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MODULE 6 > PAEDS - dental anomalies > Flashcards

PAEDS - dental anomalies Flashcards

(93 cards)

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1
Q

when do teeth begin to develop?

A

6 weeks IUL

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2
Q

what are the stages of tooth development?

A

initiation - dental lamina
morphogenesis - bud and cap stage
cell differentiation - bell stage
matrix secretion - eruption

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3
Q

what is formed at cap stage?

A

enamel knot

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4
Q

what is amelogenesis regulated by? and what are the 3 phases?

A

ameloblasts
- secretory phase
- calcification phase
- maturation phase

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5
Q

what regulates dentinogenesis?

A

odontoblasts

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6
Q

what is the term used to describe an anomaly of tooth number in which there is developmental absence of primary or permanent teeth?

A

hypodontia

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7
Q

what is another name for severe hypodontia?

A

oligodontia - more than 6 teeth absence (excluding third molars)

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8
Q

what stage of development is interrupted to result in hypodontia?

A

initiation stage

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9
Q

what is the genetic aetiology of hypodontia?

A

single gene defect - MSX1

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10
Q

what syndromes may have hypodontia as a feature?

A

ectodermal dysplasias
trisomy 21
cleft lip and palate
solitary median maxillary central incisor syndrome

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11
Q

what environmental factors may cause hypodontia?

A

sequela of severe disease and cancer tx early on in childhood

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12
Q

list the order of most commonly teeth affected by hypodontia?

A

lower 5
upper 2
upper 5
lower 1

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13
Q

list clinical features of hypodontia?

A

failure of primary tooth to exfoliate at expected time
permanent tooth hasnt erupted several months after primary exfoliates
teeth erupt out of sequence
contralateral tooth has been erupted for more than 6 months
teeth appear unusually spaced
primary teeth become infraoccluded
high association with microdontia
association with ectopic teeth
no tooth palpable in the buccal or lingual/palatal sulcus

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14
Q

how is a hypodontia diagnosis confirmed?

A

radiograph (PA first)
DPT if PA doesnt show enough

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15
Q

what is the multidisciplinary approach for managing hypodontia?

A

diagnosed by GPD
referred to paeds or ortho depending on age and stage of development
seen in secondary care by paeds, ortho, and restorative

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16
Q

why is OHI paramount for patients with hypodontia?

A

fewer teeth so ones that remain must be caries free as the patient is likely to undergo ortho and may require a prosthesis

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17
Q

what does treatment for hypodontia involve?

A

space redistribution, tooth modification and prosthetic replacement

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18
Q

what is cleidocranial dysplasia?

A

autosomal dominant disorder
- clavicles dont form
- primary teeth dont exfoliate on time
- permanent teeth delayed eruption
- loads of supernumeraries

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19
Q

what is ectodermal dysplasia?

A

a group of diseases affecting the structures arising from the ectoderm:
- teeth
- hair
- nails
- sweat glands
- salivary glands

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20
Q

what is the most common type of ED?

A

x-linked hypohydrotic ectodermal dysplasia

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21
Q

what are characteristics of ED?

A

sparse hair
dry skin
inability to sweat

may also suffer from xerostomia, dry eyes and nasal congestion

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22
Q

what do the teeth of patients with ED present as?

A

conical appearance
microdontia and hypodontia of multiple teeth

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23
Q

what is the dental anomaly in which there is addition of a tooth/teeth to the normal sequence?

A

supernumerary teeth

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24
Q

what stage of development do supernumerary teeth form at?

A

initiation stage

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25
what is the aetiology of supernumerary teeth?
genetic, often runs in families
26
what syndromes do supernumerary teeth tend to present in?
cleidocranial dysplasia cleft lip and palate gardner syndrome
27
what is the prevalence of supernumerary teeth?
<1% primary dentition 35-50% permanent dentition M>F
28
how can supernumeraries be defined?
position; mesiodens, paramolar shape; conical, tuberculate, supplemental, odontome
29
what are the most common shapes of supernumerary teeth?
conical
30
what types of supernumerary teeth are likely to erupt ?
likely to erupt: conical (if not inverted) supplemental (particularly incisors) not likely to erupt: tuberculate odontomes
31
where do you commonly find conical supernumerary teeth?
midline maxilla often in pairs often inverted
32
what teeth are usually supplemental?
lateral incisors 3rd premolars 4th molarsw
33
what is an odontome?
collection of tooth tissue compound: denticles complex: disorganised collection of tooth tissue likely to impede eruption of nearby teeth
34
what is the first sign of a supernumerary?
eruption of the supernumerary delayed eruption of the normal sequence
35
what are the effects of supernumerary teeth?
crowding +/rotation, malposition, ectopic position of surrounding teeth common cause for delayed eruption of central incisors
36
what is the clinical examination for supernumerary teeth?
palpate for the presence and position of unerupted teeth
37
what is management for supernumeraries?
monitor simple xla surgical xla teeth which have been impeded may need to be surgically exposed +/- ortho repositioned
38
what is the name for the dental anomaly in which teeth present smaller than the average tooth?
microdontia
39
what stage of development does microdontia occur at?
morphogenesis
40
what is the aetiology of microdontia?
genetic component environmental - childhood illness, cancer treatment associated with hypodontia
41
what syddromes are associated with microdontia?
ectodermal dysplasia cleft lip and palate
42
what is the prevalence of microdontia?
slightly higher in permanent F>M
43
what tooth is most commonly affected by microdontia?
maxillary lateral incisor (peg lateral)
44
what are clinical features of microdontia?
generalised microdontia presents with spacing localised microdontia - lateral incisor is small, narrow, and conical or 'peg shaped'
45
what are microdont laterals associated with?
palatally ectopic canines
46
what are radiographic features of microdonts?
lack of resorption of root presence of wear poor enamel quality root may be short and narrow
47
what is the management of microdonts?
accept ortho space redistribution composite build up extract
48
what is the name of the dental anomaly in which teeth are larger than average tooth/ teeth?
macrodontia
49
what is the aetiology of macrodontia?
usually tooth is large because it is a double tooth or has another defect such as a talon cusp
50
what are the types of double teeth?
fusion: 2 tooth germs joined together, may be associated hypodontia gemination: one tooth germ divided
51
what is the prevalence of macrodontia?
true macrodontia is very rare M>F associated with supernumeraries
52
what are clinical features of macrodonts?
large crown extra cusps or grooves crowding
53
what are radiographic features of macrodonts?
root form and root canal anatomy varies double teeth very from: 2 separate roots butterfly-shaped with 2 canals or 1 canal to a single large root
54
what is management of macrodontia?
accept reshape extract
55
what is the definition of dens invaginatus?
(dens in dente) "tooth within a tooth" enamel is folded in on itself creating an enamel lined cavity within the tooth
56
what is the Oehlers classification for dens invaginatus?
type I - invagination limited to crown up to ACJ type II - invagination extends to root beyond the CEJ with no communication to pulp type III A - invagination extends in to root and communicated laterally with PDL with no pulpal communication type III B - invagination extends in to root and communicates apically with PDL, with no pulpal communication
57
what is the aetiology of dens invaginatus?
possible genetic
58
at what stage of development does dens invaginatus occur?
morphogenesis
59
what is the prevalence of dens invaginatus?
10%
60
what teeth does dens invaginatus affect?
upper 2s and 1s often bilateral
61
what are clinical features of dens invaginatus?
often subtle pronounced cingulum pit first indication may be unexplained loss of vitality in the absence of trauma or caries
62
what are radiographic features of dens invaginatus?
infold of enamel additional root canals root expansion apical radiolucency due to loss of vitality
63
what is management of dens invaginatus?
fissure seal deep cingulum pits RCT for loss of vitality but very complex xla is root morphology is too complex
64
what is the name of the disorder of tooth form in which there is an additional cusp or tuberculate AKA talon cusp?
dens evaginatus
65
what is the aetiology of dens evaginatus?
genetic - different in different populations
66
at what stage of tooth development does dens evaginatus occur?
morphogenesis
67
what is the prevalence of dens evaginatus?
asian populations (affects lower 5s)
68
what teeth commonly have talon cusps?
maxillary incisors
69
what are clinical features of dens evaginatus?
clinically obvious cusps can wear down due to attrition premolars: central cusp but if worn down then exposure of dentine may lose vitality without any reason incisors: talon cusp palatally - may interfere with occlusion, displacement, prevent ortho some cusps look like extra teeth
70
what are radiographic features of dens evaginatus?
pulp extension into extra cusp
71
what is management for dens evaginatus?
accept and prevent: OHI and fissure seal additional cusp will contain pulp horn gradual reduction to encourage reactionary dentine removal of cusp and pulp capping/ pulpotomy/ RCT
72
what is the name of the anomaly of tooth form in which there is a bend in the root or crown of the tooth?
dilaceration
73
what is the aetiology of dilaceration?
acquired defect in permanent tooth, resulting from trauma to the primary tooth high risk injuries: avulsion or intrusion position of dilaceration along the long axis of tooth depends on stage of development at time of insult
74
what is the prevalence of dilaceration?
uncommon complication of trauma in the primary dentition
75
what teeth does dilaceration most commonly affect?
maxillary centrals
76
what are clinical features of dilaceration?
failure of eruption altered path of eruption ectopic position dilaceration in crown visible in erupted tooth
77
what are radiographic features of dilacerated teeth?
difficult to access on plain films lat ceph will show a dilacerated incisor CBCT to properly assess morphology
78
what is management of dilacerated teeth?
mild - ortho aligned unerupted - surgical exposure and bonding or SR mild dilacerations of the crown - composite/ shaping
79
what is the name of the tooth form anomaly in which the pulp chamber is elongated with a low bifurcation?
taurodontism
80
how can taurodontism be classified?
hypotaurodont mesotaurodont hypertaurodont
81
what is the aetiology of taurodontism?
associated with some types of AI and can present in syndromes such as Trisomy 21 and Klinefelter
82
at what stage of tooth development does taurodontism occur?
morphogenesis
83
what is the prevalence of taurodontism?
12%
84
what are the clinical features of taurodontism?
visible crown appears normal
85
what are the radiographic features of taurodontism?
long pulp chamber with short root canals
86
what is the management of taurodontism?
no management unless the tooth requires tx for another reason may be more difficult to perform RCT xla more challenging
87
are short roots a disorder?
yes, disorder of tooth form
88
what is the genetic aetiology of short roots?
genetic - dentine dyplasia short root anomoly
89
what is the environmental aetiology of short roots?
arrested root development due to loss of vitality prior to apexogenesis arrested root development due to illness or tx e.g., childhood cancer during root formation root resorption caused by trauma or ortho, ectopic teeth, pathology
90
what is the prevalence of short roots?
depends on cause genetically, very rare environementally, common
91
what are clinical features of short roots?
may be mobility pain or sinus if loss of vitality other associated anomalies like microdontia and enamel defects (if caused by childhood illness)
92
what are radiographic features of short roots?
dentine walls thin and wide root canals (where there is arrested development due to loss of vitality) roots may be tapered (where there is arrested development without loss of vitality) dentine walls thin and root canal normal width with blunted apex and irregularity in outline of root (where there has been resorption of previous fully formed teeth)
93
what is management of short roots?
non-vital teeth need RCT with apexification vital teeth must be taken care with ortho and perio must be well maintained where roots are very short plans must be made for their eventual loss

MODULE 6 (69 decks)

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