Anomalies pt 2

Question 1

MIH - what teeth must it affect for diagnosis? what appear on teeth? where to lesion start/progress? how does colour of lesion change from deeper to more superficial?

Answer 1

must affect at least 1 first permanent molar
well demarcated lesions - white, cream to brown
lesion start in inner aspect of enamel and work outwards

more superficial lesions are whiter, browner lesions further into enamel

Question 2

what does hypomineralised enamel mean? what is it prone to? how do bond strengths differ?

Answer 2

right quantity of enamel but defect in quality - softer enamel prone to post eruptive breakdown

poorer bond strengths

Question 3

when should first permanent molars be XLA’d in MIH? what will this allow?

Answer 3

8-10yrs
space will spontaneously close w/ 7s erupting in (7s erupt around 11-13yrs)

Question 4

what will happen if 6s XLA’d too early or too late?

Answer 4

too early = 7s will drift distally
too late = 7s will not close space as already erupted/partially erupted

Question 5

explain balancing and compensating XLA approach - what does each approach ensure?

Answer 5

balancing = take out contralateral tooth at same time - maintains midline

compensating = take out opposing tooth at same time as XLA - prevents overeruption

Question 6

how is LA affected in MIH teeth? what LA techniques are often required? possible resolution?

Answer 6

LA harder to achieve as inflamed pulp
buccal/palatal infiltration w/ articaine, IDB and intraligamentary often required

could do comp dressing of pulp to help settle down inflammation so easier to achieve LA at next appt

Question 7

what could be done to FPMs prior to XLA time to stabilise?

Answer 7

hall crown

Question 8

how do margins and caries resistance of white patches on fluorosis differ to MIH?

Answer 8

fluorosis show diffused patches - whereas MIH patches are well demarcated
fluorosis teeth caries resistant whereas MIH caries prone

Question 9

list 6 ways to manage MIH & fluorosis?

Answer 9

microabraison - removes white patches to match rest of teeth
bleaching - matches normal tooth to whiter patches
resin infiltration
localised comps on lesions
veneers

Question 10

is amelogeneis imperfecta caused by genetic or environmental factors? how does this differ from MIH/fluorisis?

Answer 10

completely genetic - no environemntal factors (unlike MIH & fluorosis)

Question 11

name 3 types of AI - explain appearance

Answer 11

hypomaturation - enamel thinner and less dense/hypomineralised/pitted
hypoplastic - normal strength but not right shape (thin or absent enamel)
hypocalcified - enamel contains less calcium so thinner and weaker

Question 12

what type of AI is associated w/ taurodontism?

Answer 12

hypomature enamel

Question 13

give differing physical differences in the types of AI

Answer 13

hypomature - snow capped (white/brown striations), mottled/spotted/pitted

hypoplastic - not right size/shape but normal hardness, may be sensitive due to thin/absent enamel

hypocalcified - discoloured, opaque, chalky, extremely sensitive

Question 14

chronological enamel hypoplasia - cause? presentation of enamel?

Answer 14

caused by environmental factor

thin or absent enamel - teeth look yellow

Question 15

what is a turner tooth? what are they prone to? clinically present as?

Answer 15

permanent tooth that has been affected by infection or insult to primary tooth

prone to post eruptive breakdown and caries
may be sensitive

Question 16

hypolasia/hypoplastic definition - how does this affect bond strength?

Answer 16

underdevelopment or absence of tissue - normal bond strength

Question 17

list 4 dentine defects

Answer 17

dentinogenesis imperfecta - pulp absent, bulbous crowns
dentine dysplasia - short roots, extreme mobility
hypophosphatemia rickets - spontaneous abcesses
intrinsic staining

Question 18

Dentinogenesis Imperfecta - how do teeth present?

Answer 18

funny shape
short thin roots
normal enamel - but shearing off of enamel due to poor bond between enamel and dentine
looks worse in primary teeth as enamel usually thinner
teeth are brown/orange

Question 19

what occurs in teeth with dentogenesis imperfecta? how does pulp respond after sclerosis? what can present if pulp stays massive? how do teeth look on radiograph?

Answer 19

enormous pulp, rapid secondary dentine laid down to shrink and sclerose pulp
teeth therefore have low pulpal inflamm. response and hardly get painful
lots of spontaneous abcesses if pulp stays enormous

bulbous crowns, no pulp, cevrical constriction so crowns eventually ping off

Question 20

management for DI

Answer 20

aesthetic management
cuspal coverage
MCC if attrtion to prevent pulp exposure

Question 21

dentine dysplasia - how do teeth appear clinically? consequence to teeth? how do teeth appear radiographically?

Answer 21

normal enamel
atypical dentine formation w/ abnormal pulp morphology
teeth appear normal in appearance and colour
bur extreme mobility and often exfoliated prematurely

Question 22

how do teeth W/ dentine dysplasia present on radiograph?

Answer 22

pulp chamber does not extend down roots

Question 23

hypophosphatemia rickets (XLH) - clinical presentation? what causes this?

Answer 23

spontaneous abcesses
caused by larger pulps and pulp horns extending to the ADJ

Question 24

intrinsic staining - what may this be caused by?

Answer 24

tetracycline

Question 25

how should intrinsic staining be managed? how may caries diagnosis in these teeth be aided?

Answer 25

may not respond to bleaching - so direct comp veneers in kids/traditional veneers in adults

consider BW interval - harder to diagnose caries clinically

Question 26

name a disorder of cementum - how does this condition affect the body?

Answer 26

hypophosphatasia - endocrine disorder affecting the skeleton

skeletal deformaties, restricted growth, fractures, bone pain

Question 27

how does hypophosphatasia affect teeth? in what order do the teeth fall out? which teeth first?

Answer 27

fully rooted teeth fall out
cementum does not form properly and is patchy - not covering whole root
teeth will fall out in eruption pattern - lower 1s first

Question 28

what is odontohypophosphatasia?

Answer 28

hypophosphatasia with only dental features

Question 29

what is regional odontodysplasia?

Answer 29

mixed tooth structure disorder

segment of the arch does not form properly
disorder does not cross midline
more common in maxilla

Question 30

how does regional odontodysplasia present?

Answer 30

unerupted teeth
may be alveolar expansion
teeth that do erupt have abnormal shape, size and mineralisation