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Localized
Peg laterals Maxillay third molars Supernumerary
Localized/regional
Hemifacial hypertrophy
Rhizomegaly=radiculomegaly
Mandibular canine
Hypodontia
Ectodermal dysplasia
Transmembrane protein in
Keratinocytes Teeth (partial, rarely complete/total anodontia) Sweat glands Hair follicles
Ectodermal dysplasia
Ectodermal dysplasia
Shape: conical or like normal counterpart In deciduous teeth: maxillary lateral incisor
SUPERNUMERARY
Disturbances in Eruption
Premature eruption:
One or 2 teeth usually deciduous mandibular central incisors May be familial Not supernumerary
Natal teeth: present at birth Neonatal teeth: present in first 30 days of life Permanent teeth: think of endocrine disorder if generalized
Natal/neonatal teeth
Disturbances in Eruption
Delayed eruption:
Cleidocranial dysplasia, cretinism Gingival fibromatosis
Impacted teeth:
Physical barrier Crowding, supernumerary teeth, odontogenic cyst and tumors e.g: third molars, max. canines
Disturbances in Eruption
Eruption sequestrum: A small spicule of calcified tissue that is extruded through the alveolar mucosa that overlies an erupting molar. Requires no treatment
Complications :
Complications
Dense in Dente
Disturbances in Shape
Supernumerary cusp: Cusp of Carabelli mesiolingual surface of upper 6s Causes no problems, requires no treatment
Talon cusp
Lingual aspect of maxillary centrals Cingulum portion Pits on lateral aspects May interfere with occlusion Contain prominent pulp horn
Disturbances in Shape
Gemination Fusion Concrescence Hypercementosis Cervical enamel projection
Fusion
Unusual wide crown Union between adjacent
tooth germs at least with dentin Complete or incomplete according to the stage of development Differentiate from gemination by counting number of teeth Clinical significance: esthetic, crowding, periodontal disease
Gemination
Usually anterior teeth Single rooted tooth
with wide crown Incompletely divided tooth germ Affect deciduous and permanent
Concrescence
Confluence of
cementum after root formation is complete Trauma, crowding Affect maxillary molars Significance: tooth extraction problems
Hypercementosis
Excessive deposits of cementum: Increased or decreased occlusal forces Hyperpituitarism Chronic inflammation Significance: tooth extraction
Enamel pearl
Hereditary or environmental Environmental Bacterial and viral infections, nutritional deficiencies, chemical injuries, trauma Resultant defect: focal or generalized Either deciduous or permanent Affect both types of hard tissues Hereditary Genetically determined Both deciduous and permanent dentitions Either enamel or dentine
Localized Causes
Turner tooth:
local infection related to deciduous predecessor range varies: discoloration (yellow to brown) to grooves (hypoplasia)
Enamel opacities:
hypomineralized, white spot on central incisor very common
Turner tooth
Generalized Causes
Chronological
Hypoplasia
Bands of pits and grooves Distribution depends on enamel developing at time of the disease
Dental Fluorosis
Amelogenesis imperfecta
Defective maturation/mineralization:
hypomineralized enamel
White and opaque Brown and pigmented
Amelogenesis imperfecta
Hypoplastic type:
Generalized: Localized:
pits scattered across the surfaces of teeth may be in rows and columns In the middle of the buccal surfaces All the teeth or scattered teeth may be affected affect deciduous and permanent teeth Open contacts White to brown color Like the smooth pattern Denser enamel and more resistant to attrition
AD smooth pattern:
Rough pattern
Amelogenesis imperfecta
Hypocalcification
Teeth erupt in normal shape but are orange to brown in color Enamel is lost easily upon eruption Radiographically: enamel less radio dense than dentin
Hypocalcification
Amelogenesis imperfecta
Hypomaturation
opaque, white to yellow discoloration softer enamel, chip easily radiographically: density is similar to dentin mottled, fractures easily like a denture dipped in white paint
Pigmented pattern:
Snow capped pattern
Dentinogenesis imperfecta
Developmental disorder results in irrigularly formed dentin, obliteration of root canals Type 1: associated with osteogenesis imperfecta Type2: teeth only affected Type3: Brandywine isolate, rare racial isolates in USA multiple pulpal exposures
Dental manifestations: Type II (hereditary opalescent dentin) Both dentitions are affected Distinctive translucent color Enamel separated easily Bulbous crowns, cervical constrictions, early obliteration of pulp spaces Not prone to dental caries
Dentinogenesis Imperfecta
Dentinogenesis imperfecta
Dental manifestations: Shell teeth
Extremely thin dentin and extremely large pulp Especially in deciduous dentition
Dentinogenesis imperfecta
Histopathology: Short misshapen dentinal tubules
Dentin Dysplasia
Hereditary Abnormal dentin and abnormal pulp morphology 2 major types of dentin dysplasia Type I: Radicular dentin dysplasia; rootless teeth Type II: Coronal dentin dysplasia;
Deciduous dentition has many features similar to dentinogenesis imperfecta
Neville, Color Atlas of Clinical Oral Pathology, 2nd ed, Fig 2.54
Dentin Dysplasia I
Dentin Dysplasia I
Neville, Color Atlas of Clinical Oral Pathology, 2nd ed, Fig 2.53
Permanent teeth: normal root length Abnormally large pulp champers with abnormal radicular
extension: flame shaped root pulp Pulp stones and narrowed canals
Hypophosphatasia
Autosomal recessive condition Deficiency of alkaline phosphatase in serum and tissues Disorders of bone mineralization: Rickets and osteomalacia
Dental manifestation: Absence (inadequate formation) of cementum Enamel normal, pulp is large Alveolar bone loss + - hypoplastic enamel defects Delayed formation and eruption of dentition Premature loss of primary teeth Spontaneous loss of permanent teeth
Soft Tissue
Invagination: Blind
tracts or dilated ducts Autosomal dominant trait Paramedian pits may be associated with cleft lip/palate (Van der Woude syndrome)
Paramedian lip pits
Double lip
Horizontal fold Inner aspect of upper lip Congenital or acquired Visible when the lip is tensed Ascher Syndrome: drooping of eyelids and non toxic goiter and double lip
Frenal Tag
A redundant piece of
mucosal tissue that projects from the maxillary labial frenum. Familial, AD Histologically: normal oral mucosa
Ankyloglossia
e
Lack of normal
tongue mobility Anteriorliy positioned lingual frenum Adverse effects Treatment
Macroglossia
Congenital: Down syndrome Secondary: tumors
lymphangioma, hemangioma,
neurofibroma, amyloidosis, acromegaly, cretinism.
Fordyce granules
Fordyce granules
Sebaceous glands Not associated with
hair Bilaterally on buccal mucosa, upper vermilion border, gingiva
Leukoedema
accumulation of fluid within the epithelial cells-edema Bilateral More in black Variation of normal White milky appearance that disappears upon stretching
AD Mutation in keratin pair K4 and K13 White thickened and folded oral mucosa Other mucosal surfaces Generalized involvement of the oral mucosa and other mucosal surfaces Histopath: hyperkeratosis, acanthosis, edema of spinous layer.
Oral Tonsil
Lingual tonsil: at base of the tongue Part of Waldeyer ring Reactive hyperplasa: Foliate papillitis Oral tonsil Sides of lingual frenum Oral lymphoepithelial cysts may develop
Retrocuspid papilla
A slightly raised area lingual to mandibular
canine Uni or bilateral More in children Histopathology: resemble incisive papilla
May be covering a fibrovascular canal
Hemifacial hypertrophy
Increased neurovascular supply to the affected side Increased incidence of visceral tumors Involves all tissues in the affected side even brain hemispheres Mental retardation and seizures in 15-20%
Cleidocranial Dysplasia
Genetic disease, abnormal growth of bones. Skull, clavicle, failure of tooth eruption
Fontanels are open or have late closure Sutures remain open Prominent frontal, parietal and occipital bones
Shoulders
Aplasia, hypoplasia or thinning of clavicles Hypermobility of shoulders
Oral
High narrow palate. May be cleft Hypoplastic maxilla and sinuses Supernumerary teeth
Cleidocranial dysplasia
Cleidocranial Dysplasia
Teeth
Prolonged retention of primary teeth Succedaneous teeth may fail to erupt or have delayed eruption due to lack of cellular cementum Multiple unerupted supernumerary teeth Severe malocclusion
Crouzon Syndrome
Oral
High-arched palate, sometimes cleft Hypoplastic maxilla --> malocclusion