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ACS > Dental Anomalies II > Flashcards

Dental Anomalies II Flashcards

1
Q

Abnormalities in tooth eruption?

A

Premature eruption:(primary and permanent teeth)

  • Natal/neonatal - born with teeth or within first 30 days of life = can be wobbly and in a superficial position = may be inhaled by baby (usually removed)
  • More likely when: Hormonal abnormalities and high birth weight

Delayed eruption:

  • More common in low birth weight babies, pre-term syndromes, endrocrinopathies
  • Can occur in impaction/ supernumerary/early extraction

Differences - jaws, race, gender

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2
Q

Abnormalities in exfoliation?

A

Premature abnormalities due to:

  • Trauma
  • Extraction
  • Immune/cementum deficiencies

Delayed:

  • Infraocclusion (submerged) = primary>permanent, 4 and 5 absent = genetic
  • Ectopic successors
  • Double primary
  • Hypodontia
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3
Q

Abnormalities in structure?

A

All tissues:

  • Arrested development
  • Odontodysplasia - ghost teeth on radiographs (not radiopaque)

Enamel defects

  • Hypomineralisation (defect 1)
  • Hypoplasia (defect 2)
  • Discolouration (defect 3)

Dentine defects
Cementum defects

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4
Q

Enamel defects?

A
  1. Hypomineralisation (1)
    - Quality
    - Opacity (porous)
    - Altered translucency
  2. Hypoplasia (quality) (2)
    - Pits, grooves, areas, absence
    - Variation in thickness
  3. Discolouration (intrinsic) (3)
    - Intrinsic discolouration
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5
Q

Aetiology of dental anomalies?

A

Genetic (polygenic)

  • Primarily involving enamel = amelogenesis imperfecta
  • Associated with generalised disorders, syndromes
  • Non-chronological
  • Affects both dentitions to variable extent

Environmental

  • Systemic/chronological e.g. trauma, infection, systemic illness
  • Non-chronological e.g. prolonged fluoride
  • Local
  • Timing (development, insult)

If combo of both = multifactorial determination

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6
Q

Examples of systemic effects that can impact tooth development?

A

Maternal/foetal conditions
Pre-term/low birth weight/neonatal
Fluoride
Severe/chronic childhood illness (fevers: measles, chicken pox, tetracyclines)

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7
Q

What can cause localised defects?

A

Infections/trauma

Cleft lip/palate

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8
Q

Example of an idiopathic/environmental defect?

A

Molar-incisor hypomineraisation (MIH) (defect 1)

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9
Q

Presentation of enamel opacity defects - type 1?

A

Opacity (defect 1)

  • Opaque patches (white/cream, yellow/brown)
  • Hypominerlisation (hypocalcified/hypomature)
  • Disruption to mineralisation at maturation stage
  • Porosity (subsurface/surface)
  • Altered translucency and texture
  • Boundary of opaque defects can be diffuse or demarcated
  • Localised to 1 or 2 teeth, generalised (all teeth), symmetrical or asymmetrical
  • Poorly mineralised zones through full enamel thickness (due to maturation permanently interrupted) OR surface unaffected (ameloblasts returned to normal maturation)
  • Enamel may be softer and may be lost (post eruptive breakdown)
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10
Q

Fluoride induced opacities (defect 1) presentation?

A 
Opacities (brown), enamel loss
Primary and permanent 
Posterior and anteriors (development)
Dose dependent 
Symmetrical distribution
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11
Q

Enamel hypoplasia (defect 2) presentation?

A

Deficient matrix production
Thin
Pits, grooves, areas

Chronological - matching teeth affected

Localised (turner teeth)

  • Affects 1-5 only
  • Due to Trauma or infection of primary tooth
  • = Damage to underlying developing permanent tooth germ
  • May also exhibit hypomineralisation
  • Commonly affects 4s and 5s
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12
Q

Variation in tooth colour (defect 3) due to?

A

Changes in tooth thickness and/or structure - hypoplasia/hypomin

Incorporation of circulating substances/pigment deposits
- E.g metabolic disorders - circulating bilirubin, tetracycline during development

Incorporation of pulp products
- E.g loss of vitality and infection

Exogenous agents
- E.g. intrinsic, not developmental - diet, bacterial

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13
Q

Prevalence of defects in opacity and hypoplasia in white school children?

A

Opacity - 68%

Hypoplasia - 14.6%

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14
Q

Amelogenesis imperfecta features?

A

Hereditary
1:700 to 1:14000
Enamel defects, not associated with systemic abnormalities
Cause - Single gene mutations, genes critical for enamel formation:
- Amelogenin (AMELX)
- Inheritance patterns - AD, AR, X-linked

Can present with hypomineralisation and hypoplastic (defects 1 and 2)
Diverse phenotypes

Bilateral symmetry but not always
Soft enamel wears away
Snowcapped - incisal portions of anterior and occlusal portions of posters can be affected

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15
Q

What is lyonisation?

A

Bands of normal and abnormal enamel

Seen in females

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16
Q

What disorders may cause enamel defects?

A

Epidermolysis bullosa
Tuberous sclerosis
Vitamin D dependent rickets

17
Q

Genetic anomalies of dentine?

A

Limited to dentine:

  1. Dentinogenesis imperfecta (DI)
  2. Radicular dentine dysplasia (DD) = limited to root dentine
  3. Fibrous dysplasia

Associated with generalised disorders:

  1. Osteogenesis imperfecta (OI) with DI (type 1)
  2. Ehlers-danlos syndrome
  3. Vit D dependent and resistant rickets
  4. Hypophosphatasia
18
Q

Dentinogenesis imperfecta features?

A 
Hereditary opalescent dentine
1:8000, AD
Defect in non-collagenous dentine matrix protein 
Defect in DSPP gene
Variability in expression, severity

Teeth opalescent on transillumination, blue or brown in colour
All teeth, both dentitions
Primary > permanents

Bulbous crowns, short, thin roots
Pulp chamber obliteration
Flattened ADJ
Enamel chips away, soft dentine quickly wears
Dentine abnormal:
- Tubules decreased and irregular
- Cellular inclusions from pulp
- Gradual pulp obliteration

Can have large pulps that are flamed shaped and shell shaped teeth with thin dentine and enamel

19
Q

Dentine defects caused by genetic abnormalities (type 1 DI)?

A

Osteogenesis imperfecta

  • Group of CT disorders
  • Mutation in type 1 collagen genes
  • Bone fragility, deformity
  • Lax joints
  • Opalescent dentine (90% collagenous protein)
  • Blue sclera

Primary teeth resemble DI
Permanent teeth variable, better prognosis

20
Q

Dentine dysplasia features?

A 
Rootless teeth 
Normal, bluish or brown colour
Both dentitions
RG normal crown morphology and crown dentine
Roots short, blunt, teeth mobile
Rare
21
Q

Fibrous dysplasia of dentine features?

A

Lacunae
Cellular inclusions
More common in permanent dentition, rare

22
Q

Environmental dentine defects due to?

A

Local trauma
Nutritional deficiencies
Drugs
Interglobular dentine, predentine and osteoid

ACS (23 decks)

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