Professional Documents
Culture Documents
CONTENTS
Supernumerary teeth . . . . . . . . . . . . . . . . . . . . . . . . . 1 Hyperdontia and Cleidocranial Dysplasia . . . . . . . . . . . 1 Hypodontia , Oligodontia and Ectodermal Dysplasia . . . 2 Taurodontism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Fusion, Gemination, Dilaceration and Concrescence . . . 3 Hypercementosis, Screwdriver incisors and Mulberry molars . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Macrodontia , Dens in dente, & Enamelomas . . . . . . . . 4
OF
TEETH
Attrition, Erosion and Abrasion . . . . . . . . . . . . . . . . . . 5 Internal and External Resorption. . . . . . . . . . . . . . . . . 6 Dentinogenesis Imperfecta , types I, II, & III . . . . . . . 7 Dentin Dysplasia, types I & II. . . . . . . . . . . . . . . . . . . 8 Regional Odontodysplasia. . . . . . . . . . . . . . . . . . . . . . 8 Segmental Odontomaxillary Dysplasia . . . . . . . . . . . . . 9 Amelogenesis Imperfecta . . . . . . . . . . . . . . . . . . . . . . 9 Self-Exam Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
There are many acquired and inherited developmental abnormalities that alter the size, shape and number of teeth. Individually, they are rare but collectively they form a body of knowledge with which all dentists should be familiar. The discussion of each condition is short and to the point. Comprehensive reviews of each may be found in any reasonably new textbook of oral pathology. For those conditions that are inherited (eg: ectodermal dysplasia, dentinogenesis imperfecta and others) go to: www3.ncbi.nlm.nih.gov/ ,it will bookmark as OMIM (Online Mendelian Inheritance in Man).
Supernumerary Teeth
Slide #1 is an example of an extra incisor. When located in the midline between the two permanent central incisors, they are referred to as mesiodens. Slide #2 depicts an extra molar tooth (a paramolar) and Slide #3 is an example of a supernumerary bicuspid tooth. These are the most common supernumerary teeth in the order shown.
Slide 1: mesiodens
Slide 8: oligodontia
"Abnormalities of Teeth"
Taurodontism
A morphologic abnormality of teeth called taurodontism (bull teeth) is seen in slide #12. Slide #13 is a normal cynodont for comparison. Slide #14 is also a taurodont. This condition is most conspicuous in the molar teeth. The distance from the roof of the pulp chamber to the root bifurcation is greatly increased. Variants include hypotaurodontism, mesotaurodontism and hypertaurodontism. Cases illustrated here are hypertaurodonts. This conditions may exist as an isolated trait (autosomal dominant) or as part of several syndromes including the trichodentoosseous syndrome (TDO), otodental dysplasia, ectodermal dysplasia, tooth and nail syndrome, amelogenesis imperfecta and others. (Am. J. Med. Genetics 11; 435-442 1982 April). Visit OMIM for more.
"Abnormalities of Teeth"
Slide 24: Slide 26: dens in dente dens invaginatus (also dens invaginatus)
"Abnormalities of Teeth"
EROSION: The chemical dissolution of tooth structure often attributed to regurgitation of gastric acid, excessive intake of acidic food or drink, (eg, two liters of cola/day for years) Sometimes a cause cannot be identified, it is idiopathic.
ABRASION: Wear beyond normal caused by mechanical forces. This sounds like pathologic attrition but the difference is the pattern of wear. Attrition is ordinarily confined to the occlusal and incisal surfaces. Abrasion is ordinarily used when the loss is on a non-occluding surface. ABFRACTION: I have avoided this because I am not sure it exists but it is in the literature and you should be familiar with the term. It is proposed that with each bite, occlusal forces causes the teeth to flex ever so little. Constant flexing causes enamel to break from the crown, usually on the buccal surface. Does this really happen? If it does, why dont we all have it? ("Abfraction lesions: myth or reality." Journal of Esthetic & Restorative Dentistry 15(5):263-71, 2003) As the following slides will show, it is not always easy to distinguish between attrition, erosion and abrasion, they may coexist. Slides #28 and #29 are of a 21-yearold man who had occlusal wear that had flattened the occlusal surfaces and loss of enamel on the buccal surfaces that cannot be explained by occlusion. Is the occlusal wear just an example of advanced attrition and the buccal lesions caused by erosion or abfraction? We could not identify a reason for erosion and he denied nocturnal bruxing or coarse diet that could account for the wear. Slide #30 shows advanced wear on the occlusal and incisal surfaces presumably due to end to end occlusion coupled with erosion. We could not identify an erosive agent but there is an almost identical picture in your text that identifies it as erosion. (Nevilles 2nd ed. Oral and Maxillofacial Pathology) Slides #31 and #32 are two different people with what appears to be erosion but I was not able to identify a chemical or dietary habit that could account for it. Slide #33 is a little less mysterious. Notice the loss of enamel on the lingual surfaces caused by long term, daily exposure to gastric acid reflux in a patient with bulimia. And finally Slide #34 is abrasion caused by tooth brushing. Toothbrush abrasion is common but usually not to the extent seen here.
"Abnormalities of Teeth"
"Abnormalities of Teeth"
"Abnormalities of Teeth"
"Abnormalities of Teeth"
SELF-EXAM CASES
#1 What is your diagnosis of the condition in Slide #67? #3 Slide #70 Several children in the family had mottled teeth, the parents did not. Is this an example of recessively inherited hypomaturation amelogenesis imperfecta? Note the marked similarity to HAI in Slide # 66.
Slide 67
#2 Slides # 68 and #69. Does this child have dentinogenesis imperfecta? Neither parent had discolored teeth.
Slide 70
Answers
Slide 68
Slide 69
#1 The answer is taurodontism and hypoplastic (smooth) amelogenesis imperfecta. Note the large, tall pulp chamber and the thin enamel cap on the teeth. #2 The answer is no. This child has mottled teeth caused by taking tetracycline during the years the teeth were forming. This antibiotic is deposited in teeth and bone and darkens both. Slide # 69 is an undemineralized, thin section of a tooth viewed with fluorescent light. Each yellow band of fluorescence in the dentin marks an episode of treatment with tetracycline. #3 Slide #70 is an example of dental fluorosis. The family moved to a farm in the Texas panhandle and drank water from a well with a fluoride content of greater than four ppm. Charles Dunlap, DDS September 2004
"Abnormalities of Teeth"
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