Charting supernumerary teeth may come with one challenge or the other. It could be the unpredictable nature and diverse forms of extra teeth; inconsistent communication and record-keeping due to variability in notation systems; miscommunication, especially in cases where supernumerary teeth are small, impacted, or irregularly shaped; confusion, as different dental professionals or offices may use varying notation systems. We have identified these problems and provided simplified practical solutions to ensure accuracy and enhance your dental practice.
Supernumerary teeth chart
An average adult’s permanent teeth are numbered 1-32, with eight incisors, four canines, eight premolars, and 12 molars. Supernumerary teeth are additional teeth beyond the normal dental formula. This is also known as hypodontia—a condition of having supernumerary teeth in the permanent dentition. They are much less likely to be found in primary dentition because they develop late and usually erupt with the primary teeth.
Hyperdontia is commonly seen and associated with certain congenital genetic disorders, such as cleidocranial dysplasia, Gardner’s syndrome, trichorhinophalangeal syndrome, Ehlers-Danlos syndrome, Ellis-Van Creveld syndrome, Anderson-Fabry disease, and cleft lip and palate.
The prevalence of these conditions varies widely across populations, studies, and methodologies. In the context of gender, studies suggest a higher prevalence of supernumerary teeth in males compared to females, with an occurrence of 0.3–0.8 % in the primary dentition and 0.1–3.8% in the permanent dentition.
A study of school-aged kids provides a prevalence report of 1–3% in permanent dentition and 0.3–0.6% in primary detention among children between the ages of 6 and 15 years.
This study from the International Journal of Oral Science says it could vary from region to region between 0.2% and 5.3% and also occurs sporadically or be inherited, with evidence suggesting an individual may have a higher likelihood of having a family history of supernumerary teeth or other dental anomalies.
What are the 4 types of supernumerary teeth, where are they found and what characteristics do they have?
Supernumerary teeth are classified according to morphology and location. In the primary dentition, morphology is usually normal or conical, while the permanent dentition has different morphological types, which are:
Conical
The conical supernumerary is peg-shaped and the most common in permanent dentition. It is usually present between the maxillary central incisors as mesiodens and occasionally found high and inverted into the palate, horizontal position. The conical supernumerary rarely delays eruption and can result in rotation or displacement of the permanent incisor.
Tuberculate
The tuberculate type of supernumeraries is barrel-shaped (and may be invaginated), larger than the conical type, and are mostly located on the central incisors’ palatal aspect. They rarely erupt into the oral cavity and are frequently associated with delayed eruption of the incisors.
Supplemental
The supplemental supernumerary is shaped like a typical tooth and is found at the end of a tooth series. They are found in addition to the normal set of teeth and look exactly like the permanent teeth (the shape and the anatomical features are the same). There may be variations in size, shape, and structure, and may or may not be fully developed. The most common type is the maxillary lateral incisor, but supplemental premolars and molars also occur. Most supernumeraries found in the primary dentition are of the supplemental type and seldom remain impacted.
Odontoma
The odontoma (also odontome) is a harmless, noncancerous tumor composed of various dental tissues. The two separate types of odontomas are:
- The complex composite odontoma. They are the diffused and disorganized dental tissue masses. They occur in various locations within the jaws and are typically considered developmental anomalies rather than true supernumerary teeth.
- The compound composite odontoma consists of multiple miniature tooth-like structures, such as enamel, dentin, pulp, and cementum, arranged in an organized pattern and are often found in the anterior maxilla.
Charting supernumerary primary teeth
The primary dentition consists of 20 total teeth. Usually, dentists divide the whole dentition into four quadrants or sections: two on the maxillary sections (upper right and upper left sections) named first and second quadrants, respectively. The mandibular has the third and fourth quadrants. Each quadrant contains 5 teeth.
In the Universal/National Tooth Designation System, letters A to T denote the primary teeth, starting with the upper right second molar (A) and proceeding around the arch. In essence, naming starts with the letter A, beginning from the upper right all the way across to the upper left, T. Coming down to the lower left and the lower right, naming also follows a similar pattern, starting from the letter K to T. However, naming is in reverse alphabetical order around K, designated to the lower second left molar.
To identify supernumerary teeth in the primary dentition, the letter S is placed adjacent to the letter identifying the primary tooth. For example, supernumerary AS is adjacent to A; supernumerary TS is adjacent to T. This pattern is consistent with other denoted teeth.
Charting supernumerary permanent teeth
In the Universal/National Tooth Designation System for permanent dentition, numbers are also assigned sequentially. Each tooth is sequentially numbered from 1 to 32: 1-16 from the upper right third molar tooth to the left third molar tooth. The lower left third molar is numbered 17 and continues sequentially to the lower right molar tooth, numbered 32.
Supernumerary teeth in the permanent teeth are identified by the numbers 51 through 82, starting from the upper right third molar, following around the upper arch, and continuing on the lower arch to the area of the lower right third molar. For example, supernumerary 51 is adjacent to the upper right molar 1; supernumerary 82 is adjacent to the lower right third molar 32; supernumerary 61 is between the upper left second molar and first molar; supernumerary 31 is distal to the lower right first molar.
How to code supernumerary teeth on a dental insurance claim
The American Dental Association (ADA) uses a standardized coding system, the Current Dental Terminology (CDT) code.
It’s one thing to know how to chart the supernumerary teeth numbers, and it’s another to code the supernumerary teeth. It is also worth noting that there are no separate CDT codes specifically for supernumerary teeth. For example, when coding a supernumerary tooth extraction, you may use the following CDT codes: D7140 and D7210. All you need to do is first identify the supernumerary tooth number, then use the appropriate CDT code for the type of extraction.
Keep in mind the need to have very clear and specific clinical notes with supporting evidence when submitting a dental claim for supernumerary teeth, regardless of the CDT code. Other examples of CDT codes are D0120 for periodic oral evaluation, D1110 for prophylaxis (cleaning), D2140 for amalgam, etc.
