Dental Anomalies Revision PDF

Dental anomalies  Need to be able to: Identify anomalies Understand treatment options Refer appropriatley Anomalies in tooth NUMBER: Hypodontia = not enough teeth. Anodontia = no teeth. Both linked to genetics (likely hereditary). May be linked to...

Dental anomalies  Need to be able to: Identify anomalies Understand treatment options Refer appropriatley Anomalies in tooth NUMBER: Hypodontia = not enough teeth. Anodontia = no teeth. Both linked to genetics (likely hereditary). May be linked to syndromes. Hyperdontia/supernumerary = extra teeth. Supplemental - Extra tooth that looks like other teeth in region of mouth. Mesiodens - Additional tooth in midline. Tuberculate - Square, barrel-like appearance. Conical - Pointed, conical appearance. Anomalies in tooth SIZE: Macrodontia = larger teeth than expected. Patients with Microdontia = smaller teeth than expected hypodontia, are Generalised - All or majority of teeth are affected. more likely to Localised - Couple teeth affected. have microdontia Anomalies in tooth 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. 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. 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. Taurodontism = Elongated coronal aspect of tooth with shorter roots. Dens in dente Hypercementosis = Cementum layer on outside of tooth has increased in size. Usually seen as increased radio-opacity around tooth root). May be challenging during tooth extraction. Dilaceration = Acute curvature of tooth root. May occur naturally or due to trauma when tooth is developing. More difficult for teeth to erupt. Enamel pearl = Extra enamel on tooth root (secondary local factor). Can cause difficulties with managing periodontal disease. Anomalies of the DENTAL PULP: Resorption = Tooth has begun to be worn away/eat itself. May be following trauma, orthodontic tx or infection/disease associated with tooth. Internal - Worn away from the inside out. External - Worn away from outside in. Physiological - Natural. Idiopathic - No obvious reason. Pathological - Disease process. 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. 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. 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. Intrinsic staining = Staining within the tooth. Isolated teeth may be due to pulpal necrosis. Generalised staining suggests developmental issue. Tetracycline staining = Brown/grey staining within banding present due to antibiotics during development. Management of these conditions Case by case basis, if in doubt get second opinion! Do nothing and review - many of these conditions do not need treatment unless there is an aesthetic concern of risk of pathological affect. Specialist referral - due to complicated conditions, if treatment if required it may be best to refer to multidisciplinary team in secondary care. Restoration - some conditions may be manageable in primary care with restorations.  Hypodontia = Not enough teeth. Anodontia = No teeth. Supernumerary: Hyperdontia/supernumerary = Extra teeth/tooth. Supplemental = Looks like teeth in region of mouth. Mesiodens = Additional tooth in midline. Macrodontia = Larger teeth than expected. Tuberculate = Square, barrel like appearance. Conical = Pointed and conical appearance. Microdontia = Smaller teeth than expected. Concrescence = Roots are joined together, but crowns and pulp canals remain separate. Fusion = Roots and crown are joined together, but pulp canals remain separate. Germination = Roots, crown and pulp canals are all joined together. Dens in dente (invaginatus) = Tooth within a tooth. Dens evaginatus = Tooth projection out of the tooth. Talon cusps = Extra cusps on anterior teeth. Taurodontism = Coronal aspect of tooth elongated. Hypercementosis = Cementum layer outside of tooth root has increased in size. Dilaceration = Acute curvature of tooth root. Resorption = Tooth has begun to be worn/eat away. (Internal or external) Ankyloses = Tooth becomes fused with surrounding bone. Submerged = Tooth stayed in same position but everything else has grown around it. Transposed = Teeth not in correct order or position. Pulp stones = Calcified areas within pulp.  Fluorosis = Caused by overexposure to fluoride during tooth development. (White, yellow, brown spots/streaks/patches) Hypoplasia = Tooth has fewer cells than normal (not enough matrix laid down). Hypomineralisation = Tooth has not been mineralised enough (softer). MIH = Molar incisal hypomineralisation. Turner tooth = Isolated hypoplasia/hypomineralisation. Dentinogenesis imperfecta = Condition when dentine component of tooth is not formed properly. (Blue/grey appearance) Amelogenesis imperfecta = Condition when enamel component of tooth is not formed properly. (Yellow appearance) Dentinogenesis: Type 1 = Linked to osteogenesis imperfecta. Type 2 = Not linked to osteogenesis imperfecta. Type 3 = Brandywine isolate (very rare). Amelogenesis: Hypoplastic = Enamel hasn’t been laid correctly. Hypocalcified = Enamel hasn’t been calcified correctly. Hypomaturation = Enamel hasn’t matured correctly. Hypomaturation-hypoplasia = Enamel hasn’t been laid down or matured correctly. How to manage: Do nothing and review = Some conditions do not require treatment unless aesthetic concern. Restorations = Some conditions may be manageable in primary care with restorations. Specialist referral = Some conditions are complicated and best managed by multidisciplinary team if treatment is required.