A 3-year-old female Standardbred was admitted for evaluation of a firm swelling on the right side located rostral to the facial crest and a firm intraoral swelling located rostral to the erupted cheek teeth. Examination of skull radiographs revealed a supernumerary cheek tooth rostral to the erupted third premolar. The supernumerary tooth was removed via lateral buccotomy. The horse did not have complications after surgery and resumed racing. Lateral buccotomy should be considered for removal of rostrally located maxillary or mandibular cheek teeth. Supernumerary cheek teeth can be found in locations in the upper dental arcade, other than caudal to the last molar.