Have you ever noticed strange bumps or points on your child’s teeth? Tooth abnormalities are pretty common since the human mouth can grow in all sorts of peculiar ways. A very strange situation can be seen when there are extra points or bumps on your child’s tooth. Some have special names like talon’s cusp, mamelons, and cusp of carabelli. Others may just be grouped into the generic term ‘supernumerary cusp.” You may be glad to know that whatever type they are, much of the time extra points are just fine and don’t need to be treated.
Common Tooth Anatomy
Before you go look at your child’s teeth (or your teeth) to see if they have extra points, let’s talk about what is normal, that most people will have. You can check out the diagram below to see the common number of cusps on each tooth.
The 8 incisors at the front of the mouth (4 on top and 4 on the bottom) each have a ridge instead of cusps. Their job is to cut food, and the sharp ridge helps do this best. The other teeth have grooves and cusps (that protrude from the tooth’s surface), which are useful for grinding and crushing food.
Canine teeth (the pointiest teeth directly behind the incisors) each have 1 cusp. Premolars (behind the canine teeth) each have 2 cusps and molars have 4 or 5 cusps.
Mamelons are something almost every single child will have as their permanent incisors grow in. They are the bumps that stick up from the ridge of the incisor and make the edge look serrated. Most incisors erupt with 3 of these bumps. They help the tooth erupt through the gum and usually wear away in a few months to a few years. They may last much longer if the bite does not rub the mamelons against another tooth due to alignment problems such as crossbite, underbite, open bite, or overjet. Mamelons are perfectly normal and should not need treatment. Some people may choose to have the mamelons reshaped if they do not wear down naturally, but it is important to be sure there is enough enamel to protect the tooth.
Cusp of carabelli (also called a tubercule of carabelli) is an extra cusp on the side of upper molars. Usually, it is smaller than the other cusps on a molar and is often made up only of enamel but may have some dentin. Cusp of carabelli is a genetic trait that, interestingly, is caused by more than one gene.
Buccal Cusp or Uto-Aztecan' upper premolar is a rare genetic trait that is common in Arizona, as it is often found in Native Americans from Arizona. This trait results in a bulge in the upper premolar, on the side facing the cheek.
Dens Evaginatus (DE) is another genetic trait that is seen in a small percentage of people of Asian or Eskimo descent. DE occurs on the chewing surface of premolars and molars and looks like an extra bump or cusp. They contain pulp and are easily worn away or damaged, which can be painful and will require treatment. Since DE is essentially a raised portion of the chewing surface, it also can lead to complications such as malocclusion, TMJ pain, and tooth decay.
Talon’s cusp is another rare genetic trait. This is seen when a cusp forms on the back of an incisor or, very rarely, a canine. These are most common on top teeth. A lot of the time, when you look at the chewing surface the tooth will look like a “T”. It can also look like a curved talon (eagle claw) growing on the back of the tooth. A talon’s cusp is made up of enamel, dentin, and sometimes will contain pulp.
Enamel pearls form when enamel cells travel to the root and produce little spots of enamel that look like pearls. Usually, you won’t see these unless they grow right at the gumline. Enamel pearls usually will need to be treated, as they can harm the health of the tooth and collect bacteria that will cause cavities.
Other abnormal tooth cusps may form in the middle of the chewing surface of a molar. Some even resemble a flower and were named the “marigold central cusp formation!”
As you can see, most of these are normal characteristics are caused by the genetic traits passed down from your ancestors. Other times, trauma to the tooth bud or a viral attack while the tooth is forming can also play a role in abnormal tooth formation.
These differences in teeth make each person unique. Anthropologists use them to determine the ancestry of skeletons, what people ate, and even social behaviors.
A forensic dentist (someone who identifies human remains) can tell how old a person was, if they were male or female, and their ancestral background. They can also tell what they ate, if they smoked, if they were stressed out a lot, and even if they had certain physical or mental health conditions! Since every person’s dental record is unique, they can match the teeth of the person to their dental record to identify the person.
We use these differences, too. Differences in teeth can let us know to look out for other, hidden anomalies. Sometimes, if baby teeth have some of these variations, we know to look out for them as the permanent teeth erupt.
When To Get Treatment.
Anytime you notice something unusual in your mouth or your child’s mouth, it is a good idea to get it evaluated. Often, we can simply take a wait and see approach.
Sometimes, these things will cause problems, so we will treat them. They may cause irritation of the tongue, cheeks, or gums (which could cause cuts and canker sores) or malocclusions (or prevent braces from correcting a malocclusion). If part of your tooth is ever bothersome, please make an appointment to get it looked at.
Some of these cusps, especially talon’s cusps, may chip or break. If that happens, we will definitely treat it.
Finally, they can provide a perfect hiding place for bacteria and food particles. This increases the chance of developing cavities and gum disease.
How Extra Cusps Are Treated
Most will be just fine left alone. If it becomes necessary to treat, the tooth will be evaluated, based on the symptoms it is causing, location in the mouth, and location of the cusp or protrusion on the tooth, then treated accordingly.
If the extra cusp or ridge is just made of enamel, we can simply smooth it down. Sometimes, it may need to be covered by a small filling after being smoothed down. Some in the center of the tooth can be covered by a sealant. (The same type we put on children’s permanent molars to protect them from cavities.
When the cusp contains dentin or pulp, it may need to be treated with a filling or a crown to protect the nerve. In rare cases, a root canal could be necessary.
If you are getting orthodontic treatment, we evaluate extra points and cusps on teeth in relation to the overall health of your bite. Sometimes, a cusp that would have been left alone may receive treatment to gain an optimal bite and allow for the healthiest treatment outcome.
Interesting tooth development is nothing unusual and a large percentage of people have some kind of tooth abnormality. Whether your child’s teeth look just like a dental diagram, or have some interesting features, it is always a good idea to get regular checkups to be sure that their ever-changing mouth is developing in the healthiest way possible. We love when children call us their dental home and are grateful to have the privilege of evaluating and monitoring a child’s teeth as they grow. Whether your family has been visiting us for years, or you are visiting us for the first time, we can’t wait to see your smile!
At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.