PROJECT WORK

INTRODUCTION

BACKGROUND OF THE STUDY

       According to Steven (2014), hyperdontia is an oral condition characterized by having an excess number, which can appear in any area of the dental arch and which can affect the organ. The excess or additional teeth are referred to as supernumerary teeth. A supernumerary tooth is any tooth substance in excess of the usual configuration of twenty deciduous and thirty- two permanent teeth.

       The etiology of hyperdontia is not well known. It can occur anywhere in the dental arch as a result of a rare alteration in odontogenesis and many theories have been put across to explain their presence (Mossey & peter, 2013). One theory states that hyperdontia is formed as a result of a dichotomy of the tooth bud is splitted to create twp teeth and the second is the hyperactivity theory, most accepted worldwide, which propose that hyperdontia is initiated as a result of local, independent, conditioned hyperactivity of the dental lamina( Udita, 2012). Udita ( 2012) futher stated that heredity plays an important role in the occurrence of hyperdontia, but does not follows a simple mendelian pattern and above all cleidocranial dysplasia, trichorhinophary syndrome, gardner’s syndrome, cleft lip/ palate and other syndrome are associated with multiple supernumerary teeth, well develop but failed to erupt and also associated with increased prevalence of supernumerary teeth.

       Supernumerary teeth may occur as single or multiple, may be unilateral or bilateral, erupted or impacted, either in maxilla or mandible or both and maybe classified chronologically, morphologically and topographically (Fariborz, Vahid & Senarz, 2013). The supernumeraries affect both dentitions, though they are less common in primary dentition, that is, they are seldomappearing with deciduous tooth and more common in permanent teeth and in the permanent teeth males are twice affected than females (Holloway & More, 2013).

       Occasionally supernumerary teeth are asymptomatic and they can lead to esthetic and functional complication such as crowding of the teeth, delayed eruption, mal-alignment or displacement of permanent toothor teeth, impaction, abnormal diastema, cystic lesion, abnormal root formation of the adjacent teeth, gingivitis, periodontitis, abscess formation and resorption of or rotation of adjacent teeth (Shereen & Mohammed, 2014). In rarecase, Supernumerary teeth do not cause any problem at all and they are not discovered until the use of a dental x-ray machine, during clinical examination, thorough investigation, detailed history etc. Therefore early diagnosis, proper evaluation and appropriate treatment are essential.

STATEMENT OF THE PROBLEM

       Most studies indicate that the prevalence of hyperdontia is more in males than females at a ratio of 2: 1 and most frequently the cases are restricted to a single tooth but sometimes multiple rows of teeth also erupt and are common in permanent teeth and seldom appear in deciduous teeth. They are discovered on compliant by the patient or when patient seeks treatment for malocclusion (Rylee, 2016).

       Presence of supernumerary teeth may be seen as an isolated finding or are frenquently associated with cleidocranial dysostosis, gardner’s syndrome, cleft lip and palate, fabrig anderson’s syndrome or chondoectodermal dysplasia (Featherstone, 2008).

       Supernumerary teeth  in the mouth may give rise to a number of problems in the mouth such as gingivitis, periodontitis, abscess formation, abnormal diastema, cystic lesion, delayed eruption of the tooth, mal-alignment of the dentition and may be cosmetically objectionable and because they can cause problems, it is generally a good idea to have supernumerary teeth removed (Akpata, 2007).

       In view of the above, the researcher intends to carry out a study on the prevalence of hyperdontia among students attending Divine Love Secondary School Trans Ekulu, Enugu.

OBJECTIVES OF THE STUDY

General objective of the study

       The general objective of this study is to determine the prevalence of hyperdontia among student attending Divine Love Secondary School Trans- Ekulu, Enugu State.

Specific Objective of the study

The specific objective of the study is to;

•               Determine the prevalent rate of hyperdontia among the student of Divine          Love Secondary school Trans- Ekulu, Enugu State.

•               Identify the type of hyperdontia that is more common among the students.

•               Determine the sex that is mostly affected with hyperdontia among the students.

•               Investigate the age range that suffers mostly from hyperdontia among the students.

RESEARCH QUESTIONS

•               What is the prevalent rate of hyperdontia among student of Divine Love Secondary School Trans- Ekulu, Enugu?

•               Which type of hyperdontia is more common among the students?

•               Which sex is more affected with hyperdontia among the students?

•               What is the age range that suffers mostly from hyperdontia among the     students?

SIGNIFICANCE OF THE STUDY

          This study will help to determine the prevalence of hyperdontia among students attending Divine Love Secondary School and also highlight the complications, medical conditions that lead to the problem and the types of treatment already received by those affected; it will also provide relevant data that can be used for upcoming researchers.

SCOPE OF THE STUDY

          This study is limited to the students of Divine Love Secondary School, Trans- Ekulu, Enugu State.

LIMITATION AND DELIMITATIONS OF THE STUDY

          The major problem encountered in the course of completing this work was insufficient fund and time constraint, due to other work in school. But with the careful management of resources by the researcher and the proper guide from the supervisor, the project was executed successfully.

STATEMENT OF HYPOTHESIS

Ho: Hyperdontia is not significantly prevalent among students of Divine Love Secondary School Trans-Ekulu, Enugu State.

H₁: Hyperdontia is significantly prevalent among the students of Divine Love Secondary School Trans- Ekulu, Enugu State.

CHAPTER TWO

LITERATURE REVIEW

DEFINITION OF HYPERDONTIA

          Hyperdontia is defined as an oral condition of having teeth in excess when compared to the normal series. It is the existences of additional teeth to the normal series in the dental aches. It occurs with both primary and permanent teeth. It can also be defined as any teeth or tooth substance in excess of the usual configuration of twenty deciduous and thirty two permanent teeth (Scheiner and Sampson, 2010). Such a surplus can also be accompanied by a deficit or other teeth. For example thirty two permanent teeth may be present with five lower incisors and only three lower premolars.

          Hyperdontia is an oral condition of having extra teeth in the mouth which is known as supernumerary teeth (satton, 2011). Satton (2011) further stated that they can be found at any location in the oral cavity. Supernumerary teeth may occur singly, multiply, unilaterally or bilaterally in one or both jaws. Supernumerary teeth or hyperdontia are the existence of additional teeth to the normal series in the dental arches. The rarest form of hyperdontia is the molar type and many supernumerary teeth never erupt and these may delay eruption of nearby teeth or cause other dental problems. Delayed tooth or eruptions are possible signs of hyperdontia, usually diagnosis are performed after radiographic assessment (cassia, 2012).

HISTORY OF HYPERDONTIA

          The first documented report of supernumerary teeth has been found in the ancient human skeleton remains of the lower Pleistocene era (Khandewa, 2011). Until recently, the most primitive evidence of the presence of supernumerary teeth goes back to 13,000 years, when it was found among the remains of an Australian Aborigine, Mesiodens account for 45 to 67% of all supernumerary teeth. Jacob (2013) defined Mesiodens as the most common among supernumerary teeth, located to both central incisors, appearing peg- shaped in a normal or inverted position. Regezi and Sciubba (2013) mentioned that the anterior midline of the maxilla is the most common site of supernumerary teeth; hence the supernumerary teeth have been reported in the primary dentition.

AETIOLOGY OF HYPERDONTIA

          Dental anomalies can occur as a result of a variety of genetic and environmental factors and the combinations of dental anomalies are associated with specific syndromes (Preire,et al, 2011). Preire, et al, (2011) further stated that the etiology of supernumerary teeth is not completely understood and there are different theories for the different types of supernumerary teeth and One theory suggested that a supernumerary tooth is created as a result of dichotomy of the tooth bud and another theory well supported on literature is the hyper activity theory which suggest that supernumerary teeth are formed as a result of local independent and condition hyperactivity of dental lamina. Heredity might also play a role in this anomaly. Multiple supernumerary teeth are rare in people with no other associated disease or syndromes.

          The etiology of supernumerary teeth may be partly genetic as supernumerary teeth are commonly in relative of affected individuals than the general population; however the inheritance pattern does not follow mendelian principles (Mitchell, 2014). Environmental factors must also be considered in the etiology of supernumerary teeth as shapira and kuftinec (2010) propose hyper-productivity of the dental lamina and dichotomy of tooth germs as etiological factors, which have been supported by in vitro experiment. They also suggest the phylogenic process of activism, syndromes and the late development of some supernumerary teeth or a post permanent dentition may also be an etiological factor.

THEORIES THAT EXPLAIN THE OCCURRENCE OF HYPERDONTIA

          According to Shah (2012), several theories have been suggested to explain the occurrence of hyperdontia and they include;

•         Activism

•         Dichotomy Theory

•         Dental Lamina hyperactivity theory

•         Genetic factors

ACTIVISM

It was originally suggested that supernumerary teeth were the result of phylogenic reversion to extinct primates with three pairs of incisors. This theory has been largely discounted.

DICHOTOMY THEORY

This stated that the tooth bud split into two equal or different size part, resulting in the formation of two teeth of equal size or one normal and one dysmorphic tooth, respectively (Rajab and Hamdan, 2012). However this theory has been discounted.

DENTAL LAMINA HYPERACTIVITY

This involves localized, independent conditioned hyperactivity of the dental lamina ( Rajab and Hamdan, 2012). Rajab and Hamdan further stated that according to this theory, a supplemental form will develop from the lingual extension of an accessory tooth bud, whereas rudimentary form would develop from the proliferation of epithelial remnant of the dental lamina (primosh, 2015).

GENETIC FACTORS

These are considered important in the occurrence of supernumerary teeth. Many cases have been reported of reoccurrence within the family (Rajab and Hamdan, 2012). A sex- linked inheritance has been suggested by observation that males are affected approximately twice as often as females

CLASSIFICATION OF HYPERDONTIA

          Supernumerary teeth are classified into several groups based on their morphology (shah, 2012). On the bases of morphology, four types emerge. They are;

•         Supplemental

•         Conical

•         Tuberculate

•         Odontoma

The odontoma type is further classified into;

•         complex composite odontoma and

•         compound composite odontoma

SUPPLEMENTAL

          Supplemental supernumerary teeth resemble their respective normal teeth. They form at the end of tooth series. The most common supplemental tooth is the permanent maxillary lateral incisor, although supplemental premolars and molars occur (Rajab and Hamdan, 2012). Majorities of supernumerary teeth in the primary dentition are supplemental and rarely remain unerupted

CONICAL

          Conical- shape supernumerary teeth are the most common. They visually present with conical or triangular- shaped erosions and complete root formation. They are found most often as isolated single cases and are usually located between the maxillary central incisor( Mesiodens) (primoish, 2012). However they can occur as bilateral (Mesiodentes) structures in the paramaxillar.

TUBERCULATE

          The tuberculate supernumerary has a barrel- shaped appearance and a crown consisting of multiple tubercles (primosh, 2012). It may be invaginated, Unlike conical supernumerary teeth which have complete root formation, tuberculate types have either incomplete or absent root formation. They are generally larger than conical supernumerary teeth and are usually found in a palatal position relative to the maxillary incisor. Tuberculate supernumerary teeth are often paired and bilateral supernumerary cases have a predominance of tuberculate shaped teeth. It has been suggested that tuberculate supernumeraries may represent a third dentition.

ODONTOMES

          These are hematomas  (benign, disordered over- growth of matured tissue) comprising all dental tissues and appearing radiographically as well as demarcated, mostly radio-opaque lesions in tooth- bearing area (primosh, 2015).There are two different type of odontomes. Compound odontomes comprises many separate, small tooth like structures. A complex odontomes is a single, irregular mass of dental tissue that has no morphological resemblance to a tooth (shah, 2012).shah (2012) further stated that on the basis of location, four classification emerge which include:

•         Mesiodens

•         Paramolar

•         Distomolar

•         Parapremolar

MESIODENS

          Typically, mesiodens is a conical supernumerary tooth located between the maxillary central incisors. mesiodens are the supernumerary teeth present in the midline of the maxilla between the two central incisor. The mesioden are the most common supernumerary teeth and are usually responsible for eruption disturbance or delay of the maxillary anterior permanent teeth. Mesioden could be unerupted, found in the central region of the paramaxilla, between the two central incisors.mesiodens may occur as single, multiple, unilateral or bilateral.

          According to Khandelwal (2011), the presence of mesiodens often results in complications including:

•         Retention of primary teeth and delayed eruption of permanent teeth

•         Rotations

•         Root resorption

•         Pulp necrosis

•         Diastema

•         Nasal eruption

•         Formation of dentigerous and primodal cysts

•         Less common complications involving the permanent incisors include dilacerations of the developing roots and the loss of tooth vitality. Therefore easy diagnosis of mesiodens has particular importance in terms of preventing such complications

PARAMOLAR

          A paramolar is a supernumerary molar, usually rudimentary, situated bucally/ palatally to one of the molars or in the interproximal space, buccal to the second and third molar. Paramolars may be caused as a result of combination of genetic paramolars and environmental factors. Paramolars is found in males compared to females in ratio of 2:1(munshi, 2014). Prevalence of these teeth has been recorded in the third molars and is seen to be greater in the permanent dentition. Complications of the paramolar include food lodgment, difficulty with proper cleaning leading to easy development of dental caries

DISTOMOLAR

          A distomolar is a supernumerary tooth located distal to a third molar and is usually rudimentary. It rarely delays the eruption of associated teeth.  distomolars( also known as fourth molar) is an abnormality in the number of teeth, This finding is usually present on the one side of the maxilla and is comparatively rare as a bilateral finding. distomolars are usually found on pantomography in clinical situations (sekiya, 2007). With the advent pantomography in private dental clinics, the frequency on this finding is increasing in clinical situations. Several theories have been suggested for the occurrence of distomolars such as the phylogentic reversion theory, splitting of the tooth bud and a combination of genetic and environmental factors (parolic and kundabala, 2010).

PARAPREMOLARS

          This is a supernumerary tooth that forms in the premolar region and resembles a premolar (shah, 2012).

CLINICAL FEATURES OF SUPERNUMERARY TEETH

          Supernumerary teeth may erupt normally, remain impacted, appear invested or assume an abnormal path of eruption. Supernumerary teeth with a normal orientation will usually erupt. However, only 13- 34% of all permanent supernumerary teeth are erupted, compared with 73% of supernumerary teeth (Rajab and hamdan, 2012). A supernumerary may be discovered by chance as a radiographic finding with no associated complications. However, if complications arise, they may include

•         Prevention or delay of eruption of association permanent teeth

•         Displacement or rotation of permanent teeth

•         Crowding

•         Incomplete space closure during orthodontic treatment

•         Dilacerations, delayed or abnormal root development of associated permanent teeth

•         Root resorption of adjacent teeth

•         Alveolar bone grafting

•         Pathology

•         Implant site preparation

•         Asymptomatic

•         Late forming supernumerary teeth

PREVENTION OR DELAY OF ERUPTION OF ASSOCIATED PERMANENT TEETH

          The presence of a supernumerary tooth is the most common cause for failure of eruption maxillary incisors. it may also cause the retention of the primary incisor (Borlin, Julin and Thompson, 2011). The problem is usually notices with the eruption of the maxillary lateral incisors together with the failure of eruption of one or both central incisors. Mitchell and Bennett (2012), stated that delayed eruption of associated teeth has been reported to occur in 28- 60% of causasians with supernumerary teeth. Tuberculate supernumeraries are the main cause of failure of eruption of maxillary permanent incisors

DISPLACEMENT OR ROTATION OF PERMANENT TEETH

           In cases where the unerupted incisors are severely rotated, early removal of the causative supernumerary tooth can result in self correction and crowns of the incisor teeth is a common feature in the majority of cases associated with delayed eruption (Arx, 2012). The presence of a supernumerary tooth between the roots of adjacent teeth may prevent root approximation and result in the formation of a diastema (shah, 2012).

CROWDING

          Erupted supplemental teeth most often cause crowding, although any form of supernumerary can cause this complication. Robinson (2014), found that, in patients with supernumerary teeth most of the normal teeth present were longer than in controls. The differences were significant for the mesio-distal dimension of incisors and in the bucco-lingual dimensions of lower first premolars. Similarly, Mitchell and Bennett (2012), found that in patient with supernumerary maxillary incisor teeth, most of their normal teeth were larger than those of controls. The differences were significant for the mesio-distal crown sizes of the maxillary central and lateral incisors, maxillary canines and mandibular lateral incisors. Dento- alveolar disproportion, as well as the presence of additional teeth may contribute to crowding in patients with supernumerary teeth. The problem may be resolved by extracting the most displaced or deformed tooth (Garvey and Blake, 2013).

INCOMPLETE SPACE CLOSURE DURING ORTHODONTIC TREATMENT

          The presence of an undiscovered supernumerary tooth, particularly then a late form premolar, may obstruct orthodontic space closure.

DILACERATION, DELAYED OR ABNORMAL ROOT DEVELOPMENT OF ASSOCIATED PERMANENT TEETH

           The presence of a supernumerary may delay root development of the associated permanent teeth. It can also result in an abnormal root development of the associated permanent teeth.

ROOT RESORPTION OF ADJACENT TEETH

          According to Zmner (2014), the presence of a supernumerary can further lead to the root resorption of the adjacent teeth. This can lead to loss of tooth vitality.

ALVEOLAR BONE GRAFTING

          A supernumerary teeth may comprise secondary alveolar bone grafting in patients with cleft lip and palate. Erupted supernumeraries are usually removed and the socket site allowed to heal prior to bone grafting, unerupted supernumeraries in the cleft site are generally removed at the time of bone grafting (Garvey and Blake, 2012).

PATHOLOGY

          Dentigerous cyst formation is another problem that may be associated with supernumerary teeth (Awang and siar, 2013). Hogstrom and Anderson (2012) reported an enlarged follicular sac in 30% of cases, but histological evidence of cyst formation was found only in 4% to 9% of cases. Another complication of the supernumerary teeth is migration into the nasal cavity, maxillary sinus or hard palate. However, this is extremely rare.

IMPLANT SITE PREPARATION

          The presence of an unerupted supernumerary in a potential implant site may comprise implant placement

ASYMTOMATIC

           Supernumerary teeth are not associated with any adverse effects and may be detected as a chance finding during radiographic examination (Gravey and Blake, 2014), occasionally.

LATE FORMING SUPERNUMERARY TEETH

          Patients with a history of anterior conical or tuberculate supernumerary teeth at an early age have a 24% possibility of developing single or multiple supernumerary premolars (Solares and Romeo, 2012).

MEDICAL CONDITIONS ASSOCIATED WITH SUPERNUMERARY TEETH

          According to Yusuf (2013), developmental disorders that show an association with multiple supernumerary teeth include:

•         Cleft lip and palate

•         Cleidocranial dysostosis

•         Gardner’s syndrome

          less common disorders include Fabry Anderson’s syndrome, Elhert, Danlos syndrome, Incontinentia pigment and Trico-Rhino- Phalangeal syndrome (Khalaf, et al, 2014).

CLEFT LIP AND PALATE

          Clefts can form in the lip or palate alone, or in both structures. The etiology is unknown, but there is a genetic component in approximately 40% of cases (Cawson and Odell, 2013). Cleft lip occurs in about 1per 1000 live births, while isolated cleft palate occurs in about 1p23 2000 live births. Teeth in the region of the cleft are typically missing, however, supernumerary teeth can also occur.

CLEIDOCRANIAL DYSOSTOSIS

          This is a rare syndrome with antosomonal dominant inheritance (Crawson and Odell, 2013). The affected gene has been located on chromosome 6p21. The main features include supernumerary teeth, hypoplasia of one or both clavicles and other skeletal deformities. The triad of multiple supernumerary teeth, partial or total absence of the clavicles and open sagittal suture and fontanelles is considered pathognomonic for cleidocranial dysostosis ( Khalaf et, al, 2014).dental features include multiple supernumerary teeth, multiple crown and root abnormalities, ectopic positions of teeth and failure of eruption. The maxilla is poorly developed while the growth of the mandible is usually normal, resulting in a characteristics skeletal ill relationship

GARDNER’S SYNDROME

          Gardner’s syndrome typically comprises multiple adenomators polyposis of the larger intestine, multiples osteomes of the facial bones, cutaneous epidermoid cycts, demoid tumors and fibrous hyperplastic of the skin and mesentry inheritance is autosomonal and dominant with complete penetrance and variable expressivity. The affected gene is located on the long arm of chromosome 5. The syndrome represents part of the spectrum of familial colorectal polyposis. Oral manifestations include multiple odontomes and other supernumerary teeth, impacted teeth and osteomas of the jaws

DIAGNOSIS OF SUPERNUMERARY TEETH

          An erupted supernumerary tooth may be found during radiographic examination, with no effect on adjacent teeth (Rajab and Hamda, 2013). Unilateral persistence of a deciduous incisor, failure of eruption or ectopic eruption of a permanent incisor should alert the clinician to the possible presence of supernumerary teeth and indicated appropriate radiographic examination (Shah, 2012). Shah (2012), further stated that, the most useful radiographic investigation is the rotational tomography (OPG), with additional views of the anterior maxilla and mandible, in the form of occlusal periapical radiographs. If concerns are present regarding the possibility of root resorption of a permanent tooth caused by a supernumerary tooth, then long- conceperiapical radiographs will be required for diagnosis.

          In order to localize an unerupted supernumerary tooth, the parallax method is recommended (Jacob, 2011). Parallax is the apparent movement of an object against a background, caused by a change in observer position. This can be achieved with two separate radiographs taken at different angles, but showing the same region. When using this technique, the reference point is usually the root of an adjacent tooth. The image of the tooth that is further away from the x-ray tube head will move in same direction as the tube head; the image of the tooth that is closer will move in the opposite direction

          Cone beam computed demography has recently been used to evaluate supernumerary teeth (Liu, Zhang, Wu and Ma, 2010). This technique yields detailed three- dimensional image of local structures and may prove useful in pre- treatment evaluation of supernumerary teeth and may prove useful in pre- treatment evaluation of supernumerary teeth and surrounding structures. Supernumerary premolars commonly occur in several regions of the same mouth, so the finding of one indicates radiographic examination (solares and romeo, 2015).

MANAGEMENT OF HYPERDONTIA

          Treatment depends on the type and position of the supernumerary tooth and on its effect or potential effect on adjacent teeth (Gravey and Blake, 2010).

          The first stage of management of supernumerary is the localization and identification of the complication associated with the supernumeraries. Teeth can be localized using the vertical or horizontal parallax techniques. A periapical radiograph taken using the paralleling technique gives the most detailed assessment compared to the other radiographic views.

          If teeth are causing no complication and are not likely to interfere with the orthodontic tooth movement (i.e. if they lie beyond the dental apices) they can be monitored with yearly radiographic review. The patient should be warned of complication such as cystic change and migration with damage to nearby roots. If the patient does not wish to risk such complication it is acceptable to remove supernumerary teeth, it may be sensible to alleviate full root development before surgical extraction to minimize the changes of root damage .root development of the maxillary incisors should be complete by the age of ten years. If supernumerary teeth are associated with complications usually involves a surgical procedure .easy extraction of supernumeraries causing incisors impaction, may have the benefit of minimizing loss of eruptive potential, space loss and centre line displacement even in cases when the unerupted incisors are severely rotated, early removal of the causative supernumerary tooth can also result in self correction and correction alignment (primosh,2010).The greatest concern with early removal is the risk of affecting the formation of adjacent roots. Additionally, young child may be able to tolerate such a procedure and may develop a dental phobia .However delayed eruption of maxillary central incisors can result in medial movement of the lateral incisors, space loss and diminished development of dental alveolar harpers (Rajab and Hamdan2010) furthermore, Institution where a supernumerary tooth is preventing the eruption of an incisors .The eruption potential of the incisors may be lost in intervention is delayed.

          Following removal of supernumerary tooth, the time taken for the unerupted tooth to erupt can vary between six months and three years (Rajab and Hamdan, 2010). Up to 90% of impacted permanent incisors erupted within 18 months following removal (layland,Batra,belong and Liewlelyn, 2012). Factors affecting the time taken include the distance the unerupted tooth was displaced, the space available in the dental arch and the stage of root development of the permanent tooth (Rajab and Handan,2010). The patient’s age and availability of space in the dental arch are the two critical factors in determining whether spontaneous eruption occurs following removal of supernumerary teeth (leyand, et al, 2012).

          At the initial operation to remove the supernumerary, attachment of a gold chain to the unerupted teeth gives the option of applying orthodontic traction to the tooth if it does not erupt spontaneously (Mitchell and Bennett, 2012). However, in order to expose the unerupted tooth sufficiently of an attachment to be bonded, a greater amount of supporting bone needs to be removed. Exposure of the unrepted tooth   (with or without a bonded attachment) may result in poor gingival aesthetics, with less attached gingivae between the exposure tooth and neighbouring teeth (Mitchell and Bennett, 2012). If supernumerary teeth are likely to interfere with orthodontic tooth movement, they should be removed prior to the commencement of treatment, (shah, 2011). If a supplemental tooth is present and erupted, it may be difficult to determine which is the supplemental and which is the tooth of the normal dental series. In these circumstances assuring both teeth are healthy, it is logical to extract the tooth most displaced from the line of the arch for the relief of crowding. Finally the presence of a supernumerary tooth should alert the clinician, to the possibility of the development of late firming supernumerary teeth, especially in the lower premolar region. It has been reported that up to 2490 of patients with an anterior maxillary supernumerary may develop supplemented premolars.

INDICATIONS FOR SUPERNUMERARY REMOVAL

          Garvey and Blake (2010) , stated that supernumerary tooth removal is commended where:

•         Central incisor eruption has been delayed or inhibited

•         Altered eruption or displacement  of central incisors ids evident

•         There is associated pathology

•         Active orthodontic alignment of an incisor in close proximity to the supernumerary is envisaged

•         Its presence would compromise secondary alveolar bone grafting

•         Its presence would compromise secondary alveolar bone grafting in cleft and palate patients

•         The tooth is present in bone designated for implant placement

•         Spontaneous eruption of the supernumerary has occurred

INDICATION FOR MONITORING WITHOUT SUPERNUMERARY REMOVAL

          Extraction is not always the treatment of choice for supernumerary teeth (Garvey and Blake 2012). They may be monitored without removal where:

•         Satisfaction eruption of related teeth as occurred

•         No active or orthodontic treatment envisaged

•         There is no any associated pathology

•         Removal would prejudice the vitality of the related teeth

  RECOMMENDATION FOLLOWING SUPERNUMERARY REMOVAL

          Three factors influence the time; it takes for an impacted tooth to erupt following removal of the supernumerary:

•         The type of supernumerary tooth.

•         The distance the unerupted permanent tooth was displaced.

•         The space available within the arch for the unerupted tooth.

          Removal of a supernumerary tooth preventing permanent tooth eruption usually results in the eruption of the tooth, provided adequate space is available in the arch to accommodate it (Mitcholle and Bennet, 2010).

          Although the majority of authors recommend exposure of the unerupted tooth when the supernumerary is removed (Di Base, 2012). It advocates conservative a management without exposure.

          If there is adequate space in the arch for the unerupted incisors following supernumerary removal, space maintenance can be ensured by fitting a simple removable appliance. If the space is inadequate the adjacent teeth will need to be moved distally to create space for incisor and orthodontic traction is usually required (Garvey and Blake, 2012).

PREVALENCE PF HYPERDONTIA

          A study was carried out to determine the current prevalence of supernumerary teeth in a Swiss community (schonuckli, liporsky, pehomaki, 2010). A population of 1391 girls and 1613 boys with an average age range of 6-15 years. The study found 44 supernumerary teeth which yield a prevalence of 1.590. The prevalence among boys was higher than among girls, with 1.190 and 0.490 respectively. The greatest population of supernumerary teeth had the same shape as a maxillary anterior region (38 to 44 teeth, 8690). Based on their position 33 of these were classified as melodeons. Five supernumerary teeth had the same shape as a maxillary lateral incisor. In the mandibulary anterior region, five supernumerary teeth where shaped as the same conical. The prevalence of supernumerary teeth Swiss communities is 100 (1.590) and comparable to similar studies in the literature. The majority (8690) of supernumerary teeth where located in the maxillary anterior region. This in the case of delayed eruption, dentists should bear in mind that supernumerary teeth may be the cause and proximity between tooth germs. Because of the inheritance pattern of five mandibular incisors in the studied family, classia et al, (2004) suggested the involvement of a single gone bearing a recessive mutation.

          A retrospective study was performed to determine the prevalence and characteristics of supernumerary tooth and evaluate the associated pathologies and treatment protocol in a Turkish patient population (celikogu, kamakand oktay, 2010). Radiographs of 3491 patients (2146 females and 1345 males)ranging in age from 12 to 25, for each patient with supernumerary tooth. The demographic varied (including age , sex, number, location, position, type morphology of  supernumerary teeth, associated pathologies or complication previous treatment carried out teeth were recorded supernumerary teeth were detected in 42 subjects (1.2percent ) of which 27 were males and 15 were females with 1: 8 :1 male female ratio. The commonly found supernumeraryteeth were mesiodens  (31.3 percent ) followed by premolar (25.0 percent) lateral (22.9), distomolar (14.5%), paramolar  (4.2%) and canine (2.1%) of the 48 supernumerary teeth examined , 50% were conical, 81.3%were in a vertical position , and 20.8% were erupted. Supernumerary teeth caused rotation or displacement of the adjacent teeth in 14 cases, in one case, impacted maxillary central incisor erupted mesiodens. In seven cases orthodontic forces were used for erupted of impacted permanent teeth. No cysts enlargements in the follicular epithelium a root desorption were found. No other dental anomalies associated with supernumerary teeth were detected.

          It was reported that the prevalence of the supernumeraries in permanent dentition in Mexico is between 0.075 and 0.20% and that supernumerary premolars account for only 10% of all supernumerary cases (Rajah and Hamadan, 2002). The difference of these teeth from the other supernumeraries is that they more commonly occur in the mandible. Single supernumeraries occur in 76 to 80 % of cases. Double supernumeraries occur in 12 to 23% of the cases and multiple supernumerary teeth in less than 1% of cases.

          Simones, Crusoe, Herves, Oliveira, Ciampond and Da Silva (2011), carried out a study to investigate the prevalence of supernumerary teeth in orthodontic patient from south western Brazil, panoramic radiographs of 1719 orthodontic patient (762 males and 957 females). The age range of the patients is 4 years and 4 months to 14 years and 6 months at the time the radiographs were taken supernumerary teeth were found in thirty subjects (1.7%) of which 16 were males (0.9%) are fourteen females (0.8%).

          The different among sexes was not statistically significant. Among the 30 patients with this dental anomaly twenty-four (80%) presented one supernumerary tooth while six (20%) had two extra teeth. No differences among sexes for number of supernumerary teeth were found. 29 supernumerary teeth (96.7%) were located in the maxilla, whilst only one (3.3%) was located in the mandible seventeen supernumerary teeth (56.7%) located in the maxilla were mesiodens, i.e. supernumerary teeth located near the midline in the maxilla.

          Uroweni and Osunbor (2012) , carried out a study to ascertain frequency of multiple supernumerary teeth not associated with syndrome in patients from Benin, Nigeria. a total of 13 patients comprising of 10 males (76.2%) and 3 females (23.07%) representing 8.098% of the study population had multiple supernumerary teeth. Multiple supernumerary teeth without any associated systemic disease or syndrome are rare. The maxillary region has the highest frequency of occurrence with 12 times (66.67%) followed by the mandibular premolar region with 4 times ( 22.22%) while maxillary premolar and mandibular anterior region shared (5.55%) respectively. The conical and tubercule types of supernumerary teeth were found in midline region, why the supplemental supernumerary teeth were moved in the mandibule premolar region with 12 (70.58%) followed by maxillary midline 4 (23.52%) and lower incisor region 1 ( 5.88%). The role of genetics in the etiology of multiple supernumerary teeth as found in this study, the occurrence of supernumerary teeth on two brothers and daughter to one of the affected brothers, tends to suggest an autosomonal dominant mode of inheritance and the challenges to management by the orthodontists are discussed.

           Scheiner and Sampson (1997), a study was carried out in Australia to determine the prevalence of supernumerary teeth. Yusuf (2012), stated that the prevalence of supernumeraries in Australia varies between 0.1 and 3. 690 of the populations studied. Luten (1967) studied the prevalence of supernumerary teeth in the primary and permanent dentition of 1558 children in Australia and found a prevalence of 290.Methodology included the use of bitewing and periapical radiographs for detection. Scheiner and Sampson (1997), carried out a recent study using 2338 randomly selected panoramic radiographs of intact dentitions of Australia subject aged 7- 20 years and found 2.3% with supernumeraries of those with supernumeraries, 68.6% had single, 20.3% had double, and 11.1% had multiple supernumeraries. The supernumeraries were located in the maxillary incisor region ( 64.3%) with mesiodens accounting for 32. 4% of such presentations. In decreasing order of frequency came supernumeraries in the maxillary third molar region (29.6%), mandibular third molar region (7.0%), mandibular premolar region (7%), mandibular incisor region (4.2%). Supernumeraries were encountered more frequently in males than in females. In a ratio of 2: 1. Acton ( 1987), stated rhat sexual dimorphism is reported by most authors with males being more commonly affected. Michell (1989), suggested no difference with the sex distribution in cases with deciduous supernumeraries but a 2:1 ratio in favour of males in cases exhibiting permanent supernumerary teeth. Hogstum and Anderson (1987), also reported a 2: 1 ratio of sex distribution while Luten ( 1965), found a sex distribution of 1: 3: 1.

          According to Sampson and Regaidi (1990), a study of supernumerary in asian school children found a greater male to female distribution of 5: 5: 1 for Japanese and 6: 5: 1 for Hongkong children.

          Vahid (2011) examined 1751 Iranian orthodontic patients and found that 0. 7490 had supernumerary teeth. This confirm the finding of 0.69% of supernumerary teeth in a study carried out by Sogra ( 2012) where as Udom and Terrence ( 1998), reported prevalence of 11.8% for supernumerary teeth were mandibular premolars followed in decreasing order by mesiodens. Mesiodenses may cause delay or ectopic eruption of the permanent incisor and subsequent change in occlusion and appearance

                 According to Brook (1979), in a survey of 2000 British school children supernumerary teeth were present in 0.8% of primary dentitions and in 2.1% permanent dentitions.  Occurrence may be single or multiple, unilateral or bilateral, erupted or impacted and in one or both jaws. The frequency of supernumerary permanent teeth in the cleft area in children with unilateral cleft lip or palate or both was found to be 22.2%. the frequency of supernumeraries in patients with cleidocranial dysplasia ranged from 22% in the maxillary incisor region to 5% in the molar region. While there is no significance sex distribution in primary supernumerary teeth males are affected approximately twice as frequently as females in the permanent dentition ( Kinirons, 1982).

          Casia (2004) carried out a study to illustrate the epidemiology of supernumerary teeth in the Arab world, the presence of five mandibular incisors in four patients did not show any abnormalities in tooth number and the patient did not show any abnormalities in tooth number and the patients were partially or completely edentulous. The pedigree revealed that the four patients had consanguineous parents. Diagnosis was based on clinician examination and radiography. The first patient was a 25 years old male who had five normal, well individualized mandibular incisors. The second patient was a 22 years old female and she had five distinct mandibular incisors with normal roots. The identification of the supernumerary tooth in the first and second patients was difficult because there was no significant difference between the incisors. The third patient was a 24 years old female with five separate, crowded mandibular incisors. The fourth patient was a 22 years old male. He had five normal, well aligned mandibular incisors. Both the third patient and the fourth patient had on the left side partial coronal fusion of two incisors. The fusion could be attributed to the decreased available space caused by the presence of supernumerary tooth.

CHAPTER THREE

RESEARCH METHODOLOGY

This chapter encompasses the nature of the research on the procedures adopted for data collection and data analysis. The sub- headings are described below:

RESEARCH DESIGN

       The study was a cross sectional survey research design of the entire student attending Divine Love Secondary School.

DESCRIPTION OF STUDY AREA

       The study area was Divine Love Secondary School, Trans-E00kulu, Enugu State. It was established in the year 2006, 18^th September by the federal ministry of education. It is situated at number 54/56 Jim Nwobodo Avenue, Trans Ekulu, Enugu state. The school has 12classrooms and 1 staffroom, with 6 functional laboratories. Each class has 2 classrooms ( A and B) with an average of 50students per classroom giving an average of 100 students in a class. The school has magnificent 3 storey building, well furnished with essential infrastructures to enhance adequate teaching and learning and it is located opposite st mary’s catholic church (Source: Sr. Fausta Maris Ezeji: principal; personal communication)

POPULATION OF THE STUDY

       The total number of students attending Divine Love Secondary School Trans Ekulu, Enugu State is 700 having about 12 classes, with female population of 382 and male population of 318.

SAMPLE SIZE AND TECHNIQUE

          The sample size of 180 students for 6 classes was derived from each class in the study. Stratified sampling technique was used, 30 students from each of the 6 classes in Divine Love Secondary School Trans Ekulu, Enugu was used.

INSTRUMENT FOR DATA COLLECTION

          The instruments for the data collection were through personal interview and observation of the oral cavity of the students. Specially designed data sheets will be used to record the observation.

METHOD OF DATA COLLECTION

          An introductory letter will be collected from the Head of Department (HOD) dental technology to the principal of the school for permission and easy access to the students. This enabled the researcher to get the approval and assistance of the school authority and subsequently the co- operation of the student.

METHOD OF DATA ANALYSIS

          The data was analysed using a Simple Frequency Distribution Table and percentage, where data collected are categorized, organized and represented such as age, sex and classes etc. Data was also presented in essay form for easy understanding and interpretation.

TEST OF HYPOTHESIS

          The hypothesis was tested using prevalence rate. The formular which is mathematically presented below;

Prevalence Rate = number of affected cases x 100

                                      Sample size

CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION OF RESULTS

          This chapter deals with the analysis with data collected during field work and presentation of result collected from the students attending Divine Love Secondary School, Trans- Ekulu, Enugu. Data was obtained from personal interview and physical (intraoral) examination of the study participants, which were analysed and the results presented below:

TABLE 1: CLASS OF THE STUDENTS USED FOR THE STUDY

Class	Frequency	Percentage %
JSI	30	16.67
JS2	30	16.67
JS3	30	16.67
SS1	30	16.67
SS2	30	16.67
SS3	30	16.67
Total	180	100

Table 1 above shows the classes of the students that participated in this study. 30(16.67%) students were equally selected from each class.

TABLE 2: AGE RANGE OF STUDENTS

Age range	Total freq	Total %	JSS1	%	JSS2	%	JSS3	%	SS1	%	SS2	%	SS3	%
9- 11	19	10.56	0	0	0	0	0	0	0	0	0	0	0	0
12-14	1	0.56	10	5.56	20	11.11	10	5.56	10	5.56	0	0	0	0
15-17	20	11.11	8	4.44	5	2.78	15	8.33	2	1.11	5	2.78	3	1.67
18-20	121	67.22	9	5	5	2.78	5	2.78	18	10	25	13.89	0	0
20 & Above	19	10.56	3	1.67	0	0	0	0	0	0	0	0	27	15
Total	180	100.01	30	16.67	30	16.67	30	16.67	30	16.67	30	16.67	30	16.67

            Table 2 above shows the age range of the students. The age range of the study participants were divided into five groups of 3 years interval each of the

30 participants in jss1,none of them were in the age range of 9-11years;10(5.56%) were in the range of 12-14years; 8(4.44%) were in the range of 15-17years; 9(5%) were in the range of 18-20years and 3(1.17%) were in the range of twenty and above.

          Of all the 30 participant in jss2, none of them were in the age range of 9-11years; 20(11.11%) were in the age range of12-14years;5(2.78%) were in the age range of 15-17years; 5(2.78%) were in the range of 18-20years and none of them were above twenty years.

          Of all the 30 participant in jss3, none of them were in the age range of 9-11years; 10(5.56%) were in the age range of 12-14years; 15(8.33%)  were in the age range of 15-17years; 5(2.78%) were in the age range of 18-20 years and none of them were above twenty years.

          Of all the 30 participants in ss1, none of them were in the age range of 9-11 years; 10(5.56%) were in the age range of 12-14years; 2(1.11) were in the age range of 15-17years; 18(20%) were in the age range of 18-20years and none of them were above twenty years. Of the30 participants in ss2, none of them were in the age range of 9-11years. None of them were in the age range of 12-14years; 2(1.11%) were in the age range of 15-17years and 25(13.89%) were in the age range of 18-20years and none of them were above twenty years.

          Of all the 30 participants in ss3, none of them were in the age range of 9-11years; none of them were in the age range of 12-14years; 3(1.67%) were in the age range of 15-17years; none of them were in the age range of 18-20years and; 27(15%) were in the age range of 20 and above.

          Therefore, jss1 had the highest frequency in the age range of 12-14years with 10(5.56%), jss2 had the highest frequency in the age range of 12-14 years with 20(11.11%); jss3 had the highest frequency in the age range of 15-17 years with15(8.33%); SS1 was highest in the range of 18-20 years with 18(10%); SS2 was highest in the range of 18-20 years with 25(13.89%); while SS3 still had the highest frequency in the range of twenty and above with 27(15%).

TABLE 3:     SEX OF THE STUDENT USED FOR THE STUDY

Sex	Total Freg.	Total %	JSS1	%	JSS2	%	JSS3	%	SS1	%	SS2	%	SS3	%
Male	88	48. 89	19	10.56	17	9.44	14	7.78	15	8.33	19	10.56	20	11.11
Female	92	51.11	11	6.11	13	7.22	16	8.89	15	8.33	11	6.11	10	5.56
Total	180	100	30	16.67	30	16.66	30	16.67	30	16.66	30	16.67	30	16.67

            The sex of the students used for the study is shown in the table 3 above, 88(48.89%) were males and 92 (51.11%) females. Of the 30 participant in Jss1 19(10.56%) were male while 11(6.11%) were females. Of the 30 participant in JSS2 17(9.44%) were males while 13(7.22%) were females. Of all the 30 participant in JSS3 14(7.78%) were males while 16(8.89%) were females.  Of all the student that participated in Ss1 15(8.33%) were males while 15(8.33%) were females. Of all the students that participated in Ss2 19(10.56%) were males whiles 11(6.11%) were females. While the 30 students that participated in Ss3 20(11.11%) were males while 10(5.56%) were females.

          Therefore, SS3 had the highest number of male students with 20(11.11%) followed by SS2 19(10.56%), JSS1 19(10.56%) , JSS2 17(9.44%), SS1 15(8.33%) and finally JSS3 14(7.78%).

          JSS3 had the highest number of female students with 16(8.89%). This was followed by SS1 with 15(8.33%), JS2 13(7.22%), JS1 11(6.11%), SS2 11(6.11%) and finally SS3 10(5.56%).

TABLE 4:   PRESENCE OF HYPERDONTIA AMONG THE STUDENT THAT PARTICIPATED IN THE STUDY

Presence of Hyperdontia	Total Freg	Total %	JSS1	%	JSS2	%	JSS3	%	SS1	%	SS2	%	SS3	%
Yes	28	15.56	5	2.78	3	1.67	4	2.22	2	1.11	3	1.67	6	3.33
No	152	84.44	25	13.89	27	15	26	14.44	28	15.56	27	15	24	13.33
Total	180	100	30	16.67	30	16.67	30	16.66	30	16.67	30	16.67	30	16.66

           

            Table 4 above shows the presence of hyperdontia among the participants of the study. Of all the 180 participants of the study, 28 (15.56%) had cases of hyperdontia while 152 (84.44%) had no cases of hyperdontia.

          Therefore, participants without hyperdontia had the highest number with 152 (84.44%) while the participants with hyperdontia were the least 28(15.56%).

TABLE 5: TYPES OF HYPERDONTIA SEEN AMONG THE                                                   PARTICIPANTS

Types of hyperdontia	Total Freg.	Total %	JSS1	%	JSS2	%	JSS3	%	SS1	%	SS2	%	SS3	%
Supplemental	6	3.33	2	1.11	1	0.56	1	0.56	0	0	2	1.11	0	0
Taberculate	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Conical	5	2.78	1	0.56	1	0.56	0	0	0	0	0	0	2	1.11
Odontomes	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Mesodens	6	3.33	1	0.56	0	0	2	1.11	1	0.56	1	0.56	1	0.56
Paramolars	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Distomolar	5	2.78	1	0.56	0	0	2	1.11	1	0.56	0	0	1	0.56
Parapremola	1	0.56	0	0	1	0.56	0	0	0	0	0	0	0	0
Without Hyperdontia	157	87.22	25	13.88	27	15	25	13.88	28	15.55	27	15	26	14.44
Total	180	100	30	16.67	30	16.67	30	16.66	30	16.67	30	16.67	30	16.67

            The types of hyperdontia seen among the participants with cases of hyperdontia were shown in table 5 above. A total of 6(3.33%) participants had the supplement supernumerary teeth, 0(0%) participants had tuberculate supernumerary teeth, 5(2.78%) had conical supernumerary teeth, 0(0%) participants had odontomes 6(3.33%) participants had mesiodens, 0(0%) participants had paramolars, 5(2.78%) participants had distomolars, 1(0.56%) participants had parapremolars while 157(87.22%) participants did not have hyperdontia.

          The participants in JSS1 and JSS2 had the highest number of supplemental supernumerary teeth with 2(1.11%) each. This was followed by JSSS2 and JSS3 which had 1(0.56)

          The participants in SS3 had the highest number of conical supernumerary teeth with 2(1.11%). This was followed by JSS1 and JSS2 with 1(0.33%) each.

          The participants in JSS3 had the highest number of mesiodens supernumerary teeth with 2(1.11%). This was followed by JSS1, SS1, SS2 and SS3 with 1(0.56%) each.

          The participant in JSS3 had the highest number of Distomolar supernumerary teeth with 2(1.11%). This was followed by JSS1, SS1 and SS3 with 1(0.56%).

          The participants in JSS2 had the highest number of parapremolar supernumerary teeth with 1(0.56%). Therefore the highest frequency of hyperdontia was found to be the supplemental and mesiodens with 6(3.33%) each, followed by Conical and Distomolar with 5(2.78%) and parapremolar with 1(0.56%).

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

DISCUSSION

          T he result of this study has shown that the participants between the age range of 18- 20 years were the highest in number with 121(67.22%) participants while those between the age range of 9- 11 years had 19(10.56) participants, 12- 14 years had 1(0.56%), 15-17 years had 20(11.11%) and those above 20 had 19(10.56%) participants bearing in mind that the sample size was 180 participants.

          Observations on the percentage of students with hyperdontia was seen to be 28 (15.56%) cases out of the 180 participants used for the study. It was observed that there were 15( 8.33%) males and 13(7.22%) females with cases of hyperdontia. This gave a male to female ratio of 2:1. This confirmed the findings of Scheiner and Sampson (1997) as well as Mitchell (1989) who found a male to female ratio of 2:1 in Austria and Asia respectively.

          It was observed that the types of hyperdontia seen among the students were supplemental with 6(3.33%) cases, Tuberculate with 0(0%), Conical with 5(2.78%) cases, Odontomes with 0(0%) cases, Mesiodens with 6(3.33%) cases, Paramolars with 0(0%) cases, Distomolars with 5(2.78%) cases and Parapremolars with 1(0.56%) cases. The most common type being the supplemental and Mesiodenes with 6(3.33%) cases each. This is comparable with the findings of Schiner and Sampson (1997) in Australia which stated that the supernumeraries were mostly located in the maxillary incisor region with the Mesiodens accounting for 32.4% of such presentations.

 

CONCLUSION

          The study on the prevalence of hyperdontia has been carried out in Divine Love Secondary School, Trans- Ekulu, Enugu.

          The population of the study was 180 students from JSS 1, JSS2, JSS3, SS1, SS2 and SS3 with 30 students selected from each class. The data obtained has been presented and analysed using simple frequency table and calculation of percentages.

          During the investigation of the reported case of hyperdontia among students, it was observed that the cases of hyperdontia were mostly found in males with the age range of 18- 20 year. Most of these cases were asymptomatic and as a result no known cause has been established as regards hyperdontia

          From the study concluded, it can be deduced that hyperdontia is not significantly prevalent among students of Divine Love Secondary School.

RECOMMENDATIONS

•         Oral health awareness campaign and seminars should be carried out in schools and rural areas from time to time to educate people on how to maintain good oral health and the effect of bad oral habit.

•         People should be educated on the need to visit dental clinics at all times especially when there is an oral problem

•         The government and private investors should try to establish dental clinics in the rural areas in order to dental care assessable.

•         There is need to include oral health education in the existing curriculum of secondary school students. This will go a long way in treating the needed oral health awareness among the students.

SUGGESTIONS FOR FURTHER STUDIES

•         The need for orthodontic treatment among school children

•         A survey of demand for orthodontic treatment in primary and secondary schools.

      

DEFINITION OF TERMS

Aetiology:                               The cause of a specific disease

Asymptomatic:                       Not showing any symptoms of disease, whether                                                 disease is present or not

Adenomatoes polyposis:                  This is a hereditary disease caused by a                                                  defective dominant gene in which multiple                                                        adenomas develop in the intestine, usually the                                           large bowel or rectum at an early stage.

Adenoma:                               A benign tumor of epithelial origin that is                                                  derived from glandular tissue or exhibits clearly                                          defined glandular structures.

Autosomal:                             Any chromosome that is not a sex chromosome                                        and occurs in pairs to diploid cells.

Cleidocranial dysostosis:        A congenital defect of bone formation in which                                         the skull bones ossify imperfectly and the collar                                          bones (clavicle) are absent.

Diastema:                                   A space between two teeth

Dilacerations:                          A condition affecting some teeth after                                                         traumatic injury which the incomplete root                                                            continues to form at an       abnormal angle to the                                                      path already formed.

Dysplasia:                                 Abnormal development of the skin/ bone or                                              other tissue.

Ectopic:                                        The occurrence of something in an unnatural                                                    location

Haematomas:                           An accumulation of blood within the tissues                                              that clots to form a solid swelling injury                                                              disease of the blood vessels or a clothing                                                             disorder of the blood are the usual causative                                                            factors.

Malocclusion:                         A condition in which there ia an abnormal                                                           arrangement of the teeth, either within one jaw                                            or in one jaw in relation to the other.

Phylogenic:                                       The evolutionary history of a specie or                                                      individual.

Prevalence:                              A measure of morbidity based on current                                                  sickness in population, estimated over a                                                              particular time or a state period.

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APPENDIX 1

TEST FOR HYPOTHESIS

Formula; Prevalence rate = Number of affected cases × 100

                                                     Sample size                 1

Number of affected cases = 28

Sample size                      = 180

         

            ˸^.    Prevalent rate =               28       ×      100

                                                          180                1     

                        

                                         =         0.15555556   ×     100

                                         =          15.56%

Decision rule:

Result of test of hypothesis shows the prevalence rate value of 15.56 %( 0.16) which is lesser than 50 %( 0.5) which is the level of significance of the sample size. This shows that hyperdontia is not significantly prevalent among the students of Divine Love Secondary School, Trans- Ekulu, Enugu. Therefore we reject the H₁ and accept H₀.