Paeds - Anomalies Flashcards
List the 4 categories of anomalies that can occur
- Number
- Size and shape
- Structure (hard tissue defects)
- Eruption and exfoliation
What is the most commonly permanent missing tooth?
3rd molars
What conditions are most likely to be associated with hypodontia? (5)
- Ectodermal Dysplasia
- Down Syndrome
- Cleft Palate
- Hurler’s syndrome
- Incontinentia pigmentii
What problems are associated with hypodontia? (6)
- Abnormal shape and form (small and straight sided or cone shaped teeth)
- Spacing of teeth
- Submergence or infraocclusion of primary teeth
- Deep overbite
- The lower opposing tooth can overerupt = restorative problem
- Reduced LFH (lower face height)
What patient group is most likely to have hyperdontia? (sex, race, disorder)
- males
- Japanese
- higher frequency in cleidocranial dysplasia
what arch does hyperdontia usually occur in?
maxilla
List the 4 types of supernumerary teeth.
- Conical = cone shaped
- Tuberculate = barrel shaped, has tubercles
- Supplemental = looks like tooth of normal series however can be smaller (commonly a lateral incisor)
- Odontome = irregular mass of dental hard tissue
What are the complications of supernumerary teeth?
Most common cause of delayed eruption of permanent teeth
What is the most common type of supernumerary?
conical
when are supernumeraries removed and why?
Taken out at age 7/8 once crown formation of the unerupted teeth is complete and root formation has started
List the types of size&shape anomalies and describe. (8)
- microdont e.g. 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 looks like a bulls horn and teeth appear normal
- dilaceration – can affect crown or root
- accessory cusps e.g. talon cusp
- Dens in dente – appears as invaginations where there is a tooth within a tooth (comes alongside its own pulp)
List the types of structure anomalies. (11)
Short root anomaly
enamel structure anomalies
- amelogenesis imperfecta (and subtypes)
- environmental enamel hyperplasia
- localised enamel hyperplasia
dentine structure anomalies
- dentinogenesis imperfect (and subtypes)
- dentine dysplasia (and subtypes)
- odontodyspluasia
- systemic disturbance
cementum structure anomalies
- cleidocranial dysplasia
- hypophosphatasia
What tx carries risks in those with the short root anomaly?
Ortho tx
What teeth are commonly affected by the short root anomaly?
Maxillary incisors - these children can also have short roots in the canine/premolars
What are the causes of the short root anomaly? (3)
- radiotherapy
- dentine dysplasias
- accessory roots
What systemic disorders are commonly associated with enamel defects? (except amelogenesis imperfecta) (8)
- epidermolysis bullosa
- incontinenta pigmenti
- Down’s
- Prader-Willi
- porphyria
- tuberous sclerosis
- pseudohypoparathyroidism
- Hurler’s
List the types of amelogenesis imperfecta - enamel structure defect (4)
- Hypoplastic
- Hypocalcified
- Hypomaturational
- Mixed forms
(other forms presents)
List the causes of environmental enamel hypoplasia - enamel structure defect. (4)
- Systemic
- Nutritional
- Metabolic e.g. rhesus incompatibility, liver disease
- Infection e.g. measles
List the causes of localised enamel hypoplasia - enamel structure defect. (2)
- trauma
- infection of primary tooth
Describe the difference between hypomineralised teeth and hypoplastic teeth.
Hypomineralised = all tooth tissue present and is the normal shape (enamel matrix has been formed adequately/secretory phase occurred and something has gone wrong during the mineralisation phase)
Hypoplastic = parts of the enamel structure is missing, tooth not intact
Occurs at an earler stage of amelogenesis
Problems have occurred in the secretory phase when the enamel matrix is being formed
List the generalised environmental causes of enamel structure defects. (2)
Fluorosis
MIH
What does fluorosis look like clinically?
symmetrical diffuse white flex
What must we advise px that will occur post micro abrasion (fluorosis tx)?
Advise that tx very successful as it is on the surface layers of enamel – however the very white appearance of the tooth will be gone and the teeth will have the duller appearance of the deeper layers of the tooth.
What are the tx options for fluorosis? (3)
microabrasion
Composite veneers
Vital bleaching
What causes MIH? - generalised environmental enamel structure defect.
childhood illness - Chronological hypomineralisation (you can see at what age/stage of tooth development the problems have occurred)
e.g. liver or kidney failure
List the prenatal causes of MIH (6)
- Rubella
- Congenital syphilis
- Thialomide
- Fluoride
- Maternal A&D deficiency
- Cardiac & kidney disease
List the neonatal causes of MIH (2)
- Prematurity
- Meningitis
List the postnatal causes of MIH? (9)
- otitis media
- measles
- chickenpox
- TB
- Pneumonia
- Diphtheria
- deficiency of Vits A,C&D
- heart disease
- Long term health problem e.g. organ failure
List the types of amelogenesis imperfecta - generalised hereditary enamel structure defect. (4)
- hypoplastic
- hypomineralised
- hypomaturation
- mixed with taurodontism
What occurs in hypoplastic amelogenesis imperfecta?
Enamel crystals do not grow to the correct length
What occurs in hypomineralised amelogenesis imperfecta?
Crystallites fail to grow in thickness and width
What occurs in hypomaturational amelogenesis imperfecta?§
Enamel crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
What complications are associated with amelogenesis imperfecta? generalised hereditary enamel structure defects. (6)
- sensitivity
- caries/ acid susceptibility
- poor aesthetics
- poor oral hygiene
- delayed eruption
- anterior open bite
What tx options are available for amelogenesis imperfecta? generalised hereditary enamel structure defects. (6)
- preventive therapy
- composite veneers/ composite wash to improve sensitivity and appearance
- fissure sealants
- metal onlays
- stainless steel crowns
- orthodontics
How does dentine dysplasia present? (4) dentine structure defect
– normal crown morphology
– amber radiolucency
– pulpal obliteration
– short constricted roots
How does odontodysplasia present? (3) dentine structure defect
– localised arrest in tooth development
– thin layers of enamel and dentine
– large pulp chambers, “Ghost Teeth
What are the 3 types on dentinogenesis imperfecta? dentine structure defect
- Type I associated with osteogenesis imperfecta
- Type II autosomal dominant genetic transmission
- Brandywine
What are the clinical signs of dentinogenesis imperfecta type I? (2)
- Osteogenesis imperfecta – blue sclera of eyes, patients in a wheelchair
- Teeth are amber and translucent (grey)
What are the radiographic signs of dentinogenesis imperfecta? (3)
- Bulbous crowns
- Pulps start large and then Pulpal obliteration follows
- Occult abscess formation (occurs without disease)
What are the complications associated with dentinogenesis imperfecta? (3)
- aesthetics
- caries / acid susceptibility
- spontaneous abscess
How do we manage px with dentinogenesis imperfecta? (5)
- Enhanced prevention
- composite veneers – may be hard to bond to the tooth
- overdentures – cover the vulnerable dentine
- removable prostheses
- stainless steel crowns
what anomaly in eruption is associated with babies with a high birth weight or those with precocious puberty?
premature eruption
When is delayed eruption common? (4)
- pre-term & low birth-weight children
- children wirh malnutrition
- associated general conditions:
Downs, hypothyroidism, hypopituitarism, cleidocranial dysplasia - gingival hyperplasia/ overgrowth – pseudodelayed eruption (teeth covered by gums and don’t appear to be erupted)
What causes pseudo delayed eruption?
- gingival hyperplasia/ overgrowth
What causes premature exfoliation? (6)
- trauma
- following pulpotomy
- hypophosphatasia
- immunological deficiency e.g. cyclic neutropaenia
- Chediak-Higashi syndrome
- Histiocytosis X
What causes delayed exfoliation? (5)
- infra-occlusion
- ‘double’ primary teeth
- Hypodontia – no permanent to push out a primary tooth
- ectopic permanent successors
- following trauma
