13.2.3 Treatment
The care of children with multiple missing teeth can be complex and ideally requires
multidisciplinary input from paediatric dentists, orthodontists, and prosthodontists as
well as genetic counselling. Missing teeth and small teeth often present together, so
masking of conical or similarly distinctive teeth with composite is strongly advised. In
cases of anodontia, full dentures are required. These can be provided, albeit with
likely limited success, from about 3 years of age, with the possibility of implant
support for prostheses provided in adulthood. (786HFig. 13.4 (a) and (b)). Multiple missing
teeth can be treated by the use of partial dentures, with implants as part of the
treatment protocol at a later age. Implant placement is best left until skeletal maturity.
Dentures will need to be replaced as the jaws grow. Progressive provision of dentures
with annual replacements during the school holidays ('the long vacation'), mimicking
the developing dentition at the child's age, can do much to minimize the stigma of
these conditions. Although, ultimately, dentures can be retained by implants, the lack
of development of the alveolar bone may prove to be a limiting factor.
787H
Fig. 13.4 Hypohidrotic ectodermal dysplasia; erupted permanent teeth masked by
'porthole' denture with canine retractors during eruption.
13.3 EXTRA TEETH
Extra teeth (supernumerary teeth) have been reported to occur in 0.2-0.8% of
Caucasians in the primary dentition and 1.5-3% in the permanent dentition in the
same populations. There is a male to female ratio of approximately 2 : 1. Patients with
supernumerary primary teeth have a 30-50% chance of these being followed by
supernumerary permanent teeth. Teeth which resemble those of the normal series are
referred to as supplemental teeth (788HFig. 13.5) while those of less typical, often reduced,
form-sometimes further described as tuberculate or conical-can be termed accessory
supernumerary teeth.
Supernumerary teeth are most often located in the anterior maxilla in the midline, or
immediately adjacent to the midline, and are then referred to as a mesiodens.
Supernumerary teeth in the molar regions adjacent or distal to the normal sequence of
teeth are referred to as paramolars or distomolars respectively.
In some cases the supernumerary teeth may be an odontome.
Supernumerary teeth are more common in the maxilla than the mandible, with a ratio
of about 5 : 1. Apart from those in the midline, they may be present bilaterally and