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Oral Surgery/Oversized adult tooth


I have recently had my 7 year old daughter into the orthodontist and then to oral surgeon.
When we went to the orthodontist (for a clicking jaw... not related to the tooth I am inquiring about, at least I don't think so) the x-ray revealed an over-sized adult tooth. I under stand this is very rare and I was told it would need to be removed but I would really appreciate more info.
The surgeon was not very clear about the timeline, the effects of such a tooth or what I should be looking for to determine when to have my child in for surgery. I don't even know what the condition is called so I can research it.

I have attached the x-ray.

I would be very grateful for any information and guidance you could offer me. I obviously want to do the best for my child and right now I feel a little lost.

with appreciation,



Thank you for your question. The radiograph helps tremendously. Yes this condition is rare. It is called Macrodontia. There are three types of this condition. The first is True Generalized Macrodontia in which all the teeth are larger than normal and this is seen in another condition called Giagantism. The second type is relative generalized macrodontia and this is thought that the jaw size is inherited from one parent and the teeth from the other and the difference in size gives the illusion of macrodontia. In your daughters case it is of the type of Single Tooth Microdontia. The causes of this condition range from insignificant to significant. Does your daughter have any other medical conditions? If not, I would suggest possible genetic testing to rule out other possible conditions. It is also quite possible that your daughter does not have any conditions at all and this is just a malformation of a premolar tooth. As far as treatment, I would agree that the tooth be removed before continued root development that may cause additional complications like wrapping around the nerve at which point the removal would most likely end up with nerve damage. I would recommend genetic testing first and then plan for removal of that tooth sooner than later. Not an urgent situation but I would not wait 6 months to take care of it either. Any other info about your daughters, yours or her fathers medical history would be helpful. I hope that helps.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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