The tooth fairy is working overtime this week. On Thursday, a group of oral surgeons in Chennai, India, released a case report describing an already rare phenomenon at its most extreme. A young boy, just 7 years old, was being treated for jaw pain last month at Saveetha Dental Hospital near the country’s southeastern coast when clinicians realized he had 547 teeth—the most ever counted in one person.
The boy, who appears in photos shared by the hospital but remains unnamed, only ever had a standard child’s set of 20 or so teeth visible to the naked eye. (The average adult has 32.) His parents first noticed a small lump pushing up against his right cheek when their son was 3; when they took the toddler to the doctor, however, he refused to sit still for any exams, so it remained untreated. By the time the boy’s parents brought him to the dental hospital, the lump was nearly the size of a golf ball. Last month, doctors surgically removed the growth and sliced it open. They found a sac with 526 tiny teeth inside, like a fleshy, overstuffed coin purse.
The sac was an odontoma, a noncancerous growth that forms in some children during the years-long process of tooth development. Baby teeth, and then later on secondary teeth, grow from clusters of stem cells deep in the jaw, pushing up from below and erupting through the gums once fully formed. As the secondary set grows and baby teeth begin to fall out, the jaw stretches to accommodate its new, larger tenants. With all this growth and movement, the stem-cell hubs can sometimes forget what they were supposed to be doing and spin out of control, producing tooth-building materials.