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Double teeth can cause other dental problems such as Malocclusion, Ectopic tooth of adjacent teeth, gum issues, Tooth decay, malocclusion, poor esthetics, and more. Treatment depends on whether the tooth is a Deciduous teeth or Permanent teeth tooth, the degree of fusion, and its functional & esthetic impact.
Double teeth are usually larger than normal teeth, may have an incisal notch present on the crown of the tooth, and may have a groove/fold in the Tooth enamel on the labial surface that can extend further down the Tooth root. In fused teeth, this groove may not symmetrically divide the tooth in half if one of the fused teeth is abnormally shaped or an Hyperdontia.
Mader’s “two-tooth” rule can help distinguish between tooth fusion and gemination. If the double tooth is counted as two teeth and the number of teeth in the mouth is normal, then the double tooth is likely a fused tooth. However, in some rare cases a tooth is fused to an extra tooth in which case counting the double tooth as two teeth will result in an increased number of teeth in the mouth.
The exact cause of tooth fusion is unknown, but is the result of alterations in embryonic tooth development. Environmental (e.g. trauma, thalidomide exposure, hypervitaminosis A of the mother, viral infections), systemic, and genetic factors can cause formation of double teeth. While the specific pathophysiology of double teeth is difficult to determine, many purport it is due to force that brings tooth germs close together during development with necrosis of the tissue separating them allowing for the enamel organ and dental papilla to unite. The extent of fusion depends on when during tooth development this union occurs.
If the double tooth will have little impact functionally or esthetically, then it can be monitored with an emphasis on oral hygiene and prevention (e.g. topical fluoride).
The groove present on the enamel of double teeth can increase risk of complications and depending on how far the groove extends down the root even gum issues. Thus, if possible this groove can be Dental sealant to decrease risk.
As double teeth are large and tend to be in the visible anterior teeth, one may consider altering their shape to improve esthetics. The tooth can be selectively grinded to achieve a more esthetic shape. A dental crown may even be placed to achieve this. If the two teeth have separate root systems, then they can be cut in half, however, root canal treatment may be needed. Alternatively, instead of cutting the tooth in half and leaving both teeth, one of the double teeth can be removed after splitting the tooth structure. This too may require root canal treatment and/or reshaping of the tooth that is not removed. In the previous scenarios, if the double tooth is separated without doing root canal treatment, then root canal treatment may be needed in the future as connections may exist between the root systems of double teeth even if they appear separate on an x-ray. Finally, the double tooth could be removed and the space replaced by autotransplantation of another tooth or closing the space using Dental braces.
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