Info missed first time paeds Flashcards by Rodwan Halimi

What happens during the bud stage?

Migration of neural crest cells

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What happens during the cap stage?

Proliferation: Condensation of ectoderm and formation of enamel organ and the dental papilla

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What developmental anomalies arise from the cap stage?

Odontogenic cysts

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What is morphodifferentiation and which stage of development is it?

Proliferation of inner oral epithelium to form the shape of the crown occurs during the bell stage

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Which developmental anomalies and traits are associated with the morphodifferentiation phase of development of the tooth?

Tooth size and shape (macro and microdontia, talon cusps, hutchinson’s incisors/mullberry molars, taurodontism, dens in/evaginatus, cusps of cerebelli)

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Which developmental anomalies and traits are associated with the histodifferentiation stage of development?

Regional odontoplasia

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What is histodifferentiation and which stage of development is it?

Differentiation of precursor cells -> ameloblasts, odontoblasts depend on secondary enamel knots

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What are the stages of crown formation?

Apposition (Reciprocal induction and laying of mantle dentin and first enamel)

Calcification

Maturation (enamel crystal formation)

Eruption (Emergence and continued root development)

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Which genes are important for formation of the oral epithelium?

BMP
FGF
WNT
SHH
TNF

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Which genes are important for formation of the dental placode?

BMP
FGF
WNT
SHH

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Which genes are important for formation of the enamel knots during morphogenesis?

BMP
FGF
WNT
SHH

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What proteins are required for the ectomesenchyme?

BMP and ACTIVIN

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What proteins are required to be expressed for condensed ectomesenchyme?

BMP
FGF
WNT

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What proteins are required to be expressed for dental papilla ectomesenchyme?

BMP
FGF
WNT

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What are the possible locations of hyperdonts?

Mesiodens (somewhere in premaxilla)

Para(pre)molar

Distomolar (as a 9)

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What are the possible morphologies of hyperdonts?

Conical

Tuberculate

Supplemental

Odontomes

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What are the types of odontomes?

Compound: Well-circumscribed (Discrete tooth-like structures)

Complex

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Clinical signs of odontomes?

Diastema/local crowding/irregularity

Displacement of other teeth

Failure of teeth to erupt

Retention of primary incisors

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What conditions are associated with hyperdontia?

Cleidocranial dysplasia

Gardner syndrome

Nance-Horan syndrome

Cleft lip and palate

Ehler-Danlos Syndrome

Fabry-Anderson’s syndrome = X-linked lysosomal storage disorder

Incontinentia pigmenti

Chondroectodermal dysplasia

CGNCEFIC

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Which condition leads to hutchinson’s teeth that isn’t syphillis?

Nance-Horan syndrome

What should be done to treat supernumerary teeth?

Surgical complications associated with early or late supernumerary teeth. More
favourable to exo mesiodens etc before age 6 – no association with damage in surgery (even though
some people say “don’t take out too early for fear of damaging tooth germs”)

What environmental factores cause hypodontia?

Intrauterine drugs

Radiotherapy and chemotherapy (if kids have undergone oncology treatment)

Trauma

Infection

What syndromes can lead to hypodontia?

Hypohidrotic ED +/- immunodeficiency

Axenfeld-Rieger syndrome (cataract-dental syndrome)

Clefts

Van der Woude syndrome -> clefting

Down syndrome

Oral-facial-digital syndrome

Williams syndrome

Oligodontia and colorectal cancer syndrome

Odonto-onycho-dermal dysplasia

Incontinentia pigmenti

Ecterodactyly, ectodermal dysplasia

Ellis-van creveld syndrome

Witkop syndrome

Curry-Hall syndrome

Angel-shaped phalango epiphyseal dysplasia

What happens in hypohidrotic ED?

Can cause immunodeficiency

Hidrosis = sweating

What is axenfeld-rieger syndrome?

Predominantly an eye disease - strangely shaped pupils and hypertelorism (Wide eyes) Leads to microdontia as well as oligodontia

What are the clinical features of hypodontia?

infraocclusion of primary teeth Increased overbite, tooth rotation, and ectopic maxilalary canines Reduced mandibular plane angle

How is hypodontia treated?

Build up peg lateral incisors, conical teeth etc Orthodontic managemetn Dentures or fixed prostheses Autotransplants Implants

What commonly coexists with a primary lateral incisor that has a talon cusp? What does this mean clinically?

A supernumerary tooth If there is a talon cusp on the primary lateral incisor take an occlusal radiograph.

What syndromes cause talon cusp?

Sturge weber syndrome Rubenstein-Taybi Ellis van Creveld (Chondroectodermal dysplasia)

What is Rubenstein-Taybe syndrome?

Condition that causes short stature, moderate to severe intellectual disability, distinnctive facial features, and broad thumbs + First toes. Small jaws Crowding High palate TALON CUSPS

What causes dens evaginatus to form?

Inner enamel epithelium proliferates into the stellate reticulum due to outflowing of the enamel epithelium, and transient focal hyperplasia of the primitive pulpal mesenchyme.

What causes dens invaginatus?

Due to invasion of dental papilla by a rapid, progressively proliferating area of internal enamel epithelium

What causes taurodontism?

Unknown but probably linked to failure of hertwig's epithelial rooth sheath to invaginate.

What anomalies are commonly associated with taurodontism?

Amelogenesis imperfecta Hypodontia

What is HPSM and what does it mean?

Hypomineralised primary second molars. It means that the child will have 4x more chance of MIH

How should HPSM be treated?

Need to manage fairly aggressively – fissure seal/SS crown asap (esp if brown)

What features of MIH microstructure make it hard to treat?

High levels of TRPV1 receptors which trigger hypersensitivity. Increased pulpal innervation These make it difficult to anaesthetize so PDL injections may be necessary. Higher protein content make bonding difficult

How is MIH treated?

Currently depends on how bad it is. No treatment -> Tooth mousse -> Fluoride varnish -> F/S -> Composite Resin infiltration is currently used as it penetrates deeper than CPP-ACP. The microporosities fill with resin and then are cured. Follow this up with a Stainless Steel Crown

What is a turner tooth?

Usually result of trauma to dentition before the age of 3 leading to enamel defects.

What is amelogenesis imperfecta?

Hereditary defect of enamel of the permanent and/or primary dentition.

What causes amelogenesis imperfecta?

Can be inherited: X-linked (AMELX), Dominant (Enamelin), and recessive in some families.

What are the classes of amelogenesis imperfecta?

Hypoplastic Hypomature Hypocalcified HM/HP + taurodontism

What clinical considerations to have with AI?

Low caries risk Rapid attrition Extensive calculus deposition Sensitivity Gingival hyperplasia/inflammation Non-enamel related factors: Open bite, eruption disturbances, congenitally missing teeth, increased impaction of permanent teeth

Differentials for AI:

Extrinsic disorders such as fluorosis Chronologic disorders of tooth formation (Extent and number of teeth depends on timing. Not thought to have genetic component)

What are the grades of ectopic eruption of the 1st permanent molar teeth?

Grade 1: Mild, limited resorption of the cementum with minimum dentin penetration Grade 2: Moderate, resorption of dentin without pulp exposure Grade 3: Severe, Resorption of the distal root leading to pulp exposure Grade 4: Very severe, Resorption that affects the mesial root of the primary second molar

What causes ectopic eruption?

Mesial angulation of the 6 Larger than average width of the 6 Crowding Unfavourable shape of the Es

What is the prognosis of ectopic eruption like?

Can be reversible or irreversible. Spontaneous correction occurs in 50 - 69%. If permanent molar is blocked distal movement is indicated to create space and correct eruption

When is ectopic eruption of 6s diagnosed?

5 - 7 years of age via radiograph.