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| CASE REPORT |
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| Year : 2016 | Volume
: 7
| Issue : 3 | Page : 187-189 |
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Primary double teeth in siblings: A report
Santanu Mukhopadhyay1, Chiranjit Ghosh2, Pinaki Roy3, Mrinal Chakraborty4
1 Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
2 Department of Pedodontics and Preventive Dentistry, Haldia Institute of Dental Sciences, Haldia, West Bengal, India
3 Department of Orthodontics, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
4 Department of Dentistry, Calcutta Medical College and Hospital, Kolkata, West Bengal, India
| Date of Web Publication | 22-Aug-2016 |
Correspondence Address:
Santanu Mukhopadhyay
Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0976-433X.188807
Double teeth are developmental malformations affecting both primary and permanent dentition. This article describes primary double teeth in both the siblings of a family. A 5-year-old boy had a bilateral distribution of anomaly involving lower lateral incisor and canine. Radiographic analysis revealed that his right mandibular permanent lateral incisor was missing. His sister, a 3½-year-old girl, also had double teeth affecting mandibular left lateral incisor and canine. She displayed no other dental anomaly. The boy presented shovel-shaped maxillary permanent central incisors. Family involvement of double teeth is very rare. Double teeth in siblings and simultaneous occurrence of multiple dental anomalies probably show a hereditary etiology. Keywords: Dental anomaly, double teeth, fusion, gemination, primary dentition, siblings
How to cite this article:
Mukhopadhyay S, Ghosh C, Roy P, Chakraborty M. Primary double teeth in siblings: A report. SRM J Res Dent Sci 2016;7:187-9 |
| Introduction | |  |
Double teeth are relatively uncommon developmental anomaly, arise from joining of adjacent tooth buds, or from an attempt by a single tooth bud to divide, resulting in a bifid crown. The former is known as fusion, whereas the latter is termed gemination.[1] Both germination and fusion appear clinically similar although some investigators have attempted to distinguish the two conditions by counting the number of teeth present in the dental arch.[1],[2],[3] Gemination shows a normal number of teeth in the dentition, whereas in fusion, there will be one less tooth in the dental arch, considering the anomalous teeth as one. Double teeth are united by dentin; pulp chambers and root canals may be joined or separated depending on the developmental stage when the odontogenesis occurs.[1],[2],[3] However, the differential diagnosis between germination and fusion of a normal and a supernumerary tooth is often difficult.
This anomaly occurs more commonly in the primary dentition than in permanent dentition. Prevalence of primary double teeth is 0.5%, with no recognized gender predilection.[1] The exact etiology of the anomaly is not known. Both genetic and environmental influences are responsible for its development.[1],[2],[3],[4],[5],[6]
Bilateral double teeth are rare with a prevalence of <0.02%.[1] Till date, very few cases of bilateral double teeth involving primary mandibular lateral incisor and canine has been reported in the literature.[1],[2],[3] Very rarely, the anomaly has been reported in siblings of a family.[4],[5],[6] The objective of this article is to report the occurrence of double teeth affecting mandibular lateral incisors and canines among the two siblings of a family. The boy had a bilateral distribution of the anomaly in association with a hypodontia in the permanent dentition and shovel-shaped maxillary permanent incisors. His sister exhibited a unilateral distribution of the anomaly in the lower arch.
| Case Reports | | |
Case 1
A 5-year-old boy presented with multiple carious teeth. He was the elder of the two siblings and appeared healthy. The clinical examination showed a bilateral presence of double teeth involving the mandibular lateral incisors and the canines [Figure 1]. An incisal notch was seen on both the double teeth. Radiographic analysis revealed a common pulp chamber and a single root in both the double teeth [Figure 2] and [Figure 3]. Pulp therapy was performed on teeth #74, #75, and #85. | Figure 1: Intraoral photograph of the boy showing bilateral primary double teeth
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 | Figure 2: Periapical radiograph indicating two double teeth with single pulp chamber and root canal
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 | Figure 3: Periapical radiograph taken 2½ years later indicating the boy had missing tooth bud #42
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After 2½ years from the initial visit, the parents brought their son for checkup. Intraoral examination of the boy showed two shovel-shaped maxillary permanent central incisors. Teeth #31 and #41 had erupted. His radiographic examination exhibited permanent teeth in their varying stages of development. Tooth bud of #42 had been found missing.
Case 2
A 3½-year-old girl, younger sister of the boy, was brought to our clinic for a dental checkup. The intraoral examination demonstrated the presence of double teeth involving teeth # 72 and #73 [Figure 4]. Periapical radiograph showed two crowns, two distinct but joined roots, and root canals [Figure 5]. Tooth #85 was found carious. The carious tooth was restored with silver amalgam. No other member of the family was affected by similar dental anomalies. The condition was explained to the parents. Both the children were kept under observation. | Figure 4: Intraoral photograph of a girl showing double teeth in place of teeth #72 and #73
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 | Figure 5: Intraoral photograph of a girl showing double teeth in place of teeth #72 and #73
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| Discussion | | |
Double teeth are commonly occurred anomaly in the primary dentition, typically involving the mandibular anterior region. Bilateral distribution of double teeth is rare.[1] Till date, very few cases of bilateral double teeth were reported in the literature.[1],[2],[3] In this report, the boy had a bilateral presence of double teeth in the mandibular anterior region. His younger sister also had double teeth localized in the mandibular lateral incisor-canine region.
Fusion is often confused with germination. Comparison of these two anomalies, according to some authors, is of greater academic interest than practical importance because clinical complications and treatment objectives of both are same.[7] Complications associated with double teeth are unsightly appearance, plaque accumulation in the developmental grooves, crowding, delayed resorption of the anomalous teeth, ectopic eruption, and impaction of succedaneous teeth.[2] Another significant problem related to the primary double teeth is hypodontia of its permanent successors.[2],[6],[8] Hagman reported that fused primary teeth showed missing succedaneous permanent teeth in 75% of cases.[6] In our report, radiographic analysis of the boy indicated the tooth bud of mandibular permanent lateral incisor was missing.
Reports showing double teeth with familial characteristics are very few. Moody et al. described three families each with multiple cases of fused primary lower incisors.[4] Passarge et al. observed fusion of mandibular incisors in a father and his son.[5] Hagman reported fused teeth in two of the five siblings involving contralateral mandibular primary lateral incisors and canines.[6] One of them also had an underlying permanent lateral incisor missing.
Racial variation, bilateral distribution, and family involvement of double teeth suggest that genetic factors play an important role in its development. In the present case, both the siblings had double teeth in the mandibular anterior region.
Several different approaches for the management of double teeth are available. A valid option in the primary dentition is to leave the double teeth as they are. Since there was uniform root resorption without interfering the path of eruption of a permanent successor, treatment in this case was limited to periodic observation of the anomalous teeth.
Double teeth in the primary dentition are associated with anomalies in the permanent dentition. When one member of the family exhibited this anomaly, other members should also be examined. Recognizing the condition early will allow pedodontist to formulate a treatment plan at an appropriate time.
| Conclusion | | |
Racial predilection, involvement of specific teeth and its occurrence in siblings suggests that heredity might be an etiologic factor of double teeth. This paper highlights the importance of screening of other family members when a patient exhibited double teeth. Moreover, radiographic examination of the anomalous teeth is also necessary since primary double teeth are often associated with anomalies in the permanent dentition.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: W.B. Saunders; 2002. pp. 74-6.  |
| 2. | Prabhu RV, Chatra L, Shenai P, Prabhu V. Bilateral fusion in primary mandibular teeth. Indian J Dent Res 2013;24:277. [ PUBMED]  |
| 3. | Milano M, Seybold SV, McCandless G, Cammarata R. Bilateral fusion of the mandibular primary incisors: Report of case. ASDC J Dent Child 1999;66:280-2, 229. |
| 4. | Moody E, Montgomery LB. Hereditary tendencies in tooth formation. J Am Dent Assoc 1934;21:1774-6. |
| 5. | Passarge E, Bosman H. Fusion of lateral incisors as autosomal dominant trait. Birth Defects Orig Artic Ser 1971;7:194-5. |
| 6. | Hagman FT. Fused primary teeth: A documented familial report of case. ASDC J Dent Child 1985;52:459-60. |
| 7. | White SC, Pharoah MJ. Oral Radiology Principles and Interpretation. 6 th ed. St Louis: Mosby; 2009. p. 301. |
| 8. | Mukhopadhyay S, Mitra S. Anomalies in primary dentition: Their distribution and correlation with permanent dentition. J Nat Sci Biol Med 2014;5:139-43. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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