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Paediatric Dentistry > Developmental abnormalities > Flashcards

Developmental abnormalities Flashcards

1
Q

List developmental defects affecting tooth number

A

Hypodontia
Oligodontia
Anodontia
Supernumerary teeth

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2
Q

Define: hypodontia

A

Congenital absence of 1-6 teeth excluding the third molars

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3
Q

Which teeth are most commonly missing due to hypodontia?

A

Upper second premolars
Upper lateral incisors
Lower second premolars
Lower central incisors

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4
Q

Define: oligodontia

A

More than 6 congenitally missing teeth

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5
Q

Define: Anodontia

A

Complete congenital absence of one or both dentitions

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6
Q

Define: Supernumerary teeth

A

Addition to the normal series of tooth

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7
Q

What would multiple supernumerary teeth indicate?

A

Disease or syndrome e.g. CLP, Gardner syndrome or Ehlers-Danlos

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8
Q

What is the most common supernumerary tooth?

A

Mesiodens

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9
Q

List the types of supernumerary teeth

A

Supplemental
Conical
Tuberculate
Odontome

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10
Q

Define: supplemental tooth

A

Extra tooth of normal form occurring at the end of a series (most commonly lateral incisor)

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11
Q

Where do conical supernumerary teeth occur

A

Anterior maxilla in the midline (mesiodens)

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12
Q

When will a conical supernumerary remain unerupted

A

If it is inverted

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13
Q

Where do tuberculate supernumary teeth occur

A

In the anterior maxilla on the palatal aspect of central incisors

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14
Q

What is an odontome?

A

Benign tumour linked to tooth development

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15
Q

What are the types of odontomes

A

Complex

Compound

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16
Q

Define: Complex odontome

A

Calcified structure with no resemblence to the anatomical arrangement of dental tissues

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17
Q

Define’ Compound odontome

A

Calcified structure made up of rudimentary teeth

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18
Q

What is thought to be the developmental issue causing hypodontia

A

Defect in dental epithelial growth

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19
Q

What stage of development does anodontia occur?

A

Dental lamina formation stage

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20
Q

What is the developmental issue causing supernumerary teeth

A

Disturbance during initiation and proliferation stages

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21
Q

What are the theories of supernumerary teeth

A
  • Dichotomy (division) of tooth buds

- Organised hyperactivity of the dental lamina

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22
Q

Define: peg laterals

A

Small tapered maxillary lateral incisor

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23
Q

What stage is important for peg lat formation

A

Morphodifferentiation stage

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24
Q

Define: microdontia

A

Teeth smaller than nrmal

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25
Q

Define: macrodontia

A

Teeth larger than usual

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26
Q

What stage is implicated in macrodontia

A

Disturbance in initiation and proliferation stages

Morphodifferentiation stages

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27
Q

Define: Taurodontism

A

Multirooted teeth with a long body and pulp chamber and short roots. The Pulp chambers are elongated and the pulp is apically displaced

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28
Q

Which teeth are often implicated in Taurodontism

A

Mandibular molars

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29
Q

Hypothesised cause of taurdontism

A

Disturbance in growth of hertwig’s epithelial root sheath or morphodifferentiation stage

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30
Q

Define: dens envaginates

A

Formation of an accessory cusp whose morphology is described as tubercle, elevation, protruberance, extrusion or bulging.

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31
Q

What makes up the dens envaginates

A

Enamel covering a dentine core and pulp tissue

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32
Q

Which teeth are often implicated in dens envaginates

A 
Anterior teeth (lingual or palatal aspect) 
Occlusal surface of premoalrs
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33
Q

What stage is implicated in dens envaginates formation

A

Organic matrix apposition and primary mineralisation stage

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34
Q

Define: dens invaginatus (Dens in dente)

A

Infolding of enamel into dentine

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35
Q

Where is dens in dentine more common

A

Maxillary lateral incisors, central incisors, canines then molars

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36
Q

Stage implicated in dens in dente

A

Morphodifferentiation

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37
Q

Define: dilaceration

A

Deviation or bend in the linear relationship of the crown relative to the root

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38
Q

Which type of dilaceration is more common

A

Root dilaceration > crown dilaceration

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39
Q

Where do root dilacerations occur

A

Posterior region of permanent dentition

40
Q

Where do crown dilacerations occur

A

Permanent maxillary and mandibular teeth

41
Q

Cause of dilaceration

A

Trauma to primary tooth causing damage to permanent predecessor

42
Q

Define: Fusion

A

Two normally seperate adjacent tooth germs fuse into one large tooth, sharing the same enamel and dentine

43
Q

When does complete fusion occur

A

If fusion occurs before calcification stage

44
Q

When does incomplete fusion occur

A

If fusion occurs later on (after calcification stage)

45
Q

What stage is implicated in fusion

A

Initiation and proliferation stages

46
Q

Define concresence

A

Cemental union of adjacent teeth without confluence of dentine, they have separate pulp chambers and root canals

47
Q

Which teeth are often implicated in concresence

A

Posterior maxillary teeth, often 7s

48
Q

What is the cause of developmental concresence

A

Close proximity of developing roots of adjacent teeth

49
Q

Define germination

A

Two teeth from the same follicle attempt to divide, but division is incomplete thus forming an abnormally large tooth

50
Q

Which teeth are often affected by germination

A

Anterior teeth

51
Q

What are enamel pearls

A

Localised formation of enamel on the root of a tooth

52
Q

What is the cause of enamel pearls

A

Continued formation of Hertwig’s epithelial root sheath

53
Q

Define amelogenesis imperfecta

A

Group of inherited enamel disorders leading to altered enamel morphology, alongisde normal dentine and pulp formation

54
Q

What are the types of AI

A

Hypoplastic
Hypocalcified/hypomineralised
Hypomatured

55
Q

Define hypoplastic enamel

A

Reduction in the amount of enamel matrix protein secretion thus causing thin enamel, surface pitting or vertical grooves

56
Q

Define hypomineralised enamel

A

Normal enamel matrix present but the enamel is deficiently mineralised causing soft enamel

57
Q

Define hypomatured enamel

A

Normal enamel matrix present but the enamel lacks hardness forming opaque, discoloured enamel that easily fractures

58
Q

Define dentinogenesis imperfecta

A

Genetic disturbance of dentine formation leading to altered morphology of dentine

59
Q

Features of dentiogenesis imperfecta

A

Brown, opalescent discolouration and fracture of overlying enamel
Rapid wear/attrition of teeth
Progressive pulp obliteration

60
Q

What is regional odontodysplasia

A

Hypoplastic and hypocalcified enamel and dentine

61
Q

Features of regional odontodysplasia

A

Small, brown teeth with large pulp chambers and root canals

62
Q

Define: molar-incisor hypomineralisation

A

Developmental defect resulting in 1-4 hypomineralised permanent first molars, frequently associated with similarly affected permanent incisors

63
Q

What is the prevalence of MIH

A

2.8-40%

64
Q

What are the stages of amelogenesis

A

Secretory
Transition
Maturation

65
Q

Which stage of enamel formation is associated with enamel hypoplasia

A

Secretory

66
Q

Which stages of enamel formation are associated with hypomineralised/hypomatured enamel

A

Transition

Maturation

67
Q

Aetiology of MIH

A

Unknown

Possibly systemic in origin

68
Q

What age is the critical period for enamel defects in incisors and 6s ? WHY?

A

1yo - as it coincides with early maturation phase

69
Q

Proposed etiological factors of MIH

A
  • Maternal illness, diabetes, medicines or pyrexia
  • Complicated delivery, c section, hypoxia, premature
  • ENT infections, respiratory problems, antibiotics, chickenpox/measles/mumps
70
Q

Stages of management of MIH

A 
Early diagnosis 
Risk identification 
Remineralisation & desensitisation 
Prevent caries + PEB 
Restorative care/extractions 
Maintenance
71
Q

Presentation of MIH

A
  • 1-4 permanent molars (or incisors) with signs of hypomineralised enamel e.g. opacities
  • Post eruptive enamel breakdown
  • Atypical caries pattern
72
Q

What are the consequences of MIH

A
  • Caries
  • PEB
  • hypersensitivity and difficulty obtaining LA
  • Frequent restorative failure
73
Q

What are the features of the hypomineralised lesions

A
  • Clear demarcated opacities which -
    1 - Vary in colour - white, cream, yellow or brown
    2- Vary in size
74
Q

What is post-eruptive enamel breakdown (PEB)

A

Severely affected enamel subject to masticatory forces results in rapid breakdown, exposure of dentine and rapid caries development soon after eruption

75
Q

What type of prevention is required in MIH ptsq

A

ENHANCED PREVENTION - includes high dose fluoride, frequent recalls, dietary advice

76
Q

What remineralisation products can be used for MIH

A
  • CPP-ACP
  • Enamelon
  • Novamin
77
Q

How does CPP-ACP work

A

Incr bioavailability of calcium and phosphate within saliva and prevents spontaneous precipitation, thus encouraging remineralisation deep into lesions and desensitisation

78
Q

What are the two options to prepare MIH affected teeth for restorative tx

A
  • Remove all defective enamel until sound surface reached

- Remove porous enamel only until resistance to the bur is felt

79
Q

Disadvantages of a minimally invasive approach in MIH

A
  • Since not all the defective enamel is removed, the tooth is still susceptible to breakdown thus restorative failure
80
Q

What does restorative tx for MIH depend on?

A
  • Cooperation of patient
  • Longevity required
  • Extent of PEB (cuspal involvement, restorable?)
  • Orthodontic needs
81
Q

Methods for restoring MIH 6s

A

Direct - RMGIC as temporary, Composite

Indirect - Crowns or cast onlays

82
Q

Indications for planned loss of 6s

A
  • Poor long term prognosis
  • Underlying malocclusion
  • Extent and location of crowding
  • No missing teeth (8s present)
  • Correct timing
  • Which 6s are affected
83
Q

When is the ideal timing for extraction of 6s ?

A

DPT showing calcification of the bifurcation of 7s

84
Q

Why is timing important in planned loss of 6s

A

Provides good prognosis for the 7s replacing the position of the 6s

85
Q

Are balancing / compensating extractions done in MIH

A
  • balancing to prevent asymmetry

- Compensating is not recommended

86
Q

When is timing of planned loss of 6s most important?

A

for MANDIBULAR 6s

87
Q

Why is timing of planned loss of 6s not a big concern in the maxilla

A

The 7 usually takes up a good occlusal position anyway

88
Q

What is the most favourable age for planned loss of 6s?

A

8-10

After laterals erupt but before 7s and/or 5s

89
Q

What happens if planned loss of 6s occurs too early

A

Loss of space due to 5 drifting distally, retroclination of labial segments and incr overbite

90
Q

What happens if planned loss of 6s occurs too late

A

7s are well formed and will not erupt into the space of the 6
Risk of mesial tilt or rotation of 7s
Risk of 5s drifting distally

91
Q

Explain MIH and LA issues

A

Hypomineralised enamel is a poor insulator therefore the pulp is not well protected and becomes hypersensitive and difficult to numb up

92
Q

Options to treat MIH incisors

A 
Bleaching 
Resin infiltration 
Microabrasion 
Composite restorations/veneers 
Porcelain veneers
93
Q

Timing of treatment of MIH incisors

A

Aesthetic tx should be postponed until older as immature teeth have large and sensitive pulps

94
Q

What is resin infiltration

A

Hcl as an etchant and low viscosity resin to penetrate demineralised enamel

95
Q

What is microabrasion

A

Removal of a small layer of superficial enamel using abrasion and erosion with 18% hcl and pumice

96
Q

Age and bleaching

A

GDC states products containing 0.1-6% hydrogen peroxide cannot be used on under 18s unless wholly intended to prevent/treat disease

97
Q

Differential diagnosis of MIH

A

Fluorosis
AI
WSL
Traumatic hypomineralisation

Paediatric Dentistry (11 decks)

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