Improving a smile that has a mesiodens (supernumerary tooth).

This digital smile makeover features case where the person has an extra upper tooth.

Supernumerary vs. Mesiodens.

Extra teeth in general are termed "supernumerary" teeth. When the extra tooth lies between a person's center teeth (the upper ones in this case, which is the most common situation) it's referred to as a "mesiodens."

Having a supernumerary tooth is relatively rare (less than 4% of the general population has one). Having a mesiodens is even rarer (less than 2% of people have them). And only about 25% of them erupt (come through the gums), which is the case we have here.

[This page gives more background information about having a medsiodens.]

Case issues and concerns:

The mesiodens.

The fact that this person's extra tooth has erupted creates an obvious cosmetic dilemma.

Even if the tooth hadn't come through the gums its still would have most likely kept the upper central incisors (the teeth on each side) from aligning properly. They probably would have had a sizable gap between them.

The lower teeth.

The bottom teeth have some alignment issues too. Also, the biting edges of some of them have chipped or worn.

  • A smile that has a mesiodens (extra center tooth).
    A smile that has a mesiodens (extra center tooth). A smile that has a mesiodens (extra center tooth).
  • After tooth extraction and orthodontic treatment.
    After tooth extraction and orthodontic treatment. After tooth extraction and orthodontic treatment.

Photo submitted by website visitor.

[How to view other cases.]

Treatment solutions:

The upper teeth.

When we look at a person, we expect to see a smile that is bilaterally symmetrical, meaning it's left and right sides are mirror images of each other.

With this case, creating that symmetry won't be possible unless the mesiodens (extra tooth) is extracted.

Here's the usual way this type of case would be treated:

  • Extract the extra tooth.
  • Perform orthodontic treatment (braces), so to bring all of the teeth together and improve their overall alignment.
The lower teeth.

Since the alignment of the lower teeth isn't ideal, it only makes sense that they should receive orthodontic treatment too. (In our picture, the mid lines of the upper and lower teeth don't match up. In real life that would be a major goal of the orthodontic treatment.)

The wear and chipping that's evident on the lower teeth could be resolved by placing tooth bonding (white fillings).

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Input from site visitors.


Hi. How are you? (pause) Well, goid, I hope, if not better.
I am not good at all...
I am not eating anymore bc its gotten to the point that when I bite into anything soft it hurts down to the nerve bc the enamal is worn off. I have no back teeth upper or lower, I only have my own lower teeth in front and my own upper front teeth have been drilled to nubs so a fake set of 4 teeth covers them, but thats been badly chipped.
Even a soft banana hurts severely to bite into.
I havent smiled in I dont know how long and I cant eat anything any more. I am at a loss and dont know what to do.
I have Medi-cal but, every dental place I hace gone to (at least 20 different places in the past 5 years) say they refuse to pull my teeth bc they say my 4 front lower teeth r perfectly fine, but they hurt me severely when I bite into anything even soft!
Actually, 1 dentist did say he would pull my teeth and give me dentures, but yet he also advised me not to bc he said that my jawbone is too small and fragile, like a childs.
I want to eat again, I want to smile again, but I cant unless I get some help.
PLEASE, PLEASE...please help me.


Biologically front teeth are intended for biting through and incising food, not chewing it. So your not having back teeth places these teeth under stress and exposed to wear much more so than nature intended. It seems likely that that alone is a big factor working against your case.


The way you describe things, we're under the impression that you have had dental crowns placed on your upper teeth.

The porcelain surface of crowns sometimes place opposing teeth at greater risk for wear. Possibly that is an added complication with your case.


Conceivably crowns might be placed over your lower teeth to protect them from thermal sensitivity (hot and cold sensitivity due to worn enamel).

In regard to the sensitivity, you don't specifically mention that it occurs in response to hot and cold. If what you are experiencing is different than previously investigated by dentists, possibly the nerve is degenerating in one or more teeth. Timely further evaluation would be needed to determine this.


Beyond those comments, as a webite there's essentially nothing we can contribute about your situation that would have more validity that the opinion of the 20 dentists who have actually examined your mouth. You'll simply need to return to one of them for further evaluation and care.

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