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Dystopian tooth

Medical expert of the article

Maxillofacial surgeon, dentist
, medical expert
Last reviewed: 12.07.2025

Among the numerous dental problems, there is another one – a dystopic tooth, that is, one that is located incorrectly (from the Greek dystopia – incorrect location or lack of space) or has erupted in the wrong place.

Epidemiology

As dental statistics show, almost a quarter of patients have teeth that are dystopic to varying degrees. And more than half of patients with dental anomalies have some type of dental dystopia.

As for the delay in the eruption (retention) of teeth, according to orthodontists, among children and adolescents, this anomaly is observed in 15-20% of cases, and up to half of them are retention of canines.

Sandham and Harvie [ 1 ] conducted a study of Scottish schoolchildren and found that 0.38% had dystopic teeth out of a sample of 800, which was confirmed by a study in India where the prevalence was 0.4%. Thilander and Jakobsson [ 2 ] reported a prevalence of 0.26% among Swedish schoolchildren. According to Peck and Peck [ 3 ] and Feichtinger et al. [ 4 ], dystopic teeth are equally common in both sexes.

Causes dystopian tooth

Most often, the causes of dental dystopia can be associated with:

  • non-compliance with age and physiological norms of the timing of teeth eruption and its sequence;
  • early or premature loss of temporary (baby) teeth;
  • intrauterine disorders of odontogenesis - anomalies in the development of teeth;
  • underdevelopment of the alveolar processes of the jaws, narrowing of the dental arches and other anomalies and deformations of the jaws, including those accompanying chromosomal syndromes;
  • incomplete number of teeth (oligodontia);
  • extra (supernumerary) teeth – hyperdontia;
  • pathology of the dental arches in the form of crowding of teeth, especially in the early period of mixed dentition - due to a deficiency of the jaw bone and its discrepancy with the size of permanent teeth, which are larger than milk teeth;
  • anomalies in the size and shape of teeth: an increase in the width of the crowns of the teeth (upper central incisors or premolars) – macrodontia or an increase in the roots of the teeth – taurodontism (taurodontia). [ 5 ]

For example, frequent dystopia of wisdom teeth is caused by both the late period of their eruption and the localization of these molars - they are the last in the dental row.

In addition, the result of a violation of tooth formation is considered to be retention (in Latin, retentio means retention) - a delay in the eruption of a tooth. If a tooth does not erupt, remaining in the bone of the alveolar part of the jaw or the mucous tissues of the gum, or has erupted partially, it is called impacted (in the second case - partially impacted). Most often, this happens with lower wisdom teeth, lower second premolars and upper canines. [ 6 ]

It is also possible to have a tooth that is both impacted and dystopic, that is, one that is growing incorrectly and is “stuck” in the jaw.

Risk factors

Experts name the following risk factors for the appearance of dystopic teeth:

  • presence of genetic predisposition; [ 7 ]
  • pregnancy pathologies;
  • early removal of baby teeth (resulting in delayed eruption of permanent teeth);
  • injuries to the jaw or its alveolar part;
  • high radiation levels;
  • rickets;
  • endocrine insufficiency associated with disturbances in the functioning of the hypothalamus (or pituitary gland);
  • hypothyroidism;
  • diabetes;
  • nasal breathing disorder.

Pathogenesis

Diphyodontism is common in humans, and when baby teeth (of which children have two dozen by the age of 2.5) are replaced by permanent teeth (of which adults should normally have 32), certain deviations may occur.

Thus, dystopia of canines, which are cut in children with mixed bite (after 9-10 years), is often a consequence of a lack of space for their correct positioning in the alveolar part of the gum or existing disorders of the dental row.

A dystopic wisdom tooth (third molar) erupts at the age when ossification of the skeleton is complete (up to 25 years); in addition, it appears in a place where there was no baby tooth before it, and this leads to difficulties during eruption.

The exact mechanism of tooth dystopia during odontogenesis is unknown, but researchers associate it with hereditary features of the formation of tooth rudiments during intrauterine development (from the fifth week of gestation), as well as teratogenic effects (ionizing, chemical) on the fetus - since the rudiments of not only baby teeth, but also permanent teeth such as the first molars, incisors and canines are formed. The formation of the rudiments of the remaining permanent teeth occurs in childhood, and the pathogenesis of dystopia can be due to a violation of intestinal calcium absorption in rickets; a possible deficiency of the pituitary growth hormone somatotropin (which ensures the maturation of tooth rudiments and their eruption); insufficient levels of thyroid hormones in its pathologies (thyroid-stimulating hormones in a certain way affect the secretion of somatotropin); excess glucose in the blood (hyperglycemia) in diabetes mellitus. [ 8 ]

Tooth retention is most often explained by the fact that the tooth germ is abnormally located, may be trapped between the approaching (or fused) roots of adjacent teeth that have already erupted, or is blocked by a gingival cyst or odontogenic tumor.

Symptoms dystopian tooth

Symptoms of dental dystopia depend on the type of their abnormal position:

  • with vestibular dystopia, the tooth erupts in front of the dental arch;
  • in oral - behind the dental row with displacement of the tooth into the oral cavity;
  • with mesial - the tooth grows in the dental row, but is tilted forward (outward);
  • with distal - the tooth is tilted backwards (inside the dental arch).

The localization of a dystopic tooth above the dental arch is a sign of its supraposition, and eruption below the dental arch is called infraposition. Also, a tooth can rotate around its axis during eruption, and in this case we are talking about tortopoposition. And when teeth "change places" (that is, a tooth erupts in the place of a neighboring tooth), the anomaly is defined as transposition. [ 9 ]

For a long time, a retained and displaced tooth does not manifest itself in any way, and is only detected during an X-ray. [ 10 ]

But a displaced wisdom tooth (especially often the lower one) can erupt with pain and limited opening of the mouth, hyperemia and swelling of the surrounding tissues, as well as the development of their inflammation - pericoronitis (pericoronaritis). [ 11 ]

Complications and consequences

Dystopia of teeth has serious consequences and complications in the form of:

  • malocclusion;
  • traumatic damage to the gums and mucous membranes of the oral cavity with the formation of tissue erosion and painful ulcers;
  • formation of gingival pockets;
  • increased formation of dental plaque;
  • enamel lesions caused by caries;
  • development of inflammation of the periosteum of the jaw (with the formation of submandibular phlegmon), the pulp of the tooth or the membrane of its root (with a possible abscess);
  • formation of root cysts. [ 12 ]

Diagnostics dystopian tooth

A routine examination of the teeth and oral cavity and recording of the patient's complaints, which is the beginning of any diagnosis in dentistry, is not enough to identify a dystopic tooth. [ 13 ]

The maximum information is provided only by visualizing instrumental diagnostics – orthopantomogram – panoramic radiograph of the maxillofacial region.

In cases of impacted dystopic teeth, computed tomography or MRI of the maxillofacial region is used.

Differential diagnosis

To determine only dystopia or only tooth retention, differential diagnostics are carried out.

Who to contact?

Treatment dystopian tooth

Is orthodontic treatment of dystopic teeth possible? This depends on both the localization of the incorrectly grown tooth and the type of its abnormal position, as well as the nature of the dental row disorder that has arisen.

This treatment is carried out with a permanent bite (i.e. after the change of all baby teeth), installing braces, special retention plates, splints and arches; using aligners and caps to align the teeth. More information in the material - Teeth alignment: main types. [ 14 ]

But surgical intervention – removal of a dystopic tooth – is sometimes necessary when correcting dental irregularities is extremely difficult, for example, due to a lack of space in the dental arch. [ 15 ]

If there is a high probability of subsequent disruption of the position of adjacent teeth and the presence of severe pain syndrome or inflammation that has taken a chronic form, the impacted dystopic tooth is removed (which may require this operation to be performed by a maxillofacial surgeon). [ 16 ]

In almost all cases, it is necessary to remove the impacted, dystopic wisdom tooth. Read about how to do this in the publication – Removing a Wisdom Tooth.

Prevention

There are currently no special measures to prevent the appearance of improperly erupted teeth or anomalies of the dental system. Regular visits to the dentist help to detect this pathology early.

Forecast

A dystopic tooth does not pose a threat to life, but it can cause curvature of the dental arch and occlusion disorders.


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