Dental Anomalies PDF

Dental Anomalies Josh Hudson GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica;on to pa;ent management 1.2.4 Recognise abnormali;es of the oral cavity and the rest of the pa;ent and raise concerns where a...

Dental Anomalies Josh Hudson GDC Learning Outcomes 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their applica;on to pa;ent management 1.2.4 Recognise abnormali;es of the oral cavity and the rest of the pa;ent and raise concerns where appropriate 1.5.4 Iden;fy where pa;ents’ needs may diBer from the treatment plan and refer pa;ents for advice when and where appropriate 1.7.7 Refer to other members of the dental team or other health professionals Intended learning outcomes By the end of the session you will be able to; DeGne common dental anomalies Outline the basic ae;ology of common dental anomalies Recognise common dental anomalies Explain referral pathways for the management of common dental anomalies How can we classify dental anomalies?  Classi>ca?on of dental anomalies Generally speaking, dental anomalies will fall under a number of categories Why do I need to know this? Why do I need to know this? Although you will not be managing a lot of these conditions, you need to know about them to.. 1.Identify abnormalities and deviation from normal clinically and radiographically 2.Understand treatment options for these patients 3.Refer appropriately for management Why do these occur? Common causes of dental anomalies: Altera?ons in tooth number: Altera?ons in tooth number: Hyperdontia/supernumerary Supplemental Extra mouth but looks like other teeth in region of Mesiodens Additional tooth in midline Tuberculate Square barrel like appearance Conical Pointed and conical appearance  Macrodontia = larger teeth than expected. Microdontia = smaller teeth than expected Generalised - All or majority of teeth are affected. Altera?ons in size: Localised - Couple teeth affected. Macrodontia Microdontia Generalised or localised Altera?ons in shape: Concrescence = Roots of teeth have joined together. Crowns and pulp canals are separate. Fusion = Both roots and crown are joined together. Pulp canals are separate. Germination = Roots, crowns and pulp canals are all joined together. May only be aware following radiographic examination. Concrescence Fusion Gemination  Dens in dente (invaginatus) = Tooth within a tooth. Difficult to clean so likely to get dental caries. Look to seal area to prevent dental caries. Altera?ons in shape: Dens evaginatus = Projection out of the tooth. Pulp within these projections. Generally cause no issues, however if broken/damaged can cause pulpal exposure and symptoms. Talon cusps = Extra cusp on anterior tooth. Dens in dente (Dens invaginatus) Dens evaginatus Talon cusps  Taurodontism = coronal aspect elongated (shorter root and longer crown aspect) Have elongated and extended pulp space. Altera?ons in shape: Hypercementosis (increased radio-opacity around root) (seems to be fused with root) = cementum layer outside of tooth root has increased in size. no trouble essential unless needs extraction due to bulbous root. Taurodontism Hypercementosis  Dilaceration = acute curvature of tooth root May occur naturally or due to trauma when tooth is developing. More difficult for teeth to erupt. Altera?ons in shape: Enamel pearl = cause difficulties with managing periodontal disease (secondary local factor) island of enamel on tooth root Dilaceration Enamel Pearl  Resorption = Tooth has begun to be worn/eat away. Internal - Worn away from the inside out. Abnormali?es of the dental pulp: External - Worn away from outside in. Physiological - Natural. Idiopathic - No obvious reason. Pathological - Disease process. Resorption Internal/External Physiologic Idiopathic Pathologic  Abnormali?es of the dental pulp: Pulp calcification Pulp stones Secondary/reparative dentine Pulp obliteration Pulp calcification = Formation of hard mineralised deposits within the pulp chamber/canals. More challenging for root canal treatment. Pulp stones - Small area of radio-opacity on radiograph. Secondary/reparative dentine - Due to previous caries. Pulp obliteration - Rare, no pulp space within tooth. May be due to trauma or syndromes.  Abnormali?es in tooth posi?on: Submerged teeth Impacted teeth Transposed teeth Ankylosed teeth Anomalies in TOOTH POSITION: Submerged teeth = Tooth has stayed in same position but everything else has grown around it (lower occlusal plane). Ankyloses = Root of tooth becomes fused with surrounding bone. Tooth doesn’t move easily and stays put, difficult for extractions. Impacted teeth = Common with wisdom teeth and canines, growing vertically. Eruption can be affected. Transposed teeth = Not in corrected order/position. Teeth may be further back or forward. Abnormali?es in tooth structure: Hypoplasia Molar incisal hypoplasia Hypomineralisation Turner tooth Abnormali?es in tooth structure: Dentinogenesis Imperfecta Type I, II and III Amelogenesis Imperfecta Hypoplastic AI, hypocalcified AI, hypomaturation AI, hypomaturation-hypoplasia AI Anomalies in TOOTH STRUCTURE: Hypoplasia = Components of tooth have not been laid down properly. Reduced thickness or quality of tooth surface. MIH - Molar incisal hypoplasia. Hypomineralisation = Tooth has developed normally but has not become mineralised. Turner tooth = Isolated hypoplasia or hypomineralisation. May be due to chronic infection of deciduous tooth which leads to altered development of permanent tooth. Dentinogeneis imperfecta = Condiiton where dentine component of tooth is not formed properly. Blue/grey appearance. Radiographic appearance - pulp canal obliteration, bulbous crowns. Type 1 - linked to osteogenesis imperfecta. Type 2 - NOT linked to osteogenesis imperfecta. Type 3 - brandywine isolate (Very rare). Amelogeneis imperfecta = Condition where enamel component of tooth is not formed properly. Classic clinical presentation - really yellow teeth due to enamel not forming properly. Radiographic appearance - may not get classic difference of radio-opacity between dentine and enamel. Hypoplastic AI - Enamel hasn’t been laid correctly. Hypocalcified AI - Enamel hasn’t been calcified correctly. Hypomaturation AI - Enamel not matured correctly. Hypomaturation-hypoplasia AI - Enamel hasn’t been laid down or matured correctly. Abnormali*es in tooth structure: Staining Tetracycline staining How are these condi*ons managed? How are these condi*ons managed? This would be on a case by case basis. Some management options may be.. Do nothing and review – many of these conditions don’t need treatment unless there is aesthetic concern Specialist referral – many of these conditions are complicated and if treatment is required may be best completed by a multidisciplinary team in secondary care Restoration – some conditions may be manageable in primary care with restorations e.g. composite resin or pre-formed metal crowns If in doubt, get a second opinion! Thank You! References Welbury, R; Duggal, MS & Hosey, MT. Paediatric Den=stry. Chapter 13. Oxford University Press, 5th Edi=on. 2018. Page: 257-276. Lagana G, Venza N, Borzabadi-Farahani A, Fabi F, Danesi C & Cozza P. Dental anomalies: prevalence and associa=ons between them in a large sample of non-orthodon=c subjects, a cross-sec=onal study. BMC Oral Health 2017; 17:62. DOI 10.1186/s12903-017-0352-y. Dang HQ, Constan=ne S & Anderson PJ. The prevalence of dental anomalies in an Australian popula=on. Australian Dental Journal 2017;62: 161-164.