Earlier this week, a seventeen year old boy from a village in western India underwent a seven hour surgery at Mumbai's JJ Hospital to remove 232 teeth from the right side of his lower jaw.

Over an 18 month period, Ashai Gavai experienced swelling on the right side of his lower jaw. About a month ago, the pain became so severe in his jaw that his parents had feared the worst – that their son had cancer. When village doctors were unable to determine the cause of the swelling and pain, Gavai's parents took him to Mumbai's JJ Hospital. Gavai was scheduled for surgery to have the tumor removed.

Ashai Gavai post surgery - 232 teeth on display - image courtesy of BBC.com

Once the surgeon opened the tumor, something unsuspected appeared. There were tiny pearl-like teeth and tooth fragments inside the tumor. The surgeon began to remove the teeth one by one, stopping at one point to use a chisel and hammer to remove fragments of a marble-like structure that had formed. The total amount of teeth removed – a whopping 232!

The tumor that had formed in Gavai's lower jaw is called a complex composite odontoma. An odontoma is a benign tumor composed of dental tissue – enamel, dentin, and cementum. A complex odontoma is characterized by the formation of enamel and dentin present in an abnormal pattern. The cause is due to the lack of normal morphodifferentiation.

Between the sixth and eight week of fetal development, our teeth begin to form. The process is characterized into 5 stages, one of which is referred to as the Bell stage. In this stage of tooth development, the teeth begin to take shape. The process is called morphodifferentiation. In Gavai's case, this process failed to take place normally.

Gavai's tumor was removed successfully and he has all 28 of his erupted teeth. However, there is a possibility that a tumor may develop again, especially if a tooth or any tooth fragments were left behind.