DEVELOPMENTAL DISTURBANCES OF THE TEETH. LEC 2.pptx

Teeth

1. DEVELOPMENTAL DISTURBANCES OF THE TEETH Dr. Farah Farhan

2. Developmental Disturbances Dr. Farah Farhan , Asst Prof Oral Pathology Dept 1) Size 2) Shape 3) Number 4) Defects of Enamel and Dentin

3. SIZE Dr. Farah Farhan, Asst Prof Oral Pathology Dept Microdontia Macrodontia

4. MICRODONTIA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Microdontia  is a condition in which one or more teeth appear smaller than normal. In the generalized form, all teeth are involved. In the localized form, only a few teeth are involved. The most common teeth affected are the upper lateral incisors and third molars.

5. MACRODONTIA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Macrodontia  (or megadontia ) is a type of localized gigantism in which teeth are larger than normal for the particular type(s) of teeth involved. The three types of  macrodontia  are true generalized  macrodontia , relativegeneralized   macrodontia , and  macrodontia  of a single tooth.

6. SHAPE Dr. Farah Farhan, Asst Prof Oral Pathology Dept Germination Fusion Concrescence Dilaceration Talon cusp Dens Invaginatus Dens Evaginatus Taurodontium

7. GERMINATION Dr. Farah Farhan, Asst Prof Oral Pathology Dept Germination arises when two teeth develop from one tooth bud.  There is one main crown with a cleft in it that, within the incisal third of the crown, looks like two teeth, though it is not two teeth. The number of the teeth in the arch will be normal. Single rooted tooth.

8. Dr. Farah Farhan, Asst Prof Oral Pathology Dept

9. FUSION Dr. Farah Farhan, Asst Prof Oral Pathology Dept Joining of 2 developing tooth germs resulting in a single large tooth structure May involve the entire length of tooth or only at root levels Trauma is a suggested cause

10. Dr. Farah Farhan, Asst Prof Oral Pathology Dept

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12. CONCRESCENCE Dr. Farah Farhan, Asst Prof Oral Pathology Dept It is a form of fusion that occurs after root formation has been completed. Teeth are united through cementum only. Could be due to result of traumatic injury/crowding of teeth. May occur before and after teeth have erupted. Often involves a 2 nd molar tooth in which its roots closely approximate the adjacent impacted 3 rd molar.

13. DILACERATION Dr. Farah Farhan, Asst Prof Oral Pathology Dept Angular/ sharp bend / curve in root or crown of a formed tooth. Trauma to a developing tooth can cause root to form an angle to normal axis of tooth. Caused due to injury to the permanent teeth.

14. TALON’S CUSP Dr. Farah Farhan, Asst Prof Oral Pathology Dept Anomalous structure resembling an eagle’s talon. Projects lingually from the cingulum area of maxillary and mandibular permanent incisor. Causes problems for patient in terms of esthetics, caries control, occlusal accomodation . Most commonly associated withRubinstein Taybi syndrome.

15. DENS INVAGINATUS Dr. Farah Farhan, Asst Prof Oral Pathology Dept Developmental variation that arises as a result of invagination in the surface of tooth crown before calcification has occurred. Caused due to : Increased localized external pressure Focal growth retardation Focal growth stimulation Commonly found in permanent maxillary lateral incisors.

16. DENS INVAGINATUS Dr. Farah Farhan, Asst Prof Oral Pathology Dept

17. DENS EVAGINATUS Dr. Farah Farhan, Asst Prof Oral Pathology Dept Also called as Leung’s Premolar Evaginated Odontome Occlusal Enamel Pearl Rare developmental condition that appears clinically as an accessory cusp or globe of enamel on the occlusal surface between buccal and lingual cusp of premolar.

18. TAURODONTISM Dr. Farah Farhan, Asst Prof Oral Pathology Dept It’s a dental anomaly in which the body of the tooth is enlarged at the expense of the root. Bull- like tooth. Classification: Hypotaurodont – mild Mesotaurodont Hypertaurodont – extreme

19. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Seen in Taurodontism – occuring in association with Amelogenesis imperfecta Klinefelter’s syndrome

20. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Radiographic Features: . Pulp chamber is large with greater apico occlusal height than normal . Roots are short. . Bifercation / trifercation may only be few millimeters above apices of root.

21. Number Dr. Farah Farhan, Asst Prof Oral Pathology Dept Anodontia Supernumerary

22. ANODONTIA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Lack of tooth development Absence of teeth Types 1 . Complete Anodontia 2. Partial Anodontia Hypodontia Oligodontia 3. Pseudoanadontia 4. False Anodontia

23. Dr. Farah Farhan, Asst Prof Oral Pathology Dept 1. Complete Anodontia . Rare . All teeth are missing. . Associated with Hereditary Ectodermal Dysplasia

24. Dr. Farah Farhan, Asst Prof Oral Pathology Dept 2. Partial Anodontia Hypodontia : lack of development of one or more teeth Oligodontia : lack of development of six or more teeth

25. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Pseudoanadontia when teeth are absent clinically because of impaction or delayed eruption

26. Dr. Farah Farhan, Asst Prof Oral Pathology Dept False Anodontia when teeth have been exfoliate / extracted.

27. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept A condition that demonstrate developmental alterations in the structure of the enamel in the absence of a systemic disorder The formation of enamel is a multistep process and problems may arise in any one of the steps

28. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Development of enamel can be divided into 3 major stages: Deposition of matrix ( hypoplastic ) Mineralization of matrix ( hypocalcified ) Maturation of enamel ( hypomaturation )

29. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept CLASSIFICATION: Hypoplastic Generalized Localized X-linked dominant smooth Autosomal dominant smooth Rough pattern Enamel agenesis

30. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Hypocalcified Autosomal dominant Autosomal recessive Hypomaturation Pigmented pattern X linked Snow capped

31. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Hypoplastic amelogenesis imperfecta : Due to inadequate deposition of enamel matrix The different patterns are discussed briefly as follows: GENERALIZED PATTERN: Pinpoint to pin head sized pits on surface of the teeth Buccal surface most severely involved Pits may be arranged in rows or columns Staining of pits may occur Enamel in between the pits is normal

32. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept

33. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept LOCALIZED PATTERN: Horizontal rows of pits, linear depression or one large area of hypoplastic enamel surrounded by a zone of hypocalcification Middle third area of buccal surface is usually affected Both dentitions but most commonly primary teeth are effected Scattered teeth or all teeth are affected at the same time Incisal edges or occlusal surfaces very rarely involved

34. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept

35. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept AUTOSOMAL DOMINANT SMOOTH PATTERN : Enamel is thin, hard and glossy Smooth surface Look like crown prepared teeth and demonstrate open contact points Radiographically , the teeth exhibit a thin peripheral outline of radiopaque enamel

36. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept

37. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept ROUGH SURFACE PATTERN : The enamel is thin, hard and rough surfaced Present open contact points making them look like crown preparations Colour varies from white to yellowish white Enamel is denser then the smooth pattern Radiographically , a peripheral rim of radiodense enamel is seen

38. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept X-LINKED DOMINANT SMOOTH PATTERN : It is called x linked because all effected individuals with two X chromosomes usually have one member of the pair inactivated in each cell One X is normal and the other is abnormal so teeth would exhibit alternating zones of normal and abnormal zones of enamel

39. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Males: Teeth show thin, diffuse and shiny enamel in both primary and secondary dentition Teeth have shape of crown preparation with open contact points Colour varies from brown to yellow brown A peripheral outline of thin enamel is seen radiographically

40. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept FEMALES: Vertical furrows of thin hypoplastic enamel alternating between bands of normal enamel This banding can only be seen on radiographs

41. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept ENAMEL AGENESIS : A total lack of enamel formation Teeth are the shape and colour of dentine Yellowish brown hue, open contact points and tapering crowns Surface of dentine is rough Anterior open bite present Radiographically , no peripheral outline of enamel seen

42. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Hypocalcified Amelogenesis Imperfecta : In this type, proper enamel is laid down but no proper mineralization is seen Teeth are appropriately shaped at the time of eruption but the enamel is later lost due to its softness Enamel is yellowish brown but later becomes blackish brown due to rapid calculus deposition

43. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Most of the cuspal enamel is lost Cervical enamel is left behind due to its site Anterior open bite may also be seen

44. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Hypomaturation Amelogenesis Imperfecta : The deposition of the enamel and its calcification is accurate but there is a defect in the maturation of enamel’s crystal structure Affected teeth are normal in shape but have mottled , opaque brownish yellow discolouration Enamel is softer and chips off easily Radigraphically , shows similar radiodensity to normal dentine

45. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept 3 patterns are seen: Snowcapped Pigmented X linked

46. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Snow capped pattern : White opaque enamel on incisal edges Look like denture dipped in white paint

47. AMELOGENESIS IMPERFECTA Pigmented pattern : Surface is mottled and agar brown Soft enough to be punctured by a dental explorer May often fracture from underlying dentine

48. AMELOGENESIS IMPERFECTA Dr. Farah Farhan, Asst Prof Oral Pathology Dept X linked pattern : Males and females both effected Decidious teeth exhibit opaque white colour with a translucent mottling Permanent teeth are opaque white which may darken with age Degree of enamel loss is rapid Brown discolourations seen In females, vertical bands of white opaque enamel and normal translucent enamel is seen

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50. DENTINOGENESIS IMPERFECTA A hereditary developmental disorder of the dentine in the absence of any systemic disease Usually associated with osteogenesis imperfecta Both diseases involve both the types of dentition Decidious teeth effected most commonly

51. DENTINOGENESIS IMPERFECTA Dentitions have a blue to brown discoloration with a distinctive translucence Enamel separates from underlying defective dentine Significant attrition is seen Radiographically , teeth have bulbous crowns, cervical constriction, thin roots, early obliteration of root canals and pulp chambers

52. DENTINOGENESIS IMPERFECTA

53. DENTINOGENESIS IMPERFECTA SHELL TEETH is a common feature seen These teeth have dramatically enlarged pulps, normal enamel but extremely thin dentin The thin dentine may involve the whole tooth or may be restricted to the root area

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55. DENTIN DYSPLASIA Dr. Farah Farhan, Asst Prof Oral Pathology Dept Rare disturbance of dentin formation characterized by normal enamel but atypical dentin formation with abnormal pulp morphology. Clinically teeth appear normal in morphological appearance and colour . Teeth exhibit extreme mobility and commonly exfoliates prematurely.

56. DENTIN DYSPLASIA 2 major patterns : Dentine dysplasia type 1 Dentine dysplasia type 2

57. DENTIN DYSPLASIA Dentin dysplasia type 1 Also known as “rootless teeth” because of loss of organization of the root dentine leading to shortened root length Enamel and coronol dentine normal If dentine deformation is seen early, marked deficiency in roots are seen If dentine deformation is seen inlater developmental stage, minimum root malformation is present

58. DENTIN DYSPLASIA Changes most prominent in permanent teeth Because of shortened roots , tooth mobility and extreme premature exfoliation are seen Delayed eruption Radiographically , in early disorganization, no pulp can be detected and roots are short/absent In late deformation, cresent shaped pulp chambers seen over short roots

59. DENTIN DYSPLASIA

60. DENTIN DYSPLASIA Dentin dysplasia type II Coronol dentine dysplasia Root length normal in both dentitions Decidious teeth resemble those of dentinogenesis imperfecta Blue-amber-brown discolouration Radiographically , bulbous crowns, cervical constriction, thin roots and early obliteration of pulp seen

61. DENTIN DYSPLASIA Permanent teeth show enlarged pulp chambers and apical extension HISTOPATHOLOGY : Coronal enamel and dentine are normal Atypical tubular pattern seen in deeper dentine with atubular areas and irregular organization

62. DENTIN DYSPLASIA TREATMENT: Treatment is toward retaining the teeth for as long as possible Short roots and numerous periapical lesions make this impossible

63. REGIONAL ODONTODYSPLASIA Involves the hard tissues derived from all 3 layers of teeth( enamel, dentine and cementum ) Effected teeth show short roots, open apical foramina, enlarged pulp chambers “Ghost teeth” term given because of poorly mineralized enamel and dentine Trauma, nutritional deficiency, infections, genetic influences are few of etiological causes

64. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Most frequently affected teeth are permanent Central incisors, lateral incisors and cuspids . Affected teeth are small and mottled brown. Teeth are suspectible to caries. Either delay or tooth failure of eruption.

65. REGIONAL ODONTODYSPLASIA

66. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Condylar hypoplasia   characterized by the decreased development of one or both the mandibular   condyles . presents as progressive facial asymmetry which is usually asymptomatic.

67. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Associated Syndromes Mandibulofacial dystosis Oculoauriculovertebral Syndrome Hemifacial Microsomi

68. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Condylar hyperplasia  (CH) is a bone disease characterized by the increased development of one mandibular   condyle It regularly presents as an active growth with facial asymmetry generally without pain.

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70. Dr. Farah Farhan, Asst Prof Oral Pathology Dept   Leukoedema   Benign abnormality of the buccal mucosa characterized by a filmy, opalescent-to-whitish gray, wrinkled epithelium similar to that seen in leukoplakia .

71. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Fordyce Granules 80% adults soft yellowish spots heterotopic sebaceous or papules symmetrical, buccal location

72. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Macroglossia   Cause cosmetic and functional difficulties in speaking, eating, swallowing and sleeping.   Tumorous  cancer, acromegaly ( giantism ), amyloidosis , sarcoidosis , hypothyroidism, Kawasaki disease.   Down’Syndrome

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74. Dr. Farah Farhan, Asst Prof Oral Pathology Dept   Buccal Exostosis Exostosis  (bone prominence) on the  buccal  surface (cheek side) of the alveolar ridge of the maxilla or mandible Variation of normal anatomy rather than a disease.

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76. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Torus Palatinus Bony protrusion on the palate. ... Most palatal tori are less than 2 cm in diameter, but their size can change throughout life.

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78. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Torus Mandibularis   Bony growth in the mandible along the surface nearest to the tongue. Present near the premolars and above the location of the mylohyoid muscle's attachment to the mandible.

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80. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Tongue-tie  ( ankyloglossia ) condition present at birth that restricts the tongue's range of motion. Short, thick or tight band of tissue (lingual frenulum ) tethers the bottom of the tongue's tip to the floor of the mouth.

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82. Dr. Farah Farhan, Asst Prof Oral Pathology Dept   Hairy Tongue . : Dark  furry  or  hairy  discoloration of the tongue   Hyperplasia of the filiform papillae usually with an overgrowth of microorganisms — called also blacktongue .

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84. Dr. Farah Farhan, Asst Prof Oral Pathology Dept   Commissure Lips Corner of the  mouth , where the vermillion border of the superior labium (upper  lip ) meets that of the inferior labium (lower  lip ). The commissure  is important in facial appearance, particularly during function such as smiling.

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86. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Paramedian lip pits Congenital invaginations of the lower lip arising from persistent lateral sulci on the embryonic mandibular arch. Also called as congenital fistulas or congenital lip pits and they normally disappear by six weeks of embryonic age

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88. Dr. Farah Farhan, Asst Prof Oral Pathology Dept Double Lip Characterized by excessive tissue sagging below the usual giving it thicker wider appearance is referred to as  double lip . It is a rare occurrence with a proposed male predilection. Ascher Syndrome.

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