Author Name: Dr. Sandra Thompson
Concrescence of the teeth takes place where two different teeth are united by the cementum that covers the roots. Cementum is a thin hard tissue that serves as attachment of the root of each tooth to the supporting tissues. In case of concrescence the crowns of the teeth stay separated and the dentin, which is the firm tissue below the enamel, stays separate as well. That means that these teeth were separately formed but united later at the root level.
It must be noted that concrescence must be distinguished from fusion and gemination. The phenomenon of fusion is when two buds of teeth unite more completely and may involve the dentin and produce an abnormal form or size of the crown. The process of gemination is when there is division of one tooth bud resulting in wide or split crown.
This problem might occur in baby teeth as well as permanent teeth. It is a condition that occurs mostly in back teeth, especially in the upper molars where the roots of the teeth grow too close together. The roots of the teeth are not visible to the parents; hence, dental imaging is required to diagnose the problem. Even if there is no pain caused by the condition, monitoring should be done prior to the process such as braces or tooth extraction. Parents can also learn more about monitoring primary and permanent teeth development.
Developmental concrescence occurs while the roots of neighboring teeth are still forming. When two developing teeth are positioned unusually close together, the cementum covering their roots may eventually connect.
Possible contributing factors include:
These factors do not guarantee that concrescence will occur. In many cases, dentists cannot identify one definite cause.
Acquired concrescence develops after the tooth roots have already formed. It may occur when additional cementum is deposited between neighboring roots that are already positioned close together.
Factors that may contribute include:
These factors are possible associations rather than confirmed causes in every child. Dental imaging and a review of the child’s dental history may help the pediatric dentist understand how the condition developed.
The presence of tooth concrescence may not result in pain or any other symptoms such as discoloration or bleeding. Since the fusion occurs under the gum line at the roots, it is impossible for the parents to detect it through visual inspection of the child's mouth.
When signs or related problems occur, they may include:
Similar eruption concerns can have several causes, so parents may also find it useful to understand common tooth eruption issues in children.
A pediatric dentist may begin by examining the child’s teeth, gums, bite, spacing, and alignment. The dentist may also review the child’s dental history and compare the eruption of the teeth with the pattern expected for the child’s age. Evaluation of tooth development and eruption over time can help identify abnormalities requiring further investigation.
Dental imaging is commonly required because concrescence usually cannot be confirmed through visual examination alone. The diagnostic process may include:
Parents who want to understand why imaging may be recommended can review this parent’s guide to pediatric dental X-rays.
The concrescence of the tooth roots might not be easy to spot in a 2-D radiograph. The two roots may overlay each other in the radiograph and be mistakenly seen as being connected, whereas there might not necessarily be a connective tissue bridge between the roots. Three-dimensional imaging would help the dentist see the roots from multiple angles in relation to adjacent teeth and bone structures.
Where there is no discomfort caused by the teeth, as well as when these are healthy, stable, and correctly aligned, the dentist can opt for monitoring instead of treating the situation. By conducting regular checks and dental X-rays, the dentist will be able to monitor any changes regarding the eruption of the tooth, its position, as well as health of the gums and bones.
Monitoring is essential prior to braces, extractions of the teeth, and other procedures affecting the roots of the teeth.
Routine preventive care helps protect both teeth and the tissues surrounding them. Depending on the child’s needs, this may include:
Preventive care cannot separate teeth joined at the roots, but it can reduce the risk of additional dental problems that may make treatment more complicated.
A pediatric dentist may coordinate with an orthodontist when dental concrescence affects:
Because joined roots may prevent two teeth from moving independently, the orthodontist may need to modify the treatment plan. Dental imaging helps the orthodontic team understand the root position before applying pressure to either tooth. Parents can also read more about orthodontic treatment for children and the dental issues that may affect treatment planning.
Surgical care or tooth extraction may be considered when dental concrescence contributes to:
Careful planning is essential because attempting to remove one tooth could loosen, damage, or unintentionally remove the connected tooth. The dentist must evaluate the root connection and determine whether one or both teeth can be safely preserved. An impacted tooth in a child can also cause delayed eruption and may need to be considered during the evaluation.
Parents should arrange a pediatric dental examination when they notice changes in their child’s tooth eruption, alignment, or comfort. Although these concerns do not necessarily indicate dental concrescence, professional evaluation can help identify the underlying cause.
Schedule an appointment when:
A children dentist may use an examination and appropriate imaging to determine whether the symptoms are related to dental concrescence, an impacted tooth, infection, limited space, or another dental concern.
Families can also learn more about pediatric dental services for growing children available through Desert Kids Dental. Parents who are concerned about unusual tooth development, delayed eruption, or dental discomfort can contact Desert Kids Dental to arrange an evaluation.
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