A MOUTH FULL OF TEETH: A CASE REPORT

Abstract

<h3>Background</h3> An increase in the number of teeth is termed <i>supernumerary teeth</i>.¹^,² These teeth can be present both unilaterally or bilaterally, in one jaw, or in both jaws.² In the maxilla, the anterior region is the most common location, and a solitary tooth in the midline is referred to as <i>mesiodens</i>. However, supernumerary teeth are more often seen in the mandible, especially in the premolar region, and are referred to as <i>peridens</i>.¹^,² Supernumerary teeth distal to the molars are referred to as <i>distodens</i>.² This type of dental anomaly is commonly associated with developmental disorders, such as Gardner syndrome and cleidocranial dysplasia.²^,³ The excess number of teeth affects both the primary and permanent dentitions. It more commonly affects the permanent dentition and usually interferes with the eruption pattern, leading to malposition, crowding, ectopic eruption, and malocclusion.¹^,² <h3>Clinical and Radiographic Presentation</h3> A 9-year-old female with multiple impacted supernumerary teeth was referred by an orthodontist requesting a cone beam computed tomography (CBCT) scan for evaluation of impacted teeth. According to the clinic notes from the orthodontist, the patient was not complaining of any pain and had not been previously diagnosed with any medical disorder. There was no concerning medical history reported for the patient. The family history revealed that the patient's mother was deaf. The CBCT scan revealed multiple impacted permanent and supernumerary teeth in the jaws. On the basis of the radiologist's recommendation, the patient was referred to the University of Iowa Hospital and Clinic for genetic tests to rule out a possible underlying disorder. <h3>Differential Diagnosis</h3> Cleidocranial dysplasia, Gardner syndrome, Apert syndrome, and Crouzon syndrome were considered. <h3>Diagnosis and Management</h3> The CBCT scan revealed 19 impacted supernumerary teeth, apart from the impacted permanent teeth. The scan also showed a dentigerous cyst around the unerupted permanent mandibular right first molar. The image revealed multiple open sutures. A chest radiograph revealed marked variations in the clavicles bilaterally. On genetic testing, in addition to the findings from the scan, led to the diagnosis of cleidocranial dysplasia. The patient is currently scheduled for systematic removal of the supernumerary teeth as part of the comprehensive treatment plan. <h3>Discussion</h3> This case demonstrates the crucial role and importance of interpretation of CBCT volumes by a radiologist and the immense benefit of interdisciplinary care provided to a patient. CBCT is an excellent imaging tool to evaluate the location of teeth and aids in the treatment plan by revealing incidental findings that could be life changing for a patient and by enabling better patient care and outcomes.