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Supernumerary teeth in Nepalese children.

1. Introduction

Supernumerary teeth maybe defined as teeth in excess of the usual configuration of twenty deciduous and thirty-two per manent teeth [1]. Their reported prevalence ranges between 0.3 and 0.8% in the primary dentition and 0.1 and 3.8% in the permanent dentition. Supernumerary tooth does not show any sexual predilection in the deciduous dentition. However, twice as many males are affected as compared to females in the permanent dentition [2-5]. The supernumerary tooth may show isolated occurrence or may be multiple, maybe unilateral or bilateral, erupted, or impacted, and can occur in either or both the jaws. Multiple supernumerary teeth are rare and are usually seen in association with cleft lip/palate, cleidocranial dysplasias, Gardner's syndrome, and so forth [6].

The exact etiology of supernumerary teeth is unknown; however, several theories have been postulated to explain their presence. The phylogenetic theory as a regression to the anthropoids whose dentition had more teeth, the autonomic recessive inheritance or linkage to the x chromosome, an abnormal reaction to a local traumatic episode, environ mental factors, dichotomy of the tooth germ, and the theory of hyperactivity of the dental lamina are the most accepted ones [7].

Supernumerary teeth can be classified according to their location and morphology. The most frequent location is the maxilla, of which the mesiodens (anterior maxillary medial region) is the most commonly observed supernumerary tooth. Based on morphology, they can be classified as conical, tuberculate, supplemental, and odontomas [8, 9]. Clinically, supernumerary teeth can cause various problems locally such as retention of the primary tooth, delayed/failure of eruption of the permanent tooth, ectopic eruptions, tooth displacements, follicular/dentigerous cysts, and other alterations which require surgical or orthodontic intervention [10,11].

The objective of the present study was to investigate the prevalence and characteristics of supernumerary teeth in the Nepalese population which is the first study of its kind in Nepal.

2. Materials and Methods

A survey was performed on 2864 patients (1829 females and 1035 males) ranging in age from 6 to 14 years attending the Department of Orthodontics, College of Dental Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal, over a period of two years from January 2010 to February 2012 for the presence of supernumerary teeth. This study was approved by institutional ethical review board and guidelines from the Helsinki declaration were followed. Informed con sent was taken from the parents of the subjects. The patients with any syndrome or congenital anomalies such as cleft lip/palate were not included in the study. For each patient with supernumerary teeth, the demographic variables (age and sex), number, location, eruption status, and morphology of supernumerary tooth were recorded. Descriptive statistics were performed and results were tabulated.

3. Results

Supernumerary teeth were detected in 46 subjects (1.60%), of which 26 were males and 20 were females with male female ratio of 1.3: 1 (Table 1).

Table 2 shows the characteristics of supernumerary teeth. In 82.60% (n = 38) of cases, one supernumerary tooth was observed, in 15.21% (n = 7) two supernumerary teeth were observed, and three supernumerary teeth were observed in one patient only (n = 1,2.17%). A total of 55 supernumerary teeth were observed, of which 98.18% (n = 54) were located in the maxillary arch, while 1.81% (n = 1) were found in the mandible. The most commonly found supernumerary tooth was mesiodens (63.63%) followed by maxillary lateral incisor (25.45%) and maxillary first premolar (10.90%). Conical morphology was seen in 58.18% (n = 32) (Figure 1), while 30.90% (n = 17) were tuberculate (Figure 2) and 10.90% (n = 6) were supplemental (Figure 3) in form. Regarding their eruption status, 56.36% (n = 31) had erupted and 46.63% (n = 24) were impacted.

4. Discussion

Supernumerary teeth are developmental alterations that may manifest in both primary and permanent dentition, may be seen in both maxilla and mandible, and can involve any tooth. They may be associated with a syndrome or can be found in nonsyndromic patients also [21]. In our study, the prevalence of supernumerary teeth in nonsyndromic cases was found to be 1.60% and showed male predilection with a male : female ratio of 1.3: 1.

Table 3 provides an overview of studies done on supernumerary teeth in different populations. It can be observed that the prevalence of supernumerary teeth in the Nepalese population is similar to that of Hungarian 12], Swedish [16], and Brazilian [19] population. The male : female ratio was in accordance with the studies of Gabris et al. [12] in Hungarian population, Brook [17] in British population, and Kuchler et al. in Brazilian population [18]. However other studies have reported that males are affected approximately twice as frequently as females in permanent dentition [2,13-15, 20]. These differences may be due to the differences in methodology employed and due to racial and ethnic differences in various populations [5].

In accordance with other reported studies, 82.60% (n = 38) of the supernumerary teeth were found to be single, 15.21% (n = 7) were paired, and only one case showed triple supernumerary teeth [2, 22]. Also, 98.8% (n = 33) of the supernumerary teeth were found to be in the maxillary arch. This value is high as compared to Salcido-Garcia et al. [23] who found 66% of supernumerary teeth in the maxillary arch. However, it is in accordance with Simoes et al. [19] and de Oliveira Gomes et al. [11] who reported 96.7% and 91.3% of the cases in maxilla, respectively. The most commonly found supernumerary tooth has been reported to be mesiodens [19,20,23-25], which coincides with our findings. In order of decreasing frequency, some authors consider that mesiodens are followed by distomolars [25, 26], but others [21, 23] found that mesiodens are followed by lateral incisors and premolars. Our findings are in accordance with the latter, the mesiodens being most prevalent followed by lateral incisors and premolars. However, we were unable to find supernumerary canines and molars which may be because of the lower incidence of such teeth and further due to late developing supernumeraries [27]. In terms of morphology, conical form was most common followed by tuberculate and supplemental forms which was in agreement with the findings of other researchers [2, 11, 14, 18]. When assessing eruption status, it was found that 56.36% (n = 31) of the supernumerary teeth were erupted. This finding depicts a higher rate of eruption frequency than that reported by other authors [2, 11, 15, 27]. Liu [14] and de Oliveira Gomes et al. [11] showed that eumorphic teeth had a higher frequency of eruption, whereas in our study there was no significant relation between morphology of supernumerary tooth and their eruption status.

5. Conclusion

The prevalence of supernumerary teeth in Nepalese patients was found to be 1.60%. Males were affected more commonly than the females. The supernumerary teeth occurred more frequently in the maxilla as compared to the mandible with mesiodens being the most common type. Morphologically, conical type was the most prevalent. The majority of the supernumerary teeth were erupted.

http://dx.doi.org/10.1155/2014/215396

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

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Varun Pratap Singh, (1) Amita Sharma, (2) and Sonam Sharma (3)

(1) Department of Orthodontics, College of Dental Sciences, B.P.K.I.H.S., Dharan, Nepal

(2) Department of Dentistry, SHKM Government Medical College, Mewat, Haryana 122107, India

(3) Department of Pathology, SHKM Government Medical College, Mewat, Haryana 122107, India

Correspondence should be addressed to Amita Sharma; dramitasharma09@gmail.com

Received 31 July 2014; Revised 10 November 2014; Accepted 15 November 2014; Published 23 November 2014

Academic Editor: Mehmet Ozgur Sayin

TABLE 1: The prevalence and distribution of supernumerary teeth in
males and females.

Gender   Number   Supernumerary teeth   Frequency (%)   [X.sup.2] value

Female    1829            20                1.09%            8.11
Male      1035            26                2.51%

Gender   P value   Total (%)

Female   0.0043    46 (1.60%)
Male

TABLE 2: Summary of the characteristics of supernumerary teeth.

                   Supernumerary                             Number
                       teeth                              (total = 55)
                  characteristics

Number                                     Single              38
                                           Double              7
                                           Triple              1

Location          Maxilla (n = 54)       Mesiodens             35
                       98.18%         Lateral incisor          13
                                     Maxillary premolar        6
                  Mandible (n = 1)    Lateral incisor          1
                       1.81%

Eruption Status                           Impacted             24
                                          Erupted              31

Morphology                                Conical              32
                                        Tuberculate            17
                                        Supplemental           6

                   Supernumerary                           Percentage
                       teeth                                  (%)
                  characteristics

Number                                     Single            82.60
                                           Double            15.21
                                           Triple             2.17

Location          Maxilla (n = 54)       Mesiodens           64.81%
                       98.18%         Lateral incisor        24.07%
                                     Maxillary premolar      11.11%
                  Mandible (n = 1)    Lateral incisor          --
                       1.81%

Eruption Status                           Impacted           43.63
                                          Erupted            56.36

Morphology                                Conical            58.18
                                        Tuberculate          30.90
                                        Supplemental         10.90

TABLE 3: Summary of various studies carried out on supernumerary teeth
in different populations.

Authors             Sample size        Country             Age

Present study          2864             Nepal           6-14 years

Gabris et al.          2219            Hungary         15-20 years
(2006) [12]

Tyrologou et        97 children         Sweden          3-15 years
al. (2005) [13]   with mesiodens

Rajab and               152             Jordan          5-15 years
Hamdan (2002)
[2]

Liu (1995) [14]         112             Taiwan          4-14 years
                   (premaxillary
                      region)

von Arx (1992)     90 (anterior      Switzerland        6-10 years
[15]                 maxilla)

Bodin et al.          21,609            Sweden              --
(1978) [16]

Brook (1974)           1331         United Kingdom     11-14 years
[17]

Yusof (1990)          48,550             USA         Average 40 years
[3]

Kuchler et al.         1166             Brazil          6-12 years
(2011) [18]

Simoes et al.          1719             Brazil         4-14.5 years
(2011) [19]

Celikoglu et           3491             Turkey         12-25 years
al. (2010) [20]

Authors               Method        Prevalence   Male : female
                                                     ratio

                     Clinical
Present study     examination and     1.60%          1.3:1
                    radiographs

Gabris et al.       Radiographs       1.53%          1.4:1
(2006) [12]

Tyrologou et         Clinical           --            2:1
al. (2005) [13]   examination and
                    radiographs

Rajab and            Clinical           --           2.2:1
Hamdan (2002)     examination and
[2]                 radiographs

Liu (1995) [14]      Clinical           --           2.8:1
                  examination and
                    radiographs

von Arx (1992)       Clinical           --           2.6:1
[15]              examination and
                    radiographs

Bodin et al.            --             1.6%          1.7:1
(1978) [16]

Brook (1974)         Clinical          2.1%          1.4:1
[17]              examination and
                    radiographs

Yusof (1990)        Radiographs       0.91%           --
[3]

Kuchler et al.       Clinical          2.3%         1.45:1
(2011) [18]       examination and
                    radiographs

Simoes et al.       Radiographs        1.7%           --
(2011) [19]

Celikoglu et        Radiographs        1.2%          1.8:1
al. (2010) [20]
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Title Annotation:Research Article
Author:Singh, Varun Pratap; Sharma, Amita; Sharma, Sonam
Publication:The Scientific World Journal
Article Type:Report
Geographic Code:9NEPA
Date:Jan 1, 2014
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