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DMD3 > Dental Anomalies 1 > Flashcards

Dental Anomalies 1 Flashcards

1
Q

What are the stages of tooth development?

A

Initiation

Bud stage

Cap stage

Bell stage

Dentinogenesis

Amelogenesis

Continued dentinogenesis/amelogenesis

Eruption

Mature

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2
Q

What happens during the bud stage?

A

Initiation with migration of neural crest cells into the arches

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3
Q

What happens during the cap stage?

A

Proliferation.

Condensation of ectoderm and formation of dental organ and dental papilla

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4
Q

What happens during the bell stage?

A

Morphodifferentiation: Proliferation of inner enamel epithelium to form the shape of the crown.

Histodifferentiation: Differentiation of precursor cells, ameloblasts, and odontoblasts.

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5
Q

What happens during crown formation?

A

Apposition: Reciprocal induction and laying down of mantle dentine and first enamel.

Calcification

Maturation: Enamel crystal formation

Eruption: Emergence of tooth and continued development of roots

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6
Q

What stage of maturation are the following anomalies associated with?

Supernumerary/hypodontia

Macrodontia/microdontia

Odontogenic cysts

Regional odontoplasia

Enamel hypomineralisation

Amelogenesis imperfecta

Enamel hypoplasia

Dentinogenesis imperfecta

Impacted teeth

A

Supernumerary/hypodontia: Bud stage (initiation)

Macrodontia/microdontia: Bell stage (morphodifferentiation)

Odontogenic cysts: Cap stage (Proliferation)

Regional odontoplasia: Bell stage (histodifferentiation)

Enamel hypomineralisation: Crown stage (maturation)

Amelogensis imperfecta: Crown stage (calcification)

Enamel hypoplasia: Crown (apposition stage)

Dentinogenesis imperfecta: Crown stage (calcification)

Impacted teeth: Crown stage (Eruption)

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7
Q

What is the difference between an anomaly and a trait?

A

An anomaly is a rare variant that occurs in any given population. (eg hyperdontia,

A trait is a variant exhibited by a significant number of people in a population such that it is considered a trait for the dentition of that population

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8
Q

What theories are out there about the possible causes of hyperdontia?

A

Causes remain unclear.

Various theories postulated:

Result of hyperactivity of dental lamina

Tooth germ dichotomy (split tooth germ): An imbalance between molecules = 2 part split of teeth.

Genetic predisposition

Environmental factors

Multifactorial, combination of environmental and genetic factors

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9
Q

How common is hyperdontia?

A

Prevalence is higher in permanent dentition (0.5 - 3.5%) than primary dentition (0.2 -0.8%)

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10
Q

Who more commonly gets hyperdontia?

A

Males > Females

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11
Q

Which areas are most commonly affected by hyperdontia?

A

Maxillary incisor region > mandibular premolars > maxillary molar region

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12
Q

What are the types of classifications of supernumerary teeth?

A

Location (mesiodens, paramolar, distomolar, parapremolar)

Morphology (conical tuberculate, supplemental (or eumorphic), odontome (can be simple or complex)

Orientation (Vertical or normal, inverted, or horizontal)

Position (Buccal, palatal or transverse)

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13
Q

What is the most common type of supernumerary tooth?

A

Mesiodens (“Most mesially invested tooth” “the lost incisor”)

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14
Q

Which conditions are associated with hyperdontia? (most important causes are mentioned first)

A

Cleidocranial dysplasia

Gardner syndrome (Familial adenomatous polyposis)

Cleft lip and palate

Nance-Horan syndrome

Tricho-Rhino-Phalangeal syndromes

Fabry Anderson’s syndrome

Ehlers-Danlos syndrome

Incontinentia pigmenti

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15
Q

What are odontomes?

A

A benign tumour linked to tooth development. Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way.

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16
Q

How are odontomes treated?

A

Surgical enucleation

May require surgical exposure and orthodontic alignment

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17
Q

What are the clinical signs of hyperdontia?

A

Spacing eg midline diastema

Failure of adjacent teeth to erupt (Especially with failure of upper incisors to erupt, also may cause retention of primary incisors)

Displacement (May cause displacement of permanent tooth from mild rotation to complete displacement)

Eruption into the mouth

Local crowding or irregularity

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18
Q

What are the potential complications of hyperdontia?

A

Failure of eruption of permanent teeth

Displacement or rotation or crowding

Ectopic eruption of permanent teeth

Abnormal diastema or premature space closure

Dilaceration, delayed or abnormal root development of permanent teeth

Pathology (dentigerous cyst formation)

Rare complication (root resorption/loss of viability or nasal eruption)

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19
Q

How can hyperdontia be diagnosed?

A

Clinical examination (failed or eruption disturbance of permanent tooth)

Routine radiographic finding

As part of a syndrome (Cleidocranial dysplasia)

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20
Q

How can hyperdontia be treated?

A

Long term monitoring

Extraction

Surgical removal

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21
Q

What is hypodontia?

A

Developmental absence of one or more teeth excluding third molars

22
Q

What is the difference between hypodontia, oligodontia, and anodontia?

A

Anodontia = no teeth

Oligodontia = 6 more more missing teeth

Hypodontia = < 6 missing teeth

23
Q

What does hypodontia tell us about the rest of the body?

A

Agenesis of teeth is associated with syndromes or systemic abnormalities.

24
Q

What are the classifications of hypodontia?

A

Mild = 1 - 2 missing teeth

Moderate = 3 - 5 missing teeth

Severe = > 6 missing teeth

25
Q

How common is hypodontia?

A

Uncommon in primary (0.1 - 4.1%)

More common in permanent (4 - 6% caucasian)

26
Q

Where is hypodontia most common? (3 most common sites)

A
  1. 9% of cases are in mandibular second premolars.
  2. 3% in maxillary lateral incisors
  3. 7% in maxillary second premolars
27
Q

Which jaw is more commonly affected by hypodontita?

A

the maxilla (53.2%)

28
Q

What is hypodontia often associated with?

A

Several theories (both genetic and environmental)

Hypodontia is often associated with small teeth.

It can be isolated in non-syndromic or complex methods.

29
Q

What genes are involved in the majority of cases of hypodontia?

A

MSX1

PAX9

AXIN2

30
Q

What environmental factors can result in hypodontia?

A

Intra-uterine effects of drugs (eg thalidomide)

Early radiotherapy + chemotherapy

Trauma (alveolar or jaw fracture, jaw surgery, iatrogenic damage to permanent tooth germ from traumatic extraction)

Infections (eg rubella)

31
Q

What are the major syndromes associated with hypodontia that should be noted? (most important 2 first)

A

Hypohidrotic ectodermal dyplasia (HED)

Axenfeld-Rieger syndrome (Rieger Syndrome)

Dento-alveolar clefting

Trisomy 21

Oral-facial digital syndrome type 1

Williams (Beuren syndrome) (WBS)

Solitary Median Maxillary Central Incisor

Oligodontia and Colorectal Cancer Syndrome

32
Q

What are the clinical features of hypodontia?

A

Delayed/asymmetric eruption of permanent teeth

Retained or infraoccluded deciduous teeth

Absent deciduous teeth

Can be associated with short root anomaly.

33
Q

What are the common orthodontic changes to teeth that occur in patients with hypodontia?

A

Lip protrusion

Increased overbite

Increased rotations of teeth

Increased prevalence of ectopic maxillary canines

Reduced mandibular plane angle

34
Q

How are teeth treated in hypodontia?

A

Acid-etch retained composite buildups of conical teeth

Orthodontic management of spaces

Removable prosthesis (partial dentures, conventional dentures, overdentures)

Fixed prosthesis (Composite resin veneers, crowns, and bridges)

Autotransplantation

Osseointegrated implants (usually after cessation of growth)

35
Q

How does microdontia commonly manifest?

A

In general microdontia teeth are small, the crowns are short, and normal contact areas between the teeth are frequently missing.

36
Q

In which people is microdontia most prevalent?

A

Permanent dentition > primary dentition

Females > Males

Maxillary teeth > Mandibular teeth

Permanent dentition (1.9 - 6.9%) > primary dentition (0.5 - 6.3%)
Most prevalence data are available for maxillary lateral incisors.
37
Q

What are the classifications of microdontia?

A

True generalised microdontia

Generalised relative microdontia

Localised microdontia

38
Q

What is true generalised microdontia?

A

All teeth smaller than normal

All of the teeth are of a normal morphological form

This is very rare. Reported in Radiation/chemotherapeutic treatment during development stage of the teeth

Pituitary dwarfism

Fanconi’s anaemia

39
Q

What is generalised relative microdontia?

A

Normal or slightly smaller than normal teeth but the jaws are somewhat larger than normal (impression of microdontia)

Inheritance of jaw size from one parent and tooth size from other parent can lead to this.

40
Q

Which tooth is most commonly affected by localised microdontia?

A

Maxillary lateral incisor

41
Q

What are the subtypes of localised microdontia?

A

Microdontia of the whole tooth

Microdontia of the crown of the tooth

Microdontia of the root alone

42
Q

What is the name given to maxillary lateral incisors affected by microdontia? What are the features of these maxillary lateral incisors?

A

PEG lateral incisors.

the roots are frequently shorter than normal

43
Q

Which conditions and syndromes are commonly associated with microdontia?

A

patients with ectodermal dysplasia often present with microdontia.

Pituitary dwarfism

Down syndrome

Facial hemiatrophy

William’s syndrome

Chromosome d/u, 45X

44
Q

How is microdontia treated?

A

Composite resin buildup

Porcelain veneers

Ceramic crown

Cast restoration

Orthodontic alignment and extraction of the tooth

Autotransplantation

Extraction and implants

45
Q

What is the definition of macrodontia?

A

Tooth size that is outside normal limites of variation for that type. For practical purposes, a tooth that is 1mm larger than their antimere or the mean dimension of the tooth, and exhibits normal crown, root and pulp morphology.

46
Q

Where is macrodontia most commonly seen?

A

Male > Female

Permanent dentition (1.1 - 3.6%) > Primary dentition (0 - 2.3%

47
Q

What are the classifications of microdontia?

A

True generalised macrodontia

Generalised relative microdontia

Localised macrodontia

48
Q

How is macrodontia treated?

A

Stripping of the macrodont with or without resin build-up of antimere.

Extraction and replacement by fixed prosthesis, removable prosthesis, or implant.

Autotransplantation.

49
Q

What are potential complications caused by macrodontia?

A

Problems with aesthetics

Arch length discrepancies

Crowding

Disruption of the developing occlusion

Teeth predispose to caries.

50
Q

What conditions are associated with macrodontia?

A

Pituitary gigantism

Hemifacial hyperplasia

Otodental syndrome

Klinefelter syndrome

KBG syndrome

Pineal hyperplasia with hyperinsullinism

51
Q

What are the features of generalized relative macrodontia?

A

It is more common than true macrodontia

Normal or slightly larger sized teeth in smaller jaws

An illusion of generalized macrodontia

Hereditary factors

52
Q

In which teeth is macrodontia most commonly reported?

A

Incisors and canines.

however alos common in second mandibular premolars, mandibular molars or premolars, and third molars

DMD3 (53 decks)

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