Most children grow 20 baby teeth and, eventually, 32 permanent ones. Some grow one more.
An extra tooth that appears between the two upper front teeth is called a mesiodens. It’s one of the most common dental abnormalities in children—and if left alone—it can crowd, block, or push permanent teeth out of position.
A new report in the Journal of Oral and Maxillofacial Surgery (JOMS) suggests that for many children, having it removed around ages 6 to 7 is the best way to protect normal dental development.
The study, published in the February 2026 issue of the peer-reviewed official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS), examined existing research on when removal tends to produce the best outcomes. Author Makoto Adachi, DDS, PhD, found that acting early—before permanent front teeth are fully formed—can prevent problems that become significantly harder to correct later.
“Current evidence supports early surgical intervention around 6 to 7 years of age,” Dr. Adachi writes, especially when imaging shows the extra tooth is likely to interfere with nearby permanent teeth.
Why timing matters
A mesiodens doesn’t always cause immediate, visible problems, which is why determining when to remove it can be tricky. The extra tooth can disrupt permanent teeth from forming around it, and by the time the damage is obvious, a child may need more extensive treatment to correct it.
Removing the tooth earlier, when the roots of nearby permanent teeth are still developing, gives those teeth a better chance to grow in normally. In some cases, the review notes that waiting and monitoring is still the right call. But the decision should be based on the tooth’s position, its orientation, and how close it sits to developing permanent teeth—not age alone.
What parents can ask their dental specialist
If a child has been diagnosed with a mesiodens, these questions can help guide the conversation:
- Where exactly is the extra tooth? The location of the extra tooth relative to developing permanent incisors matters. A specialist may recommend 3D imaging, such as cone-beam computed tomography (CBCT), for a clearer picture.
- Is it already causing a problem? Ask whether any nearby permanent teeth show signs of being blocked, shifted, or affected in their root development.
- Is it better to remove it now or wait? There is no single answer for every child. Families should weigh the benefits of early removal against the risks of surgery.
Read the full article, “Mesiodens Removal: Resolving the Early Versus Late Intervention Dilemma,” at JOMS.org/article/S0278-2391(25)00801-8/fulltext.
About JOMS
The Journal of Oral and Maxillofacial Surgery is published by AAOMS to present to the dental and medical communities comprehensive coverage of new techniques, important developments, and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia, and analgesia. The journal also includes specifics on new instruments, diagnostic equipment, and modern therapeutic drugs and devices.
About AAOMS
The American Association of Oral and Maxillofacial Surgeons (AAOMS) represents more than 9,000 oral and maxillofacial surgeons in the United States and supports the specialty through education, advocacy, and public awareness.