Dental Anomalies

Question 1

1. what is it called for missing teeth?
2. what teeth are least likely to be missing?
3. what are conditions are associated with hypodontia?
4. what are features of ectodermal dysplasia?

Answer 1

1. hypodontia
2. first permanent molars and upper central incisors - (if a tooth is going to be missing it tends to be the last one in a series)
3. Ectodermal Dysplasia - (very sparse hair, blonde, saddle shaped noses, intolerant to sweatin)
   Down Syndrome
   Cleft Palate
   Hurler’s syndrome
   Incontinentia pigmentii

Question 2

what is this and what is happening here?

Answer 2

• hypodontia - missing lateral

Question 3

what is happening here?and what problem can arise?

Answer 3

retained baby tooth

Over-eruption of lower canines can be a restorative problem when upper lateral incisors are missing

Question 4

1. what do hypodontia patient also tend to have?
2. 2. what is chronology of dental management for hypodontia patients?

Answer 4

1. small teeth and straight sided teeth
2. diagnosis
   removable prosthesis - bridge not until older
   ortho
   comp build ups - common. increase size and shape
   porcelain veneers - not until pt early 20s when gingival margin is at the level
   crowns bridges
   preventative tx - high risk they can’t lose anymore

Question 5

1. what are problems with hypodontia?
2. what are solutions to hypodontia?

Answer 5

1. abnormal shape - (cone shaped)
   spacing
   submergence - ( or infraocclusion of primary teeth) - (could be why overdenture good idea)
   deep overbite
   reduced LFH
2. overdenture
   partial denture
   composite
   porcelain veneers
   fixed prostheses
   implants

Question 6

1. what is more teeth called?
2. what are tendencies of it?

Answer 6

1. hyperdontia/supernumerary
2. more common males, more common maxilla, higher frequence in cleidocranial dysplasia

Question 7

what are types of supernumerary?

Answer 7

Conical (cone shaped)
Tuberculate (barrel shaped, has tubercles)
Supplemental (looks like tooth of normal series) - (tend to be a little smaller) - (keep tooth that is best orthodontically)
Odontome (irregular mass of dental hard tissue, compound or complex)

Supernumerary teeth are the most common cause of delayed eruption of permanent incisor teeth

Question 8

what are anomalies of size and shape?

Answer 8

microdont (2.5%, F>M) e.g. peg-shaped lateral incisors:
macrodontia rare, less than 1% for single teeth and 0.1% in generalised form in Caucasians
double teeth
Gemination (one tooth splits into 2)
Fusion (two teeth join to form 1)
odontomes
taurodontism 6.3% in UK (flame shaped pulp)
dilaceration (crown or root)
accessory cusps e.g. talon cusp

Question 9

what is this an example of?

Answer 9

peg shaped lateral incisors

Question 10

what is this an example of?

Answer 10

talon cusp

Question 11

what is this? what do you do?

Answer 11

dens in dente

• seal all areas to stop ingress of bacteria as these teeth are impossible to treat

Question 12

1. what is main types of amelogenesis imperfecta?
2. causes of environmental enamel hypoplasia?
3. causes of localised enamel hypoplasia?
4. what do you ask if a patient has localised enamel hypoplasia?

Answer 12

1. hypoplastic
   hypocalcified
   hypomaturational
   mixed forms

there are 100s

2. systemic
   nutritional
   metabolic e.g. Rhesus incompatability, liver disease
   infection e.g. measles
3. trauma
   infection of primary teeth
4. ask if they had any bad baby teeth or removed early

Question 13

What is this? features? what would be cause of hypoplastic?

Answer 13

hypomineralised enamel

• appears as brown or white patches
• all tissue there and normal shape just have marks on them
• enamel chunks missing

Question 14

how would you treat fluorosis?

Answer 14

treat using microabrasion therapy, veneers/ vital bleaching

Question 15

what kind of illnesses can MIH be associated with?

Answer 15

MIH assoc. with childhood illness or chronological hypomin. Eg. Liver or kidney failure

Question 16

what are generalised environment enamel defects
1. prenatal
2. neonatal
3. postnatal

Answer 16

1. rubella, congenital syphilis, thalidomide, Fluoride, maternal A&D deficiency, cardiac & kidney disease.
2. prematurity, meningitis.
3. otitis media, measles, chickenpox, TB, pneumonia, diphtheria, deficiency of Vits A,C&D. heart disease. Long term health problem e.g. organ failure

Question 17

what can you see here?

Answer 17

hypoplastic tooth - left premolar has chunks missing

Question 18

what is hereditary hard tissue defects?

Answer 18

amelogenesis imperfecta

Question 19

how do you diagnose amelogensis imperfecta?

Answer 19

family history
generally affects both dentitions - (lots of diagnossi not made until permanent dentition)
affects all teeth
tooth size, structure, colour
radiographs - (you will fail to see an obvious change in radiolucency between enamel and dentine)

Question 20

what do the gene mutations found involve?

Answer 20

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

Question 21

describe each type
1. hypoplastic
2. hypomineralised
3. hypomaturational

Answer 21

1. Hypoplastic type
   Enamel crystals do not grow to the correct length
2. Hypomineralised
   Crystallites fail to grow in thickness and width
3. Hypomaturational
   Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation

Question 22

1. what are problems with amelogenesis imperfecta?
2. what are solutions

Answer 22

1. sensitivity - leads to poor OH - difficulty brushing
   caries/ acid susceptibility
   poor aesthetics
   poor oral hygiene
   delayed eruption
   anterior open bite
2. preventive therapy
   composite veneers/ composite wash
   fissure sealants
   metal onlays
   stainless steel crowns
   orthodontics

Question 23

what are SYSTEMIC DISORDERS ASSOCIATED WITH ENAMEL DEFECTS (not Amelo)/

Answer 23

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

Question 24

What are types of DENTINOGENESIS IMPERFECTA?

Answer 24

Type I - osteogenesis imperfecta
Type II - autosomal dominant
Brandywine

Question 25

how to DIAGNOSE DENTINOGENESIS IMPERFECTA?

Answer 25

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

Question 26

what is this?

Answer 26

TYPE I DENTINO

Question 27

what is this and why?

Answer 27

Child with osteogenesis imperfecta, (blue sclera of eye apparent)

Question 28

Answer 28

Question 29

what are 1. problems 2. solutions of dentinogensis imperfecta

Answer 29

1. aesthetics
   caries / acid susceptibility
   spontaneous abscess
2. prevention
   composite veneers
   overdentures
   removable prostheses
   stainless steel crowns

Question 30

what are other hereditary dentine defects you can get?
1) limited to dentine only?
2) associated with a general disorder?

Answer 30

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

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

Question 31

what are conditions that have anomalies of cementum?

Answer 31

cleidocranial dysplasia
- hypoplasia of cellular component of cementum

hypophosphatasia
- hypoplasia or aplasia of cementum
early loss of primary teeth

Question 32

what causes anomalies of eruption?

Answer 32

pre-term & low birth-weight children

malnutrition

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

gingival hyperplasia/ overgrowth

Question 33

what causes premature exfoliation?

Answer 33

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

Question 34

what causes delayed exfoliation?

Answer 34

infra-occlusion - also from trauma

‘double’ primary teeth
hypodontia
ectopic permanent successors
following trauma