We’ve discussed complicated names for simple tooth conditions before, but this one is interpreted as an extra bump on the tooth! Here, we will examine the term and its meaning.
Dens evaginatus (DE) is a dental anomaly seen on the chewing surface of the premolars and molars. It looks like an extra bump or cusp on the grinding surface of your tooth.
In the normal anatomy of the mouth, canine teeth have one cusp, the premolars (bicuspids) have two cusps, and the molars have four to five cusps. When you have an extra cusp or bump on any of these teeth, it is called dens evaginatus. These extra cusps are usually raised higher than the others and may be worn away with grinding and chewing.
This trait can be genetic and is more common in Asian, Native American, and Eskimo populations. It supports the Alaskan land bridge migration theory of migration east from Asia.
Possible Land Bridge Migration route with locations of the Clovis and Folsom Paleo-Indian sites.
By User:Roblespepe - File:Poblamiento_de_America_-_Teoría_P_Tardío.png, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=32583959
Another explanation is that pressure has been exerted on the child’s tooth, either from trauma or other incident, and the tooth bud has been damaged. It may also be caused by abnormal development of cells that form enamel while a tooth is developing.
Dens evagintus can be seen in primary and adult teeth but is more common in adult teeth. This condition often goes unnoticed unless pain or abscess formation occurs from infection or decay.
The teeth most often affected are the mandibular permanent premolars. It occurs five times more often in the mandible (lower jaw) than in the maxilla (upper jaw), and females have a higher incidence than males.
Dens evaginatus is associated with various dental and developmental abnormalities, including dens invaginatus (dens in dente), or a “tooth within a tooth.” Dens in dente occur when a tooth's enamel folds into the underlying dentin during tooth development.
No, not usually. We will often wait and watch a tooth with extra cusps. However, treatment may be necessary if the extra cusp of the affected tooth starts to wear down and cause complications or a cavity forms.
A sealant may be added to the surface of the tooth as a prophylactic treatment to help protect it from forming cavities or wearing down to the pulp chamber.
Small areas where a cusp is raised long enough to grind against the opposing tooth can cause enamel to wear down, exposing the dentin or pulp, which can become painful. If the pulp chamber is exposed, the nerve can be exposed, which is usually very painful and will also become decayed and infected if not treated. Grinding against the extra cusp may also lead to dental caries or a fractured tooth, and even TMJ problems.
If complications occur, we will discuss the appropriate treatment based on the child’s unique needs.
As mentioned above, treatment for this condition may not be necessary, but we will monitor any changes at each visit. Children should receive a dental exam and cleaning every six months, with X-rays to be taken every year.
A sealant can cover some cusps that are in the center of the tooth. (The same type we put on children’s permanent molars to protect them from cavities).
If the extra cusp or ridge is made of enamel and causing abnormal wear to the opposing tooth, we can simply smooth it down. Sometimes, it may need to be covered by a small filling after being smoothed down. We may also recommend a filling if the tooth shows excessive wear on the extra cusp or fractured enamel.
Pulp capping may be done if the pulp has been thoroughly exposed. This involves removing the decay from the tooth, cleaning it, and applying a medicinal material to protect the pulp from bacteria build-up. Then, a permanent filling can be used.
Root canal treatment is necessary when the pulp becomes exposed due to decay or trauma and the pulp is infected. The pulp is removed from the tooth by drilling a hole and using specific tools to remove it. Then, the cavity and root anatomy are cleaned thoroughly and shaped. These canals are filled with filling material to seal the space and prevent further infection. A crown is placed to protect the entire tooth.
Dens evaginatus is when a tooth has an extra “bump” or cusp on the biting surface. The condition can be monitored if there are no signs of cavities or pain or the tooth is not worn down. We are here to help you and your child understand this condition, answer any questions you may have, and determine the best course of action. Please reach out and let us know if you ever have any questions or concerns about your child’s dental health. We look forward to seeing you at your next visit!
