Ch. 3 - Acquired and Developmental Disturbances of the Teeth and Associated Oral Structures

Question 1

What is the single most common chronic childhood disease?

Answer 1

Dental caries

Question 2

Define Incidence

Answer 2

refers to the occurrence of a new case of disease or injury in a population over a specified time period

Question 3

Define Prevalence

Answer 3

the proportion of persons in a population who have a disease at a specified point in time or over a specified time period of time; includes all cases

Question 4

How many children in the U.S. are born with cleft lip and palate?

Answer 4

Every 1 in 1000

Question 5

What is cleft lip with or without palate caused by?

Answer 5

Failure of the maxillary first branchial arch to complete fusion with the frontonasal process in early gestation (4th to 12th week)

Question 6

what is an alveolar abscess associated with?

Answer 6

pulpal necrosis

Question 7

What percentage of pre-eruptive caries can you see on a BW and PAN?

Answer 7

BW - 2%, PAN - 0.5%

Question 8

what’s another name for pre-eruptive caries?

Answer 8

Pre-eruptive coronal resorption or pre-eruptive intracoronal radiolucency

Question 9

Impacted teeth or teeth delayed in eruption may be at higher risk for developing what kind of lesions?

Answer 9

pre-eruptive caries lesions

Question 10

What are the charactersitics of taurodontism?

Answer 10

the body of the tooth enlarges at the expense of the roots; the pulp chamber is elongated and extends deeply into the region of the roots

Question 11

What is seen as an isolated trait in individuals with syndromes such as tricho-dento-osseous syndrome, otodental dysplasia, and X-chromosome aneuploidies?

Answer 11

taurodontism

Question 12

What stage is taurodontism an anomaly in?

Answer 12

morphodifferentiation

Question 13

Dentinogenesis imperfecta is an anomaly in which stage?

Answer 13

histodifferentiation

Question 14

What is the prevalence of the dentinogenesis imperfecta trait?

Answer 14

every 1:8000

Question 15

The anomaly of DI may be seen in which condition?

Answer 15

osteogenesis imperfecta

Question 16

Characteristics of (Shields) type I dentinogenesis imperfecta

Answer 16

with osteogenesis imperfecta

Question 17

Characteristics of (Shields) type II dentinogenesis imperfecta

Answer 17

DI as an isolated incident

Question 18

Characteristics of (Shields) type III dentinogenesis imperfecta

Answer 18

Shell like teeth, multiple pulp exposures; without OI; In this condition, normal dentin formation is confined to a thin layer next to the enamel and cementum, followed by a layer of disorderly dentin containing a few tubules. The roots of shell teeth are short, and the primary teeth may be exfoliated prematurely.

Question 19

the clinical picture of dentinogenesis imperfecta

Answer 19

primary and permanent teeth are a characteristic reddish-brown to blue-gray opalescent color

Question 20

What’s another name for Dentinogenesis Imperfecta?

Answer 20

Hereditary Opalescent Dentin

Question 21

What do you see in DI soon after the primary dentition is complete?

Answer 21

Soon after the primary dentition is complete, enamel is worn and often breaks away from the incisal edges of anterior teeth and the occlusal surfaces of posterior teeth. The exposed soft dentin abrades rapidly, occasionally to the extent that the smooth, polished dentin surface is continuous with the gingival tissue

Question 22

What is seen on radiographs of patients with DI? What happens to the pulp over time?

Answer 22

Radiographs show slender roots and bulbous crowns. The pulp chamber is large initially and undergoes obliteration. Periapical rarefaction in the primary dentition is observed only occasionally

Question 23

characteristics of dentinogenesis imperfecta in permanent teeth

Answer 23

Slender roots with ribbon-like pulp canals and bulbous crowns are characteristic of dentinogenesis imperfecta. The primary molars show periapical rarefaction. Root fractures are common in older patients.

Teeth are reddish brown to blue gray
Enamel worn and breaks away from incisal and occlusal surfaces
Dentin may be continuous with gingiva
Slender root 
Bulbous crowns, obliterated pulp

Question 24

Treatment plan for patients with DI?

Answer 24

The placement of stainless steel crowns on primary posterior teeth. Full-coverage restorations may be placed on the permanent teeth if the crowns need protection in late adolescence or young adulthood. Bonded veneer restorations on anterior teeth have also been used successfully for aesthetic improvement in patients with dentinogenesis imperfecta when full-coverage restorations are unnecessary. Unfortunately, the long-term prognosis of these teeth is poor, and, despite best efforts, they are usually lost in early adulthood. Teeth with periapical rarefaction and root fracture should be removed.

Question 25

What is dentin dysplasia?

Answer 25

Dentin dysplasia is a rare disturbance of dentin formation

Question 26

what are the two types of dentin dysplasia?

Answer 26

radicular dentin dysplasia (type I) and coronal dentin dysplasia (type II)

Question 27

radicular dentin dysplasia (type I)

Answer 27

Primary and permanent dentition affected
Short, pointy roots
Root canals, pulp chambers absent
Chevron-shaped remnant in crown
Crowns opalescent blue or brown

Question 28

coronal dentin dysplasia (type II)

Answer 28

Primary teeth opalescent
Obliterated pulp chambers
Permanent teeth-normal color, thistle tube pulp configuration with pulp stones

Question 29

What stage is dentin dysplasia an anomaly in?

Answer 29

Dentin Dysplasia- Anomaly in apposition stage

Question 30

Dentin Dysplasia is inherited as what kind of trait?

Answer 30

DD is inherited as an autosomal-dominant trait

Question 31

amelogenesis imperfecta affects what dentition?

Answer 31

primary and permanent dentitions

Question 32

what is the prevalence of AI?

Answer 32

1-14,000 to 1-16,000

Question 33

what are the three types of AI?

Answer 33

3 types: Hypocalcified, hypomaturation, hypoplasatic

Question 34

what does hypoplastic AI look like?

Answer 34

Hypoplastic- thin enamel with spacing btwn adjacent teeth giving rise to pits;

Enamel matrix imperfectly formed
Hard enamel
Defective in amount
Roughened, pitted surface

Question 35

what does hypomineralized AI look like?

Answer 35

Hypomineralized- soft, poorly formed enamel with altered color and translucency

Matrix formation normal
Calcification deficient
Soft enamel

Question 36

what stage(s) can AI be an anomaly in?

Answer 36

Anomaly in apposition, mineralization, maturation, histodifferentiation stage

Question 37

treatment for AI?

Answer 37

Full coverage crowns

Veneers

Question 38

Odontogenesis Imperfecta, Enamel and Dentin Aplasia

Answer 38

Characteristics of both AI and DI
Primary teeth- no enamel, reddish-brown enamel, pulp exposure, pulpal degeneration, large pulp chambers
Permanent teeth-thin, gray enamel, brown dentin on facial of incisors and permanent first molars
SSCs

Question 39

Anodontia

Answer 39

Complete failure of the permanent teeth to develop
NOTE: Natal teeth are present at birth
Isolated or part of syndrome
Anomaly in initiation stage
Isolated primary teeth are not affected, part of syndrome, ectodermal dysplasia

Question 40

What stage is anodontia an anomaly in?

Answer 40

Anomaly in initiation stage

Question 41

Hypodontia

Answer 41

Hypodontia-Agenesis of fewer than 6 teeth, not counting thirds

Question 42

Oligodontia

Answer 42

Oligodontia-when more than 6 permanent teeth do not develop

Question 43

What stages of the life cycle are hypodontia and oligodontia and anomaly in?

Answer 43

Anomaly in initiation, proliferation stage

Question 44

what are circumvallate papillae? where can they be found? and what purpose do they serve?

Answer 44

From 10 to 15 large circumvallate papillae may be found on the posterior border of the dorsum. These papillae have a blood supply and are the site of numerous taste buds.

Question 45

Fungiform (mushroom-shaped) papillae

Answer 45

may be distributed over the entire dorsum of the tongue; however, they are present in greater numbers at the tip and toward the lateral margins of the tongue. Inflammatory and atrophic changes occurring on the dorsum of the tongue may involve the vascularized fungiform papillae

Question 46

filiform papillae

Answer 46

The most numerous papillae of the tongue are the filiform papillae, which are thin and hairlike, and evenly distributed over the dorsal surface. The filiform papillae are without a vascular core, and their continuous growth is slight.

Question 47

foliate papillae

Answer 47

represent a fourth type and are arranged in folds along the lateral margins of the tongue; the taste sensation is associated with these papillae.

Question 48

Gemination

Answer 48

it represents an attempted division of a single tooth germ by invagination occuring during the proliferation stage of the growth cycle of the tooth, in which case the geminated tooth appears clinically as a bifid crown on a single root. can be seen in both primary and permanent teeth but it appears more frequently in primary teeth

Question 49

Fusion

Answer 49

union of two independently developing primary or permanent teeth. the condition is usually limited to anterior teeth and may show familial tendency. fused teeth with have separate pulp chambers and pulp canals. a frequent finding in fusion of primary teeth is the developmental absence of one of the corresponding permanent teeth

Question 50

concresence

Answer 50

fusion of teeth involving only cementum

Question 51

what is cherubism also known as?

Answer 51

Cherubism (Familial Fibrous Dysplasia)

Question 52

what is cherubism?

Answer 52

Cherubism is a rare childhood disease affecting jaw development. The children have “chubby” facies and upturned eyes, giving the condition its name. Cherubism is usually inherited as an autosomal-dominant trait, with somewhat reduced penetrance in females.

Question 53

Ramon syndrome

Answer 53

(cherubism, eye anomalies, epilepsy, mental deficiency, hypertrichosis, lack of growth, juvenile rheumatoid arthritis, and gingival fibromastosis).

Question 54

what are radiographic characteristics of cherubism and outcomes of the disease?

Answer 54

Characteristically there is a symmetric enlargement of the jaws that may be noted at an early age. Radiographically the condition presents multilocular areas of bone destruction (soap-bubble lesions) and thinning of the cortical plate ( Fig. 3-10 ). Teeth in the involved area may exfoliate prematurely because of the loss of support or root resorption or, in permanent teeth, because of interference in the development of roots. Spontaneous loss of teeth may occur, or the child may pull the teeth from the soft tissue. Developing permanent teeth are usually ectopic, being displaced by the growing lesion.

Question 55

what is acrodynia and what are its effects?

Answer 55

Acrodynia or pink disease results from the exposure of young children to minute amounts of mercury; ointments and medications are the usual sources of the mercury.
The clinical features of the disease include fever, anorexia, desquamation of the soles and palms (causing them to be pink), sweating, tachycardia, gastrointestinal disturbance, and hypotonia. The oral findings include inflammation and ulceration of the mucous membrane, excessive salivation, loss of alveolar bone, and premature exfoliation of teeth

Question 56

Hypophosphatemia (Familial or X-Linked Hypophosphatemic Rickets or Vitamin D–Resistant Rickets)

Answer 56

hypophosphatemia is the most common inherited abnormality of renal tubular transport. 19 Clinical features become evident in the second year of life and include short stature and bowing of the lower extremities in affected boys. Premature tooth exfoliation is sometimes also a feature. The inheritance pattern of the disease is usually X-linked dominant, and the disorder is twice as common in females as in males.

Question 57

Cyclic Neutropenia (Cyclic Hematopoiesis)

Answer 57

Cyclic neutropenia is an autosomal-dominant condition in which affected individuals are at risk for opportunistic infection during intervals of neutropenia that occur in a 21-day cycle concomitant with oscillation in bone marrow blood cell production. The condition may appear at any age, and numerous cases in children have been reported. The patients have fever, malaise, sore throat, stomatitis, and regional lymphadenopathy as well as headache, cutaneous infection, and conjunctivitis accompanying the neutropenia. Children exhibit severe gingivitis with ulceration. When the neutrophil count returns to normal, the gingiva may return to a nearly normal clinical appearance. Children experiencing repeated insults from the condition have a considerable loss of supporting bone around the teeth.

Question 58

conditions that may cause premature exfoliation of teeth

Answer 58

Premature exfoliation due to periodontal disease may be caused by quantitative neutrophil disorders or qualitative disorders, including acatalasia, Chédiak-Higashi syndrome, or leukocyte adhesion defect (LAD). Early loss of primary teeth is seen in other systemic conditions, such as Coffin-Lowry syndrome, Down syndrome, Ehlers-Danlos syndrome types IV and VIII, Hajdu-Cheney syndrome, hyperpituitarism, hyperthyroidism, juvenile diabetes, Papillon-Lefèvre syndrome, progeria, Singleton-Merten syndrome, Langerhans’ cell histiocytosis (see Chapter 28 ), and the leukemias

Question 59

Amelogenesis occurs in how many stages… and what happens?

Answer 59

Amelogenesis occurs in three stages. In the first stage, the enamel matrix is secreted by ameloblasts and in the second stage, it undergoes calcification; a final stage of enamel maturation, with crystal growth and removal of water and protein, continues until eruption. Local or systemic factors that interfere with normal matrix formation cause disorders of tooth quantity with enamel surface defects and irregularities termed enamel hypoplasia . Factors that interfere with calcification and maturation of the enamel and are disorders of quality are termed enamel hypocalcification .