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Dental Anomalies Flashcards

1
Q

Conditions hyperdontia is associated with?

A
  1. Cleidocranial dysplasia
  2. Gardner syndrome
  3. Cleft lip and palate (-40% have supernumeraries in area of cleft)
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2
Q

Hyperdontia results in?

A
  1. Crowding
  2. Impede path of eruption of permanent teeth
  3. Resorption of root of adjacent teeth
  4. Cyst may develop around buried supernumerary teeth
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3
Q

Management of Hyperdontia

A
  1. Early diagnosis and treatment
  2. Removal by extraction or surgery before root of permanent tooth > 1/2 formed
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4
Q

Teeth most often absent in Hypodontia?

A

Terminal teeth of a series

  1. Third molars
  2. Mandibular 2nd premolar
  3. Maillary lateral incisors
  4. Maxillary 2nd premolar
  5. Mandibular central incisors
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5
Q

Etiology of Hypodontia?

A
  1. Environmental (trauma CT, RT)
  2. Genetic
  • Non-syndromic: Mutations of PAX9, MSX1, AXIN2
  • Syndromic: Ectodermal dysplasia, cleft lip/palate, trisomy 21
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6
Q

Management of Hypodontia

A
  1. Clinical and radiographic assessment -> Referral
  2. Regular preventive care
  3. Restore aesthetics/function -> Multi-disciplinary
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7
Q

Accessory roots are associated with what anatomical features?

A

Large cusp of Carabelli and paramolar tubercles

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8
Q

Accessory roots are more common in which teeth?

A

Lower 6s, canines and premolars

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9
Q

Reduction in root number are seen in which teeth?

A

<1% of 1st molars

15-40% of 2nd and 3rd molars

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10
Q

Most dental anomalies are more common in permanent teeth except?

A

Double tooth

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11
Q

Double tooth is most common in which teeth?

A

Incisors

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12
Q

Definition of Gemination

A

Budding of a second tooth from a single tooth germ

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13
Q

Features of Gemination

A
  1. One root canal present
  2. Bifid crown with single root and pulp chamber
  3. Familial inheritance
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14
Q

Definition of Fusion

A

Joining of two teeth of normal series or a normal tooth and supernumerary tooth by pulp and dentine

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15
Q

Features of fusion

A
  1. Two canals
  2. Number of teeth in dentition is normally reduced by 1 unit
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16
Q

Clinical Significance of Double Tooth

A
  1. Site of fusion may be at increased risk for plaque collection -> Caries or periodontal issues
  2. May retard eruption of permanent successor
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17
Q

Management of Double Tooth in Primary Dentition

A
  1. Fissure sealant in labial and palatal groove
  2. Monitor root resorption of primary double tooth to prevent delayed eruption of permanent successor
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18
Q

Management of Double Tooth in Permanent Dentition

A
  1. Permanent dentition: Surgical separation of fused teeth -> Orthodontic alignment and restorative treatment
  2. Reshaping or reduction of double tooth with single canal (gemination)
  3. Deliberate extraction and prosthodontic replacement
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19
Q

Definition of Concrescence

A

1.Joining of two teeth by cementum

  1. Fusion that occurs after root formation is complete
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20
Q

Concrescence is most common in which teeth?

A

Maxillary posterior region

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21
Q

Clinical significance of Concrescence?

A

Difficult extraction

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22
Q

What is a Talon Cusp?

A

Cusp projecting from cingulum of incisors

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23
Q

Talon Cusp is most common in which teeth?

A

Permanent incisors

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24
Q

Features of Talon Cusp

A

Consists of enamel, dentine and pulp horn

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25
Q

Accessory Cusps include?

A
  1. Paramolar cusp
  2. Cusp of carabelli
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26
Q

What is a Paramolar Cusp?

A

Extra cusp on buccal of molars

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27
Q

What is a Cusp of Carabelli?

A

Extra cusp on mesiopalatal of 6s, usually bilateral

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28
Q

Dens Invanginatus are most commonly seen in which teeth?

A

Maxillary lateral incisors

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29
Q

Types of Dens Invaginatus

A

Type 1: Above CEJ, Seal the groove

Type 2: Below CEJ

Type 3a: Communication laterally with periodontal ligament

Type 3b: Communication apically with periodontal ligament

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30
Q

Problems with Dens Invaginatus?

A
  1. Caries may develop in the invaginatus
  2. Enamel lining may be incomplete and dentin deficient in some areas → Direct communication with pulp → Acute dentoalveolar infection
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31
Q

Management of Dens Invaginatus

A

Prophylactic sealing of invaginatus soon after eruption

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32
Q

What is a Dens Evaginatus

A

Enamel covered tubercle projecting from tooth surface

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33
Q

Dens Evaginatus usually affects which teeth?

A

Premolars (Leong’s premolar), sometimes canines and molars

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34
Q

Problems with Dens Evaginatus?

A

Tubercle may fracture and cause pulpal infection

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35
Q

What condition is associated with Dens Evaginatus?

A

Rubinstein Taybi Syndrome

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36
Q

What is Taurodontism?

A

Describes a molar tooth with a pulp chamber that is vertically enlarged at the expense of the roots

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37
Q

What conditions is associated with Taurodontism?

A
  1. Ectodermal dysplasia (Hypodontia)
  2. Klinefelter’s Syndrome
  3. Tricho-dento-osseous syndrome
  4. 20% of A.I cases
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38
Q

What is dilaceration?

A

Abrupt deviation of long axis of crown or root portion

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39
Q

Etiology of dilaceration

A
  1. Trauma to primary dentition (2-5 yo)
  2. Idiopathic or developmental disturbances
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40
Q

Management of Dilaceration

A

If mild, the tooth may erupt then reshape for aesthetics

If fail to erupt, tracking tooth down orthodontically or remove surgically

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41
Q

What is a Hutchinson’s incisor?

A
  1. Barrel-shaped (Incisal-edge < cervical width)
  2. Incisal angles rounded, edge may be notched
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42
Q

What is a Moon’s molar?

A

Reduction of crown form towards occlusal surface of 6’s

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43
Q

What is a mulberry molar?

A

Hypoplasia of early mineralising part of 6’s

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44
Q

What is Globodontia?

A

Globular deformity of crowns of canines and posterior teeth of both dentitions

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45
Q

Associated conditions with Globodontia?

A

Otodental syndrome

  • Rare, AD condition
  • High frequency deafness from childhood
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46
Q

Microdontia is most common in which teeth?

A

Maxillary lateral incisors, 2nd premolars, 3rd molars

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47
Q

Microdontia is more common in permanent or primary dentition?

A

Permanent

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48
Q

What is the inheritance pattern of microdontia?

A

AD with incomplete penetrance

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49
Q

Conditions associated with microdontia?

A
  1. Ectodermal dysplasia
  2. Down syndrome
  3. Pituitary dwarfism
50
Q

Management of Microdontia

A
  1. No treatment
  2. Composite build-up or veneers
51
Q

Macrodontia is more common in permanent or primary dentition?

52
Q

Macrodontia affects which teeth?

A

Permanent maxillary central, mandibular 2nd premolar

53
Q

Conditions associated with Macrodontia

A
  1. Klinefelter syndrome (taurodontism)
  2. Hereditary gingival hyperplasia
  3. On affected side of hemifacial hyperplasia
  4. Pituitary gigantism
54
Q

Larger root size is seen in which teeth?

A

Maxillary canine

55
Q

Smaller root size is seen in what conditions?

A
  1. Dentin and pulp dysplasia
  2. Hypoparathyroidism
  3. Excessive irradiation of jaw or severe malnutrition
56
Q

What is Odontodysplasia?

A

Localised, non-hereditary developmental abnormality affecting enamel, dentin and pulp

57
Q

How does Odontodysplasia appear on X-rays

A
  1. Mild cases: Root formation normal or develop a few years after normal teeth in same mouth
  2. Severe cases: ‘ghost-like’, little differentiation of dental tissues
58
Q

Arrest of tooth germ development can be caused by?

A
  1. Osteomyelitis
  2. Irradiation of jaw in childhood
  3. Severe trauma
  4. Untreated chronic pulpal infection of primary teeth
  5. Fracture of jaw
59
Q

What is Amelogenesis Imperfecta?

A

Inherited enamel defects affecting both dentitions in the absence of a systemic disorder

60
Q

Mode of inheritance of AI?

A

AD, AR, X-linked

61
Q

What are the phenotypes of AI?

A
  1. Type I Hypoplasia: Secretory defect -> Reduced enamel thickness
  2. Type II Hypomaturation (Hypomineralisation)
  3. Type III Hypocalcification (Hypomineralisation)
62
Q

Clinical Features of Type 1 Hypoplastic AI?

A
  1. Thin enamel: Smooth/rough/pitted/grooved
  2. Generalised spacing
  3. Delay in eruption
  4. Unerupted teeth may undergo replacement resorption
  5. AOB in 60% of AI cases
  6. Enamel more radiopaque than dentine
63
Q

Clinical Features of Type II Hypomaturation AI?

A
  1. Normal thickness of enamel
  2. Slightly softer than normal
  3. Not as severe as Type III hypocalcified
  4. Enamel approximately same radiodensity as dentine
64
Q

Clinical Features of Type III Hypocalcified AI?

A
  1. Initially, normal thickness of enamel
  2. At eruption, dark yellow/brown/chalky white enamel
  3. Enamel may wear away to expose rough sensitive dentine
  4. Enamel is less radiopaque than dentin
65
Q

What is Type IV Hypomaturation-Hypoplastic with Taurodontism AI?

A

Hypomaturation and hypoplasia appearance

66
Q

Clinical Features of Hypomaturation-Hypoplastic with Taurodontism AI

A
  1. Enamel is mottled white-yellow-brown
  2. Pits on labial surface or thin with areas of hypomaturation
  3. Molars have taurodontism
  4. Enamel have same or slightly greater radiodensity than dentine
67
Q

Management of AI?

A
  1. Genetic counseling
  2. Good preventive program
  3. SSC for molars or overdentures to maintain VD
  4. CR veneers
  5. Orthodontic treatment for AOB
  6. Definitive crowns/ veneers in late teens
68
Q

Challenges in Management of AI

A
  1. Pain + Eating difficulties
  2. Tooth hypersensitivity
  3. Rapid wear -> Loss of OVD
  4. Malocclusion
  5. Poor aesthetics
  6. Protracted course of treatment
69
Q

Etiology of Junctional Epidermolysis Bullosa?

A
  1. Disruption of the COL17 gene
  2. Abnormal interaction between enamel epithelium and underlying mesenchyme, resulting in defective ameloblast differentiation
70
Q

Features of Junctional Epidermolysis Bullosa?

A
  1. Multiple bullae of mucus membrane and skin
  2. Dystrophic nails
  3. Thin hypoplasia to fine pitting hypoplasia (honeycomb)
71
Q

Etiology of Tricho-dento-osseous syndrome?

A

DLZ3 gene expressed in hair, teeth and bones

72
Q

Clinical Features of Tricho-dento-osseous Syndrome?

A
  1. Increased thickness of cranial bones
  2. Tight curly hair
  3. Thick and cornified nails
  4. Teeth present as in Type IV AI
  • Thin hypoplastic enamel
  • Taurodontic pulp chambers
73
Q

What is Molar-Incisor Hypomineralization?

A

Hypomineralization of systemic origin of 1-4 permanent 1st molars, frequently associated with affected permanent incisors

Qualitative defect

74
Q

Clinical Features of MIH

A
  1. Cheese molars: Enamel friable
  2. Small white, yellow or brown patches to extensive loss of enamel
  3. Rapid breakdown of enamel and is very sensitive: Irregularly distributed mottling
75
Q

Diagnosis of MIH

A
  1. At least one permanent molar affected
  2. Presence of demarcated opacity (defective enamel is normal thickness with a smooth surface and can be white,yellow or brown.)
  3. Post-eruptive enamel breakdown
  4. Atypical restoration on smooth surface
76
Q

Challenges of MIH

A
  1. Poor adhesion of restorative materials to hypomineralised enamel
  2. Hypersensitivity
  • Difficult to achieve anaesthesia
  • Prone to caries
77
Q

Management of MIH

A

Preventine: Topical fluoride varnish, fissure sealants

Restorative:

  1. Molars: Preformed metal crowns if unsuitable for CR/GIC. Analyse occlusion if severely compromised KIV extraction
  2. Incisors: Microabrasion, resin infiltration, etch-bleach-seal OR CR veneers for incisors if aessthetics compromised
78
Q

What is enamel fluorosis?

A

Disturbance in 3rd stage (maturation) of amelogenesis

79
Q

Features of Enamel Fluorisis

A

Mildest form: Manifest as hypomineralisation of enamel leading to opacities

Severe form: Manifest as hypoplasia

80
Q

Localised enamel defect due to environmental changes such as?

A
  1. Infection
  2. Trauma of primary teeth
81
Q

Generalised enamel defect due to environmental changes such as ?

A

During tooth development,

  1. Prematurity
  2. Malnutrition
  3. Exanthematous fevers
  4. Excessive ingestion of F
82
Q

Types of Dentinogenesis Imperfecta?

A

Type I (associated with osteogenesis imperfecta)

Type II

Type III (Brandywine isolate)

83
Q

Types of Dentinal Dysplasia

A

Type I: Radicular Dentinal Dysplasia

Type II: Coronal Dentinal Dysplasia

84
Q

What is Dentinogenesis Imperfecta?

A

Hereditary dentine defects confined to dentition.

All teeth are affected with varying severity, primary teeth usually worse

85
Q

Clinical Features of Dentinogenesis Imperfecta?

A
  1. Opalescent bluish/brownish colour
  2. Enamel chip away at EDJ, exposing soft dentine which wears away rapidly
86
Q

How does Dentinogenesis Imperfecta appear on the X-ray?

A

Bulbous crowns, short roots, obliteration of pulp chamber and root canals by abnormal dentine

87
Q

Histology of Dentinogenesis Imperfecta?

A
  1. Hypomineralised enamel in 1/3 of cases
  2. Dentine matrix is amorphous
  3. Tubules abnormal size and shape, haphazard
88
Q

Mutation in Osteogenesis Imperfecta

A

Mutation in genes that encode Type 1 collagen? COL1A1, COL 1A2

89
Q

Clinical Features of Radicular Dentinal Dysplasia?

A
  1. Rootless teeth
  2. Crowns of teeth are normal in shape, form and colour
90
Q

Xrays on Radicular Dentinal Dysplasia appear as?

A
  1. Crown normal shape
  2. Roots short and blunt
  3. Multiple PA radiolucencies
  4. Obliterated pulp chambers (Completely in primary teeth, crescent shaped in permanent tooth)
91
Q

Clinical Features of Coronal Dentinal Dysplasia?

A
  1. Primary teeth blue-grey-brown and translucent
  2. Permanent teeth are clinically normal, radiographically L thistle-tube shaped pulps, multiple pulp stones
92
Q

Localised dentin effect is caused by?

A

Severe trauma/infection to primary teeth, leading to formation of interglobular dentine below area of hypoplastic enamel on permanent teeth

93
Q

Generalized dentin defect due to environmental such as?

A
  1. Tetracycline taken during tooth formation may discolour dentine and delay dentinogenesis
  2. Irradiation and hypothyroidism retards dentinogenesis in children
94
Q

Defects of pulp include?

A
  1. Pulp stones
  2. Diffuse pulp calcification
95
Q

Genetic defects of cementum?

A
  1. Cleidocranial dysostosis (AD): Hypoplasia of cementum, related to delay or failure of eruption
  2. Hypophosphotasia (AR/AD): - Lack serum alkaline phosphatase
    - Hypoplasia of cementum, lack of perio attachment, early loss of primary teeth
96
Q

Environmental-related defects of cementum?

A

Excessive deposition of cementum due to

  1. Chronic infection
  2. Traumatic occlusion
97
Q

Extrinsic Discolouration of Teeth

A
  1. Food, drinks
  2. Medication
  3. Chromogenic bacteria
98
Q

Intrinsic discolouration of teeth

A
  1. Localised (Caries, internal resorption, trauma, infection of primary teeth)
  2. Generalised (AI, DI, tetracycline, excessive fluoride during tooth formation, blood-borne pigments such as bilirubin, hemosiderin, porphyria
99
Q

What is the sequence of eruption of Primary Teeth?

100
Q

What is the sequence of eruption of Permanent Dentition?

A

Maxillary: 61245378

Mandibular: 61234578

100
Q

When do Natal teeth erupt?

100
Q

When do Neonatal teeth erupt?

A

Within 1st month of birth

101
Q

Prematurely erupted teeth are usually?

A
  1. Poorly formed
  2. Mobile due to lack of root development (risk of aspiration, nursing obstacle)
102
Q

Management of Premature Eruption

A
  1. Leave to firm up
  2. Extract
103
Q

What condition is Premature Eruption associated with?

A

Riga Fede Disease

104
Q

What causes Ectopic Eruption?

A
  1. Ectopic crypt position
  2. Presence of supernumerary teeth or odontomas causing deflection of path of eruption
105
Q

When should maxillary canine impaction be suspected?

A
  1. Canine bulge not palpable at 9-10 years old
  2. Asymmetric canine eruption
  3. Peg-shaped laterals
106
Q

Localised Delayed Eruption is due to?

A
  1. Ankylosis
  2. Impaction
  3. Supernumerary teeth
  4. Trauma
107
Q

Generalised Delayed Eruption

A
  1. Premature babies
  2. Down and Turner’s Syndromes
  3. Cleidocranial dysplasia
  4. Gross malnutrition
  5. Growth hormone deficiency
108
Q

Localised Premature Exfoliation is caused by

A
  1. Pulpal infection spreading to periradicular tissue
  2. Ectopic eruption of 6 -> Resorption of distal root of E which may lead to early loss of E
109
Q

Generalised Premature Exfoliation is caused by

A
  1. Hypophosphatasia
  2. Histiocytosis X
110
Q

Localised delayed exfoliation is caused by?

A
  1. Primary double tooth
  2. Congenital absence of permanent successor
  3. Infraocclusion
110
Q

Generalised delayed exfoliation is caused by

A
  1. Down’s Syndrome
  2. Turner’s Syndrome
111
Q

Infraocclusion occurs due to

A

Fusion of cementum with alveolar bone

112
Q

Which teeth are most likely infraoccluded?

A

Primary mandibular 2nd molar > Mandibular 1st molar > Maxillary 1st molar > Maxillary 2nd molar

113
Q

Classification of Infraocclusion

A

Mild, moderate to severe in relation to contact point

114
Q

Problems with infraocclusion?

A
  1. Tipping and space loss
115
Q

Management of Infraocclusion

A
  1. Majority exfoliate spontaneously if successor tooth present
  2. Monitor timing for extraction
116
Q

Types of Resorption

A
  1. Physiological/Pathological
  2. Internal/External
  3. Coronal/Radicular
117
Q

When does Physiological resorption begin?

A

Begin soon after root formation is completed at 3-4 years old

118
Q

When does Pathological resorption occur?

A

Complication following trauma, infection, excessive orthodontic forces, impacted/ supernumerary teeth

Paeds (10 decks)

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