Lecture 2- Dental Anomalies I Flashcards
Dental anomalies can be divided into: (3)
- congenital
- developmental
- acquired
Dental anomalies that are genetically inherited:
congenital
Dental anomalies that occur during tooth formation:
developmental
Dental anomalies that occur after teeth formation:
acquired
Developmental abnormalities of teeth involve: (5)
- number of teeth
- size of teeth
- eruption of teeth
- enamel pearl or enameloma
- altered morphology
Developmental abnormalities involving the NUMBER of teeth: (2)
- supernumerary teeth
- missing teeth
Developmental abnormalities involving SIZE of teeth: (2)
- macrodontia
- microdontia
Developmental abnormality involving the ERUPTION of teeth: (1)
Transposition
Enamel pearl or enameloma is considered a ____ abnormality
developmental
Developmental abnormalities involving ALTERED MORPHOLOGY of teeth: (8)
- Fusion
- Gemination
- Concrescence
- Taurodontism
- Dilaceration
- Supernumerary roots
- Dens in vaginatus & dens in dente
- Dens evaginatus & talon cusp
Acquired abnormalities include: (3)
- attrition
- abrasion
- erosion
Presence of extra-erupted or unerupted teeth:
Supernumerary teeth
Supernumerary teeth are also known as:
hyperdontia
The 2nd most common dental anomaly involving 1-4% of the population:
supernumerary teeth
What can be seen in this image?
supernumerary tooth in between lateral & canine (mesiodens)
A supernumerary tooth located in between the lateral & canine:
mesiodens
Most common supernumerary teeth that are single:
mesiodens
4th molars (supernumerary teeth) more commonly seen in the maxillary dentition:
distodens (distomolar)
What is more common, hyperdontia or hypodontia?
HYPOdontia
What can be seen in this image?
distodens (distomolar)
Most common single supernumerary tooth is:
mesiodens or distodens
Multiple supernumerary teeth are most commonly found in:
mandibular premolar region
What type of images should be taken if you suspect a supernumerary tooth (singular)?
PA or Pano
(but she would still recommend CBCT as image of choice)
What type images should be taken if you suspect supernumerary teeth (multiple)?
CBCT
What can be seen in the following CBCT?
supernumerary teeth
What can be seen in this pano?
multiple supernumerary teeth (common for mandibular premolar area)
What is a risk of leaving an impacted tooth in the oral cavity?
dentigerous cyst risk
What can be seen in the following image?
mesiodens
What can be seen in the following image?
distodens (distomolar)
Top differential diagnosis associated with multiple SUPERNUMERARY TEETH:
- Cleidocranial dysplasia
- Gardner syndrome
List some characteristics of Cleidocranial dysplasia:
- absent or hypoplastic clavicles
- high palate or cleft palate
- open cranial sutures (can see on CBCT)
- hypoplastic paranasal sinuses
- mandibular prognathism (due to hyperplastic maxilla)
- multiple unerupted supernumerary teeth (or erupted)
What can be seen in this image? (cleidocranial dysplasia)?
- prognathic mandible
- open cranial suture
What can be seen in this image? (cleidocranial dysplasia)
- open cranial suture
- hypoplastic paranasal sinuses
What can be seen in this image? (cleidocranial dysplasia)
hypoplastic clavicles
Given the following images, what disease can be suspected?
cleidocranial dysplasia
In addition to the prognathic mandible, what also can be seen in this image?
multiple supernumerary teeth in mandible (giving it a very radiopaque appearance)
A water’s radiograph is used to evaluate the:
maxillary sinus
What type of radiograph can be seen? What is this used for?
Waters radiograph; visualization of maxillary sinus
What can be seen in the following image? What disease do we suspect?
multiple supernumerary teeth; cleidocranial dysplasia
(note that there are multiple deciduous teeth in the dentition, not all of these are supernumerary)
What are some characteristics of Garner Syndrome:
- MULTIPLE supernumerary teeth
- osteomas
- epidermoid cysts of skin
- colorectal polyps with malignant potential
If suspect Gardner Syndrome in an undiagnosed patient, it is important to refer them to their physician as this:
may prevent them from developing cancer (colorectal polyps with malignant potential)
What are the arrows indicating in this image? What disease is this a characteristic of?
multiple osteomas; gardner syndrome
Bony outgrowths attached to the mandible & maxilla
osteomas
If a patient comes in, and radiographically you determine they have multiple osteomas, you should be thinking:
gardner syndrome
What is the treatment of supernumerary teeth?
conservative treatment (monitoring) or removal of supernumerary teeth
Why might we choose to extract supernumerary teeth?
To reduce likelihood of complications such as:
1. resorption of adjacent teeth
2. crowding/ malocclusion
3. periodontal problems
4. development of pathology (dentigerous cyst)
What can be seen in this pano?
multiple supernumerary teeth
If you decide to leave supernumerary teeth alone (conservative treatment), you should still:
monitor radiographically overtime to make sure dentigerous cyst doesn’t develop
How many supernumerary teeth can be seen in this image?
4 or 5 (upper right unsure if 1 or 2)
When do supernumerary teeth pose a threat to periodontal health?
When fully erupted into oral cavity
What is a potential risk associated with the supernumerary teeth in this image?
periodontal health concerns
Missing teeth may also be called:
hypodontia
absence of erupted tooth or dental follicle without history of extraction:
hypodontia
the most commonly missing teeth are the:
3rd molars > mandibular 2nd PM > maxillary lateral & central incisors
Excluding abscence of 3rd molars, hypdotnai affects:
3-10% of the population
Lack of development of one or more teeth:
hypodontia
total lack of development of teeth:
anodontia
What can be seen in the following image?
hypodontia (missing permeant successor)
Lack of development of 6 or more teeth (excluding 3rd molars)
oligodontia
How can you tell that this is ankylosed tooth?
due to the lower occlusal & absence of PDL space
What can you see in this image? Is the tooth ankylosed?
Hypodontia (no the tooth is not ankylosed due to same occlusal level and PDL space present)
Etiology of missing teeth or hypotonia: (3)
- absence of dental lamina
- environmental factors that may damage dental lamina prior to tooth formation
- genetics
What are some environmental factors that can lead to missing teeth or hypodontia?
- trauma
- infection
- chemo
- radiation
What is a risk of children getting radiation at a very early age (before teeth develop)?
destroys the dental lamina so the tooth will never develop
What should be the FIRST differential diagnosis if a patient presents with multiple missing teeth with NO history of tooth loss?
Ectodermal dysplasia
Ectodermal dysplasia affects all tissues of the body that originate from the:
ectoderm
List some characteristics of ectodermal dysplasia: (4)
- decreased number of sweat glands
- sparse hair, eyelashes & eyebrows
- dystrophic or malformed nails
- hypodontia with abnormal crown shape in teeth that are present
What can you see in this image? What disease might you suspect?
Hypodontia, abnormal crown shape in teeth that are present; ectodermal dysplasia
Patient presents to clinic with these conical shaped teeth and multiple missing teeth. What condition do you suspect?
ectodermal dysplasia
Larger than normal tooth, seen clinically or radiographically:
Macrodontia
Macrodontia often affects:
single tooth
Macrodontia may be associated with:
crowding and malocclusion
T/F: With macrodontia, the shape of the tooth is usually normal
true
What can be seen in the following image?
macrodontia
What can be seen in the following image?
macrodontia
In the following radiograph, what can be seen?
macrodontia- mandibular 2nd premolars
smaller than normal tooth the can be seen clinically or radiographically:
microdontia
microdontia might involve:
- all teeth
- single tooth
- group of teeth
What teeth are commonly affected by microdontia?
3rd molars & maxillary lateral incisorsW
hat is the treatment for microdontia?
restorative treatment if needed
What can be seen in the following image?
microdontia
What can be seen in the following image?
microdontia
Microdontia affecting a lateral incisor:
peg lateral
What can be seen in the following image?
microdontia
What can be seen in the following image?
microdontia- peg lateral
condition in which two typically adjacent teeth have exchanged position sin the dental arch:
transposition
the most frequently transposed teeth are:
permanent canine and first premolar
T/F: transposition may occur in the primary dentition:
false- no reported cases
What can be seen in the following image?
transposition of permanent canine & first PM
What can be seen in the following pano?
transposition, mandibular right lateral incisor and right canine
A small formation of enamel 1-3 mm in diameter that occurs not eh roots of molars:
enameloma or enamel pearl
What can be seen in the following image?
transposition of maxillary right canine and 1st premolar
What percent of the population has enamelomas (enamel pearls)?
3%
What can be seen in the following images?
enamelomas or enamel pearls
What location is most common for enamelomas (enamel pearls)?
furcation of the molars
Why can you not just automatically cut off an enameloma or enamel pearl?
some contain pulp & dentin inside
(pulp exposure risk)
Most enamel pearls form ___ to the ____ are are not detected during clinical examination
apical to the gingival crest
Enamelomas (enamel pearls) typically develop in the furcal areas of molar teeth, often lying at or just apical to the:
CEJ
Enamel pearls (enamelomas) may be a predisposing factor to formation of:
periodontal pocket and subsequent periodontal disease
What is a differential diagnosis for enamel pearls? (enamelomas)
calculus
Describe the treatment of enamel pearls (enamelomas):
Removal if it is a risk factor to periodontal disease, the possibility must consider data tit may contain a pulp horn
Results from the union of germs of developing teeth:
Fusion
Fusion results in a:
REDUCED number of teeth
T/F: Fusion is more commonly seen in deciduous dentition but may also occur in the permanent dentition
true
Where fusion most commonly seen?
anterior teeth
What can be seen in the following image?
fusion
The degree of fusion is dependent on:
which stage the teeth fuse
What can be seen in the following image?
fusion
How do you differentiate between fusion and gemination?
fusion may be differentiated from gemination when the number of teeth is reduced by 1
How do we treat fusion?
- conservatively
- RCT+ restorative
Label which image is fusion and which image is gemination:
Left: fusion
Right: Gemination
Clinically, fusion and gemination are both prone to:
caries (due to groove in middle)
If we see a much larger tooth, however have the correct number of teeth this is a sign of:
gemination
What can be seen in the following image?
fusion (missing a tooth)
What can be seen in the following image?
gemination (appropriate number of teeth)
Arises when a single tooth bud attempts to divide:
gemination
Gemination arises when a single tooth bud attempts divide. The result may be an:
invagination of the crown with partial clefting
Gemination may occur in both dentitions but ____ are the most affected and typically in the ____region
primary teeth; incisor
Describe the pulp chamber with a tooth that has undergone gemination:
Pulp chamber is usually single and enlarged and may be partially divided
What can be seen in the following image?
gemination
Common differential diagnosis for gemination:
- macrodontia
- fusion
What is the treatment for a tooth that has undergone gemination?
- restorative (cleft is a caries susceptible site)
- extraction (only when needed)
What can be seen in the following image?
gemination
What can be seen in the following image?
gemination
Occurs when the roots of TWO or more primary or permanent teeth are fused through CEMENTUM:
Concresence
What is the cause of concrescence?
Unknown but could be:
1. space restriction during development
2. local trauma
3. excessive occlusal force
4. local infection after development
What teeth are most commonly affected by concrescence?
maxillary molars (esp. third molars & supernumerary tooth)
What is a risk involving eruption of teeth that have been affected by concrescence?
involved teeth may fail to erupt of may erupt incompletely
T/F: An imaging examination will always reveal concrescence
False- an imaging examination may not always reveal concrescence. (teeth may be in close contact or are simply superimposed)
If you suspect concrescence what radiographic option may be a good choice?
small field of view; CBCT
What can be seen in the following image?
concrenscence
Concrescence involves fusion of ____ but NOT ___ or ___
cementum; enamel or dentin
What is the risk of extraction of teeth that have undergone concrescence?
VERY hard to extract
What can be seen in the following image?
concrescence
What can be seen in the following image?
concrescence
What do we mean by “2D limitation” in regards to concrescence?
In a 2D image, the teeth may just look superimposed, when in reality their cementum is fused together through concrescence
Elongation of pulp chamber in multirooted teeth with apical discpacement of the pulpal floor:
Taurodontism
What teeth may be affected by taurodontism?
primary or permanent dentition; single or multiple teeth may be affected
How must taurodontism be detected?
ONLY radiographically, not clinically
Describe how a tooth affected by taurodontism appear radiographically:
elongated pulp chamber; more apically positioned furcation; short roots
taurodontism
taurodontism
taurodontism
taurodontism
taurodontism
taurodontism
What is a differential interpretation for a taurodont?
none- taurodont easily recognized and distinguished
What treatment is required for a taurodont?
no treatment needed
Sharp bend or curve in the tooth, anywhere in the crown or the root:
dilaceration
Dilaceration most often affects what teeth?
maxillary premolars
dilaceration
dilaceration
dilaceration
dilaceration
dilaceration
A bulls eye root is an example of:
dilaceration
Increased number of roots compared to usual anatomic number:
Supernumerary roots
Extra lingual root on mandibular molars:
radix entomolaris
Extra buccal root on mandibular molars:
radix paramolaris
What teeth can be affected by supernumerary roots?
any tooth
T/F: With supernumerary roots, extra roots may be fully developed or smaller than normal
true
The presence of supernumerary roots may affect treatments such as:
- orthodontics
- endodontics
- extractions
What may be a benefit of supernumerary roots?
prosthodontics (great abutments)
supernumerary roots
supernumerary roots
supernumerary roots
supernumerary roots
Represent varying degree of invagination or infolding of the enamel surface into the interior of the tooth:
Dens invaginatus & Dens in dente
What teeth are most commonly affected by dens invaginatus/dens in dente?
maxillary lateral incisor
Dens invaginatus/dens in dente is rarely seen in:
deciduous dentition & mandibular teeth
What is a risk associated with dens invaginatus/dens in dente?
high caries risk (prophylactic restoration often performed)
dens invaginatus/dens in dente
dens invaginatus/dens in dente
dens invaginatus/dens in dente
dens invaginatus/dens in dente
dens invaginatus/dens in dente
dens invaginatus/dens in dente
dens invaginatus/dens in dente
is a result of an evagination or outpouching of the enamel organ:
dens evaginatus/talon cusp
In dens evaginatus/talon cusp, the resultant enamel covered tubercle usually occurs in or near the:
middle of the occlusal or incisal surface of the tooth
In dens evaginatus/talon cusp, the tubercle often has a _____ and a ______ frequently extends into the evagination
dentin core; very slender pulp horn
dens evaginatus/talon cusp
dens evaginatus/talon cusp
dens evaginatus/talon cusp
In dens evaginatus/talon cusp, when might treatment be necessary?
If the tubercle causes any occlusal interference or shows evidence of marked abrasion it probably should be removed
