dental anomolies 1 Flashcards by Caleb Houghton

Enamel defects
 Ameloblasts sensitivity?
 Enamel defects may be caused by what factors?
 Enamel remodeling?
 Abnormalities etched?

Enamel defects
 Ameloblasts: extremely sensitive to external stimuli
 Enamel defects may be caused by local or systemic factors
 Enamel remodeling does not occur after initial formation
 Abnormalities etched permanently on tooth surface

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Stages of enamel development

1) Matrix formation: enamel proteins laid down
2) Mineralization: minerals deposited, original proteins removed
3) Maturation: final mineralization, remaining original proteins removed> Hard, translucent enamel

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Enamel defects
 Timing of injury: affects?
 Final enamel: record of?

 Timing of injury: affects location and appearance of defect
 Final enamel: record of all significant insults received during toothdevelopment

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 Enamel hypoplasia

large areas of missing enamel
 Pits, fissures, grooves

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enamel opacities

areas of enamel hypomaturation
 diffuse or demarcated
 White, yellow, brown

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enamel hypoplasia of a systemic cause due to more generalized app

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enamel opacities

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turner hypoplasia
 Clinical and Radiographic features:
 Observed in which tooth? MC?
 Traumatic cases?
 app?
 Extensive hypoplasia may involve?
 RG?

 Periapical inflammatory disease or trauma of overlying deciduous tooth

 Clinical and Radiographic features:
 Observed in permanent teeth – MC premolar
 Traumatic cases – max central incisors
 Focal areas of white, yellow, brown discoloration
 Extensive hypoplasia – may involve entire crown
 RG: lack of enamel, irregular surface dentin

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severity of turner hypoplasia depends on?

timing on development, earlier= more severe

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Antineoplastic therapy and development
 Severity dependent on?
 which is more severe?

 Developmental abnormalities secondary to use of radiation orchemotherapy
 Severity dependent on age of treatment, form of therapy, dose and field ofradiation
 Radiation therapy – more severe alterations

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Antineoplastic therapy
 Clinical features:
 Radiation:
 Chemotherapy:

 Radiation: Hypodontia, microdontia, radicular hypoplasia, enamel hypoplasia

 Chemotherapy: enamel hypoplasia, microdontia, occasionally radicular hypoplasia

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what previous medical tx likley occurred in this pt

antineoplastic tx

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Dental Fluorosis
 Ingestion of?
 mechanism?
 Dose?

 Ingestion of excessive FL → significant enamel defects
 Retention of amelogenin proteins in enamel → hypomineralized enamel
 Dose dependent

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fluorosis clinical features
 color?
 caries?
 distribution?

 White, opaque enamel, with areas of brown/yellow discoloration
 Affected teeth are caries resistant
 Bilateral, symmetrical distribution

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fluorosis

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Treatment: enamel defects
most defects are?
focal lose of enamel may lead to?
options?

 Most defects are cosmetic
 Focal loss of enamel – increased prevalence of caries
 Composite restorations, veneers, full crowns

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Tooth wear
 Considered pathologic when?

 Considered pathologic when the degree of destruction creates functional, aesthetic, or dental sensitivity problems

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Attrition
 Loss of tooth structure due to?
 what can accelerate process?

 Loss of tooth structure due to tooth-to-tooth contact
 Poor-quality/absent enamel can accelerate process

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attrition clinical features

 Incisal and occlusal surfaces
 Large, flat, smooth and shiny wear facets
 Slow loss of tooth structure, reparative secondary dentin forms

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Abrasion
 defined?
 MC agent

 Pathologic wearing of tooth structure secondary to an external agent
 Toothbrushing MC

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abrasion clinical features
 Clinical features:
 Dependent on?
 Toothbrushing?
 additional causes?

 Dependent on cause
 Toothbrushing: horizontal cervical notches on buccal surface
 Tobacco pipe, bobby pins: V-shaped notches on incisal edge

Erosion
 Loss of tooth structure caused by?
 Exposure to?

 Loss of tooth structure caused by a non-bacterial chemical process
 Exposure to acidic source, reduced salivary flow

 erosion Clinical features:

 Cupped lesion, central depression of dentin surrounded by elevated enamel
 May create concave sloping areas on palatal surfaces

Tooth wear treatment
 cause?
 Detailed?
 Erosion: may consider?
 Restorative treatments?

Tooth wear treatment
 Multifactorial cause
 Detailed diagnosis, preventative measures
 Erosion: may consider limiting toothbrushing 1x daily
 Restorative treatment: composite, veneers, full crown

Extrinsic stains  Arises from?  Usually can be removed with?  examples?

 Arises from the surface accumulation of exogenous pigment  Usually can be removed with surface treatment  Tobacco, bacterial stains, food + beverages, iron, restorative materials,medications

Intrinsic stains  Arises from?  Cannot be?  examples?

 Arises from endogenous materials that are incorporated into enamel and dentin  Cannot be removed by prophylaxis  Amelogenesis imperfecta, dentinogenesis imperfecta, dental fluorosis, hyperbilirubinemia, trauma, medications

Internal Resorption  Loss of tooth structure on?  Commonly arises secondary to?  Continues if?

 Loss of tooth structure on the dentinal walls of the pulp  Commonly arises secondary to inflammatory reaction  Continues if vital pulp tissue remains

forms of internal resorb

inflammatory and replacement

inflammatory internal resorb clinical and radio features

resorbed dentin replaced by inflamed granulation tissue  RG: well-circumscribed radiolucent enlargement of pulp chamber

replacement internal resorb clinical and radio findings

pulpal dentinal wall is resorbed with bone and cementum-like bone  RG: partial obliteration of canal by bone (radiopacity)

pink tooth of mummery

occurs when coronal pulp is affected by internal resorb

internal resorbtion (inflammatory)

External resorption  Loss of?  Exposure of?  Common causes:  Commonality vs internal?

 Loss of tooth structure along external surface of root  Exposure of adjacent mineralized cementum to cemetoclasts  Common causes: localized pressure (ie: orthodontic therapy), excessive occlusal forces, cysts, tumors  More Common!

External resorption  Clinical and Radiographic findings:

 “moth-eaten” loss of tooth structure  Over pulp chamber, radiolucency superimposed

external resorbtion

Ankylosis  Anatomic fusion of?  May be caused by?

 Anatomic fusion of tooth cementum with the alveolar bone  May be caused by trauma, chemical/thermal irritation, genetically decreased PDL

Ankylosis  Clinical features:  MC age?  MC tooth?  Mandible vs maxilla ratio  Ankylosis of permanent teeth?  percussion?

 Clinical features:  MC 1st-2nd decade  MC mandibular primary first molar  Mandible 10:1  Ankylosis of permanent teeth uncommon  Sharp, solid sound upon percussion

Ankylosis  Radiographic features:

 Absence of PDL space (difficult to detect)  Adjacent teeth inclined towards affected tooth  Supraeruption of opposing tooth

ankylosis tx

 For primary teeth (lack of exfoliation) → extraction

what can be noticed?

ankylosis of the primary molar

Tooth number anomalies  Anodontia:  Hypodontia:  Oligodontia:  Hyperdontia:

 Anodontia: total lack of development of teeth  Hypodontia: lack of development of one or more teeth  Oligodontia: lack of development of 6 or more teeth  Hyperdontia: development of an increased # of teeth – supernumerary

Tooth number anomalies  More than ___ genes associated with odontogenesis  Syndromic or non syndromic?  MC genes implicated:

 More than 200 genes associated with odontogenesis  Syndromic and non syndromic  MC genes implicated: PAX9, MSX1, AXIN2 genes (hypodontia)

Hypodontia  Prevalence of ?% in permanent teeth  what correlates strongly with missing successor?  Syndrome associated:

 Prevalence of 3-10% in permanent teeth  Absence of primary teeth correlates strongly with missing successor  Syndrome associated: Ectodermal dysplasia

Hypodontia  Clinical features:  MC teeth?  MC sex

 After 3rd molars, MC in 2nd premolar and lateral incisor  MC in females

AMLI

Hyperdontia  Most cases represent?  Syndromes:  Positively correlated with?

 Most cases represent single-tooth supernumerary  Syndromes: Cleidocranial dysplasia, Gardner  Positively correlated with macrodontia

Hyperdontia  Clinical features:  Single tooth hyperdontia: MC in?  Accessory 4th molar?  sex ratio

 Single tooth hyperdontia: MC in anterior maxilla – mesiodens  Accessory 4th molar: distomolar/distodens  2: 1 male

Microdontia  Presence of?  factors playing a role?  Conditions:  Isolated cases vs diffuse cases?

 Presence of unusually small teeth  Genetic and environmental factors play a role  Conditions: Down syndrome, pituitary dwarfism  Isolated cases more common than diffuse cases

Microdontia  Clinical features:  Isolated microdontia: MC in?  MC sex

 Isolated microdontia: MC in max lateral – peg lateral  MC in females

Macrodontia  Teeth size?  factors playing a role?  Conditions:  Isolated cases vs diffuse

 Teeth larger than average  Genetic and environmental factors play a role  Conditions: pituitary gigantism, XYY, pineal hyperplasia, hyperinsulinism  Isolated cases more common than diffuse cases

Macrodontia  Clinical features:  Isolated macrodontia: MC in  MC sex

 Isolated macrodontia: MC in incisors or canines  MC in males