Morgan Fowler, Alissa Castellon, Karissa Grado

October 11, 2017

Case Study 3

A twenty four year old male visited a dental office for an initial examination and routine

checkup. Radiographic examination revealed an unusual mandibular second molar. The patient

denied any history of symptoms or pain associated with the mandibular molar area. The patient

appeared to be in a general good state of health with no significant medical history. His dental

history included sporadic checkups and routine restorative dental treatment. The patient’s vitals

were all found to be within normal limits. Extraoral examination of the head and neck region

revealed no enlarged or palpable lymph nodes. Intraoral examination revealed no abnormalities

present. Based on the clinical examination of the patient, selected periapical radiographs,

bitewings, and a panoramic film were ordered and exposed. A review of the periapical films

revealed a mandibular second molar with an elongated pulp chamber and an abnormally low

furcation region. Clinically, the second molar appeared normal in size and shape. No other

abnormalities were noted on the radiograph.

Dentin dysplasia is separated into two groups, type one and type two. Type one features a

normal crown with abnormal roots and an autosomal dominant inheritance pattern. The defect

lies in a disturbance in the Hertwig epithelial root sheath, which is what guides the formation of

the root. Radiographs show total or partial lack of pulp chambers and root canals. Primary and

secondary dentition are affected equally. The color of the teeth is normal and short roots cause

the teeth to exfoliate prematurely. The pulp chamber of permanent teeth are not obliterated fully

and have a half-moon appearance. Type two defect is a mutation of the gene that maps to the

long arm of chromosome four. Radiographs show a lack of pulp chamber and small root canals.
Pulp chambers show a thistle shape of single roots and a bow-tie appearance in permanent

molars.

Odontoma is a benign neoplasm, or tumor, that can produce all the tissue found in a

mature tooth, like enamel, dentin, cementum, and pulp. Radiographs show a circumscribed

lesion containing miniature teeth or radiopaque masses that do not resemble teeth. It is more

common in the maxilla and often discovered because the affected tooth fails to erupt.

Taurodont, or taurodontism, is used to describe a developmental dental anomaly in which

the teeth exhibit elongated, large pulp chambers and short roots. It is a genetic, heterogeneous

condition of molar teeth with dominant and recessive inheritance patterns characterized by

enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of

the CEJ. The cause is uncertain and can be seen in both deciduous and permanent teeth. It can

affect a single molar or several molars in a quadrant, occurring either unilaterally or bilaterally.

The crown appears clinically normal. Radiographs are the only way to diagnose taurodontism. It

can also be classified as mild, moderate, or severe depending on how far the base of the pulp

chamber extends apically. This condition can be seen in patients with Down syndrome,

ectodermal dysplasia, Ellis-van Creveld syndrome, Klinefelter syndrome, hypophophatasia, and

several other conditions.

Macrodont, or macrodontia, is an uncommon developmental anomaly in which one or

more teeth in a dentition are larger than normal. It is classified similar to the way that

microdontia is classed. There is three classifications of macrodontia, true macrodontia, relative

macrodontia, and macrodontia involving a single tooth. Although rare, it is usually seen is cases

of pituitary gigantism. Relative macrodontia is seen in patients with normal or slightly larger
than normal teeth with small jaws. This is caused from inheriting tooth size from one parent and

jaw size from the other parent.

Teeth involved with regional odontodysplasia are clinically small, hypoplastic with

surface pits and grooves and also have a brown or yellow discoloration. Because the enamel is

thin, it is susceptible to caries or fracture. Often the eruption of teeth is delayed or does not

happen at all. Frequently gingival swelling and periapical infection are findings of this disease.

Radiographically, affected teeth demonstrate decreased radiodensity of enamel and dentin, wide

pulp chambers, short roots, and open apices. Regional odontodysplasia may occur in the

mandibular primary dentition but it more frequently seen in the maxillary permanent dentition.

This condition is more common in the anterior and typically the central and lateral incisors are

involved. It is more common in females with no known racial or ethnic predilection.

The diagnosis of this patient is taurodontism because the radiographs reveal an

enlargement of the body and pulp chamber of a multirooted tooth, with apical displacement of

the pulpal floor and bifurcation of the roots. This condition could not be dentin dysplasia because

it does not show a lack of pulp chamber and small root canals. This condition could not be

odontoma because there is no visible neoplasm containing miniature teeth or radiopaque masses.

This tooth also has erupted which is not seen in odontoma. This condition is not macrodontia

because the teeth shown are all of normal size. This condition is not regional odontodysplasia

because this patient is a male, not female, and also his condtion lies in the molar region, not in

the anterior region.

 Santanu, Mukhopadhvav, et al. “Regional Odontodysplasia in the Primary Dentition

Associated with Eruption Failure.” International Journal of Health & Allied Sciences, Vol 5, Iss

3, Pp 195-197 (2016), no. 3, 2016, p. 195. EBSCOhost, doi: 10.4103/2278-344X.187838

Ibsen, A.C Olga, Phelan, Anderson Joan. “Oral Pathology for the Dental Hygienist with

General Pathology Introductions.” Elsevier. Elsevier Inc. Pgs. 206-208. 2018. St. Louis,

Missouri.

Newland, J. Robert. “Oral Hard Tissue Diseases: A Reference Manual for Radiographic

Diagnosis.” Lexicomp’s Dental Reference Library. Lexi-comp, Inc. Pgs.86, 92. 2012. Hudson,

Ohio.