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BDS4 CDS Paeds > Dental anoamlies > Flashcards

Dental anoamlies Flashcards

1
Q

4 classes of dental anonamlies

A

number
size and shape
structure - hard tissue defects
eruption and exfoliation

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2
Q

hypodontia

A

missing teeth from normal sequence

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3
Q

teeth commonly affected by hypodontia

A

3rd molars: 9-37% of population have more than 1 missing

1.0.1-0.9% in the primary dentition

4.3.5-6.5% in the permanent dentition

mandibular premolars: 1.2-2.5% (5s)
maxillary lateral incisors: 1.0-2.0% (2s)

The teeth least likely to be missing are the first permanent molars and upper central incisors
*tends to be end of series *

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4
Q

conditions associated with hypodontia

A

Ectodermal Dysplasia (sparse hair, small nose, sweating)
Down Syndrome
Cleft Palate
Hurler’s syndrome
Incontinentia pigmentii

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5
Q

hypodontia dental management

in chronological order

A

Diagnosis
Removable prosthesis (waiting to grow, full permanent dentition)
Orthodontics
Composite build ups – inc size and shape
Porcelain veneers
Crowns, bridges and implants – need to wait for gingival margin settle, early/mid 20s

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6
Q

class of preventative tx need for hypodontia pts

A

high risk as less teeth
enhanced prevention needed throughout life

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7
Q

possible dental issues associated with hypodontia pts

A

submergence/infraocclusion of permanent teeth
deep overbite
spacing
issues with occlusion - reduced LFH
abnormal shape/form
* cone shaped teeth or straight sided can happen

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8
Q

hypodontia tx aims

3

A

prevention
aesthetics
function

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9
Q

commmon solutions/tx for hypodontia pts

A

overdentures
partial dentures
composite additions
porcelain veneers
fixed prosthodontics

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10
Q

example tx plan for hypodontia pt

A

Local fixed orthodontics to oppose central incisors, and composite build up
Overdenture – restore face height
Implants
Bone augmantation, sinus lift, distraction osteogenesis

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11
Q

hyperdontia/supernumerary

A

extra teeth to normal sequence

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12
Q

most common hyperdontia/supernumerary

A

1.5-3.5% prevalence
males:females 2:1
higher frequency in Japanese
more common in maxilla
higher frequency in cleidocranial dysplasia

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13
Q

types of supernumerary

4

A

Conical (cone shaped)
Tuberculate (barrel shaped, has tubercles)
Supplemental (looks like tooth of normal series)
Odontome (irregular mass of dental hard tissue, compound or complex)

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14
Q

most common cause of delayed eruption of permanent incisor teeth

A

supernumerary teeth

*Conical supernumerary
Central incisors are at immature stage so wouldn’t go in at this stage
Wait till child is 7/8 then remove extra teeth as root formation of 1s complete *

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15
Q

microdontia

A

smaller teeth than normal

2.5%
F>M

e.g. peg shaped lateral incisors

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16
Q

macrodontia

A

bigger teeth than normal

rare
less than 1% for single teeth and 0.1% in generalised form in Caucasians

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17
Q

double teeth

2 types

A

Gemination (one tooth splits into 2)

Fusion (two teeth join to form 1)

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18
Q

odontomes

A

anomalies in size and shape

odd dentine/enamel masses

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19
Q

taurodontism

A

flame shaped pulp, teeth look normal but risk pulp exposure in restorations

6.3% in UK

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20
Q

dilaceration

A

can be to crown or root

due to trauma or anomaly

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21
Q

accessory cusp

A

e.g. talon cusp

Selective grinding over time, Fluoride on
Encourage pulp to regress

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22
Q

dens in dente

A

tooth in tooth

invagination on tooth, seal areas to prevent bacteria ingress as not able to RCT and plaque trap

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23
Q

anomalies in root structure

A

short root anomaly
* permanent maxillary incisors
* 2.5% incidence
* 15% of these children also have short roots on the canines and premolars
* Danger for orthodontic tx

Causes
* radiotherapy
* dentine dysplasias
* accessory roots

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24
Q

3 enamel anomalies

A

amelogenesis imperfecta
environmental enamel hypoplasia
localised enamel hypoplasia

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25
Q

types of amelogenesis imperfecta

100s but 4 main

A

hypoplastic
hypocalcified
hypomaturational
mixed forms

26
Q

causes of environmental enamel hypoplasia

4

A

systemic (kidney/liver failure)
nutritional
metabolic e.g. Rhesus incompatability, liver disease
infection e.g. measles

27
Q

causes of localised enamel hypoplasia

2

A

trauma
infection to primary tooth

28
Q

hypomineralised enamel

A

all tooth tissue there
normal shape but have marks on them
correct thickness

29
Q

hypoplasitc enamel

A

chunks of enamel missing
mineralisation fine

30
Q

how to categorise hard tissue defects

A

localised/generalised

if generalised environental or hereditary
if localised - trauma or abscess/infection primary tooth

31
Q

tell tale sign generalised environmental enamel defect

A

can see lines on teeth from onset of the generalised environmental defect to stop, different on each tooth as form at different times

32
Q

example generalised enviornmental enamel defects

2

A

fluorosis

MIH associated with childhood illness or chronological hypomineralisation e.g. liver/kidney failure

33
Q

possible tx for fluorosis

generalised environmental enamel defect

A

Treat using microabrasion therapy/veneers/vital bleaching

Microabrasion remove surface layer so teeth will look more dull as dark and light parts removed – ensure pt aware

34
Q

generalised environmental enamel defects
3 times cause can happen

A

prenatal

neonatal

postnatal

35
Q

prenatal factors for generalised environmental enamel defects

A

rubella, congenital syphilis, thalidomide, Fluoride, maternal A&D deficiency, cardiac & kidney disease

36
Q

neonatal factors for generalised environmental enamel defects

A

prematurity
meningitis

37
Q

postnatal factors for generalised environmental enamel defects

A

otitis media, measles, chickenpox, TB, pneumonia, diphtheria, deficiency of Vits A,C&D. heart disease. Long term health problem e.g. organ failure

38
Q

example generlised hereditary enamel defect

A

amelogenesis imperfecta

39
Q

prevalance of amelogenesis imperfecta

A

1: 14,000

4 main types:
* Hypoplastic
* Hypomineralised
* Hypomaturation
* mixed with taurodontism

familial inheritance
* autosomal dominant, recessive, and x-linked
no associated systemic disorder (studies ongoing)

40
Q

5 parts of dx for amelogenesis imperfecta

A

family history

generally affects both dentitions (primary and permanent, worse in permanent)

affects all teeth

tooth size, structure, colour

radiographs
* fail to see change in radiolunceny between enamel and dentine

41
Q

enamel formation and genes

A

Enamel formation needs multiple genes to transcribe the process of crystal growth and mineralisation.

Gene mutations found so far, involve enamel extracellular matrix molecules amelogenin and enamelin and kallikrein 4

Hypoplastic type
* Enamel crystals do not grow to the correct length

Hypomineralised
* Crystallites fail to grow in thickness and width

Hypomaturational
* Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation

42
Q

dental problems in amelogenesis imperfecta

A

sensitivity
caries/ acid susceptibility - erosion
poor aesthetics (brown colour, white teeth with flecks, alike fluorosis)
poor oral hygiene
delayed eruption
anterior open bite

43
Q

solutions for dental problems in amelogensis imperfecta

A

preventive therapy
composite veneers/ composite wash (aid sensitivity)
fissure sealants
metal onlays
stainless steel crowns (replace at older age)
orthodontics (troublesome to bond to)

44
Q

systemic disorders associated with enamel defects (not amelogensis imperfecta)

8

A

epidermolysis bullosa
incontinenta pigmenti
Down’s
Prader-Willi
porphyria
tuberous sclerosis
pseudohypoparathyroidism
Hurler’s

45
Q

4 anomalies of dentine structure

A

dentinogenesis imperfecta
dentine dysplasia
odontodysplasia
systemic disturbance (nutritional, metabolic, drugs)

46
Q

dentine dysplasia

A

normal crown morphology, amber radiolucency, pulpal obliteration, short constricted roots

47
Q

odontodysplasia

A

localised arrest in tooth development, thin layers of enamel and dentine, large pulp chambers, “Ghost Teeth”

48
Q

dentinogenesis imperfecta

A

uncommon
3 types
* Type I osteogenesis imperfecta (issue with bone)
* Type II autosomal dominant (no underlying medical conditions)
* Brandywine

49
Q

type I dentinogenesis imperfecta

A

have osteogenesis imperfecta (issue with bone)
blue sclera of eye
teeth amber/translucent/grey

50
Q

dx dentiogenesis imperfecta

A

appearance
family history
associated osteogenesis imperfecta
both dentitions affected
enamel loss
radiography:
* bulbous crowns
* obliterated pulps (I & II)

Crowns look like primary teeth but roots are like adult
Pulps quickly become obliterated
Get occult abscess, impossible to tx due obliteration

51
Q

type III dentinogenesis imperfecta -Bradywine

A

Brandywine, Maryland, USA. – genetic defect in that area

52
Q

dental problems in dentinogenesis imperfecta

3

A

aesthetics
caries/acid susceptibilty
spontaneous abscess

53
Q

dental solutions to dentinogenesis imperfecta

5

A

prevention (enhanced)
composite veneers
overdentures –* cover vulnerable dentine *
removable prostheses
stainless steel crowns – varied success, but prevents wear

POOR PROGNOSIS

54
Q

hereditary dentine defects
limited to dentine only

3

A

dentinogenesis imperfecta type II
dentine dysplasia Types I & II
fibrous dysplasia of dentine

55
Q

hereditary dentine defects
associated with general disorder

5

A

osteogenesis imperfecta
Ehlers-Danlos syndrome
brachio-skeletal genital syndrome
rickets
hypophosphatasia

56
Q

tooth structure defects tx overview

A

prevention and pain control

harness growth

restoration of lost tissue

57
Q

overview of dental management

anomalies in paeds

A

continous dental care
management of growth and development

removable prosthesis
crowns and bridges
interceptive ortho

58
Q

anomalies of cementum

2

A

cleidocranial dysplasia
* hypoplasia of cellular component of cementum
* no clavicle

hypophosphatasia
* hypoplasia or aplasia of cementum
* early loss of primary teeth (nothing holding them into bone)

59
Q

premature eruption causes

3

A

high birth weight

precocious puberty

natal / neonatal teeth
* 1: 2000-3000 births
* Just early – try to get to stay as usually part of series
* But extract if issue with feeding or inhalation risk

60
Q

delayed eruption causes

4

A

pre-term & low birth-weight children

malnutrition

associated general conditions:
* Downs, hypothyroidism, hypopituitarism, cleidocranial dysplasia

gingival hyperplasia/ overgrowth

61
Q

premautre exfoliation causes

6

A

trauma
following pulpotomy
hypophosphatasia
immunological deficiency e.g. cyclic neutropaenia
Chediak-Higashi syndrome
Histiocytosis X

62
Q

delayed exfoliation causes

5

A

‘double’ primary teeth

Hypodontia – retain primary tooth

ectopic permanent successors

following trauma

infra-occlusion
* 1-9%, m=f, lower 1st primary molar most common
* congenital absence of premolar
* the majority exfoliate normally by age 11-12 yrs

BDS4 CDS Paeds (3 decks)

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