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Dental Anomalies Flashcards

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1
Q

Conditions hyperdontia is associated with?

A
  1. Cleidocranial dysplasia
  2. Gardner syndrome
  3. Cleft lip and palate (-40% have supernumeraries in area of cleft)
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2
Q

Hyperdontia results in?

A
  1. Crowding
  2. Impede path of eruption of permanent teeth
  3. Resorption of root of adjacent teeth
  4. Cyst may develop around buried supernumerary teeth
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3
Q

Management of Hyperdontia

A
  1. Early diagnosis and treatment
  2. Removal by extraction or surgery before root of permanent tooth > 1/2 formed
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4
Q

Teeth most often absent in Hypodontia?

A

Terminal teeth of a series

  1. Third molars
  2. Mandibular 2nd premolar
  3. Maillary lateral incisors
  4. Maxillary 2nd premolar
  5. Mandibular central incisors
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5
Q

Etiology of Hypodontia?

A
  1. Environmental (trauma CT, RT)
  2. Genetic
  • Non-syndromic: Mutations of PAX9, MSX1, AXIN2
  • Syndromic: Ectodermal dysplasia, cleft lip/palate, trisomy 21
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6
Q

Management of Hypodontia

A
  1. Clinical and radiographic assessment -> Referral
  2. Regular preventive care
  3. Restore aesthetics/function -> Multi-disciplinary
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7
Q

Accessory roots are associated with what anatomical features?

A

Large cusp of Carabelli and paramolar tubercles

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8
Q

Accessory roots are more common in which teeth?

A

Lower 6s, canines and premolars

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9
Q

Reduction in root number are seen in which teeth?

A

<1% of 1st molars

15-40% of 2nd and 3rd molars

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10
Q

Most dental anomalies are more common in permanent teeth except?

A

Double tooth

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11
Q

Double tooth is most common in which teeth?

A

Incisors

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12
Q

Definition of Gemination

A

Budding of a second tooth from a single tooth germ

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13
Q

Features of Gemination

A
  1. One root canal present
  2. Bifid crown with single root and pulp chamber
  3. Familial inheritance
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14
Q

Definition of Fusion

A

Joining of two teeth of normal series or a normal tooth and supernumerary tooth by pulp and dentine

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15
Q

Features of fusion

A
  1. Two canals
  2. Number of teeth in dentition is normally reduced by 1 unit
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16
Q

Clinical Significance of Double Tooth

A
  1. Site of fusion may be at increased risk for plaque collection -> Caries or periodontal issues
  2. May retard eruption of permanent successor
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17
Q

Management of Double Tooth in Primary Dentition

A
  1. Fissure sealant in labial and palatal groove
  2. Monitor root resorption of primary double tooth to prevent delayed eruption of permanent successor
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18
Q

Management of Double Tooth in Permanent Dentition

A
  1. Permanent dentition: Surgical separation of fused teeth -> Orthodontic alignment and restorative treatment
  2. Reshaping or reduction of double tooth with single canal (gemination)
  3. Deliberate extraction and prosthodontic replacement
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19
Q

Definition of Concrescence

A

1.Joining of two teeth by cementum

  1. Fusion that occurs after root formation is complete
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20
Q

Concrescence is most common in which teeth?

A

Maxillary posterior region

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21
Q

Clinical significance of Concrescence?

A

Difficult extraction

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22
Q

What is a Talon Cusp?

A

Cusp projecting from cingulum of incisors

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23
Q

Talon Cusp is most common in which teeth?

A

Permanent incisors

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24
Q

Features of Talon Cusp

A

Consists of enamel, dentine and pulp horn

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25
Accessory Cusps include?
1. Paramolar cusp 2. Cusp of carabelli
26
What is a Paramolar Cusp?
Extra cusp on buccal of molars
27
What is a Cusp of Carabelli?
Extra cusp on mesiopalatal of 6s, usually bilateral
28
Dens Invanginatus are most commonly seen in which teeth?
Maxillary lateral incisors
29
Types of Dens Invaginatus
Type 1: Above CEJ, Seal the groove Type 2: Below CEJ Type 3a: Communication laterally with periodontal ligament Type 3b: Communication apically with periodontal ligament
30
Problems with Dens Invaginatus?
1. Caries may develop in the invaginatus 2. Enamel lining may be incomplete and dentin deficient in some areas → Direct communication with pulp → Acute dentoalveolar infection
31
Management of Dens Invaginatus
Prophylactic sealing of invaginatus soon after eruption
32
What is a Dens Evaginatus
Enamel covered tubercle projecting from tooth surface
33
Dens Evaginatus usually affects which teeth?
Premolars (Leong's premolar), sometimes canines and molars
34
Problems with Dens Evaginatus?
Tubercle may fracture and cause pulpal infection
35
What condition is associated with Dens Evaginatus?
Rubinstein Taybi Syndrome
36
What is Taurodontism?
Describes a molar tooth with a pulp chamber that is vertically enlarged at the expense of the roots
37
What conditions is associated with Taurodontism?
1. Ectodermal dysplasia (Hypodontia) 2. Klinefelter's Syndrome 3. Tricho-dento-osseous syndrome 4. 20% of A.I cases
38
What is dilaceration?
Abrupt deviation of long axis of crown or root portion
39
Etiology of dilaceration
1. Trauma to primary dentition (2-5 yo) 2. Idiopathic or developmental disturbances
40
Management of Dilaceration
If mild, the tooth may erupt then reshape for aesthetics If fail to erupt, tracking tooth down orthodontically or remove surgically
41
What is a Hutchinson's incisor?
1. Barrel-shaped (Incisal-edge < cervical width) 2. Incisal angles rounded, edge may be notched
42
What is a Moon's molar?
Reduction of crown form towards occlusal surface of 6's
43
What is a mulberry molar?
Hypoplasia of early mineralising part of 6's
44
What is Globodontia?
Globular deformity of crowns of canines and posterior teeth of both dentitions
45
Associated conditions with Globodontia?
Otodental syndrome - Rare, AD condition - High frequency deafness from childhood
46
Microdontia is most common in which teeth?
Maxillary lateral incisors, 2nd premolars, 3rd molars
47
Microdontia is more common in permanent or primary dentition?
Permanent
48
What is the inheritance pattern of microdontia?
AD with incomplete penetrance
49
Conditions associated with microdontia?
1. Ectodermal dysplasia 2. Down syndrome 3. Pituitary dwarfism
50
Management of Microdontia
1. No treatment 2. Composite build-up or veneers
51
Macrodontia is more common in permanent or primary dentition?
Permanent
52
Macrodontia affects which teeth?
Permanent maxillary central, mandibular 2nd premolar
53
Conditions associated with Macrodontia
1. Klinefelter syndrome (taurodontism) 2. Hereditary gingival hyperplasia 3. On affected side of hemifacial hyperplasia 4. Pituitary gigantism
54
Larger root size is seen in which teeth?
Maxillary canine
55
Smaller root size is seen in what conditions?
1. Dentin and pulp dysplasia 2. Hypoparathyroidism 3. Excessive irradiation of jaw or severe malnutrition
56
What is Odontodysplasia?
Localised, non-hereditary developmental abnormality affecting enamel, dentin and pulp
57
How does Odontodysplasia appear on X-rays
1. Mild cases: Root formation normal or develop a few years after normal teeth in same mouth 2. Severe cases: 'ghost-like', little differentiation of dental tissues
58
Arrest of tooth germ development can be caused by?
1. Osteomyelitis 2. Irradiation of jaw in childhood 3. Severe trauma 4. Untreated chronic pulpal infection of primary teeth 5. Fracture of jaw
59
What is Amelogenesis Imperfecta?
Inherited enamel defects affecting both dentitions in the absence of a systemic disorder
60
Mode of inheritance of AI?
AD, AR, X-linked
61
What are the phenotypes of AI?
1. Type I Hypoplasia: Secretory defect -> Reduced enamel thickness 2. Type II Hypomaturation (Hypomineralisation) 3. Type III Hypocalcification (Hypomineralisation)
62
Clinical Features of Type 1 Hypoplastic AI?
1. Thin enamel: Smooth/rough/pitted/grooved 2. Generalised spacing 3. Delay in eruption 4. Unerupted teeth may undergo replacement resorption 5. AOB in 60% of AI cases 6. Enamel more radiopaque than dentine
63
Clinical Features of Type II Hypomaturation AI?
1. Normal thickness of enamel 2. Slightly softer than normal 3. Not as severe as Type III hypocalcified 4. Enamel approximately same radiodensity as dentine
64
Clinical Features of Type III Hypocalcified AI?
1. Initially, normal thickness of enamel 2. At eruption, dark yellow/brown/chalky white enamel 3. Enamel may wear away to expose rough sensitive dentine 4. Enamel is less radiopaque than dentin
65
What is Type IV Hypomaturation-Hypoplastic with Taurodontism AI?
Hypomaturation and hypoplasia appearance
66
Clinical Features of Hypomaturation-Hypoplastic with Taurodontism AI
1. Enamel is mottled white-yellow-brown 2. Pits on labial surface or thin with areas of hypomaturation 3. Molars have taurodontism 4. Enamel have same or slightly greater radiodensity than dentine
67
Management of AI?
1. Genetic counseling 2. Good preventive program 3. SSC for molars or overdentures to maintain VD 4. CR veneers 5. Orthodontic treatment for AOB 6. Definitive crowns/ veneers in late teens
68
Challenges in Management of AI
1. Pain + Eating difficulties 2. Tooth hypersensitivity 3. Rapid wear -> Loss of OVD 4. Malocclusion 5. Poor aesthetics 6. Protracted course of treatment
69
Etiology of Junctional Epidermolysis Bullosa?
1. Disruption of the COL17 gene 2. Abnormal interaction between enamel epithelium and underlying mesenchyme, resulting in defective ameloblast differentiation
70
Features of Junctional Epidermolysis Bullosa?
1. Multiple bullae of mucus membrane and skin 2. Dystrophic nails 3. Thin hypoplasia to fine pitting hypoplasia (honeycomb)
71
Etiology of Tricho-dento-osseous syndrome?
DLZ3 gene expressed in hair, teeth and bones
72
Clinical Features of Tricho-dento-osseous Syndrome?
1. Increased thickness of cranial bones 2. Tight curly hair 3. Thick and cornified nails 4. Teeth present as in Type IV AI - Thin hypoplastic enamel - Taurodontic pulp chambers
73
What is Molar-Incisor Hypomineralization?
Hypomineralization of systemic origin of 1-4 permanent 1st molars, frequently associated with affected permanent incisors Qualitative defect
74
Clinical Features of MIH
1. Cheese molars: Enamel friable 2. Small white, yellow or brown patches to extensive loss of enamel 3. Rapid breakdown of enamel and is very sensitive: Irregularly distributed mottling
75
Diagnosis of MIH
1. At least one permanent molar affected 2. Presence of demarcated opacity (defective enamel is normal thickness with a smooth surface and can be white,yellow or brown.) 3. Post-eruptive enamel breakdown 4. Atypical restoration on smooth surface
76
Challenges of MIH
1. Poor adhesion of restorative materials to hypomineralised enamel 2. Hypersensitivity - Difficult to achieve anaesthesia - Prone to caries
77
Management of MIH
Preventine: Topical fluoride varnish, fissure sealants Restorative: 1. Molars: Preformed metal crowns if unsuitable for CR/GIC. Analyse occlusion if severely compromised KIV extraction 2. Incisors: Microabrasion, resin infiltration, etch-bleach-seal OR CR veneers for incisors if aessthetics compromised
78
What is enamel fluorosis?
Disturbance in 3rd stage (maturation) of amelogenesis
79
Features of Enamel Fluorisis
Mildest form: Manifest as hypomineralisation of enamel leading to opacities Severe form: Manifest as hypoplasia
80
Localised enamel defect due to environmental changes such as?
1. Infection 2. Trauma of primary teeth
81
Generalised enamel defect due to environmental changes such as ?
During tooth development, 1. Prematurity 2. Malnutrition 3. Exanthematous fevers 4. Excessive ingestion of F
82
Types of Dentinogenesis Imperfecta?
Type I (associated with osteogenesis imperfecta) Type II Type III (Brandywine isolate)
83
Types of Dentinal Dysplasia
Type I: Radicular Dentinal Dysplasia Type II: Coronal Dentinal Dysplasia
84
What is Dentinogenesis Imperfecta?
Hereditary dentine defects confined to dentition. All teeth are affected with varying severity, primary teeth usually worse
85
Clinical Features of Dentinogenesis Imperfecta?
1. Opalescent bluish/brownish colour 2. Enamel chip away at EDJ, exposing soft dentine which wears away rapidly
86
How does Dentinogenesis Imperfecta appear on the X-ray?
Bulbous crowns, short roots, obliteration of pulp chamber and root canals by abnormal dentine
87
Histology of Dentinogenesis Imperfecta?
1. Hypomineralised enamel in 1/3 of cases 2. Dentine matrix is amorphous 3. Tubules abnormal size and shape, haphazard
88
Mutation in Osteogenesis Imperfecta
Mutation in genes that encode Type 1 collagen? COL1A1, COL 1A2
89
Clinical Features of Radicular Dentinal Dysplasia?
1. Rootless teeth 2. Crowns of teeth are normal in shape, form and colour
90
Xrays on Radicular Dentinal Dysplasia appear as?
1. Crown normal shape 2. Roots short and blunt 3. Multiple PA radiolucencies 4. Obliterated pulp chambers (Completely in primary teeth, crescent shaped in permanent tooth)
91
Clinical Features of Coronal Dentinal Dysplasia?
1. Primary teeth blue-grey-brown and translucent 2. Permanent teeth are clinically normal, radiographically L thistle-tube shaped pulps, multiple pulp stones
92
Localised dentin effect is caused by?
Severe trauma/infection to primary teeth, leading to formation of interglobular dentine below area of hypoplastic enamel on permanent teeth
93
Generalized dentin defect due to environmental such as?
1. Tetracycline taken during tooth formation may discolour dentine and delay dentinogenesis 2. Irradiation and hypothyroidism retards dentinogenesis in children
94
Defects of pulp include?
1. Pulp stones 2. Diffuse pulp calcification
95
Genetic defects of cementum?
1. Cleidocranial dysostosis (AD): Hypoplasia of cementum, related to delay or failure of eruption 2. Hypophosphotasia (AR/AD): - Lack serum alkaline phosphatase - Hypoplasia of cementum, lack of perio attachment, early loss of primary teeth
96
Environmental-related defects of cementum?
Excessive deposition of cementum due to 1. Chronic infection 2. Traumatic occlusion
97
Extrinsic Discolouration of Teeth
1. Food, drinks 2. Medication 3. Chromogenic bacteria
98
Intrinsic discolouration of teeth
1. Localised (Caries, internal resorption, trauma, infection of primary teeth) 2. Generalised (AI, DI, tetracycline, excessive fluoride during tooth formation, blood-borne pigments such as bilirubin, hemosiderin, porphyria
99
What is the sequence of eruption of Primary Teeth?
ABCDE
100
What is the sequence of eruption of Permanent Dentition?
Maxillary: 61245378 Mandibular: 61234578
100
When do Natal teeth erupt?
At birth
100
When do Neonatal teeth erupt?
Within 1st month of birth
101
Prematurely erupted teeth are usually?
1. Poorly formed 2. Mobile due to lack of root development (risk of aspiration, nursing obstacle)
102
Management of Premature Eruption
1. Leave to firm up 2. Extract
103
What condition is Premature Eruption associated with?
Riga Fede Disease
104
What causes Ectopic Eruption?
1. Ectopic crypt position 2. Presence of supernumerary teeth or odontomas causing deflection of path of eruption
105
When should maxillary canine impaction be suspected?
1. Canine bulge not palpable at 9-10 years old 2. Asymmetric canine eruption 3. Peg-shaped laterals
106
Localised Delayed Eruption is due to?
1. Ankylosis 2. Impaction 3. Supernumerary teeth 4. Trauma
107
Generalised Delayed Eruption
1. Premature babies 2. Down and Turner's Syndromes 3. Cleidocranial dysplasia 4. Gross malnutrition 5. Growth hormone deficiency
108
Localised Premature Exfoliation is caused by
1. Pulpal infection spreading to periradicular tissue 2. Ectopic eruption of 6 -> Resorption of distal root of E which may lead to early loss of E
109
Generalised Premature Exfoliation is caused by
1. Hypophosphatasia 2. Histiocytosis X
110
Localised delayed exfoliation is caused by?
1. Primary double tooth 2. Congenital absence of permanent successor 3. Infraocclusion
110
Generalised delayed exfoliation is caused by
1. Down's Syndrome 2. Turner's Syndrome
111
Infraocclusion occurs due to
Fusion of cementum with alveolar bone
112
Which teeth are most likely infraoccluded?
Primary mandibular 2nd molar > Mandibular 1st molar > Maxillary 1st molar > Maxillary 2nd molar
113
Classification of Infraocclusion
Mild, moderate to severe in relation to contact point
114
Problems with infraocclusion?
1. Tipping and space loss
115
Management of Infraocclusion
1. Majority exfoliate spontaneously if successor tooth present 2. Monitor timing for extraction
116
Types of Resorption
1. Physiological/Pathological 2. Internal/External 3. Coronal/Radicular
117
When does Physiological resorption begin?
Begin soon after root formation is completed at 3-4 years old
118
When does Pathological resorption occur?
Complication following trauma, infection, excessive orthodontic forces, impacted/ supernumerary teeth
119

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