2 - Dental anomalies Flashcards
What are the dental anomalies of number?
- hypodontia
- hyperdontia/supernumerary
What is hypodontia?
- failure of development of teeth
- more common in permanent dentition
What are the most common teeth to be involved in hypodontia?
- mandibular premolars
- maxillary lateral incisors
Which teeth are least likely to be missing?
- FPM
- maxillary central incisors
What is a Celtic canine?
Hypodontia of upper canines commonly found in Scotland and Ireland
What conditions are associated with hypodontia?
- ectodermal dysplasia
- down syndrome
- cleft palate
- Hurler’s syndrome
- Incontinentia pigmentii
What are treatment options for hypodontia?
- RRB
- overdentures
What is the chronology of dental management of hypodontia?
- diagnosis
- removable prothesis (if required)
- orthodontics
- composite build ups
- porcelain veneers/crowns and bridges
At what age can permanent indirect restorations be placed?
- early 20s
- gingival level can change up until this age so margins of restorations may be visible if done prior
What problems are associated with hypodontia?
- abnormal shape and form
- spacing
- infraocclusion
- deep overbite
- reduced LAFH
What are the different types of supernumerary teeth?
- conical
- tuberculate
- supplemental
- odontome
Describe a conical supernumerary tooth.
Cone shaped
Describe a tuberculate supernumerary tooth.
- barrel shaped
- can have tubercles
Describe a supplemental supernumerary tooth.
- looks like a tooth of the normal series
- often smaller
Describe a odontome supernumerary tooth.
- irregular mass of dental hard tissue
- compound or complex
What are the dental anomalies of shape and size?
- microdont
- macrodont
- double teeth (gemination)
- odontomes
- taurodontism
- dilaceration
- accessory cusps
What is a common microdont?
Peg shaped lateral incisors
What is a talon cusp?
- accessory cusp
- can have pulp within the cusp
- requires selective grinding to encourage pulp to shrink back
What is dens en dente?
- invagination of tooth
- pulp within this area and can be exposed
- appears like there is a tooth within a tooth on radiograph
- must be sealed ASAP to prevent caries as very difficult to restore
What are the types of double tooth?
- gemination (one tooth splits into two)
- fusion (two teeth join to form one)
- can be hard to distinguish so refer to as double teeth
What is taurodontism?
- tooth appears normal
- has flame shaped pulp which makes pulpal exposure more common
What are the dental anomalies of structure associated with the roots?
- short roots
- radiotherapy
- dentine dysplasia
- accessory roots
Why is short root anomaly a concern?
Orthodontic treatment
What are the dental anomalies of structure associated with the enamel?
- amelogenesis imperfecta
- environmental enamel hypoplasia
- localised enamel hypoplasia
- hypomineralised enamel
What are the different types of amelogenesis imperfecta?
- hypoplastic
- hypocalcified
- hypomaturational
- mixed with taurodontism
What are the different causes of environmental enamel hypoplasia?
- systemic (kidney/liver disease)
- nutritional
- metabolic
- infection (eg measles)
What are the different types of localised enamel hypoplasia?
Permanent successors to
- traumatised primary teeth
- infected primary teeth
What permanent teeth are commonly affected by infection of primary teeth?
- premolars
- due to caries in primary molars
What permanent teeth are commonly affected by trauma to primary teeth?
Incisors
Give an example of environmental enamel defects.
- fluorosis
- MIH
How is fluorosis managed?
- microabrasion
- veneers
- vital bleaching
What prenatal factors can cause generalised environmental enamel defects?
- rubella
- congenital syphilis
- fluoride
- cardiac and kidney disease
What neonatal factors can cause generalised environmental enamel defects?
- prematurity
- meningitis
What postnatal factors can cause generalised environmental enamel defects?
- ear infection
- measles
- chickenpox
- TB
- pneumonia
- vitamin deficiencies
Describe the inheritance pattern of AI.
- autosomal dominant, autosomal recessive or X linked
- different variants across different continents
How do you diagnose AI?
- FH
- affects primary and permanent
- affects all teeth
- can affect size, structure and colour
- radiographs show radiolucency between enamel and dentine
Describe hypoplastic AI.
Enamel crystals do not grow to correct length
Describe hypomineralised AI.
Crystallites fail to grow in thickness and width
Describe hypomaturational AI.
Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
What problems are associated with AI?
- sensitivity
- caries
- poor aesthetics
- poor OH (due to sensitivity)
- delayed eruption
- AOB
What treatment options are there for AI?
- preventative therapy
- composite veneers/wash (for appearance and sensitivity)
- fissure sealants
- metal onlays
- SSC (used when young and can be replaced)
- orthodontics
What syndromes are associated with enamel defects?
- incontinenta pigmenti
- downs syndrome
- prader-willi
- porphyria
- Hurler’s syndrome
What are the dental anomalies of structure associated with dentine?
- dentinogenesis imperfecta
- dentine dysplasia
- odontodysplasia
- systemic disturbance
How does dentine dysplasia present?
- normal crown morphology
- amber radiolucency
- pulpal obliteration
- short constricted roots
How does odontodysplasia present?
- localised arrest in tooth development
- thin layers of enamel and dentine
- large pulp chambers
- “ghost teeth”
What can cause systemic disturbance to dentine?
- nutrition
- metabolic
- drugs
What are the 3 types of dentinogenesis imperfecta?
- type 1 (osteogenesis imperfecta)
- type 2 (autosomal dominant)
- Brandywine
How do you diagnose dentinogenesis imperfecta?
- appearance
- FH
- associated osteogenesis imperfecta
- affects primary and permanent
- radiographs show bulbous crowns, occult abscesses and obliterated pulps (types 1 and 2)
- enamel loss
How do children with osteogenesis imperfecta present?
- blue sclera of eye
- often wheelchair bound
- frequent fractures
What is an occult abscess?
Abscess without any demonstrable disease
What problems are associated with dentinogenesis imperfecta?
- aesthetics
- caries
- spontaneous abscess
- poor prognosis
What treatment options are available for dentinogenesis imperfecta?
- prevention
- composite veneers
- overdentures and removable prostheses
- SSC
What syndromes are associated with dentine defects?
- osteogenesis imperfecta
- Ehlers-Danlos syndrome
- rickets
- hypophosphatasia
What are the dental anomalies of structure associated with cementum?
- hypoplasia of cellular component (cleidocranial dysplasia)
- hypoplasia/aplasia of cementum (hypophosphatasia)
- early loss of primary teeth, due to nothing holding them to bone (hypophosphatasia)
What can cause premature eruption?
- high birth weight
- precocious puberty
What can cause delayed eruption?
- pre-term or low birth weight
- malnutrition
- associated syndromes
What syndromes are associated with delayed eruption?
- downs
- hypothyroidism
- hypopituitarism
- cleidocranial dysplasia
What can cause pseudo-delayed eruption?
- gingival hyperplasia/overgrowth
- teeth began eruption at correct time but have more/thicker tissue to move through
What is a consequence of XLA of natal or neonatal teeth?
- these teeth are teeth of the normal series
- these primary teeth will now be missing until permanent teeth erupt to replace them
What are causes of premature exfoliation?
- trauma
- following pulpotomy treatment
- hypophosphatasia
- immunological deficiency (eg cyclic neutropenia)
What are causes of delayed exfoliation?
- infraocclusion
- double primary teeth
- hypodontia
- ectopic permanent successors
- trauma
