damaged at their roots during surgery. If the removal is too late, cyst formation is considered a risk. In addition, if the removal is delayed, the mesiodens could resorb the adjacent tooth roots. If the supernumerary tooth does not prevent the neighboring teeth from erupting and does not represent an obstacle for orthodontic treatment, dentists wait until the surgical removal in most cases.
They usually only do this when the growth of the roots of the neighboring teeth has come to an end. During the waiting period, regular X-ray checks of the supernumerary tooth are carried out. Many mesiodentes remain symptom-free for the rest of their lives. Despite this, Mesiodentes should be surgically removed at the latest after the end of the root growth, otherwise the patients have to fear the formation of dental cysts for the rest of their lives.
Outlook & Forecast
The prognosis of Mesiodentes is favorable. A large number of those affected do not require medical care. If there are no symptoms, the affected person can spend life with the majority of existing teeth without health problems. If there are no abnormalities, usually only an incidental finding clarifies the presence of the additional teeth in the jaw.
If symptoms such as pain or crooked teeth occur, only medical treatment can remedy the situation. Otherwise, the prognosis worsens and an increase in health impairments can be expected over the lifespan. As soon as the affected person seeks medical care in these cases, the affected teeth are removed.
Although the surgical procedure is always associated with risks, it is a routine process that usually runs smoothly. You can expect to be free of symptoms within a few days or weeks after the surgical removal of the excess teeth. If the wound healing proceeds without problems, no further impairments occur. A recurrence of the disease is not possible. If there are disturbances in the wound healing process, the usual healing path is extended. Rest and protection are necessary for recovery to take place. Complications or psychological stress do not occur.
Prevention
The causes of Mesiodentes have not yet been conclusively clarified, but are still controversially discussed today. Since the cause is not certain, no promising preventive measures for Mesiodentes can exist.
Regular checking for Mesiodentes can simplify early detection. However, this check is carried out using X-ray imaging, which is associated with high radiation exposure. Since the mesiodens is rather rare, this step is hardly worthwhile either.
Aftercare
A mesiodentes can lead to many complications or discomfort, so the sufferer should definitely consult a doctor with this disease. Early diagnosis has a very positive effect on the further course and can also prevent further symptoms and complications. As a result of the disease, most of those affected suffer from an extra tooth, which is located in the oral cavity and can make it significantly more difficult to take in food and liquids.
If the disease is not recognized at an early stage, the deciduous teeth and permanent teeth will also shift, so that aesthetic problems can also occur. This can lead to bullying or teasing, especially in young people and children. The disease can be treated relatively well, so that no further complications arise if the treatment is successful. The life expectancy of the person affected is not reduced by the disease.
You can do that yourself
The treatment of a supernumerary tooth is almost always carried out in the form of a surgical intervention. The patient can only contribute little to the improvement. However, it is important that the disorder is recognized in good time, since a mesiodentes can often disrupt the development of neighboring teeth or delay their eruption and negatively affect the jaw aesthetics. Parents should always use delayed eruption of the front teeth as a reason for a thorough dental examinationtake. If a mesiodentes is actually present, determining the time for surgical removal is a critical aspect. A second opinion should always be obtained here. Removal in childhood carries the risk of damaging the growing roots of the teeth in the surgical area. On the other hand, late removal increases the risk of cyst formation and the risk of the mesiodentes resorbing the roots of the neighboring teeth.
As long as the mesiodentes does not impair the development of the neighboring teeth and does not hinder any orthodontic treatment that may be required for other reasons, you can wait and see. However, the supernumerary tooth must be constantly monitored. The patient should therefore actually attend all check-ups recommended by a dentist.