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BDS4 Paediatrics > Dental Anomalies > Flashcards

Dental Anomalies Flashcards

1
Q

What can dental anomalies be categorized into

A

number
size/shape
structure
eruption & exfoliation

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2
Q

What are the dental anomalies affecting number

A

hypodontia
hyperdontia

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3
Q

hypodontia

What is the most common tooth to be missing

A

mandibular premolar
maxillary lateral incisor

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4
Q

hypodontia

What is the least common tooth to be missing

A

first permanent molar
upper central incisors

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5
Q

What is the prevalence of hypodontia

A

3.5-6.5%

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6
Q

What are the conditions associated with hypodontia

A
  • Ectodermal dysplasia
  • Down syndrome
  • Cleft palate
  • Hurler’s syndrome
  • Incontinentia pigmentii
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7
Q

What are the aims of treamtent for hypodontia

A

prevention
restore function and aesthetics

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8
Q

What are the problems experienced by those who have hypodontia

A
  • Abnormal shape/form of present teeth (cone shaped/straight sided small teeth)
  • Spacing
  • Submergence/infraocclusion of primary teeth
  • Deep overbite
  • Reduced lower face height
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9
Q

What are solutions for the problems experienced by those who have hypodontia

A
  • Overdenture
  • Partial denture
  • Composite
  • Porcelain veneers
  • Fixed prosthesis
  • implants
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10
Q

What is the chronology of dental management for hypodontia

A
  • Diagnosis
  • Removable prosthesis (while awaiting definitive tx)
  • Orthodontics (to make restorative treatment easier)
  • Composite buildups to improve shape and size of present teeth
  • Porcelain veneers
  • Crowns/bridges
  • Preventative treatment (all the way through as we cannot afford to lose more teeth)
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11
Q

hypodontia

Why do we wait until a patient is in their 20s for veneers

A

prior to this, gingival margin moves position

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12
Q

What is hyperdontia aka

A

supernumerary

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13
Q

What is the prevelance of supernumerary teeth

A

1.5-3.5%

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14
Q

What jaw is hyperdontia more common in

A

maxilla

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15
Q

What condition is there higher frequency of hyperdontia

A

cleidocranial dysplasia

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16
Q

What are the 4 types of supernumerary

A
  • conical
  • tuberculate
  • supplemental
  • odontome
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17
Q

Describe a conical supernumerary

A

cone shaped

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18
Q

Describe a tuberculate supernumerary

A

barrel shaped
has tubercles

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19
Q

Describe a supplemental supernumerary

A

looks like a tooth of a normal series
lateral incisor most common

remove the lateral incisor which is hardest to position correctly

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20
Q

Describe odontome supernumerary

A

irregular mass of dental hard tissue
can be compound or complex

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21
Q

What is complex odontome

A

o Complex is when the calcified dental tissues are simply arranged in an irregular mass bearing no morphologic similarity to rudimentary teeth

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22
Q

What is compound odontome

A

o Compound is when the dental tissues are arranged in a more oderly pattern than complex

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23
Q

What is the most common cause of delayed eruption of the permanent incisor teeth

A

supernumerary

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24
Q

What are dental anomalies affecting size/shape

A
  • microdontia
  • macrodontia
  • double teeth
  • odontomes
  • taurodontism
  • dilaceration
  • accessory cusps
  • dens in dente
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25
Q

What is the incidence of microdontia

A

2.5%
more common in females

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26
Q

What is the prevalence of macrodontia

A

<1%

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27
Q

What are the 2 types of double teeth

A

gemination
fusion

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28
Q

What is gemination

double teeth

A

one tooth splits into 2

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29
Q

What is fusion

double teeth

A

2 teeth form to make 1

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30
Q

What is taurodontism

A

 Flame shaped pulp
 Tooth otherwise looks normal
 Real risk is pulp exposure during restorative work

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31
Q

What is an example of an accessory cusp

A

talon cusp which is an extra cusp on an anterior tooth which arises as a result of evagination on the surface of a crown before calcification

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32
Q

What is dens in dente

A

tooth within a tooth

Invagination of the enamel organ into the dental papillae that begins at the crown and often extends to the root even before calcification of the dental tissues

Invaginations can have their own pulp system

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33
Q

What should be done asap for dens in dente teeth

A

seal them
prevent bacterial ingress as root canal treatment is near impossible for these teeth

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34
Q

What are dental anomalies which effects the roots

A

short root anomaly

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35
Q

What can be the cause of short roots

A

o Radiotherapy
o Dentine dysplasias
o Accessory roots
o Orthodontic tx

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36
Q

What teeth are short roots most common in

A

permanent maxillary incisors

37
Q

How can the aetioloy of enamel deefects be split up

A

localised vs general

38
Q

If the enamel defect is localised, what is it likely to be and what are the probable causes

A
  • localised enamel hypoplasia
  • due to trauma / infection (abscess) of primary tooth
39
Q

If the enamel defect is generalised, what can this further be classified into

A

environmental vs hereditary

40
Q

What is the most common cause for environmental enamel hypoplasia

A

fluorisis

41
Q

How does fluorosis present in its milder form

A

symmetrical white marks
treated with microabrasion/veneers/vital bleaching

42
Q

What is another cause of environmental enamel hypoplasia

A
  • MIH associated with childhood illness
  • chronolgoical hypomineralisation
43
Q

What is chronolgoical hypomineralisation

A

generalised form of hypoplasia with a characteristic presentation of symmetrical defects with a chronological pattern, with only parts of the teeth developing (enamel secretion) at the time of the insult affected)

44
Q

What are prenatal conditions that can result in enamel defects

A

o Rubella
o Congenital syphilis
o Thalidomide
o Fluoride
o Maternal A&D deficiency
o Cardiac/kidney disease

45
Q

What are neonatal conditions that can result in enamel defects

A

o Prematurity
o Meningitis

46
Q

What are post natal conditions that can result in enamel defects

A

o Otitis media
o Measles
o Chickenpox
o TB
o Pneumonia
o Diphtheria
o Deficiency of vitamin A, C, D
o Heart disease
o Long term health problem

47
Q

What are hereditary causes of enamel defects

A

amelogenesis imperfecta

48
Q

What is the prevelance of AI

A

1:14000 prevalence

49
Q

How can enamel defects be hereditary

A
  • Enamel formation needs multiple genes to transcribe the process of crystal growth and mineralisation
    These genes can become mutated
  • Gene mutations found so far involve enamel extracellular matrix molecules amelogenin and enamelin and kallikrein 4
50
Q

What are the 4 types of amelogensis imperfecta

A
  • hypoplastitc
  • hypomineralised
  • hypomaturational
  • mixed with taurodontism
51
Q

Describe hypoplastic AI

A

 Enamel crystals do not grow to correct length
 Normal minerall content but chunks of enamel missing, different shape
 Due to error in secretory phase when the template is laid down, however mineralisation stage is as normal

52
Q

Describe hypomineralised AI

A

 Crystallites fail to grow in thickness and width

53
Q

Describe hypomineralised AI

A

 Crystallites fail to grow in thickness and width
 Normal shape but not correct mineral content
 Results in marks
 Abnormal mineralisation stage

54
Q

Describe hypomaturational AI

A

 Enamel crystals grow incompletely in thickness or width but to normal length with incomplete

55
Q

What is the most common type of trait that results in AI

A
  • Autosomal dominant trait is most common in USA/Europe
56
Q

Is there systemic disease associated with AI

A

Not usually

57
Q

What do we look at to diagnose AI

A

o Family history prevalence
o Generally, effects both dentitions but usually worse in permanent
o Can affect tooth size/structure/colour
o Radiographs will show similar radiolucency between enamel and dentine
o Affects all teeth

58
Q

What are problems caused by AI

A

o Sensitivity (less enamel covering dentine/pulp)
o Caries/acid susceptibility
o Poor aesthetics (brown honey-comb like lesions)
o Poor OH (pain on brushing)
o Delayed eruption
o Anterior open bite

59
Q

What are solutions for problems caused by AI

A

o Enhanced prevention
o Composite veneers/composite wash
o Fissure sealants
o Metal onlays
o Stainless steel crowns
o Orthodontics

60
Q

Why do we do composite veneers for AI patients and what problems do we face

A

 Improve appearance and sensitivity
 Composite veneers can be difficult as the differing enamel structure can impact bond strength

61
Q

When do we do fissure sealants for AI patients

A

if molars not significantly effected

62
Q

When do we do metal onlays for AI patients

A

if molars significantly effected

63
Q

Why do AI patients need orthodontics and what problems may be faced

A

 Often required due to AOB
 However brackets more likely to debond due to differing enamel structure impacting bond strength

64
Q

What systemic disorders are associated with enamael defects (not AI)

A

o Epidermolysis bullosa
o Incontinenta pigmenti
o Down’s
o Prader-willi
o Porphyria
o Tuberous sclerosis
o Pseudohypoparathyroidism
o Hurler’s

65
Q

What are anomalies effecting dentine

A

dentinogenesis imperfecta
dentine dysplasia
odontodysplasia

66
Q

What are the 3 types of dentinogenesis imperfecta

A

type 1
type 2
brandywine

67
Q

What is type 1 DI

A

osteogenesis imperfecta

68
Q

What is type 2 DI

A

autosomal dominant (no other underlying medical conditions)

69
Q

What do we look at to diagnose DI

A

o Appearance
o Family history
o Associated osteogenesis imperfecta
o Both dentitions affected
o Radiography shows
o Enamel loss

70
Q

What will we see on the radiograph if a patient has DI

A

 Bulbous crowns
 Obliterated pulps (seen in type 1 & 2)

71
Q

Why is enamel lost more quickly in dentinogenesis imperfecta

A

due to lack of connection at ADJ

72
Q

What are problems caused by DI

A

o Aesthetics
o Caries/acid susceptibility
o Spontaneous abscess
o Poor prognosis

73
Q

What are solutions to problems caused by DI

A

o Prevention
o Composite veneers
o Overdentures
o Removable prosthesis
o Stainless steel crowns

74
Q

What is dentine dysplasia clinical/radiographic appearance

A
  • Normal crown morphology
  • Amber look
  • Pulpal obliteration
  • Short constricted roots
75
Q

What is odontodysplasia

A
  • Localised arrest in tooth development
  • Thin layers of enamel and dentine
  • Large pulp chambers
  • Results in ‘ghost teeth in x-ray
76
Q

What is systemic disturbances that can result in dentine defects

A
  • Nutritional
  • Metabolic
  • Drugs
77
Q

What general disorders are associated with dentine defects

A
  • Osteogenesis imperfecta
  • Ehlers danlos syndrome
  • Brachioskeleatl genital syndrome
  • Rickets
  • Hypophosphatasia
78
Q

What dentine defects are limited to dentine only

A
  • Dentinogenesis imperfecta type 2
  • Dentine dysplasia type1 & 2
  • Fibrous dysplasia of dentine
79
Q

What are anomalies in eruption/exfoliation

A

premature
delayed

80
Q

What is premature eruption associated with

A

 Associated with high birth weight
 Precocious puberty, when a child’s body begins changing into that of an adult too soon (before 8 for girls and 9 for boys)
 Natal/neonatal teeth

81
Q

What is delayed eruption associated with

A

 Associated with pre-term & low birth weight children
 Malnutrition
 Associated general conditions
 Gingival hyperplasia/overgrowth

82
Q

What are the assocaited general conditions linked to delayed eruption

A
  • Downs
  • Hypothyroidism
  • Hypopituitarism
  • Cleidocranial dysplasia
83
Q

How is gingival hyperplasia linked to delayed eruption

A
  • Pseudodelayed
  • Gingiva covering the teeth
84
Q

What is the aetiology of premature exfoliation

A

 Trauma
 Following pulpotomy (unsure of how it happens)
 Hypophosphatasia
 Immunological deficiency
 Chediak-higashi syndrome
 Histiocytosis X

85
Q

What is the aetiology for delayed exfoliation

A

infraoccluded
double primary teeth
hypodontia
ectopic permanent successors
following trauma

86
Q

What is meant by infraoccluded

A
  • Tooth appears as if sinking
  • 1-9% permanence
  • More common when there is congenital absence, especially for premolars
  • Majority exfoliate normally by age 11-12 years old
87
Q

What is meant by double primary teeth

A
  • Adult and baby teeth present simultaneously
88
Q

What conditions result in anomalies of cementum

A

cleidocranial dysplasia
hypophosphatasia

BDS4 Paediatrics (4 decks)

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