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Paeds > Dental anomalies > Flashcards

Dental anomalies Flashcards

1
Q

What subcategories can dental anomalies be classed into?

A

Anomalies in :

  1. Number
  2. Size
  3. Form
  4. Structure
  5. Eruptio
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2
Q

What anomalies of number can you have?

A

Extra teeth - supernumeraries

Missing teeth - hypodontia

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3
Q

What are the different types of supernumerary teeth that you can have?

A
  1. tuberculate
  2. conical
  3. supplemental
  4. odontoma
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4
Q

What type of dental anomally is this?

A

Supplemental tooth

resembles a tooth of normal shape/size

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5
Q

A mesiodens is an example of what type of dental anomaly?

A

A conical supernumerary. It is conical in shape and presents in the midline

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6
Q

What type of dental amonaly is this?

A

Tuberculate

there is more than one cusp/tubercle

barrel shaped and often palatal to the upper 3s

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7
Q

What type of dental anomaly is this?

A

Odontoma

complex - posterior mandible

compound - anterior maxilla

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8
Q

What is the incidence of supernumerary teeth in the primary and permanent dentition?

A

**Primary dentition - **(0.3-0.8%)

Secondary dentition (1-3.5%)

(98% are in the maxilla, 75% of which are mesiodens)

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9
Q

What leads to the formation of supernumerary teeth?

A

Budding of the dental lamina

they occur sporadially or as a result of a syndrome e.g. cleidocranial dysplasia

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10
Q

How would you manage a supernumerary tooth?

A

**EXTRACTION **if it was impeding eruption of adjacent teeth, causing displacement, associated pathology or intefering with orthodontic plans

**MONITOR- **roots of adjacent teeth are still forming, symptomless, no pathology

conical teeth tend to erupt and are easily extracted, wheras tuberculate teeth usually dont erupt and require surgical removal

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11
Q

**Define **

hypodontia

oligodontia

anodontia

A

**Hypodontia - **generally missing teeth

**Oligodontia - ** >6 missing teeth

**Anodontia - **missing all teeth

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12
Q

What is the order of prevalence of missing teeth?

A

8s> upper 2s> 5s> 1s

Usually the last in the series

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13
Q

What is the aetiology behind hypodontia?

A
  1. Obstruction/ disruption of the lamina
  2. problems with the dental epithelium - failure of initiation or functional abnormaility
  3. space limitation
  4. environmental - during pregnancy
  5. genetic
  6. syndromes - ectodermal dysplasia, clefts, downs
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14
Q

How can you diagnose hypodontia?

A
  1. radiographically
  2. present as a retained primary tooth
  3. if teeth fail to erupt
  4. may present as part of a syndrome
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15
Q

How would you manage hypodontia?

A

DEPENDS ON THE DEGREE OF HYPODONTIA

aim to restore function, appearance and maintain vertical dimension

  1. Maintain primary teeth is possible
  2. orthodontics - space closure/ space creation
  3. Composite build ups
  4. autotransplantation
  5. resorative - implants (when fully grown), bridges, dentures
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16
Q

Which syndromes are associated with hypodontia?

A

ectodermal dysplasia

cleft lip and palate

down’s syndrome

Albrights disease

Gorlin-goltz syndrome

Hemifacial microsomia

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17
Q

What is ectodermal dysplasia?

A

A group of syndromes that all have abrnomalities of ectodermal structure. The most common of which is Hypohydrotic Ectodermal dysplasias.

The most common form has an x-linked inheritance

Hair, nails, skin, teeth atc are affected

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18
Q

Define Macrodontia

A

When a tooth/teeth are larger than normal for that single tooth type

generalised macrodontia may be due to a hormonal imbalance e.g. pituitary gigantism

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19
Q

List the treatment options for macrodontia

A
  1. stripping - stip mesial and distal aspects to make it look narrower
  2. build up of corresponding tooth
  3. incisal edge notching and labial groove
  4. extract and provide a prosthesis at a later date - RRB, Implant
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20
Q

Define microdontia

A

Tooth/teeth smaller than normal for a particular tooth type

females are more likely to be affected than males

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21
Q

Treatment options for microdontia

A

Build up with composite

veneer

extract and close space - orthodontically, autotransplantation, RRB, implant

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22
Q

What anomalies are there of the form of the tooth?

A

**CROWN - **Double teeth (germination/fusion)

Dens invaginatus (dens in dente)

dens envaginatus (extra cusp)

accessory cusps

**ROOT - **Taurodontism

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23
Q

What does fusion and germination mean in relation to double teeth?

A

**Germination - **2 adjoined teeth due to developmental separation of a single tooth germ

**Fusion - **joining of adjacent tooth germs

(if double teeth are present in the primary dentition, there is a 30-50% chance that it will occur in the permanent dentition)

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24
Q

How would you differentiate between germination or fusion of the teeth (a) and what would the treament of the permanent teeth be (b)?

A

(a) Radiographically
(b) fissure seal the join between the teeth to avoid caries

extract/retain/sugrically divide based on the space/pulp chambers/root canals

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25
Q

What is dens invaginatus?

A

Dens in dente caused by invagination of the dental papilla

it usually affects the mexiallry incisors and is often bilateral 2x more common in males than females

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26
Q

How you you treat dens invaginatus?

A

seal the fissures and pits to prevent caries

treat caries with composite

if possible RCT,but may have to extract

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27
Q

How does dens evaginatus present?

A

As enamel covered by a tubercle on the crown of the tooth. 43% contain pulp

affect mandibular teeth more than the maxialry and usually occur on the occlusal surface of the premolar

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28
Q

Which teeth are usually affected by accessory cusps?

A

Upper 6s - cusps of Carabelli

**Permanent incisors from the cingulum - **talon cusps

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29
Q

How could you categorise abnormalities of tooth structure?

A

ENAMEL

DENTINE

CEMENTUM

30
Q

What are the stages of normal enamel development?

A

**secretory - **matrix production and initial mineralisation (Defines the form of the tooth)

**maturartion - **increase in mineral content (defines the quality of the tooth)

31
Q

What is a severe defect of hypomineralised enamel also known as?

A

HYPOCALCIFICATION

32
Q

What is a less severe form of hypomineralisation know as?

A

HYPOMATURATION

33
Q

What are the local causes on enamel defects?

A

trauma

infection

idiopathic

irradiation

34
Q

What are the generalised causes of enamel defects?

A

Genetic

environmental/chronological/systemic

35
Q

What is this?

A

Amelogenesis imperfecta

36
Q

What condition is this?

A

Dentinogenesis imperfecta

37
Q

What is amelogensis imperfecta?

A

A generalized enamel defect affecting all/predominantly all teeth of the primary and permanent dentitions

38
Q

What is the mode of inheritance for amelogenesis imperfecta?

A

Autosomal dominant

autosomal recessive

x-linked

sporadic

39
Q

What are the different classifications of amelogenesis imperfecta?

A

Hypoplasia

hypocalcification

hypomaturation

40
Q

How is the presentation of X-linked AI different to that of autosomal dominant?

A

Males are more severely and uniformly affected as they only have one x chromosome

females can show vertical ridges or grooves

41
Q

How would you manage AI?

A

Depeneds on the severity of the phenotype

severely affected teeth can have cast restorations covering the crown

42
Q

What genetic disorders can cause generalised defects in the enamel?

A

Down’s syndrome

Ectodermal dysplasia

epidermolysis bullosa

occulo-dento-osseous dysplasia

43
Q

What envirmonmental/chronological/systemic causes can give rise to enamel defects?

A

**Prenatal - **rubella/syphillis

**Neonatal - **premature birth, hypocalcaemia

**Post-natal - **measles, chickenpox, vitamin A/C/D deficiency, chemical agents

44
Q

What is this?

A

Fluorosis

This is a developmental disturbance of dental enamel caused by excessive exposure to fluoride during tooth development

45
Q

What is the cause of fluorosis?

A

Excessive intake of fluoride during tooth development

drinking water >2ppm

excessive use of fluoride supplements +/- fluoride toothpaste

excessive consumption >0.05mg/kg per day

46
Q

What problems are associated with fluorosis?

A

Aesthetics

thermal/osmotic/contact sensitvity

poor OH

Compromised/ reduced occlusion

47
Q

How can you manage and treat fluorosis?

A

Do nothing

local composite fillings

composite veneers

procelain veneers

microabrasion

external bleaching

48
Q

What condition is this?

A

Molar - incisor hypomineralisation

clinical hypomineralisation of systemic origin of one or more of the first permanent molars and any associated and affected incisors

49
Q

What are the causes of defects of the dentine?

A

genetic

environmental

50
Q

What is dentinogenesis imperfecta?

A

A genetic disorder of tooth development

it is autosomal dominant and effects both the primary and secondary dentition

It can occur as an isolated condition or with osteogenesis imperfecta (blue sclera)

51
Q

What are the different cateogories of dentinogenesis imperfecta?

A

**Type I- **dental manifestation of osteogenesis imperfecta

**Type II - **classic herediatary opalescent dentine

**Type III - **Brandywine isolate opalescent dentine (involves teeth with a shell-like appearance

52
Q

What condition is this and what are its features?

A

Dentinogensis imperfecta

Obliteration of the pulp chamber (type I and II)

Short teeth

Bud/Bell shaped crowns with marked cervical constriction

53
Q

What other genetic conditions can affect the dentine?

A

**DENTINAL DYSPLASIA - **it is autosomal dominant and affects both dentitions

**Vitamin D - deficient Rickets - ** x-linked condition that affects males with skeletal conditions

54
Q

Which condition is this?

A

Tetracyline staining

Children are most suspecptible to tetraclyine staining of the permanent teeth from in utero to the age of 8.

It causes intrinsic staining

Don’t give tetracycline antibiotics to children under the age of 12

55
Q

What are the two main types of cementum defects?

A

**Hypercementosis - ** periapical inflammation and mechanical stimulation

**Hypocementosis - ** cleidocranical dysplasia and hypophosphatasia

56
Q

What condition is this?

A

Hypercementosis

57
Q

What condition is this and what caused it?

A

Turner tooth

Caused by a traumatic injury to a deciduous tooth/ due to a periaplical infection

There is hypoplasia of the enamel and usually involes a single tooth

58
Q

Give an example of premature tooth eruption

A

Natal teeth

they are present at birth, the majority of which are mandibular incisors that are not supernumerary

Problems - Mobile due due underdeveloped bone and roots. there is a risk of inhalation

59
Q

What conditions can natal teeth be linked with?

A

Ellis-van Creveld syndrome

Soto syndrome

60
Q

What are neonatal teeth?

A

Teeth that erupt within the first month of life

61
Q

What are the management options for neonatal and natal teeth?

A

Observe

extract

smooth over the incisal edges (this is difficult to do in a child)

62
Q

What can lead to delayed tooth eruption?

A

Impacted tooth

traumatic displacement of a tooth germ

dilaceration of permanent tooth germ

presence of supernumeraries/odontomes

63
Q

Which generalised causes can lead to delayed tooth eruption?

A

Nutritional deficiency

chromosomal abnormalities - Downs, Turners

Hypothyroidism

Prematurity or low birth weight

64
Q

What can cause implaction of teeth?

A

Abnormal position of the tooth germ

supernumerary teeth

cysts

odontogenic tumours

65
Q

At what age should you palpate for canines in children

A

9 years

66
Q

What can lead to premature exfoliation?

A

Local factors - Trauma, extraction

Systemic factors - hypophosphatasia

cyclic neutropenia

chronic periodontal disease

67
Q

What local and generalised factors can lead to delayed exfoliation?

A

Local - infraocclusion

Generalised - cherubism, cleidocranial dysplasia

68
Q

What is meant by the term infraocclusion?

A

occlusion in which one or more of the teeth fail to project as far as the normal occlusal plane

69
Q

how can you categorise infraocclusion?

A

**Mild - ** occlusal surface is located approximately 1 mm below the expected level of the occlusal plane

**Moderate - **occlusal level approximately level with the contact point of one or both adjacent tooth surfaces

**Severe - ** occlusal level with or below the interproximal gingival tissue or one or both adjacent tooth tissues

70
Q

Which teeth are most likely to be affected by infraocclusion

A

Primary molars

Highest incidence of ankylosis ranging rong 1.5 - 9.9%

Ankylosis involves fusion of cementum to the alveolar bone and affects almost all infra-occluded deciduous molars

71
Q

Which radiological feature suggests ankylosis?

A

Loss of the lamina dura

72
Q

What is meant by delayed eruption?

A
  • there is eruption of the contralateral teeth > 6 months previous
  • deviation from the normal sequence of eruption
  • both upper central incisors are unerrupted although the lower central incisors erupted over a year ago

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