Abnormalities of teeth (check RCS)

Hypodontia
1. Conditions associated
  1. Ectodermal Dysplasia
    1. Presentation
      1. Sparse hair
      2. Inability to sweat
      3. Anodontia/hypodontia
      4. Cone shaped tooth
      5. Bat ears
      6. Xerostomia
      7. Respiratory infections
    2. X-linked recessive
  2. Down's syndrome
    1. Fissured tongue
    2. Macroglossia
  3. Cleft lip & palate
  4. Crouzon's syndrome
  5. OFD syndrome
2. Prevalence
  1. Females
  2. Primary
    1. 0.1%
  3. Permanent
    1. 3.5-6.5%
  4. L8s > L5s > U2s > U5s > L1s
3. Management
  1. E.g. missing UR lateral incisor
    1. Do nothing
      1. Maintain deciduous teeth
        Classic is maintaining an E for a missing 5
        Maintains bone
    2. Refer
      1. Around 10
    3. Ortho
      1. Create space
        Need 6.5mm of space for implants
        Class III
      2. close space
        Class II
    4. Maintain space
      1. RBB
      2. Removable or fixed appliance
    5. Implants or definitive restorations at 18yrs
  2. Treatment aims
    1. Restore form, function & aesthetics
    2. Maintain space & OVD
4. Features
  1. Unerupted successor
  2. Microdontia
  3. Retained primary tooth
    1. Infraoccluded
  4. Lack of occlusal contacts
    1. Tooth wear
    2. Over-eruption
Supernumary
1. Prevelance
  1. Primary
    1. 0.2-0.8%
  2. Permenant
    1. 1.5-3.5%
  3. Males, premaxilla
2. Conditions associated
  1. Cleidocranial dysplasia
    1. Signs & Symptoms
      1. Absent clavicles
      2. High palate
      3. Delayed exfoliation/eruption
      4. Supernumary
      5. Hypercementosis
      6. RUNX2 gene mutation
  2. Downs Sydrome
  3. Gardner's syndrome
3. Types
  1. Supplementary = normal shape
    1. Paramolar
    2. Distomolar
  2. Accessory = abnormal shape
    1. Mesiodens
      1. Most common
4. Treatment
  1. Extract
    1. Unerupted & impeding eruption
      1. If permanent tooth still no erupted at 6m -> take radiograph
        If no movement seen on radiograph
        May need surgical exposure of permanent teeth to allow eruption
      2. Can take 18-24m for permanent teeth to erupt
    2. Erupted
      1. Wait a year before referring to ortho
        Invaginate teeth have a strong association with supernumeraries
  2. Just leave it
    1. If no pathology
    2. Unerupted & not impeding eruption of other teeth
    3. Risks
      1. Cyst
      2. Resorption of adjacent roots
      3. Ectopic eruption
5. Effects
  1. Eruption & crowding
  2. Displacement of permanent tooth
  3. Impeded eruption of normal teeth
Double teeth
1. Cause
  1. Fusion
  2. Gemination
2. 2 teeth attached at the root by cementum
  1. Concrescence
Taurodontism
1. Failure of HERS to invaginate properly
  1. Enlarged pulp chamber
  2. Short roots
2. Associated
  1. Type 4 hypoplastic Amelogenesis imperfecta
Abnormalities of enamel structure
1. Local Causes
  1. Trauma
    1. Intrusion or lateral luxation of primary tooth
  2. Infection
    1. Turner tooth
  3. Idiopathic
2. Genetic Causes
  1. Amelogenesis Imperfecta
    1. Types
      1. Hypoplastic
        Thin, pitted, grooved enamel
        Abnormal on eruption
        Insufficient amount
        Most severe
        Very sensitive
        Brown
        Tissue breakdown
      2. Hypomatured
        Snow capped teeth
        Cant tell apart from fluorosis, send to lab
        Incisal and occlusal surfaces
        White
      3. Hypocalcified
        Enamel is normal but is soft & chalky
        Dull, opaque teeth bilaterally
        Post-eruptive breakdown
3. Systemic Causes
  1. Infection
    1. Syphilis
      1. Hutchinson's incisors
      2. T-Palladium
      3. Mullbery molars
    2. Rubella
      1. Can cause chronological hypoplasia
  2. Excessive Fluoride
    1. Fluorosis
      1. Most suceptible
        < 6 years
      2. Paper white enamel opacities
      3. Can be brown if very severe
      4. Advantage
        Less susceptible to decay
      5. Usually permanent dentition
  3. Nutritional Disorders
  4. Chemotherapy
  5. Pre-mature birth, Neonatal illness
    1. MIH
  6. Drugs
    1. Tetracycline
Abnormalities in dentine structure
1. Causes
  1. Local
    1. Trauma
    2. Turner tooth
  2. Environmental
    1. Rickets
      1. Failure of calcification due to lack of Vit D
    2. Tetracycline
    3. Hypophosphatasia
    4. Hypoparathyroidism
  3. Genetic
    1. Dentinogenesis imperfecta
      1. Type 1
        Osteogenesis imperfecta
        Bue Sclera
        Defect in type I collagen
      2. Type II
        Teeth only
        Shell teeth
      3. Management
        Maintain OVD
        Restore function
        Improve aesthetics
    2. Dentinal Dysplasia
      1. Type I
        Rootless teeth
        Pulp obliteration
      2. Type II
      3. DIFFERENT to regional odontodysplasia
        Ghost teeth
        Large pulp chambers
        Upper anteriors
Hypercementosis/ Ankylosis
1. Causes
  1. Paget's
  2. Non-vital tooth
  3. Syndromes associated with hypocementosis
    1. Cleidocranial Dysplasia
    2. Hypophosphatasia
      1. Reduced ALP
      2. Hypoplastic cementum causing early loss of cementum
      3. Also get rickets
  4. 20% of PDL loss will cause ankylosis
Delayed eruption
1. Causes
  1. Local
    1. Retention of deciduous teeth
    2. Eruption/dentigerous cyst
    3. Lack of space
    4. Hypodontia
    5. Abnormal crypt position
    6. Odontome
    7. Dilaceration
  2. Generalised
    1. Cleidocranial dysplasia
    2. Down's syndrome
    3. Hypothyroidism
      1. Cretinism
    4. Rickets
Anomalies of tooth position
1. Ectopic canines
  1. Management
    1. Remove obstruction
    2. Encourage development into good position
    3. If too displaced may consider extraction
  2. Absent U3 0.3%
  3. Absent L3 0.15%
  4. Associated with hypodontia
  5. Palpate
    1. 9 years
Impacted teeth
1. Most common
  1. 8's > U3 > L4> L5> Supernumeries
2. Incidence of impacted canines
  1. 2%
  2. 15% buccal
  3. 85% palatal
3. Treatment
  1. Leave
  2. Remove
    1. Wary of vital structures
      1. Lower
        Mental& lingual N
      2. Upper
        Greater palatine N
        Nasopalatine
        Less important
  3. Expose
  4. Transplant

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Abnormalities of teeth (check RCS)

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	Created by Zainab Patel over 4 years ago

	Copied by sanna pathy about 4 years ago