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Paediatrics > 13. Hard tissue anomalies > Flashcards

13. Hard tissue anomalies Flashcards

1
Q

When does dental lamina begin to differentiate?

A

6 weeks in utero

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2
Q

When do hard tissues start to form?

A

13 weeks- 10 years

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3
Q

Where is enamel and dentine derived from?

A

Enamel- ectoderm
Dentine and supporting structures- mesoderm

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4
Q

What is the definition of hypodontia?

A

Less than 6 teeth congenitally absent, excluding third molars

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5
Q

What is the definition of oligodontia?

A

More than 6 teeth congenitally absent, excluding third molars

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6
Q

What is the definition of anodontia?

A

Total lack of development of teeth

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7
Q

What is the rate of occurrence of hypodontia in primary dentition?

A
  • 0.1-0.9% in primary teeth
  • 1 female: 1 male
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8
Q

Which teeth does hypodontia in primary teeth affect most?

A

More common maxilla- upper b’s

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9
Q

What is the rate of occurrence of hypodontia in permanent dentition?

A

3.5-6.5%
4 female: 1 male

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10
Q

Where does hypodontia in permanent dentition occur most?

A

Maxilla and mandible

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11
Q

List the frequency of absent teeth from most to least?

A
  • 8’s
  • lower 5
  • upper 2
  • upper 5
  • lower 1
  • lower 2
  • upper 4
  • lower 5
  • upper 3
  • lower 5
  • upper 6
  • lower 3
  • lower 6
  • upper 1
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12
Q

What are environmental causes for hypodontia?

A
  • chemotherapy
  • tooth bud gouging
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13
Q

What are non-syndromic causes for hypodontia?

A
  • autosomal dominant
  • incomplete penetrance
  • variable expression
  • MSX1, PAX9, AXIN2
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14
Q

What are features of ectodermal dysplasia?

A
  • sparse, fine hair
  • dry, scaly skin
  • lack of sweat glands
  • nails ridged
  • middle one third of face under developed
  • bridge of nose depressed
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14
Q

Name 5 syndromes that may cause hypodontia?

A
  • ectodermal dysplasia
  • chrondo-ectodermal dysplasia (ellis van creveld)
  • oral clefting
  • down syndrome
  • SMMCI
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15
Q

What are features in primary teeth seen in ectodermal dysplasia?

A
  • coronoid primary incisors
  • taurodont second primary molars
  • supernumerary cusps
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15
Q

What are features in permanent teeth seen in ectodermal dysplasia?

A
  • incisal crowns conical/pointed
  • molar crowns have a reduced diameter
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16
Q

How do you manage teeth in ectodermal dysplasia?

A

Multidisciplinary approach
- orthodontic space closure
- prosthetic/restorative space closure
- composite build ups
- bridges or dentures
- definitive treatment 18 years plus

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16
Q

What is SMMCI?

A

The only central incisor present in the midline of the maxillary alveolus. It is not a supernumerary tooth (mesiodens).

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17
Q

What is the cause and occurrence of SMMCI?

A
  • 1 in 50000 live births
  • aetiology is unknown
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18
Q

What other midline abnormalities is SMMCI associated with?

A

– Midline nasal cavity defects
– Holoprosencephaly
– Microcephaly
– Congenital heart disease
– Cleft lip and palate
– Oesophageal/ duodenal atresia
– Hypopituitarism
– Hypotelorism

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19
Q

What is the occurence of supernumeraries in primary dentition?

A

0.2-0.8%

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20
Q

What is the occurence of supernumeraries in permanent dentition?

A

1.5-3.5%

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21
Q

What is the ratio of supernumeraries affecting maxilla and males?

A

2 male: 1 female
5 maxilla: 1 mandible
Permanent anomalies in 50% of primary cases

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22
Q

What are the 4 types of supernumeraries?

A
  • supplemental
  • conical
  • turberculate
  • odontome
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23
Q

What is a supplemental supernumerary?

A
  • resemble those of normal series
  • often cause crowding- so extract most displaced
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24
Q

What are the most common supplemental supernumeraries?

A
  • most commonly lateral incisor
  • premolars
  • molars- paramolars or distomolars
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25
Q

What is the most common supernumerary?

A

Conical

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26
Q

Where is conical supernumerary most commonly found?

A

Usually in maxillary midline

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27
Q

What is the treatment for conical supernumeraries?

A
  • do not interfere with the eruption of permanent incisors
  • can cause displacement- median diastema
  • if erupted- extract
  • if unerupted- leave and monitor
  • take radiograph annually
  • look for resorption, follicular changes
28
Q

Name features of turberculate supernumeraries?

A
  • barrel shaped
  • poor or absent root formation
  • rarely erupt
  • often paired
  • commonly prevent eruption of upper 1’s
29
Q

What is the management of turberculates?

A
  • remove primary teeth if present
  • maintain or create space for permanent tooth
  • surgical removal of supernumerary
  • wait up to 18 months for spontaneous eruption of upper central incisors
  • consider surgical exposure and orthodontic extrusion if needed of centrals
30
Q

Why do odontomes occur?

A

Due to a disturbance in dental organogenesis

31
Q

What is a compound odontome?

A

Tooth like formations- look like collection of small teeth

32
Q

What is a complex odontome?

A

Hazardous arrangement of dental hard tissue

33
Q

Where are odontomes usually found?

A

Anterior part of maxilla or lower molar regions

34
Q

What syndromes are associated with supernumeraries?

A
  • Cleft lip and palate syndrome
  • Cleidocranial syndrome
  • Gardner’s syndrome
  • Oro-facial-digital syndrome
35
Q
A
36
Q

What are factors that affect the management of supernumerary teeth?

A
  • erupted vs unerupted
  • age
  • is it interfering with eruption of other teeth
  • is it inverted, difficult to get out
  • associated pathology
  • is it interfering with orthodontic movement
37
Q

What is macrodontia?

A
  • larger crown than normal variation but normal morphology
38
Q

What teeth does macrodontia normally affect?

A
  • usually upper 1’s followed by lower 5’s
  • usually bilateral
39
Q

What is the percentage likelihood of macrodontia?

A
  • affect single tooth in 1% of population
  • 0.1% of population have generalised macrodontia
40
Q

What are the treatment options for macrodontia?

A
  • section/reshape the tooth
  • extract- maintain the space by partial denture, resin bonded bridge or implant
  • autotransplantation
41
Q

What is the problem in the pulp in macrodontia?

A

They have an enlarged pulp so may have occasional pulpal involvement.
Do Cvek pulpotomy or endodontics

42
Q

What is the occurrence of microdontia in the primary and permanent dentition?

A
  • rare in primary dentition= 0.2-0.5%
  • in permanent dentition it is 2. 5% in single tooth, and 0.2% have generalised
  • affects females more than males
43
Q

What is the most common teeth microdontia is associated with?

A

Upper 2’s
Most often peg/conical shaped
- hypodontia

44
Q

Which diseases is microdontia associated with?

A

Ectodermal dysplasia
Down Syndrome

45
Q

What are the treatment options for microdontia?

A
  • leave
  • composite build up
  • orthodontic space closure
  • extract
46
Q

Does root size have a racial variation?

A

Yes- pt from oriental backgrounds tend to have smaller roots

47
Q

Which teeth is large root size most often seen in?

A

Upper 1’s

48
Q

Which teeth is small root size often seen in and what may it be associated with?

A

Upper 1’s
- may be associated with orthodontic tx, trauma, chemo/radiotherapy

49
Q

What are 5 anomalies of crown form?

A
  • double teeth
  • accessory cusps
  • invagination
  • evagination
  • dilaceration
50
Q

What are anomalies of root form?

A
  • taurodontism
  • accessory roots
  • dilaceration
  • enamel pearl
51
Q

What is the incidence of double teeth in primary teeth and permanent teeth?

A

primary teeth- 0.5%-1.6%
permanent teeth- 0.1-0.2%
male=female
30-50% of primary cases have anomalies in permanent dentition

52
Q

What is gemination?

A

Incomplete attempt of tooth germ to divide into two

(the single bud has attempted to divide when it should not have)

53
Q

What is fusion?

A

Complete or partial fusion between dentine/enamel of two separate teeth

(Fusion of more than one tooth bud)

54
Q

What are the management principles for double teeth?

A
  • malocclusion
  • crown width
  • root morphology
  • may require CBCT
  • multidisciplinary meeting
55
Q

What are the treatment options for double teeth when there is a single root?

A
  • if there is a single root, can extract double tooth and autotransplant another one
  • can modify crown of the tooth
  • can extract double tooth and use prosthetic placement
56
Q

What is the options for double teeth when there is separate roots?

A
  • if there is pulpal communication, hemisection, endo tx, crown modification
  • if there is no pulpal communication, do hemisection and crown modification
57
Q

What are accessory cusps?

A
  • supplemental cusps
  • cusp of carabelli most common (seen on maxillary molars)
  • does not contain pulp
  • limited/no clinical significance
58
Q

What is dens evaginatus/talon cusp?

A

Cusp like elevation located in the central groove
- contains pulp

59
Q

Which teeth and people does dens evaginatus affect most?

A
  • often upper 1’s and mandibular premolar
  • in mandibular premolars they are often bilateral
  • chinese people= 1-4%
60
Q

What are the treatment options for dens evaginatus?

A
  • leave= occlusion/aesthetics okay
  • fissure seal pronounced groove
  • gradually grind down cusp- reactionary dentine formation
  • cvek pulpotomy
  • extract
  • endodontics
61
Q

What is dens invaginatus/dens in dante?

A

Deep surface invagination of crown that is lined by enamel.
- represents an accentuation of the lingual pit

62
Q

Which teeth and people is dens invaginatus most commonly seen in?

A
  • prevalence varies from 1-10%
  • upper 2’s most common
  • less commonly upper 1’s and 3’s
  • 2 males: 1 female
  • bilateral involvement common
  • chinese ethnicity
63
Q

What is the Oehlers classification of dens invaginatus?

A
  • type 1= invagination confined to the crown
  • type 2= invagination invading root as blind sac, may connect to pulp
  • type 3= invagination through root to apical region
64
Q

What are treatment options for dens invaginatus?

A
  • early detection- may present with caries, pain, abscess
  • fissure seal pronounced groove/pit on eruption
  • root canal but very difficult
  • multidisciplinary management needed in type 2/3
65
Q

What is taurodontism?

A
  • bull like teeth
  • multirooted teeth where body and pulp is enlarged at the expense of the roots
66
Q

Which teeth are most affected by taurodontism?

A

6.3% of mandibular molars

67
Q

What diseases are taurodontism associated with?

A
  • amelogenesis imperfecta
  • klinefelter’s syndrome
  • tricho-dento-osseous syndrome
68
Q

Where are accessory roots found?

A

􏰀 Almost any tooth
􏰀 Primary dentition 1 – 9%
􏰀 Permanent dentition 1 – 45%
􏰀 Often disto-lingual/ palatal aspect of tooth 􏰀 May be difficult to identify radiographically 􏰀 Potential problems with extraction or RCT

69
Q

What is dilaceration?

A

􏰊 Abnormal bend in crown or root of tooth 􏰊 Mostly permanent incisor
􏰊 Usually result of trauma to primary incisor
􏰊 Deviation results from traumatic displacement of hard tissue (which has already been formed) relative to developing soft tissue􏰀 Almost any tooth
􏰀 Primary dentition 1 – 9%
􏰀 Permanent dentition 1 – 45%
􏰀

70
Q

What are enamel pearls?

A

Ectopic mass of enamel on the roots, normally at the furcation area.

Paediatrics (8 decks)

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