Dental Anomalies 🦷 Flashcards
CONCRESCENCE
Linked to HYPERCEMENTOSIS
Concrescence is a condition of teeth where the CEMENTUM overlying the roots of at least two teeth JOIN together. It usually involves only two teeth. The most commonly involved teeth are UPPER SECOND AND THIRD MOLARS The prevalence rate is 0.04%.
- Occlusion problems causing cheek biting and traumatic ulcers.
- Involved teeth may have DIFFICULTY ERUPTING or may not erupt completely.
- May possibly cause localized periodontal destruction due to aetiological factors.
- May cause FRACTURE of the tuberosity or floor of the MAXILLARY SINUS.
GEMINATION
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MORPHODIFFERENTIATION
(Gemini - sign) ONE TOOTH/TWO BODIES
“Twinning”
Gemination, also called DOUBLE TOOTH , is an anomaly exhibiting two joined crowns and usually a SINGLE ROOT. It may have LARGE PULP It represents an incomplete attempt of a SINGLE TOOTH GERM 🦷 to split. It is considered multifactorial in etiology, with genetic and environmental causes.
** In geminated teeth, division is usually incomplete and results in a large tooth crown that has a single root and a single canal. **
The NUMBER of the teeth in the arch will be NORMAL.
Gemination more frequently affects the PRIMARY teeth, but it may occur in permanent dentitions, usually in the INCISORS region
FUSION
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MORPHODIFFERENTIATION
Most common: PRIMARY ANTERIOR
Tooth count: ONE LESS than normal
Tooth fusion arises through UNION of TWO normally separated TOOTH 🦷 🦷 GERMS.
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and depending upon the stage of development of the teeth at the time of union, it may be either complete or incomplete. On some occasions, TWO independent PULP CHAMBERS and ROOT CANALS can be seen.
the union of two adjacent teeth at the crown level (enamel and dentin), causing the formation of a tooth with an enlarged clinical crown.
Incidence of this anomaly is approximately 0.1% in the permanent and 0.5% in the primary dentition.
What Disorders have deficient Cementum?
Anomalies of APPOSITION
- Hypophosphatasia
- Vitamin D resistant Rickets
- Cleidocranial Dysplasia
- Epidermolysis Bullosa (acellular, excess)
- Sickle Cell Anemia (hypercementosis)
C is for “CHEVyS” to “APPO hill”
If a tooth is Ankylosed what type of resorption is most likely to have occurred?
REPLACEMENT RESORPTION
Replacement resorption refers to resorption of the root surface and its SUBSTITUTION by BONE resulting in ankylosis.
Replacement resorption accompanies dentoalveolar ankylosis due to extensive TRAUMA to the tooths attachment apparatus (PDL DAMAGE).
DENTIN that is OVERMINERALIZED is called?
SCLEROTIC DENTIN
AKA
- REPARATIVE
- TERTIARY
Deposition of CALCIUM in TUBULES as a result of TRAUMA, CARIES, or normal AGING
GLASSY, TRANSLUCENT appearance
noted by ABSENCE of ODONTOBLASTS and PREDENTIN was evident where the sclerotic dentin was formed.
What is a Mulberry Molar?
What is it often associated with?
MULBERRY MOLAR
- dental condition usually associated with congenital SYPHILIS
- characterized by multiple rounded RUDIMENTARY enamel CUSPS on the permanent FIRST molars.
- This type of abnormality is characterized by DWARFED molars with cusps covered with globular enamel growths.
- These teeth are FUNCTIONAL but can be cosmetically fixed with crowns, bridges, or implants.
What is Perimolysis?
🤮
- a form of dental EROSION, characterized by dental tissue demineralization without bacterial involvement.
- It can be of intrinsic or extrinsic origin.
- Decalcification of the teeth from exposure to GASTRIC ACID in people with chronic VOMITING 🤮 .
Dentinogenesis 1 vs 2 (3)
Similarities?
Differences?
📻◼️
Type I and II have SIMILAR radiographic features:
- Total OBLITERATION of the pulp CHAMBER and root CANALS due to deposition of dentin
- BULBOUS crowns with apparent cervical constriction
- REDUCED root length with rounded apices
- AMBER translucence
- MULTIPLE PERIAPICAL radiolucency 📻◼️with Alveolar abscesses
SHEILDS TYPE 1:
- Associated WITH Osteogenesis Imperfecta (OI).
- Usually an autosomal dominant trait with VARIABLE expressivity but can be recessive if the associated osteogenesis imperfecta is of recessive type.
- PRIMARY TEETH 🦷 more severely effected
SHEILDS TYPE 2:
- Occurs ALONE; no OI
- Effects both dentitions equally
SHEILDS TYPE III: BRANDYWINE isolate.
This type is rare with occurrences only in the secluded populations at MARYLAND, USA. its predominant characteristic is bell-shaped crowns, especially in the permanent dentition. Unlike Types I and II, it involves teeth with 🐚 SHELL-like appearance and multiple pulp exposures
Molar / Incisor Hypomineralization (MIH) is associated with what vitamin deficiency and common condition
Vitamin D - PRETERM BIRTH
Disorders featuring Multiple Supernumerary Teeth
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Aperts Cleidocranial Dysplasia Gardners Crouzons Downs Sturge-Weber Orofacialdigital CLP
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Most common Primary ANKYLOSED Tooth
Mandibular 2nd Molar
correlation exist between congenital missing Permanent Tooth (2nd PM) and ANKYLOSED Primary Tooth
Disorders with multiple congenital MISSING teeth.
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Ectodermal Dysplasia Crouzon* Chondroectodermal Dysplasia (Ellis-Van Creveld) Williams Achondroplasia Incontinentia Pigmenti Orofacialdigital* Rieger CLP*
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(*) - also can have Hyperdontia
MICRODONTIA
L23
Bell Stage / Morphodifferentiation
Genetics: Autosomal Dominent (localized)
Syndromes (Generalized)
Up to 8%
Max Laterals > 2nd PM > Third Molars
Syndromes associated with MICRODONTIA
Downs Crouzons* Ectodermal Dysplasia* Chondroectodermal Dysplasia* (Ellis Van Crefeld) Pituitary dwarfism Hemifacial Microsomia
(*) associated with Hypodontia
Syndromes that cause MACRODONTIA
Localized:
Hemifacial Hyperplasia
(Accelerated eruption on affected side)
Generalized: (very rare) Pituitary gigantism Pineal hyperplasia with Hyperinsulinism XYY syndrome Crouzon syndrome* Otodental syndrome
Dens Evaginatus
Characteristics?
Syndromes?
MORPHODIFFERENTIATION
“TALON” cusp / extra cusp
Contains Enamel/Dentin/PULP
(Cannot just shave down)
Most prevalent on MAX INCISORS
Evagination of Enamel Epithelium;
Focal Hyperplasia of Pulp Mesenchyme
Syndromes:
Lobodontia “wolf-like” teeth
Rubenstein-Taybi
Dens in Dente
Dens Invaginatus
Caused by invagination of IEE
IEE which produces Ameloblasts which produces Enamal, which forms a hole and then tunnel into the tooth*
Caries can progress quickly through the tunnel
Most common in PERMANENT MAX LAT
Taurodontism
Associated with?
Vertically elongated pulp chamber and short roots
Associated with:
AMELOGENESIS Type IV
Dilaceration
Abnormal bend in root
Usually due to TRAUMA in Primary Tooth
INTRUSION pushes primary root into developing tooth.
Turners Hypoplasia
Periapical infection or trauma to primary tooth causes inflammatory response that messes up Ameloblasts of the developing permanent tooth.
Congenital Syphilis creates what two Tooth Anomalies?
Hutchinson’s Incisors (hypoplastic notch)
Mulberry Molars (globular enamel)
Enamel Hypoplasia
What stage?
Failure in APPOSITION phase
Tissue is UNDERDEVELOPED
LESS than normal number of cells
Enamel is laid down from the DEJ ➡️ Outward direction, possible to determine how early or late trauma/infection was by level of hypoplasia present
Enamel Hypocalcification
What Stage?
Failure in MATURATION stage
Abnormal mineralization resulting in WHITE SPOTS.
Amelogenesis Imperfecta
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General Facts
BELL 🔔 Stage / Histodifferentiation
(When we are seeing differentiation of IEE into Ameloblasts)
YELLOW-BROWNISH in color
(which makes senses with a thinner enamel)
Autosomal Dominant, Recessive, or X-Linked
INTRINSIC alteration to Enamel
ALL TEETH, Primary and Permanent are affected
THIN TO NO ENAMEL, but dentin and pulps are fine.
Dentinogenesis Imperfecta
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🔔
BELL 🔔 Stage / Histodifferentiation
(Mess up of Dental Papilla turning into Odontoblasts which secrete the Dentin)
Autosomal Dominant
INTRINSIC alteration of DENTIN
-amorphic and atubular
ALL TEETH, Primary and Permanent are affected
- SHORT ROOTS
- OBLITERATED ROOT CANALS
- BELL-SHAPED CROWNS
- BULBOUS CROWNS in XRAYS due to constricted DEJ
Blue Sclera 👁 🔵
Dentin Dysplasia
Autosomal Dominant
INTRINSIC alteration of DENTIN
ALL TEETH: Primary and Permanent are affected
2 types:
TYPE 1 - Short Roots
- mobility
- premature exfoliation
TYPE 2 - Chevron / Bow tie Pulps ^
- more coronal
- obliterated pulp canals
NOT good teeth for Restoration
Regional Odontodysplasia
💁🏽♀️
“Ghost Teeth”
Affects: Ameloblasts, Odontoblasts, and Cementoblasts (AOC)💁🏽♀️
Disorganized growth of ALL the tissues
ONE QUADRANT of teeth exhibit:
- Large Pulps
- Open Apices
- Short Roots
ALL TEETH (QUADRANT): Primary and Permanent affected
TX: Extract affected teeth
Enamel Pearl
Only on MOLARS
Chunk of Enamel blocking attachment of SHARPEY’S Fibers
(Terminal ends of connective tissue fibers, mostly type 1 collagen that connects PDL to Cementum)
Patient will automatically have a PERIODONTAL POCKET
Will NOT come off with scaling
Pre-Eruptive Resorption
What is it?
What does it contain?
Where is it most prevalent?
Defect located in the dentin of an unerupted tooth, just beneath the dentin-enamel junction, with a prevalence of 0.5-2% of the teeth. The depth of the lesion is variable and may also reach the pulp.
Contains soft tissue and inflammatory cells
4% for the permanent mandibular first molar,
2% for the mandibular first premolar
1% for the permanent maxillary first molar, maxillary first premolar, and mandibular second molar.
What is the percentage range of a congenital missing tooth?
1.5-10%
Taurodontism is commonly found in what Syndrome?
KLIENFELTERS
Natal teeth
Etiology?
The presence of teeth at birth or within a month post-delivery.
Superficial position of the tooth germ.
Natal and Neonatal teeth are associated with what Syndromes
ELLIS VAN CREVOLD (chondroectodermal dysplasia) PACHYONYCHIA CONGENITAL HALLERMAN-STRIEF RUBENSTIEN-TAYBI PIERRE-ROBIN CLEFT LIP / PALATE PFEIFFER ECTODERMAL DYSPLASIA
Decoronation of a tooth
What is it?
Purpose?
ROOT - PRESERVE - WIDTH - INTRUSION
Surgical method for treating ankylosed incisors in children and adolescents.
The crown and root filling are removed, leaving the ROOT IN SITU to be resorbed and covered with a mucoperiosteal flap. Leaving the root in its alveolus to be replaced by bone.
Early loss of a permanent tooth leads to loss of alveolar bone, especially in buccopalatal width. Decoronation PRESERVES not only the WIDTH of the ridge but also the vertical height.
Syndromes associated with HYPERDONTIA
APERT - CLEIDOCRANIAL - GARDNER - CROUZON
Hyperdontia is often associated with?
DELAYED ERUTION
Most common congenital missing teeth?
3/⬇️2/L/⬆️2
THIRD MOLAR - 20%
MAND 2ND PREMOLAR - 3.4%
MAX LATERAL - 2.2%
MAX 2ND PREMOLAR - .85%
Lamina issues
T/F?
Missing Third Molars is associated with missing Lateral Incisors
TRUE
What conditions are often associated with HYPODONTIA?
SSS
ECTODERMAL ORGANS
SALIVA GLANDS - SKIN - SWEAT GLANDS
Hyposalivation
Difference between CLEIDOCRANIAL Dysplasia and CHONDROECTODERMAL Dysplasia?
CLEIDOCRANIAL
+++++ Supernumerary teeth
🧠 delayed
CHONDROECTODERMAL (EVC)
- - - - Hypodontia
🚫🧠delayed
Which Dentinogenesis Imperfecta type is associated with Osteogenesis Imperfecta?
Shields Type 1
What is the difference between Dentinogenesis Imperfecta and Dentin Dysplasia?
DI
- Histodifferation
- 3 subtypes (1,2,Brandywine)
- 1 in 6,000 to 1 in 8,000
DD
- Apposition
- 2 subtypes
- 1 in 100,000
- The features of DD-II resemble DGI-II in the primary dentition. The permanent dentition, however, is either unaffected or radiographically has thistle tube-shaped deformity of the pulp chamber and pulp stone
What dental anomaly’s would be present with someone who had Vit D Rickets?
Hypomineralized Dentin
Enlarged pulp and pulp horns
Which Amelogenesis is associated with Hypocalcification, and enamel lost right after eruption?
AMELOGENESIS III - MINERALIZATION
How would a tooth that is HYPOMATURED look?
What AI’s are these?
MOTTLED BROWN-YELLOW SNOWCAPPED
POUROUS - CHIPS AWAY
AI - 2
AI - 4
What nutrient deficiencies can cause Enamel Hypoplasia?
VIT A C D - Calcium - Phosphate - Fluoride
T/F
Enamel Hypoplasia is a marker for celiac disease.
TRUE
Tetracyclines can stain teeth how quickly
What age is it ok to begin to prescribe?
Staining can result in 3 days administration
Should NOT prescribe from 5th month in utero to 8 years old
