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Dental Anomalies Flashcards

(41 cards)

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1
Q

What’s is hypoplasia

A

Reduction in the quantity of tissue formed

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2
Q

What is hypomineralisation

A

Reduction in deposition of mineral (quality)

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3
Q

What is hypomaturarion

A

Reduction in deposition of minerals at end stage of mineralisation. Defective formation of crystallites in enamel rods and sheath

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4
Q

Local factors that cause dental anomalies

A
  1. Trauma
  2. Chronic infection
  3. Radiation
  4. Local surgery
  5. Cleft lip and palate
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5
Q

Environmental causes of dental anomalies

A

Environmental factors depend on timing, severity and duration of insult
-systemic illness
-diseases
-chemicals
-malnutrition
-vitamin defects

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6
Q

What’s the most common enamel defect

A

AI

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7
Q

What is AI

A

developmental disturbance that interferes with normal enamel formation in the absence of a systemic disorder

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8
Q

Which teeth do dental defects impact (genetic causes)

A

All primary and permanent dentition

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9
Q

What are the 4 phenotypes of AI

A
  1. Hypoplastic
  2. Hypocalcified (hypomineralisation)
  3. Hypomature
  4. Mixed
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10
Q

What are the environmental causes of enamel defects

A

Fluorosis
Incorrect technique during birth
Trauma
Infection

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11
Q

What is fluorosis

A

Caused by an increase in concentration within the fluoride micro environment of the ameloblasts during enamel formation.

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12
Q

Treatment plan for fluorosis

A
  1. Bleaching
  2. Microabrasion
  3. Composite of signs of hypoplasia
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13
Q

Which teeth are most impacted by turners tooth

A

Lower mandibular premolars (because D AND E EASILY CARIOUS IN PAEDS PTS )

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14
Q

When does most damage to tooth bud occur

A

Under 3 years of age

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15
Q

Which type of trauma injuries are more likely to cause an enamel defect (turners tooth)

A
  1. Intrusive luxations
  2. Avulsion
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16
Q

How to know if a crown has dilacerated after trauma

A

Can be seen of radiograph one year after trauma/ event

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17
Q

SOOD: bleaching for paeds pts (under 18)

Study These Flashcards
A
  • If Enamel defect (not recommend in practice, would be in hospital) can be managed using bleaching, would do this for that
  • ICON is different (appropriate medicament with no legality surrounding that, not tooth whitening process)
18
Q

SOOD: when is XLA of all 6s recommended when a pt has MIH

Study These Flashcards
A
  • many things: think about presence of 7s 8s (dont want hypodontia), mineralisation and angulation of the 7s
  • Severity of MIH and how many teeth involved (whether that’s all of them or some of them)
  • Underlying occlusion, class 1 2 3, crowding or not
  • Must weigh up all of that including prognosis of teeth to decide
19
Q

MIH 6 stages of tx

Study These Flashcards
A
  1. risk identification (assess MH for putative aetiological factors, pre peri and post natal stresses, genetic etc)
  2. early diagnosis
  3. remineralisation (topical fluoride)
  4. prevention
  5. Restorability/XLA
  6. Review/recall/maintenance
20
Q

Treatment for AI if enamel is intact but discoloured

Study These Flashcards
A

Bleaching or microabrasion to improve aesthetics

21
Q

Tx for ai if enamel or dentine can’t be bonded

Study These Flashcards
A

Full coverage restoration will be required

22
Q

Care principles with AI for primary dentition

Study These Flashcards
A
  • composite of anterior teeth to address aesthetics
  • stainless steel crowns or GIC restorations on occlusal surfaces of primary molars (high priority to keep for Es)
23
Q

Care principles for AI with mixed dentition

Study These Flashcards
A

1st permanent molars:
- pre formed metal crowns
- gold onlays (supragingival margins)

Protracted (slower) eruption:
- damage can occur during this stage - consider GI/high Fl, consider operculectomy to aid OH

Permanent incisors
- direct or indirect composite veneers

24
Q

DISADV of restorations for AI eg anteriorly before gingival maturation.

Study These Flashcards
A

Over time, eruption and gingival maturation, margins may show

25
Care principles for AI in permanent dentition
PREMOLARS: - if they’re not in occlusion and not sensitive, then no intervention - aesthetics not often a problem - if wear and sensitivity an issue, then full coronal coverage with indirect or direct composite inlays CANINES: - more likely to be able to be aesthetic concern, wear down, and sensitivity - composite veneer
26
What can you do with resorbing teeth for AI
- XLA of affected teeth - attempt ortho extrusion before too much resorption
27
CARE PLANNING SUMMARY FOR AI: PROBLEMS:
- sensitivity - caries/acid susceptibility - poor aesthetics - poor OH - delayed eruption - tooth wear - AOB
28
CARE PLANNING SUMMARY FOR AI: SOLUTIONS:
- preventive therapy - composite veneers/composite wash - fissure sealants - metal onlays - stainless steel crowns - orthodontics
29
Management of MIH
- enhanced prevention - desensitisation eg with tooth mousse (CPP-ACP) - prevention of caries and PEB with DBOH and diet analysis - restorative/XLA: XLA of 6s for >12 yrs old @calcification of bifurcation of 7s, consider other adjacent successors/crowding/get ortho opinion - RMGIC/composite/PMC/onlay/inlay - avoid GIC/RMGIC in stress bearing areas - use composite - ideal to have LA and rubber dam with composite (but also not the same type of bonding so increased risk of bond failure) - PMC would have to be replaced in future with a cast indirect restoration - with creamy yellow colour of 1st permanent molar, just in fissures, no PEB, likely can do fissure sealant with FLOWABLE COMPOSITE (more wear resistant) ALWAYS SAY MAINTENANCE - regular recall/consider long term prognosis & tx options
30
How to know how much to drill for restoration for MIH?
1) removal of all defective enamel: - until sound surfaces reached = better adhesion 2) removal of porous enamel only: - less invasive - but defective enamel may continue to chip away
31
Adv of PMC for MIH for 6s
- prevent further tooth loss, control sensitivity, establish correct interproximal and proper occlusal contacts - you can do hall technique but. Need to avoid gingival irritation (bc gums aren’t as forgiving, need to adjust crown more)
32
Options for anterior teeth incisors with MIH
- bleaching - resin infiltration - etch bleach seal - microabrasion only (but removes tooth tissue - composite (but needs replacement) - microabrasion and composite restoration (simple) BLEACHING IS BEST AND STABLE BUT MEDICO-LEGAL ISSUES (only for use under 18 yrs if treating or preventing disease
33
OVERALL TX FOR MIH FOR MILD DEFECTS: MOLARS
- fl varnish on partially erupted molars - when fully erupted = sealants with prior adhesives - composite resin restorations if breakdown or caries occur
34
OVERALL TX FOR MIH FOR MILD DEFECTS: INCISORS (if needed)
- in brownish/yellow defects, etch-bleach-seal approach in younger kids OR chairside bleaching with 10% carbamide peroxide in older - resin infiltrate - in whitish defects, microabrasion followed if needed by composite resin restoration - composite restoration following enamel reduction
35
OVERALL TX FOR MIH FOR MODERATE/SEVERE DEFECTS: MOLARS
- consider XLA - fl varnish or GIC in partially erupted teeth - Composite restoration for up to 3 surfaces - PM crowns or copings for more than 3 surfaces, full porcelain crowns (or metal?)
36
OVERALL TX FOR MIH FOR Moderate/severe DEFECTS: INCISORS
- wait until defect gets better (degree of enamel mineralisation may occur in salivary environment) - composite restorations or veneers after microabrasion or enamel reduction and intermediate opaque resins - porcelain veneers if needed in adulthood
37
What age would you consider replacing PMC for MIH on 6s?
- around 14-15 yrs old consider removing PMC to replace with cast onlay
38
What is a mild defect MIH
- enamel opacities without enamel breakdown, non stress bearing areas - no sensitivty and incisor involvement is usually mild if present - mild aesthetic problems - no caries associated with affected enamel
39
What is moderate MIH
- demarcated opacities present on molars and incisors - PEB limited to 1 or 2 surfaces without cuspal involvement - atypical restoration can be needed and normal
40
What is severe MIH
- PEB - crown destruction - caries associated with affected enamel - history of dental sensitivity and aesthetic concerns
41
Adv of tooth mousse for MIH, and potential contraindication
- adv: remineralisation promoted and helps with sensitivity - can be applied like toothpaste/left on teeth overnight (provides a reservoir of free calcium and phosphate ions to maintain a supersaturation mineralization state on the enamel surface.) Contraind; - advise against using if pt lactose intolerant bc = milk derivative

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