Developmental disturbances

What do we mean by it ?
Alteration that occur during development , these alteration are not related to viral infection ,bacterial infection ,fungal infection or to any certain clear disease . Sometime these alternation have no a known cause non-known cause Generally we know that trauma maybe the cause

Developmental changes affect oral and maxillofacial region, so the changes will affect the hard tissue {teeth and bone} and the soft tissue mucosa, muscle

[1] Developmental alteration affecting the teeth What are the changes that could happen to teeth due to disturbance during the development ? -we have A] changes in the size of the tooth so the tooth may be big or it may be small When we say big/small thats bigger than normal or smaller than normal B] Regarding the number if teeth we may have extra teeth , or decreased in the number of normal teeth C] time of eruption Some time we will have premature eruption , some time we have delayed eruption D] the shape of the tooth some teeth may look up normal E] change in the structure of enamel, dentine or the structure of cemantum

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 Disturbance of the size

the teeth which are smaller than normal we will call it microdontia The teeth which are bigger than normal we will call it macrodontia Microdontia Could be true or relative, true means that the tooth is truly smaller than normal in dimensions Ex. the lateral incisor have a width of 7. Mm if we have 3 or 4 mm lateral incisor this is true microdentia What do we mean by relative ? The tooth has normal dimensions but it look small relatively. Ex. If we have lateral incisor measures 7 or 8 mm but it looks small these may be relative , because the tooth is normal but the jaw is wide maybe the patient inherited a wide jaw but a normal teeth so normal tooth in a large jaw is relatively small the microdonutia is usually localized and the teeth which are most commonly effected are the lateral incisors

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this is called peg lateral

examples of localized microdontia peg lateral which considered familial occur in some family more than others . and its an example of localized microdontia the third molars , third molar some time are smaller in size if u check your upper 8 it may look conical and smaller in size so its effected by microdontua if we have an extra tooth this extra tooth is most likely to have microdontia

Macrodontia May be true or relative it may be localized or may be generalized. If its true so there is really increase in the size of the tooth. its very rare to have localized macrodontia except for some cases like when we have hemi facial hypertrophy , so teeth in the effected side will be macrodontia larger in size this is an example of the localized just a number of teeth generalized are more common like when the patient have gaintesim for example {have increase in growth hormone or certain hormones disturbances } so everything in the body will be affected including the teeth .

some time we have increase in the size of the root previously we were talking about the crown (micro/macro dontuoa) but radiographly the root also may be effected by macrodontia we call it radimegaly and usually for the canine teeth
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Disturbances in the number of teeth ___________________________________________ There may be decrease in the number of the teeth hypodontia , complete absence anodontia or the maybe increase in the number of teeth supernumerary teeth . and another situation there maybe clinically you think that the patient doesnt have some teeth but acutely when you take a radiograph you will see that the patient is having the normal number of teeth but the are un-erputed so if u examine a patient and u dont see 4 or 5 teeth u should take a radiograph first to see if the teeth are present but not erupted, OR they are completely absence and then you say that the patient have hypodontia Hypodontia is the absences of tooth , the tooth germ itself is not there . anodontia complete absence of teeth . Which occur in ectodermal dysplasia. ectodermal dysplasia : is a genetic disease it has several types one of it types is called hypohydrotic [a variant of ectodermal dysplasia which is x-linked recessive occur more in the males. In which the males have more than one thing effected the hair , swet gland missing , and the teeth , protuberance of the upper lip, absences of eye brows ] the number if tooth is obuvisoly reduced and if we take a radiograph we will not see teeth there they are not formed ASLN and even the shape of the teeth is abnormal taper teeth ,small and absence so the condition here will be both microdontia and hypodontia number & size the problem in this disease is in the keratinocyte in the epithelium the defect is in the membrane of the epithelium there is a transmembrane protein in the membrane of keratinocyte is defected which lead to this findings so a defect in a single transmembrane protein in one type cell could cause a lifethreaten disease ! and for those patient who dont have sweat gland the will not tolerate high temperature they will die !

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*Ectodermal dysplasia patient ______________________________________________________ we can see hypodontia in lateral incisors congenitally missing so the lateral incisors maybe ]absence hypodontia , peg shape microdotia , present normally[ third molar maybe congenitally missing and some time the second molar some children retain E because the dont have 5 to push it to erupt the 5 is congenitally missing so we retain E the lateral incisors could be missing in the primary teeth also supernumerary teeth increase in the number of teeth. different types, different location , it could be single and it could be multiple it can erupt in the maxilla or the mandible one well-known supernumerary tooth is called mesiodense , meso- because it is in the mesial aspect to the upper central incisors between the central incisors mesodense shape is tapper look like the peg shape lateral

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some research said that the supernumerary teeth could be more associated with Clift lip or Clift palate and with certain syndromes , but the mesodinse could be present without any syndromes

mesodenis may erupt or it could erupt in the floor of the nose upside down , or maybe horizontal impacted and in this case it may effect the surrounding teeth cause pressure , repsorbtion ,interfere with the normal eruption, impaction in the surrounding teeth

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any supernumerary teeth will lead to problem in eruption , repsortpion and another complication it may cause tumor in association with supernumerary tooth

it shows 4 premolar , so we have two extra premolar when supernumerary tooth look exactly very similar to the normal tooth we call it supplemental similar morphology to the normal teeth

in the maxilla the most common is the mesiodense in the mandible the most common in the premolar area and sometimes we have a forth molar .. or any tooth it could be conical in shape like mesiodense or normal in shape like the premolar supplemental tooth in deciduous teeth we may have more lateral incisors in the maxilla so the lateral maxillary incisor it could be effected with hypodontia and supernumerary on the shape of lateral incisors for the deciduous

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 we may have multiple supernumerary and impacted supernumerary in satution were we have two syndrome Cleidocranial dysplasia and Gardner syndrome in these syndrome we may have multiple supernumerary and multiple impactions because they have no space to erupt actually the may interfere with normal eruption of the surrounding teeth so when the patient come to your clinic and you examine him you will found that he doesnt have premolars or lateral incisors or lower canine several teeth are not there so you take a radiograph and then you see several extra teeth present but there is no eruption > disturbances in the timing of eruption i. ii. premature eruption the teeth erupt earlier than the normal expected date, and these may be due to hormonal changes in the children delayed eruption like in multiple supernumerary teeth , another cause for interference of eruption early extraction of deciduous teeth (because they aid in the eruption of permanent teeth) , tumors or mass or cyst present over the tooth may delay the time of eruption .

premature eruption is most likely to be in the deciduous mandibular incisors , it could be familial more than a disease for example in a family maybe the time of eruption for the permanent teeth is 4 years instead of 5 or 6 natal teeth children born with teeth if the teeth erupts within the first 30 days of life we call it neonatal teeth most of the time the natal teeth are true deciduous teeth so we dont go straight forward for extraction, except when the interfere with feeding , or if they cause trauma to the tongue

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in this pic we can see redness and ulceration in the tongue due to natal or neonatal tooth while the infant move his tongue

so any reason for chronic ulcer we dont like it , so we go for extraction ,and any patient who have sharp tooth or broken he at least should have smoothed and then filed or replaced so we avoid chronic source of trauma delayed eruption due to Cleidocranial dysplasia, could be tretanism , may be the patient have gingival fibromotisis which mean that the Geneva is sick so the teeth couldnt erupt normally through the gingiva so they need surgical exposure . Unless it is familial in this case the gingeva will keep thickened unless the teeth are extracted then it will be normal now for the impaction the tooth cannot erupt , the tooth is willing to erupt but there is abstraction on the way like physical barrier crowding, there are no supernumerary teeth but the normal teeth are crowded when we have crowded teeth when the jaw is smaller than normal or the teeth are bigger than normal or the case together or if we have supernumerary teeth or cysts or tumors the most common tooth that get impacted is the third molar due to physical barrier some time the tooth is mesio angular so it cant erupt , and some time its disto angular it cant erupt through the ramous .
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Eruption sequestram is a small isolated bone island that present over the erupting tooth ,,, that mean when the tooth in the process of eruption there should be bone resorption, some times a small pieces of the bone remained if it doesnt reorsoped completely , so when the tooth enters the oral cavity the mother may fell that theres a small piece of bone on the tooth ,, and its normal so eruption sequestram small specula of calcified tissue that go through the alveolar mucosa overlying the erupting tooth which is usually the molar because the molar have wide occlusal surface compared to the incisors or bicuspid so in the center small peace of bone may remain its require NO treatment Disturbances in the shape The shape of the teeth will change look at the root how does it look like There is curvature in the root over here we call this dilacerations

Done by : Mohammad F. Elwir

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