Abnormalities in the

development of teeth
Introduction

• Abnormal, different, altered, change – since eons,

un-natural has always fascinated mankind.
• Any deviation from normal has been intricately and
detailedly analysed with.
• Similarly in the field of human biology the allure of
deviated development has fueled intense
fascination and research.
• The field of dentistry too has seen in depth analysis
and study of un-natural i.e. deviation from the
natural cycle of growth and development especially
of the teeth.
Contents

• Developmental disturbances in size of

teeth.
• Developmental disturbances in shape of
the teeth.
• Developmental disturbances in the number
of teeth.
• Developmental disturbances in the
structure of the teeth.
Developmental disturbances in
size of the teeth

• Microdontia
• Macrodontia
Microdontia

• 3 types
- true generalized
- relative generalized
- involving single
tooth (0.8-8%)
Macrodontia

• 3 types
- true generalized
- relative generalized
- involving single tooth
Developmental disturbances in
shape of the tooth

• Gemination
• Fusion
• Concrescence
• Dilaceration
• Talon cusp
• Dens in dente
• Dens evaginatus
• Taurodontism
Gemination

• Geminated teeth are anamolies which

arise from an attempt at division of a
single tooth germ by an invagination, with
resultant incomplete formation of 2 teeth.
• Seen in both deciduous and permanent
teeth
• 0.5% in deciduous 0.1%in permanent teeth
Fusion

• It arises from through union of 2 normally separated

tooth germs.
• Due to some physical force or pressure
• Prevalence in deciduous teeth is 0.5%and in
permanent dentition is 0.1%
• Occurs in any area
Fusion
Concresence

• Seen after root formation has completed

• Due to traumatic injury or crowding of teeth with
resorption of interdental bone.
Concrescence
Concrescence
Dilaceration
Talon cusp

• Resembles eagles talon, projects lingually from the

cingulum areas of maxillary or mandibular anteriors
• More frequently in permanent than primary(<1-8%)
• Maxillary > mandibular
• Maxillary lateral (67%), centrals(24%) canines (9%)
• 3 types type I (talon), type II (semi talon) type III
(trace talon)
• family histories with consanguineous parents and
hereditary character has reported
• Associated syndromes – Rubinstein taybi, Sturge
Weber, orofacial digital syndrome.
Talon cusp
Dens invaginatus

• It is a developmental variation which is thought to

arise as a result of invagination in the surface of a
tooth crown or root before calcification has
occurred.
• Due to focal growth retardation and focal growth
stimulation in certain areas of tooth bud.
• 2 types coronal type and radicular type
• Coronal type (0.04% -1%) maxillary laterals>
centrals> premolars>canines. 3 types type I, II, III
• In radicular type there is invagination of Hertwigs
epithelial root sheath into developing root.
Dens in Dente
Dens evaginatus

• Presence of accessory cusp on occlusal surface

• Seen mostly in mangoloids and caucasians (15%)
• Frequently in mandibular premolars
• 2 types type I accessory cusp arising from buccal
ridge type II centre of occlusal surface
• It is hereditary trait (autosomal dominant)
Dens evaginatus
Taurodontism

• Means Bull like teeth because resemblance of

these teeth to that of teeth of cud chewing animals
• 3 types hypotaurodont, mesotaurodont,
hypertaurodont
• Prevalence 0.5-3%
• III molar> II molar> I molar
• Associated syndromes Klien filter syndrome Down’s
syndrome, hypophasphatasia
Taurodontism
Developmental disturbances in
the number of teeth

• Anodontia
• Hyperdontia
Anodontia

• Congenital absence of teeth

• 2 types partial and total anodontia
• Prevalence 3.5%-8% female predominance with a
ratio of 1.5:1 and deciduous it is less than 1%
• Associated syndromes ectodermal dysplasia,
down’s crauzon and focal dermal hypoplasia
• Etiology is unknown
Hypodontia
Hypodontia
Hyperdontia

• Presence of extra teeth

• Prevalance is 1-5% with maxillary
predominance(9:1)
• Supernumarary teeth (mesiodens, distomolar,
paramolar)
• Associated syndromes Gardners syndrome,
Cleidocranial syndrome
Hyperdontia
Hyperdontia
Developmental disturbances in
structure of teeth

• Amelogenesis imperfecta
• Environmental enamel hypoplasia
• Dentinogenesis imperfecta
• Dentin Dysplasia
• Regional odontodysplasia
Amelogenesis imperfecta

• Hypoplastic
• Hpocalcified
• Hypomaturation
Classification

Type Pattern Features Inheritance

IA hypoplastic Generalized pitted Autosomal dominant
IB hypoplastic Localized pitted Autosomal dominant
IC hypoplastic Localized pitted Autosomal recessive
ID hypoplastic Diffuse smooth Autosomal dominant
IE hypoplastic Diffuse smooth Autosomal dominant
IF hypoplastic Diffuse rough Autosomal dominant
IG hypoplastic Enamel agenesis Autosomal recessive
II A hypomaturation Diffuse pigmented Autosomal recessive
II B hypomaturation Diffuse X- linked recessive
II C hypomaturation Snow capped X- linked recessive
II D hypomaturation Snow capped X- linked
III A Hypocalcified Diffuse Autosomal dominant
III B hypocalcified diffuse Autosomal dominant
Amelogenesis imperfecta
Amelogenesis imperfecta
Amelogenesis imperfecta
Amelogenesis imperfecta
Environmental enamel hypoplasia

• Hereditary type
• Caused by environmental factors
1. nutritional deficiency
2. congenital disease
3. local infection
4. ingestion of chemicals (fluorides)
5. hypocalcemia
6. idiopathic
Enamel hypoplasia due to
nutritional deficiency
Enamel hypoplasia due to
congenital syphilis

• Hutchinson’s incisors
• Mulberry molars
Enamel hypoplasia due to local
infection
Enamel hypoplasia due to fluoride
Distintive features

• Mottling mottling in endemic areas in drinking

water exceeds above 2 ppm
• Only those who lived in high fluoride area during
tooth development show mottling
• Permanent teeth is affected and deciduous is rare
• Mottled teeth are less susceptible for caries
• A typical effect is paper white opacities
• Brown staining of these patches are acquired after
eruption
Fluorosis

• Pathology – Fluoride combines to form calcium

fluorapatite in place of hydroxyapatite. Damage to
ameloblasts leading to defective matrix formation ;
is seen only when the concentration of fluoride are
high
• Deciduous teeth is rarely affected
• Grading – very mild, mild, moderate, severe.
Dentinogenesis imperfecta

• Type I – occurs along with osteogenesis

imperfecta(1:8000)
• Type II – Never occurs along with osteogenesis
imperfecta (1:25000)
• Type III – racial isolate in maryland (1:300000)
• C/f - gray to brownish violet or yellowish brown,
exhibit translucent or opalescent hue, abnormal
DEJ, deciduous is affected more followed by
permanent incisors and I molars
•
Dentinogenesis imperfecta
Dentin Dysplasia

• Radicular dentin
dysplasia (1:100000)
autosomal dominant,
amber transluscency,
both dentition
• Coronal dentin dysplasia
both dentition,
deciduous teeth show
yellow, brown or bluish
grey opalescent
appearance
Dentin dysplasia
Regional odontodysplasia
Regional odontodysplasia

• Etiology
- abnormal migration of neural crest cells
- latent virus
- local circulatory deficiency
- local trauma or infection
- radiation therapy
- malnutrition
- medication used during pregnancy
• Slightly female predominance (1.4:1)
Staining of teeth

• Tetracycline pigmentation
• Congenital erythropoietic porphyria
• Hyberbilurubiemia related discoloration
Tetracycline pigmentation

• Tetracycline is taken by calcifying tissue and band

of tetracycline stained bone or tooth substance
fluoresces bright yellow under UV light
• Tetracycline is deposited along the incremental
lines of dentin and to lesser extent of enamel
• Broader the band deeper the discoloration
• Stains are permanent
• Minocycline (blue gray)
• Chlortetracycline (grayish brown)
• Oxytetracycline (yellow discoloration)
Hyperbilirubinemia related
discoloration

• Deciduous teeth are affected

• Causes are erythroblastosis fetalis and biliary
atresia
• The affected teeth shows green discoloration
• This is due to biliverdin deposition
Congenital erythropoietic
porphyria

• It is autosomal recessive disorder

• Affected teeth shows marked reddish discoloration
• Both permanent and deciduous dentition are
affected
• Discoloration is due to porphyria deposition
References

• Oral pathology – Shafer

• Oral and maxillofacial _ Neville
surgery and pathology
• Journal of clinical pediatric dentistry, 2002
• Oral pathology - S.N Bhaskar
• Text book in pedodontics - Shobha Tandon
• Quintessence international
• ASDC Journal of Dental Child
Thank
You