Dens in dente, also known as dens invaginatus, is a rare dental anomaly. This anomaly occurs when the enamel (the outer, visible layer of the tooth) folds into the dentin (the hard tissue beneath the enamel) during tooth development. This results in what looks like a tooth within a tooth. In fact, that image is what gives the condition its name. Dens in dente translates to "tooth within a tooth."
Prevalence and Causes
Dens in dente is rare, and its prevalence ranges between 0.3 percent and 10 percent of people, explains the dentistry textbook Diseases and Conditions in Dentistry: An Evidence-Based Reference. The maxillary lateral incisors (the pair of teeth on either side of the two front teeth) are most commonly affected by dens in dente. The maxillary central incisors (the two front teeth) are the next most commonly affected. A report published in the Journal of Conservative Dentistry states that men are three times more likely to have the condition than women.
Researchers still aren't sure what causes this anomaly. Many theories have been proposed, including infection, pressure on the enamel and trauma during tooth development, according to a report published in the Journal of Oral Research and Review. While you may not be able to prevent this condition from forming, you can consult your dentist for a diagnosis and treatment.
Teeth affected by dens in dente may be malformed and peg-shaped, notes the Journal of Conservative Dentistry report. You may see what looks like a small tooth branching off a bigger tooth, though it may be difficult for a dentist to arrive at a definite conclusion during a regular oral exam. X-rays are most commonly the method of diagnosis for dens in dente because the affected tooth may be asymptomatic. Cone beam computerized tomography is a less common technology that may be used to diagnose dens in dente, as in a case report published by the Journal of Conservative Dentistry.
Dens in dente may cause dental complications, so diagnosing and treating the condition is very important. The space between the original tooth and the growth is especially vulnerable to cavities. Cavities can easily spread and expose the tooth's pulp to bacteria, according to Diseases and Conditions in Dentistry. If the pulp becomes infected, saving the tooth may require a root canal.
The case report in the Journal of Conservative Dentistry details one case where a patient with a tooth within a tooth experienced pain in her tooth, as well as in her sinuses. The patient developed a periapical lesion, which, if left untreated, would leave the sensitive tooth pulp vulnerable to a dental infection and treatment for a root canal.
Treatment for dens in dente depends on how far the crevice extends into the interior of the tooth. In minor cases, sealing the crevice with composite resin or sealant may be all that's required, explains the case report in the Journal of Conservative Dentistry. The sealant acts as a barrier to keep plaque from settling into the crevice and helps prevent cavities from developing.
In more serious cases where the pulp has been affected, a dentist may recommend root canal treatment. During this treatment, a dentist removes the damaged pulp from inside the tooth. The inner chambers of the tooth are then cleaned, dried and filled with a rubber-like material. During this procedure, the crevice in the tooth can be sealed.
If the shape of the affected tooth is irregular, the dentist may recommend a restoration such as a crown. A crown is a cap that is placed on top of a damaged or misshapen tooth.
Dental anomalies, such as dens in dente, can be concerning, but they are rare. If you're worried about a dental anomaly, make an appointment with your dentist. Regular dental visits can help you monitor your oral health concerns and your dentist can take action before a larger issue develops.