Disorders of Tooth Eruption and Shedding
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Questions and Answers

What is the main characteristic of natal teeth?

  • They are always permanent teeth.
  • They are present at the time of birth. (correct)
  • They erupt after the first birthday.
  • They occur in adults.

    • What anatomical abnormality is commonly associated with hypoplastic enamel in prematurely erupted teeth?

  • Absence of root formation. (correct)
  • Normal enamel thickness.
  • Excess root formation.
  • Regular structure of cementum.

    • Which endocrine condition is often related to generalized early eruption of teeth?

  • Hypothyroidism.
  • Hyperthyroidism. (correct)
  • Diabetes mellitus.
  • Cushing's syndrome.

    • Which dietary condition is linked to retarded eruption of teeth?

    <p>Nutritional deficiencies.</p> Signup and view all the answers

    What condition involves the eruption of several teeth into the oral cavity after the loss of all permanent teeth?

    <p>Postpermanent dentition.</p> Signup and view all the answers

    What dental condition is characterized by the premature loss of teeth often due to dental caries?

    <p>Premature loss.</p> Signup and view all the answers

    Which of the following is NOT associated with retarded eruption of teeth?

    <p>Daily vitamin intake.</p> Signup and view all the answers

    Delayed eruption and impacted supernumerary teeth can be features of which condition?

    <p>Cleidocranial dysplasia.</p> Signup and view all the answers

    Which condition is typically associated with the premature loss of teeth?

    <p>Hypophosphatasia</p> Signup and view all the answers

    What is the primary reason for the persistence of deciduous teeth?

    <p>Failure of eruption of the permanent successor</p> Signup and view all the answers

    Which teeth are most commonly affected by impaction?

    <p>Mandibular third molars</p> Signup and view all the answers

    What does 'submerged teeth' refer to?

    <p>Ankylosed deciduous teeth</p> Signup and view all the answers

    Which of the following is considered an intrinsic factor for tooth discoloration?

    <p>Amelogenesis imperfecta</p> Signup and view all the answers

    Which of the following is not a reason for extrinsic staining of teeth?

    <p>Hyperbilirubinemia</p> Signup and view all the answers

    What type of bacteria is commonly associated with extrinsic staining?

    <p>Chromogenic bacteria</p> Signup and view all the answers

    Which developmental condition can lead to impacted teeth?

    <p>Cleft palate</p> Signup and view all the answers

    What causes the brown discoloration associated with tobacco use?

    <p>Penetration of tar in enamel pits and fissures</p> Signup and view all the answers

    Which dental restorative material is most associated with black-gray discoloration in teeth?

    <p>Amalgam</p> Signup and view all the answers

    What effect do stannous fluoride and chlorhexidine have on teeth?

    <p>Lead to yellowish-brown staining at gingival margins</p> Signup and view all the answers

    Which condition results in reddish-brown discoloration of teeth and exhibits red fluorescence under UV light?

    <p>Congenital porphyria</p> Signup and view all the answers

    What is the outcome of severe congenital hyperbilirubinaemia on teeth?

    <p>Pigment deposition primarily in dentine</p> Signup and view all the answers

    What is a consequence of tetracycline intake during pregnancy or childhood?

    <p>Yellowish-grey bands that can change to brown</p> Signup and view all the answers

    What most likely results from pulp necrosis in a tooth?

    <p>Pigmented products diffuse into the dentine</p> Signup and view all the answers

    Which of the following substances can lead to significant black pigmentation of teeth?

    <p>Chlorhexidine</p> Signup and view all the answers

    What is a characteristic change in enamel as a person ages?

    <p>Darker coloration</p> Signup and view all the answers

    What is one effect of aging on the pulp of the tooth?

    <p>Gradual decrease in volume</p> Signup and view all the answers

    Which type of attrition occurs due to the normal aging process?

    <p>Physiological attrition</p> Signup and view all the answers

    Which of the following is NOT a cause of pathological attrition?

    <p>Normal chewing</p> Signup and view all the answers

    What happens to the pulp chamber as secondary dentin continues to form?

    <p>Obliteration occurs</p> Signup and view all the answers

    In which scenario would hypercementosis likely occur?

    <p>Increased root thickness from aging</p> Signup and view all the answers

    Which statement is true regarding the attrition seen in men versus women?

    <p>Men generally exhibit more severe attrition</p> Signup and view all the answers

    What is the average rate of normal occlusal attrition for molar teeth?

    <p>30 μm/year</p> Signup and view all the answers

    Which of the following best describes abrasion?

    <p>Wearing away of tooth substance through abnormal mechanical processes</p> Signup and view all the answers

    Where does erosion predominantly occur on a tooth?

    <p>Labial and buccal surfaces</p> Signup and view all the answers

    What characterizes the appearance of abfraction?

    <p>V-shaped or wedge-shaped ditch at the cementoenamel junction</p> Signup and view all the answers

    Which factor is NOT considered a cause of tooth abrasion?

    <p>Acidic beverages</p> Signup and view all the answers

    What type of resorption starts from the root surface and is more common?

    <p>Pathologic resorption</p> Signup and view all the answers

    What is the most common area affected by abfraction?

    <p>Buccal/labial cervical areas</p> Signup and view all the answers

    Intrinsic erosion is caused primarily by which of the following?

    <p>Gastroesophageal reflux</p> Signup and view all the answers

    Which of the following changes is NOT associated with pulp in specific dental conditions?

    <p>Decalcification of dental hard tissues</p> Signup and view all the answers

    Which clinical feature is commonly associated with internal resorption?

    <p>Presence of a pink spot on the crown</p> Signup and view all the answers

    What is a common cause of external resorption?

    <p>Idiopathic lesions in the cervical areas</p> Signup and view all the answers

    Which type of resorption is most likely to affect the crowns of anterior incisors?

    <p>Internal resorption</p> Signup and view all the answers

    Which factor is NOT associated with external resorption?

    <p>Age-related wear</p> Signup and view all the answers

    What kind of cells are involved in the resorption process mentioned in the content?

    <p>Odontoclasts</p> Signup and view all the answers

    Which statement is true regarding the appearance of external root resorption in radiographs?

    <p>It can be associated with periapical inflammation.</p> Signup and view all the answers

    In cases of internal resorption, which condition typically leads to the resorption process?

    <p>Secondary to pulpitis</p> Signup and view all the answers

    What could be a possible radiographic appearance of internal resorption?

    <p>Fusiform enlargement of pulp chamber</p> Signup and view all the answers

    Study Notes

    Disorders of Tooth Eruption and Shedding

    • Predeciduous Dentition: Infants may be born with teeth-like structures.
    • Types:
      • Natal teeth: Deciduous teeth present at birth.
      • Neonatal teeth: Deciduous teeth erupting within the first 30 days of life.
    • Postpermanent Dentition: Several teeth erupt after all permanent teeth have been lost, particularly after a full denture is inserted. The mandibular central incisors are often involved.

    Premature Eruption, Natal, and Neonatal Teeth

    • Coronal enamel and dentine formation is normal for the tooth's chronological age.
    • Premature eruption sometimes results in hypoplastic enamel; root formation is missing or irregular.

    Premature Eruption

    • Infrequent in deciduous and permanent teeth.
    • Possibly related to local factors (superficial location of tooth germ, early shedding of deciduous teeth).
    • May be seen in children with endocrine abnormalities (excess growth hormone, hyperthyroidism).

    Retarded Eruption

    • Several conditions can cause delayed eruption, including endocrinopathies (e.g., hypothyroidism), prematurity, nutritional deficiencies, chromosome abnormalities (e.g., Down syndrome).
    • Also associated with migration problems, traumatic tooth germ displacement or large crowns.
    • Often accompanied by impacted supernumerary teeth (e.g., cleidocranial dysplasia).

    Premature Loss

    • Usually a result of dental caries, sequelae, chronic periodontal disease
    • Sometimes associated with hypophosphatasia, hereditary palmar-plantar hyperkeratosis, and other systemic periodontitis.

    Persistence of Deciduous Teeth

    • Deciduous teeth fail to shed at the expected time.
    • Often associated with a missing or displaced permanent successor.
    • May stem from systemic conditions (e.g., cleidocranial dysplasia).

    Impacted Teeth

    • Teeth prevented from erupting due to physical barriers or lack of space.
    • Causes: micrognathia, retained deciduous teeth, supernumerary teeth, odontogenic cysts, or tumors, or cleft palate.
    • Completely impacted teeth are entirely surrounded by bone; partially impacted teeth are only partially surrounded by bone. Commonly impacted are mandibular third molars, maxillary canines, premolars and less commonly second molars.

    Submerged Teeth

    • Deciduous teeth are ankylosed (fused to bone).
    • Often deciduous molars; occlusal table is below the occlusal plane of other teeth.
    • The underlying permanent tooth may be impacted or erupt buccally or lingually.

    Discoloration of Teeth

    • Extrinsic: Surface accumulation of exogenous pigments. Examples of causes are bacterial stains, iron, tobacco, foods and beverages, gingival hemorrhage, restorative materials and medications.
    • Intrinsic: Endogenous factors discoloring underlying dentin. Examples of causes are amelogenesis imperfecta, dentinogenesis imperfecta, dental fluorosis, erythropoietic porphyria, hyperbilirubinemia, trauma, localized red blood cell breakdown and medications.

    Chromogenic Bacteria

    • Vary in color (green, black-brown, orange).
    • Common in children.
    • Initially discolor the labial surfaces of anterior teeth and gingiva.
    • Mostly black-brown.
    • Usually not bacterial in origin but ferric sulfide formation from interaction of bacterial hydrogen sulfide and iron in saliva or gingival fluid.
    • Creates brown discoloration.
    • Tar components dissolve in saliva, easily penetrate enamel fissures.
    • Amalgam can cause black-gray discoloration, particularly seen in younger patients with open dentinal tubules.
    • Medications (e.g., iron or iodine-containing products) in the past were associated with tooth discoloration.
    • Current culprits are stannous fluoride and chlorhexidine.

    Stannous Fluoride

    • May discolor labial anterior and occlusal posterior teeth.

    Chlorhexidine

    • Associated with yellowish-brown interproximal staining near gingival margins.

    Congenital Porphyrias (e.g., Gunther Disease)

    • Autosomal recessive disorder of porphyrin metabolism.
    • Increased porphyrin synthesis and excretion.
    • Marked reddish-brown coloration of teeth (UV light fluorescence), mainly deciduous teeth.

    Congenital Hyperbilirubinemia (Neonatal Jaundice)

    • Mild, transient jaundice common in newborns (especially rhesus incompatibility).
    • Bile pigments may be deposited in enamel and dentin, often confined to dentin, causing green to yellowish-brown discoloration particularly along the neonatal incremental line.

    Pulp Necrosis

    • Lysis of necrotic tissue and red blood cells due to hemorrhage leads to pigmented products diffused into dentin - results in tooth discoloration.

    Tetracycline Staining

    • Tetracycline taken during pregnancy or childhood can cause yellowish-grey bands, turning brown over time.
    • Permanent incorporation of the antibiotic in the calcified tissues results in a bright yellow fluorescence under UV light.

    Age Changes

    • Enamel: Becomes more brittle, less permeable and sometimes darker.
    • Dentin: Continued formation of secondary dentin, reducing pulp chamber, transparent dentin.
    • Roots: Become brittle.
    • Cementum: Increased thickness.
    • Pulp: Gradual decrease in volume, decreased vascularity, increase in collagen fiber content and reduce healing potential.

    Loss of Tooth Structure: Attrition

    • Wearing of tooth surfaces from tooth-to-tooth contact due to mastication.
    • Types:
      • Physiological attrition: Normal aging process
      • Pathological attrition: Abnormalities in occlusion, chewing pattern or structural defects - this is a clinical concern.
    • Normal occlusal attrition is 30 µm/year for molars.

    Etiological Factors for Pathological Attrition

    • Abnormal occlusions: Malocclusion and crowning of teeth leading to traumatic contacts during chewing that may cause tooth wear.
    • Acquired: Tooth extractions that can change the chewing forces and lead to altered wear patterns.
    • Premature contact: Edge-to-edge contact leading to exaggerated pathological attrition.
    • Abnormal chewing habits: Parafunctional habits (e.g., bruxism) and habitual chewing of coarse or abrasive food.

    Structural Defects

    • Conditions like amelogenesis imperfecta or dentinogenesis imperfecta that reduce enamel and dentin hardness cause teeth to be more susceptible to attrition.
    • Men tend to show more severe attrition than women.
    • Attrition may be seen in both deciduous and permanent dentition.

    Abrasion

    • Pathological wearing away of tooth substance from external agents like abrasive dentifrices, habits, occupational hazards (e.g., floss, toothpicks), or injuries.
    • Usually occurs on exposed root surfaces, more commonly on the left side in right-handed individuals.

    Erosion

    • Chemical loss of tooth substance without bacterial action.
    • Types:
      • Intrinsic (e.g:, gastroesophageal reflux, vomiting)
      • Extrinsic (e.g., acidic beverages, citrus fruits).
    • Usually affects labial and buccal surfaces of teeth; appears as a smooth, shallow, highly polished depression on enamel adjacent to the cementoenamel junction.

    Abfraction

    • Tooth structure loss from stress on the tooth caused by occlusal stresses or abnormal occlusal forces (e.g., eccentric forces).
    • Especially affects buccal or labial cervical areas of teeth.

    Resorption of Teeth

    • Physiologic resorption: Deciduous teeth resorption prior to shedding. Transient microscopic areas of superficial resorption in permanent teeth that are repaired by cementum or bone-like tissue formation.
    • Pathologic resorption: More common; External (root surface) or internal (pulpal surface) in origin. Caused by osteoclast/odontoclasts on dentin surface of the pulp.

    External Resorption Causes

    • Cysts
    • Dental trauma
    • Excessive mechanical/occlusal forces
    • Grafting of alveolar clefts
    • Hormonal imbalances
    • Periodontal treatment/inflammation
    • Pressure from impacted teeth
    • Reimplantation of teeth
    • Tumors

    Internal Resorption

    • Mostly anterior incisors affected.
    • Secondary to pulpitis or often idiopathic.
    • Characterized by a pink spot (pink tooth of mummery) as the resorptive process approaches the surface.
    • Continues as long as the vital pulp remains and extensive loss of tooth structure can occur, predisposing to fractures.

    Radiographic Appearance of Root Resorption

    • Radiographic finding includes fusiform enlargement of pulp chambers within the crown or root.
    • Microscopy shows loose connective tissue with increased vascularity and potentially few inflammatory cells.

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    Lecture 3: Disorders of Tooth Eruption and Shedding PDF

    Description

    Explore the various disorders related to tooth eruption and shedding, including conditions like natal and neonatal teeth. This quiz covers the implications of premature eruption and the characteristics of predeciduous and postpermanent dentition. Test your knowledge on the developmental aspects of children's dental health.

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