In pediatric dentistry, we come across numerous anomalies in the size, shape, number and eruption of teeth. Some anomalies which are erupted in the oral cavity may be detected through routine checkup. But on the other hand, some may remain impacted within the bone, without causing any signs and symptoms. The detection of such anomalies will come into picture only while diagnosing some other problems. Here is such a case describing the presence of inverted, palatal placed, impacted asymptomatic mesiodens without patient awareness, which was detected on radiographic examination for some other problem.
The most commonly occurring supernumerary tooth is the mesiodens. This term is used to refer to an unerupted supernumerary tooth in the central region of the premaxilla between the two central incisors.1 The cause may be due to complex interaction of genetic and environmental factors.2 In Caucasian population the incidence of mesiodens is 0.3 to 0.8% for deciduous teeth and 0.15 to 3% for permanent teeth. It is most frequently found in males than females in the proportion of 2:1.1,3
Mesiodens may be impacted or erupted. It may remain in position for many years, without clinical manifestations. Sometimes complications can be seen associated with them such as impaction, delayed eruption, ectopic eruption, crowding, diastema, and eruption into the nasal floor, formation of primordial or follicular cyst with bone destruction, pain and swelling at the site and resorption of the adjacent root. Thus, early detection and removal of mesiodens is very important to prevent such complications.