Hyperdontia

Last updated
Hyperdontia
Other namesSupernumerary teeth, Mesiodens
Intraoral-photograph-showing-conical-mesiodens.jpg
Intraoral photograph showing conical mesiodens
Specialty Dentistry
Symptoms supernumerary teeth coming out from the gum or in the mouth
Complications supernumerary teeth growing into the gum
Types5 [ citation needed ]
Causes Gardner's syndrome

Ehlers-Danlos syndrome

Cleft palate

Cleidocranial dysplasia

Genetic disorder
Risk factors supernumerary teeth causing problems in the dental arch
Differential diagnosis Hypodontia
Treatment Dental surgery

Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth (32 in the average adult). They can appear in any area of the dental arch and can affect any dental organ. The opposite of hyperdontia is hypodontia, where there is a congenital lack of teeth, which is a condition seen more commonly than hyperdontia. [1] The scientific definition of hyperdontia is "any tooth or odontogenic structure that is formed from tooth germ in excess of usual number for any given region of the dental arch." [2] The additional teeth, which may be few or many, can occur on any place in the dental arch. Their arrangement may be symmetrical or non-symmetrical.

Contents

Signs and symptoms

The presence of a supernumerary tooth, particularly when seen in young children, is associated with a disturbance of the maxillary incisor region. This commonly results in the impaction of the incisors during the mixed dentition stage. The study debating this also considered many other factors such as: the patient's age, number, morphology, growth orientation and position of the supernumerary tooth. Alongside this issue, the presence of an extra tooth can impede the eruption of adjacent additional or normal teeth. Therefore, the presence of a supernumerary tooth when found must be approached with the appropriate treatment plan, incorporating the likelihood of incisal crowding. [3] In some individuals, the additional teeth can erupt far from the dental arch, within the maxillary sinus. The extra teeth may also migrate to a different location after development. [1] In some cases, supernumerary teeth can lead to the formation of cysts. Crowding is also frequently seen in people with hyperdontia. [2]

Causes

There is evidence of hereditary factors along with some evidence of environmental factors leading to this condition. While a single excess tooth is relatively common, multiple hyperdontia is rare in people with no other associated diseases or syndromes. [4] Many supernumerary teeth never erupt, but they may delay eruption of nearby teeth or cause other dental or orthodontic problems. [5] [6] Molar-type extra teeth are the most common type. Dental X-rays are often used to diagnose hyperdontia.

It is suggested that supernumerary teeth develop from a third tooth bud arising from the dental lamina near the regular tooth bud or possibly from splitting the regular tooth bud itself. Supernumerary teeth in deciduous (baby) teeth are less common than in permanent teeth.

Evolution

Specific genes play a role in determining the number and pattern of teeth that develop in an individual, and mutations or variations in these genes can result in the formation of extra teeth. An individual can inherit a genetic predisposition to hyperdontia from its parents. [7] If an individual with hyperdontia reproduces, their offspring have an increased likelihood of having the same condition, as their offspring have an increased likelihood of having the same condition because hyperdontia has been proposed as having an autosomal dominant mode of inheritance. [7] This is the result of mutations that can be passed on to offspring through several different genes associated with tooth development. The MSX1 and MSX2 genes are among the most well-documented genetic factors associated with hyperdontia. [7] Because these genes play a crucial role in tooth development and patterning, mutations in MSX1 and MSX2 can lead to the formation of extra teeth or changes in tooth number and shape. Additionally, mutations in the AXIN2 gene have been linked to hyperdontia and other anomalous dental traits. The AXIN2 gene is involved in regulating the Wnt signaling pathway, which plays a role in tooth development. [7] Therefore, variations in this gene can disrupt tooth development and result in supernumerary teeth. PAX9 is another gene important to tooth development, and mutations in this gene have been associated with dental anomalies, including hyperdontia. PAX9 is involved in the formation of molar teeth, and disruptions in its function can lead to extra molars or changes in tooth morphology. [7]

The formation of teeth begins during embryonic development and is a process that is highly regulated by various signaling pathways, which, if disrupted as a result of genetic mutations or environmental factors, can lead to developmental anomalies, including hyperdontia. Tooth development begins with the formation of tooth buds in the jaw. The dental lamina is a band of tissue in the developing oral cavity that gives rise to tooth buds. Hyperactivity of the dental lamina, as well as disruption of the differentiation and morphogenesis stages of tooth development, can lead to the formation of extra tooth buds, which can develop into supernumerary teeth. [8] Furthermore, some developmental syndromes or medical conditions may also result in hyperdontia. For instance, cleidocranial dysplasia (CCD) is a genetic disorder that affects skeletal and dental development and is associated with the presence of supernumerary teeth. Trauma or injury to the oral cavity, particularly during tooth development, also has the potential to trigger the formation of supernumerary teeth because it disrupts normal tooth development. [8] Occasionally, additional teeth may also arise from developmental anomalies like fusion or gemination. Fusion occurs when two tooth buds fuse together, creating a single, larger tooth. Gemination involves the incomplete division of a single tooth bud into two teeth. In some cases, these anomalies may take the form of the appearance of extra teeth.

Evolutionarily, hyperdontia can be seen as a result of genetic variation. Although extra teeth may be a maladaptive trait in modern humans due to potential dental issues and crowding, whether individuals with supernumerary teeth have a benefit or disadvantage is unknown. In the context of human evolutionary history, dental care was virtually nonexistent, meaning that there was no way to address dental issues such as tooth decay, infection, or loss of teeth. Therefore, individuals with supernumerary teeth may have been better equipped to cope with dental problems, for the loss of necessary teeth could be alleviated by having extra teeth present so that chewing and processing food remained possible. [9] Furthermore, ancestral diets were often tougher and required more extensive chewing, meaning that being in the possession of extra teeth could help to facilitate the consumption of fibrous plant material and raw foods.

Hyperdontia is seen in a number of disorders, including Gardner's syndrome and cleidocranial dysostosis, where multiple supernumerary teeth develop. [10] [11]

Other associated conditions are: Cleidocranial dysplasia, Ehlers–Danlos syndrome Type III, Ellis–van Creveld syndrome, Gardner's syndrome, Goldenhar syndrome, Hallermann–Streiff syndrome, Orofaciodigital syndrome type I, Incontinentia pigmenti, Marfan syndrome, Nance–Horan syndrome, and Tricho-rhino-phalangeal syndrome Type 1.

Diagnosis

X-ray showing supernumerary teeth in the premaxillary area Supernumerary teeth.jpg
X-ray showing supernumerary teeth in the premaxillary area

Supernumerary teeth may be detected by taking two different dental X-rays at different angles. Examples of this may be an intra-oral X-ray (one that is taken inside the mouth) and a panoramic radiograph. However, these X-rays are 2D and therefore do not accurately portray the 3D view of the teeth. [2]

Types

Dental stone model showing mesiodens and accessory tooth behind right central incisor Mesiodens Accessory Teeth.jpg
Dental stone model showing mesiodens and accessory tooth behind right central incisor

Supernumerary teeth can be classified by shape and by position. The shapes include the following:

When classified by position, a supernumerary tooth may be referred to as a mesiodens, a paramolar, or a distomolar. [12] Occasionally, these teeth do not erupt into the oral cavity but manifest as a malocclusion. [13]

The most common supernumerary tooth is a mesiodens, which is a malformed, peg-like tooth that occurs between the maxillary central incisors.

Fourth and fifth molars that form behind the third molars are another kind of supernumerary teeth.[ citation needed ]

Treatment

Although these teeth are usually asymptomatic and pose no threat to the individual, they are often extracted for aesthetic reasons, to allow the eruption of other teeth, orthodontic reasons and/or suspected pathology. This is done particularly if the mesiodens is positioned in the maxillary central incisor region. The traditional method of removal is done by using bone chisels, although a more advanced technique has been found to be more beneficial, especially if surgery is required. Through the use of piezoelectricity, piezoelectric ultrasonic bone surgery may be more time-consuming than the traditional method but it seems to reduce the post-operative bleeding and associated complications quite significantly. [14]

Epidemiology

It is evident that hyperdontia is more common in the permanent dentition than in the primary. There is a considerable difference between males and females in the prevalence of these teeth in permanent dentition; hyperdontia is twice as common in males as in females. However, this approximation varies in terms of location, other associating syndromes that may be present, and the ethnicity of the individual. In terms of ethnicity, it can be seen that hyperdontia is in fact less common in European than in Asian populations. [1] There is evidence to show that an individual is more likely to have hyperdontia if other members of their family also have the condition. [2]

Famous people with hyperdontia

The actor Gaten Matarazzo had hyperdontia [15] but underwent surgery to remove his extraneous teeth.

David DeVore Jr. gained internet fame after being filmed after removing a supernumerary tooth at the dentist.

Kalpana Balan, an Indian woman entered Guinness World Records for having the most teeth in a human mouth. [16]

Historical mentions

Timarchos (either son or father or father of Nicocles of Paphos) is said to have had "a double row of cheek-teeth."

The daughter of Mithridates VI, Drypetina, is said to have a double row of teeth.

Agrippina the Younger sister of Caligula and wife of Claudius is said to have had a double canine in her right upper jaw, something that was seen as a sign of good fortune by the Romans.

The semi-mythological Emperor Ku is attributed with this condition. [17]

One of the Great Peacemaker's names is "Deganawidah," which has been translated by some to mean "Double Row of Teeth."

Realdo Colombo, a 16th-century physician, mentioned in his writings that one of his sons, Phoebus, had "a treble row of teeth" [18]

Louis XIII had a double row of teeth in one of his jaws, which impacted his speech.

Fabian Fournier, a 19th-century Canadian lumberjack (who is said to have inspired the American folklore figure Paul Bunyan)

William Morgan (an anti-mason who was found dead under suspicious circumstances) was identified by his wife, as she recognized the body by his having "double teeth all around" [19]

Freddie Mercury of Queen had four extra teeth in his upper jaw. He was self-conscious of this, so he often covered them up with his lip or hand, and by growing a mustache. Mercury refused to correct his alignment issue because he believed it contributed to his incredible singing range and that correcting his teeth would negatively affect his voice.

Peter Steele is said to have had hyperdontia.

Folklore and mythology

A poem by ancient Greek poet Ion describe the hero Heracles as having three rows of teeth. [20]

Len Linfhiaclach (lit. "Len of the Many Teeth"), a goldsmith who lived about the year 300, is the subject of Gaelic text Dindseanchas

Tukwishhemish is a character from a Cahuilla folk tale, a beautiful woman who smiled but never laughed on account of her having double rows of teeth in her upper jaw. [21]

Witches in certain parts of Estonia are said to be able to be recognized by having unusual teeth including double rows of teeth, giving rise to their being called hambamees (lit. "tooth-man"); so as well can the Slavic upyr be recognized by its double rows of teeth.

Literature

"A Legend of MacAlister More" (1828) features the character of Duncan Roy or "Duncan Roy tda reugh cachghlin" or "Red Duncan of the two rows of teeth." [22]

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

Hypodontia is defined as the developmental absence of one or more teeth excluding the third molars. It is one of the most common dental anomalies, and can have a negative impact on function, and also appearance. It rarely occurs in primary teeth and the most commonly affected are the adult second premolars and the upper lateral incisors. It usually occurs as part of a syndrome that involves other abnormalities and requires multidisciplinary treatment.

<span class="mw-page-title-main">Dental lamina</span>

The dental lamina is a band of epithelial tissue seen in histologic sections of a developing tooth. The dental lamina is first evidence of tooth development and begins at the sixth week in utero or three weeks after the rupture of the buccopharyngeal membrane. It is formed when cells of the oral ectoderm proliferate faster than cells of other areas. Best described as an in-growth of oral ectoderm, the dental lamina is frequently distinguished from the vestibular lamina, which develops concurrently. This dividing tissue is surrounded by and, some would argue, stimulated by ectomesenchymal growth. When it is present, the dental lamina connects the developing tooth bud to the epithelium of the oral cavity. Eventually, the dental lamina disintegrates into small clusters of epithelium and is resorbed. In situations when the clusters are not resorbed, eruption cysts are formed over the developing tooth and delay its eruption into the oral cavity. This invagination of ectodermal tissues is the progenitor to the later ameloblasts and enamel while the ectomesenchyme is responsible for the dental papilla and later odontoblasts.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Permanent teeth</span> Second set of teeth in diphyodont mammals

Permanent teeth or adult teeth are the second set of teeth formed in diphyodont mammals. In humans and old world simians, there are thirty-two permanent teeth, consisting of six maxillary and six mandibular molars, four maxillary and four mandibular premolars, two maxillary and two mandibular canines, four maxillary and four mandibular incisors.

Cleidocranial dysostosis (CCD), also called cleidocranial dysplasia, is a birth defect that mostly affects the bones and teeth. The collarbones are typically either poorly developed or absent, which allows the shoulders to be brought close together. The front of the skull often does not close until later, and those affected are often shorter than average. Other symptoms may include a prominent forehead, wide set eyes, abnormal teeth, and a flat nose. Symptoms vary among people; however, intelligence is typically unaffected.

<span class="mw-page-title-main">Anodontia</span> Medical condition

Anodontia is a rare genetic disorder characterized by the congenital absence of all primary or permanent teeth. It is divided into two subsections, complete absence of teeth or only some absence of teeth. It is associated with the group of skin and nerve syndromes called the ectodermal dysplasias. Anodontia is usually part of a syndrome and seldom occurs as an isolated entity. There is usually no exact cause for anodontia. The defect results in the dental lamina obstruction during embryogenesis due to local, systemic and genetic factors.

Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth. This disturbance is more likely to affect the maxillary incisors and occurs in permanent dentition. Although this may seem more of an aesthetics issue, an impacted maxillary incisor will cause issues related to occlusion, phonetics, mastication, and psychology on young patients.

<span class="mw-page-title-main">Tooth fusion</span> Medical condition

Tooth fusion arises through union of two normally separated tooth germs, and depending upon the stage of development of the teeth at the time of union, it may be either complete or incomplete. On some occasions, two independent pulp chambers and root canals can be seen. However, fusion can also be the union of a normal tooth bud to a supernumerary tooth germ. In these cases, the number of teeth is fewer if the anomalous tooth is counted as one tooth. In geminated teeth, division is usually incomplete and results in a large tooth crown that has a single root and a single canal. Both gemination and fusion are prevalent in primary dentition, with incisors being more affected.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

Tooth gemination is a dental phenomenon that appears to be two teeth developed from one. There is one main crown with a cleft in it that, within the incisal third of the crown, looks like two teeth, though it is not two teeth. The number of the teeth in the arch will be normal.

<span class="mw-page-title-main">Talon cusp</span> Rare dental anomaly resulting in teeth having more than one cusp

Talon cusp is a rare dental anomaly resulting in an extra cusp or cusp-like projection on an anterior tooth, located on the inside surface of the affected tooth. Sometimes it can also be found on the facial surface of the anterior tooth.

<span class="mw-page-title-main">Tooth eruption</span> Process in tooth development

Tooth eruption is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligament plays an important role in tooth eruption. The first human teeth to appear, the deciduous (primary) teeth, erupt into the mouth from around 6 months until 2 years of age, in a process known as "teething". These teeth are the only ones in the mouth until a person is about 6 years old creating the primary dentition stage. At that time, the first permanent tooth erupts and begins a time in which there is a combination of primary and permanent teeth, known as the mixed dentition stage, which lasts until the last primary tooth is lost. Then, the remaining permanent teeth erupt into the mouth during the permanent dentition stage.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

<span class="mw-page-title-main">Overjet</span> Medical condition

Overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Enamel hypoplasia</span> Medical condition

Enamel hypoplasia is a defect of the teeth in which the enamel is deficient in quantity, caused by defective enamel matrix formation during enamel development, as a result of inherited and acquired systemic condition(s). It can be identified as missing tooth structure and may manifest as pits or grooves in the crown of the affected teeth, and in extreme cases, some portions of the crown of the tooth may have no enamel, exposing the dentin. It may be generalized across the dentition or localized to a few teeth. Defects are categorized by shape or location. Common categories are pit-form, plane-form, linear-form, and localised enamel hypoplasia. Hypoplastic lesions are found in areas of the teeth where the enamel was being actively formed during a systemic or local disturbance. Since the formation of enamel extends over a long period of time, defects may be confined to one well-defined area of the affected teeth. Knowledge of chronological development of deciduous and permanent teeth makes it possible to determine the approximate time at which the developmental disturbance occurred. Enamel hypoplasia varies substantially among populations and can be used to infer health and behavioural impacts from the past. Defects have also been found in a variety of non-human animals.

<span class="mw-page-title-main">Maxillary lateral incisor agenesis</span>

Maxillary lateral incisor agenesis (MLIA) is lack of development (agenesis) of one or both of the maxillary lateral incisor teeth. In normal human dentition, this would be the second tooth on either side from the center of the top row of teeth. The condition is bilateral if the incisor is absent on both sides or unilateral if only one is missing. It appears to have a genetic component.

<span class="mw-page-title-main">Otodental syndrome</span> Medical condition

Otodental syndrome, also known as otodental dysplasia, is an exceptionally rare disease that is distinguished by a specific phenotype known as globodontia, that in rare cases can be associated with eye coloboma and high frequency hearing loss. Globodontia is an abnormal condition that can occur in both the primary and secondary dentition, except for the incisors which are normal in shape and size. This is demonstrated by significant enlargement of the canine and molar teeth. The premolars are either reduced in size or are absent. In some cases, the defects affecting the teeth, eye and ear can be either individual or combined. When these conditions are combined with eye coloboma, the condition is also known as oculo-otodental syndrome. The first known case of otodental syndrome was found in Hungary in a mother and her son by Denes and Csiba in 1969. Prevalence is less than 1 out of every 1 million individuals. The cause of otodental syndrome is considered to be genetic. It is an autosomal dominant inheritance and is variable in its expressivity. Haploinsufficiency in the fibroblast growth factor 3 (FGF3) gene (11q13) has been reported in patients with otodental syndrome and is thought to cause the phenotype. Both males and females are equally affected. Individuals diagnosed with otodental syndrome can be of any age; age is not a relevant factor. Currently there are no specific genetic treatments for otodental syndrome. Dental and orthodontic management are the recommended course of action.

References

  1. 1 2 3 Pathology of the Hard Dental Tissues[ full citation needed ]
  2. 1 2 3 4 R. S. Omer, R. P. Anthonappa, and N. M. King, "Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth," Pediatric Dentistry, vol. 32, no. 1, pp. 14–20, 2010.
  3. ↑ He, Dongmei; Mei, Li; Wang, Yan; Li, Jialing; Li, Huang (2017). "Association between maxillary anterior supernumerary teeth and impacted incisors in mixed dentition". The Journal of the American Dental Association. 148 (8): 595–603. doi:10.1016/j.adaj.2017.05.017. PMID   28754185.
  4. ↑ Pereira, Marilia Nalon; De Almeida, Luiz Eduardo; Martins, Marcelo Tarcísio; Da Silva Campos, Marcio José; Fraga, Marcelo Reis; Vitral, Robert Willer Farinazzo (2011). "Multiple hyperdontia: Report of an unusual case". American Journal of Orthodontics and Dentofacial Orthopedics. 140 (4): 580–584. doi:10.1016/j.ajodo.2010.02.038. PMID   21967947.
  5. ↑ Vahid-Dastjerdi, Elaheh; Borzabadi-Farahani, Ali; Mahdian, Mina; Amini, Nazila (2010). "Supernumerary teeth amongst Iranian orthodontic patients. A retrospective radiographic and clinical survey". Acta Odontologica Scandinavica. 69 (2): 125–128. doi:10.3109/00016357.2010.539979. PMID   21142585.
  6. ↑ Fleming, P. S; Xavier, G. M; Dibiase, A. T; Cobourne, M. T (2010). "Revisiting the supernumerary: The epidemiological and molecular basis of extra teeth". BDJ. 208 (1): 25–30. doi: 10.1038/sj.bdj.2009.1177 . PMID   20057458.
  7. 1 2 3 4 5 Cakan, Derya Germec, et al. (2013). “The genetic basis of dental anomalies and its relation to Orthodontics.” European Journal of Dentistry, doi : 10.4103/1305-7456.119092
  8. 1 2 Lu, Xi, et al. “The epidemiology of supernumerary teeth and the associated molecular mechanism.” Organogenesis, doi : 10.1080/15476278.2017.1332554.
  9. ↑ Subasioglu, Aslı, et al. (2015). “Genetic background of supernumerary teeth.” European Journal of Dentistry, doi : 10.4103/1305-7456.149670
  10. ↑ "Gardner syndrome – About the Disease – Genetic and Rare Diseases Information Center". rarediseases.info.nih.gov. Retrieved 2022-11-02.
  11. ↑ "Cleidocranial dysplasia – About the Disease – Genetic and Rare Diseases Information Center". rarediseases.info.nih.gov. Retrieved 2022-11-02.
  12. 1 2 Oxford Handbook of Clinical Dentistry[ full citation needed ]
  13. ↑ Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis and Management, Volume 1
  14. ↑ Gao, Yongbo; Lin, Zhenyan; Rodella, Luigi Fabrizio; Buffoli, Barbara; Wu, Xifeng; Zhou, Yanmin (2014). "Piezoelectric ultrasonic bone surgery system in the extraction surgery of supernumerary teeth". Journal of Cranio-Maxillofacial Surgery. 42 (8): 1577–82. doi:10.1016/j.jcms.2014.04.007. PMID   24942094.
  15. ↑ "'Stranger Things' star Gaten Matarazzo says surgery to remove extra teeth was a success". NBC News. 2020-02-01. Retrieved 2023-12-09.
  16. ↑ "Indian mother sets world record for having the most teeth". guinessworldrecords.com.
  17. ↑ Standaert, Nicolas (2016-05-18). The Intercultural Weaving of Historical Texts: Chinese and European Stories about Emperor Ku and His Concubines. BRILL. ISBN   978-90-04-31622-5.
  18. ↑ Collins, Samuel (1685). A Systeme Of Anatomy, Treating Of the Body of Man, Beasts, Birds, Fish, Insects, and Plants: ... And After Every Part of Man's Body Hath Been Anatomically Described, Its Diseases, Cases, and Cures are Concisely Exhibited. Containing the Parts of the Lowest Apartiment of the Body of Man and other Animals, &c. Thomas Newcomb.
  19. ↑ Weed, Thurlow (1882). The Facts Stated: Hon. Thurlow Weed on the Morgan Abduction. A Document for the People. National Christian Association.
  20. ↑ Kanner, Leo (1968). Folklore of the Teeth. Singing Tree Press.
  21. ↑ PhD, Patricia Monaghan (2014-04-01). Encyclopedia of Goddesses and Heroines. New World Library. ISBN   978-1-60868-218-8.
  22. ↑ Froude, James Anthony; Tulloch, John (1830). Fraser's Magazine for Town and Country. G. W. Nickisson.
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