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BDS4 Paeds > Developmental Anomalies > Flashcards

Developmental Anomalies Flashcards

1
Q

What is hypodontia?

A

Reduced number of teeth

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2
Q

What are the types of developmental dental anomaly?

A

Number
Size and shape
Structure- hard tissue defects
Eruption and exfoliation

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3
Q

Which teeth are most commonly involved in hypodontia?

A

Very uncommon in primary

Most common in permanent- 8, lower 5s, upper 2s (tends to be the last one in the series)

Most common lower incisor missing is central- lateral is coded before central genetically (more detail and shape, larger)

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4
Q

Which conditions are associated with hypodontia?

A

Ectodermal Dysplasia

Down Syndrome

Cleft Palate

Hurler’s syndrome

Incontinentia pigmentii

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5
Q

What are the features of ectodermal dysplasia?

A

Blonde, saddle shaped noses, intolerance to sweating, sparse hair

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6
Q

What can cause a restorative issue when upper laterals are missing?

A

Over-eruption of lower canines

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7
Q

What are the treatment options for hypodontia? (chronological order)

A

Enhanced prevention

Removable prostheses- overdenture

Orthodontics

Composite build-ups

Veneers

Crowns and bridges (resin retained)

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8
Q

What are the problems with hypodontia in children and their solutions?

A

Abnormal tooth shape and form-> composite build up

Spacing (in mixed dentition)- partial denture

Submergence-> overdenture

Deep overbite

Reduced LFH

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9
Q

Why is enhanced prevention so important in hypodntia patients?

A

As it is important that teeth they do have are healthy and are not at risk of loss (treated as high caries risk)

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10
Q

What is hyperdontia?

A

When there are extra (supernumerary) teeth

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11
Q

In what demographics is hyperdontia more common?

A

Japanese people

Males (2:1)

Maxilla

In patient with cleidocranial dysplasia

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12
Q

What are the types of supernumerary teeth?

A

Conical (cone shaped)

Tuberculate (barrel shaped, has tubercles- premolar like)

Supplemental (looks like tooth of normal series)

Odontome (irregular mass of dental hard tissue, compound or complex)

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13
Q

What is the most common type of supernumerary?

A

Conical, in maxilla and unerupted
-> Most likely to cause issues in eruption

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14
Q

How can you which tooth is supplementary?

A

Supplemental tooth is usually smaller and doesn’t look quite the same as other side

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15
Q

How do you decide which tooth to extract when you have a supplemental tooth?

A

Decide which tooth would be easier to fix with Ortho

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16
Q

What age should you wait until to remove supernumerary teeth and why?

A

Wait until child is 7/8 to remove supernumerary tooth as there is a high chance of damaging developing teeth

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17
Q

What are the developmental dental anomalies of size and shape?

A

Microdontia (peg-shaped lateral incisors)

Macrodontia

Double teeth
-> Gemination (one tooth splits into 2)
-> Fusion (two teeth join to form 1)

Odontomes

Taurodontism (flame shaped pulp)

Dilaceration (crown or root)- caused by trauma

Accessory cusps e.g. talon cusp

Dens in dente- tooth within a tooth (invaginations in tooth with their own pulp system)

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18
Q

What is the treatment for accessory cusps?

A

Selective grinding with FV over time (helps shrink pulp)

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19
Q

What is the issue with dens in dente?

A

RCT is impossible- so seal all areas to prevent ingress of bacteria

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20
Q

Which root structure anomalies can occur?

A

short roots- permanent maxillary incisors
-> can happen due to Ortho

Radiotherapy

Dentine dysplasias

Accessory roots

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21
Q

What are the types of enamel structure anomaly?

A

Amelogenesis imperfecta

Environmental enamel hypoplasia

Localised enamel hypoplasia

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22
Q

What are the causes of environmental enamel hypoplasia?

A

Systemic- liver/kidney failure

Nutritional- poor during development of dentition

Metabolic- rhesus incompatibility, liver disease

Infection e.g. measles

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23
Q

What are the cause of localised enamel hypoplasia?

A

Trauma

Infection of primary tooth

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24
Q

What is hypo-mineralisation and its features?

A

All tooth is there, normal shape (correct thickness of enamel matrix in secretory phase)

-> Something has gone wrong with mineralisation
-> Appears as white, brown, yellow patches

25
Q

What is hypoplasia and its features?

A

Chunks of enamel missing- occurs at earlier phase of amelogenesis (issues with secretory phase)

-> Mineralisation occurs normally but tooth lacking in quantity

26
Q

How are localised hard tissue defects treated?

A

Check history for trauma or abscesses to primary teeth

-> cover with composite

27
Q

What are the types of generalised environmental enamel defects?

A

Fluorosis

MIH- assoc. with childhood illness, kidney/liver disease

28
Q

How does fluorosis appear?

A

White flecks in enamel (bleached appearance)- dark parts of the tooth can remain after treatment (make sure patient knows)

Can appear as brown spots (severe)

29
Q

How if Fluorosis treated?

A

MA

Veneers

Vital bleaching

30
Q

How does MIH appear?

A

Appears as lines where enamel has not formed properly (during the time of illness)

-> Marks appear in different places in different teeth depending on stage of development at time of illness

31
Q

What are the prenatal causes of generalised environmental enamel defects?

A

Rubella

Congenital syphilis

Thalidomide

Fluoride

Maternal A&D deficiency, cardiac & kidney disease

32
Q

What are the causes of enamel defects during neonatal period (ups to 8 weeks)?

A

Prematurity

Meningitis

33
Q

What are the post-natal (up to 2 years) causes of enamel defects?

A

Otitis media

Measles

Chickenpox

TB

Pneumonia

Diphtheria

Deficiency of Vits A,C&D

Heart disease

Long term health problem e.g. organ failure

34
Q

What is an example of hereditary enamel defect?

A

Amelogenesis imperfecta

35
Q

What pattern does amelogenesis imperfecta inheritance follow?

A

Tends to be an autosomal dominant trait in USA and Europe (but can be recessive or x-linked)

Can be new mutation or not noticed before in family

36
Q

Which gene mutations are associated with AI?

A

Mutations involving:

Enamel extracellular matrix molecules

Amelogenin/ Enamelin

Kallikrein 4

37
Q

What are the main types of Amelogenesis imperfecta? (hundreds)

A

Hypoplastic- enamel crystals do not grow to the correct length

Hypocalcified- crystallites fail to grow in thickness and width

Hypomaturational- enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation

Mixed forms- assoc. with taurodontism

38
Q

What factors are important when diagnosing AI?

A

Family history

Generally affects both dentitions

Affects all teeth

Abnormal tooth size, structure, colour

Radiographs- no obvious change in radiolucency between enamel and dentine

39
Q

What are the issues caused by AI?

A

Sensitivity

Caries/ acid susceptibility

Poor aesthetics- brown colour

Poor oral hygiene

Delayed eruption

Anterior open bite

Bonding issues

40
Q

What treatment are available for AI?

A

Preventive therapy

Composite veneers/ composite wash

Fissure sealants

Metal onlays

Stainless steel crowns

Orthodontics

41
Q

Which systemic conditions are associated with enamel defect? (not AI)

A

Epidermolysis bullosa
Incontinenta pigmenti
Down’s
Prader-Willi
Porphyria
Tuberous sclerosis
Pseudohypoparathyroidism
Hurler’s

42
Q

Which anomalies of dentine structure can occur?

A

Dentinogenesis Imperfecta (rarer than AI)

Dentine dysplasia

Odontodysplasia

Systemic disturbances- nutrition, metabolic, drugs

43
Q

What are the features of dentine dysplasia?

A

Normal crown morphology
Amber radiolucency
Pulpal obliteration
Short constricted roots

44
Q

What are the features Odontodysplasia?

A

Localised arrest in tooth development

Thin layers of enamel and dentine

Large pulp chambers

Appear as Ghost Teeth on radiographs

45
Q

What are the types of dentinogenesis imperfecta?

A

Type I- osteogenesis imperfecta

Type II- autosomal dominant

Brandywine

46
Q

What are the features of patients with OI/DI (type I)?

A

Wheel chair bound

Multiple bone fractures

Bulbous crowns (amber translucent- grey)

Blue sclera

Pulp obliteration (difficult to RCT)

47
Q

What are the features of DI radiographically?

A

Appear like primary teeth with normal root formation

Large pulps- become obliterated

Occult abscess formation (no demonstrable clinical disease)

48
Q

What are the issues with DI?

A

Aesthetics

Caries / acid susceptibility

Spontaneous abscess formation

-> poor prognosis

49
Q

What are the treatment options for DI?

A

Prevention

Composite veneers

Overdentures

Removable prostheses

Stainless steel crowns- lack of tissue to bond to

50
Q

Why is enamel lost in DI?

A

No connection at ADJ- just falls off due to no support

51
Q

How is generalised wear in children with DI treated?

A

SSC on posterior and composite on anteriors

52
Q

What hereditary types of dentine defect are limited to dentine only?

A

Dentinogenesis imperfecta type II

Dentine dysplasia Types I & II

Fibrous dysplasia of dentine

53
Q

Which hereditary disorders are associated with dentine defects?

A

Osteogenesis imperfecta

Ehlers-Danlos syndrome

Brachio-skeletal genital syndrome

Rickets

Hypophosphatasia

54
Q

What are the causes of anomalies in cementum structure?

A

Cleidocranial dysplasia- hypoplasia of cellular component of cementum

Hypophosphatasia- hypoplasia or aplasia of cementum
(leads to early loss of primary teeth)

55
Q

What are the causes associated with premature eruption of teeth?

A

High birth weight

Precocious puberty

56
Q

When are neonatal teeth removed?

A

If issue with feeding or inhalation risk

57
Q

What are the causes of delayed eruption?

A

Pre-term & low birth-weight children

Malnutrition

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

Gingival hyperplasia/ overgrowth

58
Q

What are the causes of premature exfoliation?

A

Trauma

Following pulpotomy

Hypophosphatasia

Immunological deficiency e.g. cyclic neutropaenia

Chediak-Higashi syndrome

Histiocytosis X

59
Q

What re the causes of delayed exfoliation?

A

Infra-occlusion (ankylosis/trauma)
-> majority exfoliate normally by age 11-12 yrs

Double primary teeth

Hypodontia

Ectopic permanent successors

Trauma

BDS4 Paeds (2 decks)

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