Abnormalities of teeth (check RCS)

Hypodontia
1. Teeth most commonly affected
  1. Lower 8's > Lower 5's > Upper 2's > Upper 5's > Lower 2's
2. Conditions presenting with hypodontia
  1. Anhidrotic Ectodermal Dysplasia
    1. Signs & Symptoms
      1. Sparse hair
      2. Inability to sweat
      3. Anodontia/hypodontia
      4. Cone shaped tooth
    2. Clinical
      1. X-linked recessive
        Rare in females
      2. Mutation
        A (ED1) gene
  2. Down's syndrome
    1. Fissured tongue
    2. Macroglossia
  3. Cleft lip & palate
  4. Crouzon's syndrome
  5. OFD syndrome
3. Females
4. Management options (missing UR lateral incisor)
  1. Do nothing
    1. Maintain deciduous teeth
      1. Classic is maintaining an E for a missing 5
      2. Maintains bone
  2. Create space
    1. Fixed appliances
      1. Need 7mm of space for implants
    2. Class III
  3. close space
    1. Ortho treatment
    2. Class II
  4. Refer
    1. Around 10
5. 0.1-0.9%
6. 3.5-6.5%
Supernumary
1. Prevelance
  1. Primary
    1. 0.2-0.8%
  2. Permenant
    1. 1.5-3.5%
  3. Males maxillary
2. Conditions associated
  1. Cleidocranial dysplasia
    1. Signs & Symptoms
      1. Absent clavicles
      2. High palate
      3. Delayed/retained/ unerrupted teeth
      4. Supernumary
      5. Hypercementosis
      6. RUNX2 gene mutation
  2. Cleft lip & Palate
  3. Gardner's syndrome
3. Types
  1. Mesiodens
    1. Conical
      1. Diastama
    2. Tuberculate
      1. Delayed eruption
  2. Paramolar
  3. Distomolar
4. Treatment
  1. Extract
    1. Wait a year before referring to ortho
      1. Invaginate teeth have a strong association with supernumeraries
  2. Just leave it
    1. If no pathology
5. Effects
  1. Eruption & crowding
  2. Displacement of permanent tooth
Double teeth
1. Cause
  1. Fusion
  2. Gemination
2. 2 teeth attached at the root by cementum
  1. Concrescence
Taurodontism
1. Cause
  1. Klinefelter's syndrome - XXY
2. Failure of HERS to invaginate properly
  1. Enlarged pulp chamber
3. Associated
  1. Type 4 hypoplastic Amelogenesis imperfecta
Abnormalities of enamel structure
1. Local Causes
  1. Trauma
  2. Infection
    1. Turner tooth
  3. Idiopathic
2. Genetic Causes
  1. Amelogenesis Imperfecta
    1. Types
      1. Hypoplastic
        Thin, pitted, grooved enamel
      2. Hypomatured
        Enamel is normal but brownish yellow
        Snow capped teeth
        Cant tell apart from fluorosis, send to lab
        Incisal and occlusal surfaces
      3. Hypocalcified
        Enamel is normal but is soft & chalky
        Dull, opaque teeth bilaterally
3. Systemic Causes
  1. Infection
    1. Syphilis
      1. Hutchinson's incisors
        Tooth with notch
      2. T-Palladium
      3. Mullbery molars
    2. Rubella
      1. Can cause chronological hypoplasia
  2. Fluoride
    1. Fluorosis
      1. Most succeptible
        Upto approx 6 years
      2. Paper white enamel opacities
      3. Can be brown if very severe
      4. Advantage
        Less susceptible to decay
      5. Usually permanent dentition
  3. Nutritional Disorders
  4. Chemotherapy
4. MIH
Abnormalities in dentine structure
1. Causes
  1. Local
    1. Trauma
    2. Turner tooth
  2. Environmental
    1. Rickets
      1. Failure of calcification due to lack of Vit D
    2. Tetracycline
    3. Hypophosphatasia
    4. Hypoparathyroidism
  3. Genetic
    1. Dentinogenesis imperfecta
      1. Type 1
        Osteogenesis imperfecta
        Bue Sclera
        Defect in type I collagen
      2. Type II
        Teeth only
        Shell teeth
      3. Management
        Maintain OVD
        Restore function
        Improve aesthetics
    2. Dentinal Dysplasia
      1. Type I
        Rootless teeth
        Pulp obliteration
      2. Type II
    3. DIFFERENT to regional odontodysplasia
      1. Ghost teeth
      2. Large pulp chambers
      3. Upper anteriors
Hypercementosis/ Ankylosis
1. Causes of hypercementosis
  1. Paget's
  2. Non-vital tooth
  3. 20% of PDL loss will cause ankylosis
  4. Overloaded teeth
  5. Unopposed teeth
2. Syndromes associated with hypocementosis
  1. Cleidocranial Dysplasia
  2. Hypophosphatasia
    1. Reduced ALP
    2. Hypoplastic cementum causing early loss of cementum
    3. Also get rickets
Delayed eruption
1. Causes
  1. Local
    1. Retention of deciduous teeth
    2. Eruption/dentigerous cyst
    3. Lack of space
    4. Hypodontia
    5. Abnormal crypt position
    6. Odontome
    7. Dilaceration
  2. Systemic
    1. Cleidocranial dysplasia
    2. Down's syndrome
    3. Hypothyroidism
      1. Cretinism
    4. Rickets
Anomalies of tooth position
1. Ectopic canines
  1. Management
    1. Remove obstruction
    2. Encourage development into good position
    3. If too displaced may consider extraction
  2. Absent U3 0.3%
  3. Absent L3 0.15%
  4. Associated with hypodontia
  5. Palpate
    1. From 8 but expect to see from 9 years
  6. 1.5%
Impacted teeth
1. Most common
  1. 8's > U3 > L4> L5> Supernumeries
2. Incidence of impacted canines
  1. 2%
  2. 15% buccal
  3. 85% palatal
3. Treatment
  1. Leave
  2. Remove
    1. Wary of vital structures
      1. Lower
        Mental& lingual N
      2. Upper
        Greater palatine N
        Nasopalatine
        Less important
  3. Expose
    1. Open
    2. Closed
  4. Transplant
4. Suspect if canines aren't palpable by 11

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Abnormalities of teeth (check RCS)

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