ORAL PATH: DEVELOPMENTAL DEFECTS
→ Branchial grooves: separates
Development of Face and Palate
https://www.youtube.com/watch?v=iLbqzTlZ6yA&t=98s
3rd Week
• Embryo: flat disc shaped
o 3 Layers of Germ Layers
→ Endoderm
→ Mesoderm
→ Ectoderm
4th Week
• Folding of the embryo
• Neural tube: forms primitive forebrain
o Primitive forebrain: produce frontal
prominence
• Stomodeum: becomes oral cavity
o Buccopharyngeal membrane:
→ made of ectoderm and endoderm
→ separates stomodeum from foregut
→ disintegrates
o Branchial arches
→ 6 pairs and symmetrical
branchial arches externally
→ Pharyngeal pouches: internal
corresponding depression
• Branchial Arches/ Pharyngeal Arches
o 1st Pharyngeal Arch
→ Maxillary process
→ Mandibular process
• Development of face begins
o Proliferation forming nasal placodes
5th Week
• Frontonasal process:
o Where nose will develop
o Gives rise to:
→ Medial Nasal Process: inner half
horseshoe-shaped swelling
→ Lateral Nasal Process: outer half
6th Week
• Nasal placode sinks downwards to form:
o Nasal pits
 8th Week

• Maxillary process fuse with medial nasal process

forming upper lip
• Two medial nasal process forms: • Oronasal membrane disintegrates
• Primary palate
o Triangular plate of tissue
o Grows from maxillary segment
• Maxillary process develops palatine shelves

9th-12th Week

• As mandibular process grows and expands, the

tongue descends to create room for palatine shelves
o Intermaxillary Segment to elevate into horizontal position → fuse
→ bridge of nose • Nasal septum formation
→ philtrum
→ 4 upper incisors
→ primary palate 12th week
• Mandibular process forms lower jaw and lower lip • Nasal septum fuses with secondary palate
• Maxillary process + mandibular process= cheeks • Completion of development of secondary palate
• External face developing
• Internal structures developing:
o Oral cavity 6th- 12th week (2-3 months):
o Nasal cavity
o Palate • Critical period for face and palate development

6th and 7th Week

• Nasal sacs: when two nasal pits burrow deeper and

backwards just above stomodeum
CLEFT ON THE OUTER SURFACE OF THE FACE • Due to failure of 2 palatine processes and
nasal septum to unite
1. Median Nasal Cleft
b. Soft Palate:
• Cleft separating
• Failure of 2 palatine process to unite
• The median nasal process from lateral nasal
process
2. Lateral Cleft of Maxilla
• Alveolar process or gnathoschisis condition
2. Labial Cleft
may either be:
• Also called: cleft of the lip, cleft lip,
→ Unilateral
lagoschisis, lip-like hare
→ Bilateral
a. Labial Cleft of Upper Lip
3. Median Cleft of Mandible
• Due to failure of margins of globular
• Failure of 2 mandibular processes to unite
and maxillary process to unite

b. True Median Cleft of Upper Lips

Types of Cleft Lips
• Due to failure of 2 globular process
to unite 1. Unilateral
• on one side
c. Lower lip
2. Bilateral:
• Failure of the mandibular processing • on both sides
to unite in the median line producing 3. Complete:
a cleft in the lower lip • extends all the way into the nostril
3. Lateral Nasal Cleft 4. Incomplete:
• does NOT extend up into the nostril
4. Lateral Clefts of the Upper Lip 5. Isolated:
• Unilateral • cleft lip without a cleft palate
• Bilateral

5. Oblique Facial Cleft (Meloschisis)
• Cleft that passes through upper lip to lower
eyelid.
• Failure of median nasal, lateral nasal and
maxillary process to unite
6. Transverse Facial Cleft (Cheek Cleft)
• Cleft extending from the corner of the mouth
to masseter muscle or in severe cases the
tragus of the ear to embryonal tissue
separating the maxilla and the mandibular
processes
CLEFT OF THE INTERNAL PARTS OF THE FACE EXTENDING
OR INVOLVING THE MAXILLA AND MANDIBLE
1. Median Palatal Cleft
a. Hard Palate:
Types of Cleft Palates (Opening at the Roof of the Mouth)
1. Alveolar:
• A cleft in the upper gum line (alveolus) that
may or may not extend into the cleft palate
2. Submucous:
• A cleft in soft palate near the back of the roof
of the mouth that is covered by a thin layer
of skin or tissue;
• Presence of bifid uvula
• Type of cleft is often hard to diagnose
because it is not easily seen
3. Complete:
• Extends from the front all the way to the
back of the palate
4. Incomplete:
• Does not extend all the way through the hard
and soft palates
5. Isolated:
• A cleft palate without a cleft lip
What Causes Cleft Lip or Cleft Palate? c) Conductive hearing loss
d) Underdeveloped zygoma
• Most cases, cause is unknown
e) Drooping of the lateral lower
• Some of the children may have additional health eyelids
conditions that is associated with a specific f) Malformed or absent ears
syndrome
• Genetic and environmental factors DEVELOPMENTAL ANOMALIES OR DISTURBANCES
• Certain maternal behaviors may contribute such AFFECTING THE JAWS
as smoking
1. Macrognathia
Who Gets a Cleft Lip or Cleft Palate? • Refers to large jaw
• Rare condition
• More common in Asians, Latinos, and Native
Americans 2. Micrognathia
• Common on male • Refer to a small jaw
What Challenges or Other Problems May a Child with a • Rare condition
Cleft Lip and/or Cleft Palate Experience? • Related diseases:
→ Paget’s Disease: replacement of
• Speech new bone to old bone tissue
• Feeding → Pituitary Gigantism/Acromegaly:
• Appearance adult; too much growth hormone
• Development of tooth → Gigantism: children

3. Agnathia
DEVELOPMENTAL DISTURBANCES AFFECTING SKULL, • Failure of development of jaw
JAWS, AND TEETH • Rare condition
1. Cleidocranial Dysostosis (Sainton’s Disease)
• Delayed closure of the fontanelles and cranial 4. Cleft Palate
sututres with presence of Wormian bones • Result of lack of fusion of the two-palatal
• Absence or hypoplasia of the clavicles processed with each other or with the
frontonasal process (primitive palate).
2. Craniofacial Dysostosis (Crouzon’s Disease; Maladie • Varying in severity from the:
de Crouzon) → Bifid uvula: cleft of the uvula
• Same condition as cleidocranial dysostosis (submucosal cleft)
except that the clavicles are normal and the → Soft palate
disturbances is limited to the skull, face and → Hard palate
dentition → Alveolar ridges
→ Upper lip
3. Mandibulofacial Dysostosis (Treacher-Collin • Cleft Lip:
Syndrome; Franceschetti’s Syndrome) → More common than cleft palate
• Hypoplasia of the facial bones (especially the → Unilateral or bilateral
zygomatics), anomalies of the external ear and → Has defect in upper lateral and
lower eyelids upper canine
• Hypoplasia of the mandibular body
• Gives the patient a bird-face or fish-face 5. Pierre Robin Syndrome
appearance • Characterized by:
• Typical Physical Features: → Micrognathia
a) Downward-slanting eyes → Glossoptosis: drooping of the
b) Micrognathia tongue
 → Cleft palate → Dystrophic thickened nails of
• Some condition that may be present together hands and feet
with other deformities → Sparse brittle hair
→ Mongolism → Hyperkeratosis of palm and soles
→ Atresia of the Ear → Thickening of calvaria (uppermost
→ Absence of TMJ top of skull)
→ Pigmentation of skin over axilla,
6. Cleft Mandible elbow, knees, and knuckles
• Extremely rare condition in which a failure of → Diffused white lesion in oral
fusion between the right and left mandibular mucosa
processes leads to a defect in the midline of the 3. Anodontia
mandible a. True Anodontia
b. False Anodontia (Pseudo Anodontia)
→ Clinically absent tooth
DEVELOPMENTAL ANOMALIES OF THE TEETH
→ Radiograph: tooth is present
Odontogenesis (5 Stages of Tooth Development) → Commonly teeth are impacted or
ankylosed
1. Initiation
→ Can occur to pt. with Cleidocranial
• Includes dental lamina and bud stages, and
Dysostosis
affects the presence or absence of tooth
2. Morphodifferentiation
• Shape and size of tooth is determined in this Frequency of Missing Teeth
process
1. Third Molar
3. Apposition
• because of evolution
• Laying of enamel and dentin
2. Lower 2nd Premolar
4. Calcification
3. Upper lateral incisor
5. Eruption
4. Lower central incisor
• Emergence of tooth in oral cavity
5. Lower lateral incisor
Disturbances During Initiation of Tooth Germs

1. Ectodermal Dysplasia
4. Accessory and Supernumerary Teeth
• Hereditary disease
• In excess of the normal complement
• Hypotrichosis: absence or reduction in amount
• Accessory:
of hair
→ term used to the teeth that does
• Anhidrosis: absence of sweat glands
not resemble the normal form
• Asteatosis: absence of sebaceous glands
• Supernumerary
• Temperature elevation: due to anhidrosis
→ term for tooth that mimic the
• Dry skin
normal shape
• Depressed bridge
• Mesiodens:
• Protrusion of the lip
→ accessory tooth between the
• Defective mental development
maxillary central incisors
• Complete or partial anodontia of both primary
• Peridens:
and permanent dentition
→ tooth located buccal or lingual to
• Malformation of any teeth
the arch
• Distomolar:
2. Clouston’s Syndrome or Hidrotic Ectodermal
→ accessory tooth distal to the 3rd
Dysplasia
molar
• Characterized by:
• Paramolar:
 → one located buccal or lingual to the
molars
• Paramolar Tubercle
→ Fused with permanent molar
→ Common in maxilla than in
mandible
→ Most frequent sites are between
the maxillary central incisors
→ Distal to the molars but in the
mandible:
▪ Premolar region
▪ Distal to the 3rd molar
→ Schizogenesis: splitting of enamel
organ
5. Natal and Neonatal Teeth
• Always erupts at mandibular area
• Should be removed if extremely mobile
Natal teeth
• Teeth present at birth
Neonatal teeth
• Teeth that erupt in the gingiva during 1st month
of life
6. Predeciduous Dentition
• Extremely rare condition that implies the
presence of teeth preceding the deciduous
dentition
• Consist of caps of enamel or enamel and dentin
7. Postpermanent Dentition
• Extremely rare condition
• Teeth may erupt after loss of permanent
dentition
• Usually impacted accessory or supernumerary
tooth that erupts after insertion of dentures
• May show notching on the incisal edges
• Mx central Incisor: most frequently involved
Hutchinson’s Triad: pattern of presentation oof
congenital syphilis
1. Interstitial Keratitis: inflammation and
scarring of cornea
2. Hutchinson’s Incisors or malformed teeth
3. 8th Cranial nerve deafness (vestibulocochlear
cranial nerve)
• The alteration of the shape of the teeth is due to
changes in the tooth germ during the stage of
morphodifferentiation maybe due to inflammation in
and around the tooth germ during development.
2. Mulberry and Pfluger Molars
• Shape of 1st permanent molar is altered
• 10-30% seen in patient with congenital syphilis
• Occlusal surface is much narrower than normal
crown and has pinched appearance
• Shows hypoplasia of the enamel
Pfluger Molars
• Identical to mulberry molar but without
hypoplasia
3. Peg shaped lateral
• Disturbance during morphodifferentiation
4. Macrodontia
• Large tooth
• Can be proportional or disproportional
• May involve single tooth
Etiology of Macrodontia
1. Hormonal, gigantism in hyperpituitarism
2. Cross inheritance
3. Overactive odontogenesis

DISTURBANCES DURING MORPHODIFFERENTIATION OF

5. Microdontia
TOOTH GERM
• Proportional or disproportional or may involve
1. Hutchinson’s Incisors
single tooth
• Shape is altered 10-30% in children with
Etiology
congenital syphilis
• Resemble a screwdriver: incisal edges narrower 1. Hypofunction of the pituitary gland or dwarfism
than the middle part of crown 2. Cross inheritance
 3. Cross inheritance
4. Regression or Atavism (due to evolution)
Two Forms
1. Reduced number of cusps
2. Peg shaped tooth
6. Dens in dente (Dens Invaginatus)
• A tooth within a tooth
Two Types:
1. Coronal Type
• invagination of all layers of enamel organ
into the dental papilla
• As hard tissue are formed the
invaginated enamel organ produces a
small tooth within pulp.
2. Radicular Type
• There is folding of the Hertwig’s sheathe
into the developing root
• This invaginated epithelial organ then
produces enamel and dentin within the
root
7. Dens Evaginatus
• Condition occurs primarily in the Mongolian
races
• Hereditary trait
• Antithesis of dens invaginatus
• Presence of nipple-like protuberance on the
occlusal surface of premolars
• Rarely canine and molars
• Leong’s premolar: posterior teeth
• Talon’s Cusp: anterior teeth
2 Types of Dens Evaginatus
1. Tubercle in the lingual ridge of the buccal cusp
2. Tubercle in the center of the occlusal surface
8. Gemination (Twinning)
• When a single tooth germ splits or attempts to
split to form two completely or partially
separated crowns
• With single root canal with a single tooth
9. Fusion
• When two adjoining tooth germs join to form
single large crown
• Seen in incisor area
• Single crown may have 2 roots or a grooved root,
but usually have 2 root canals
10. Dilaceration
• Twisting, bending, or other distortion of the root
11. Taurodontism
• Hereditary disturbance
• Pulp chamber unusually large and extended into
the root canal
• Teeth resemble those seen in ungulates
• Can occur in Primary and permanent dentition,
but most common in permanent dentition
• Radiographically: long rectangular body with
short roots, lacks constriction at the cervix
3 Types of Taurodontism
• Hypotaurodontism: mild form
• Mesotaurondontism: moderate
• Hypertaurodontism: severe
DISTURBANCES DURING APPOSITION OF HARD DENTAL
TISSUES
1. Enamel Hypoplasia
• Reduction in the amount of thickness of enamel
formed
• Does not refer to the quality of calcification
• Maybe due to:
o Local
o Hereditary
o Systemic factors
• Teeth developing at this time of systemic disease
manifest defects in areas of crown
• Related to small pox (cause by variola virus)
• With hereditary factors
• Both primary and permanent teeth are involved
• The enamel thickness is reduced, thereby crown
appear yellow
• Called hereditary brown teeth
2. Amelogenesis Imperfecta
• An ill-defined term to denote:
o Hereditary enamel hypoplasia
 o Aplasia or hypocalcification (Bhaskar)
• Dentin layer only
o Sclerosis: way of protection
3. Dentinogenesis Imperfecta (Opalescent Dentin)
• A hereditary disturbance that affects the
development of dentin and maybe accompanied
by a similar disturbance in the bone
o Such as Osteogenesis imperfecta
• Teeth appears opalescent or gray
• Lacks dentin
Microscopically
• Dentin below DEJ (mantle dentin) is normal but
the rest have:
o Reduction of tubules
o Cellular inclusions
o Numerous resting lines: stratification
appearance
o Pulp chamber: progressively obliterated
and replaced by atypical dentin
Dentinogenesis Imperfecta associated with other
developmental anomalies:
1. Albinism
2. Cardiac Malformation
3. Osteogenesis imperfecta
• genetic disorder of bone characterized as fragile
bones, brittle bones
4. Blue Sclerae Disease
• Congenital defect in collagen synthesis causing
thinning of sclera
• Causing bluish hue on examination
4. Dentinal Dysplasia
• Hereditary disease
• Teeth appear clinically normal but are lost
prematurely
• Radiographically
o Short pointed roots
o Periapical radiolucency
o Obliteration of the pulp chamber and
root canals
• Microscopic appearance
o Dentin is whorllike, globular, and
disorganized pattern
5. Shell Teeth
• Modification of dentinogenesis imperfecta
• Root fail to form
• Pulp chamber is very wide (shell)
• Enamel is normal
6. Odontodysplasia
• Characterized by defective dentin and enamel
formation
• Discolored hypoplastic and hypocalcified teeth
with short roots
• Usually fails to erupt, have wide pulp chambers
and maybe seen with radiolucent area around
the crown
• Radiographically: crowns of teeth have moth-
eaten appearance
• Also called ghost teeth
7. Pigmentation of Enamel and Dentin
• Pigmentation is caused by administration of
tetracycline during the period of crown
development
• Result from deposition of tetracycline stain in
dentin
• Deposition in enamel is minimal
8. Cemental Hypoplasia
• Characterized by significant reduction in the
amount and rate of cementum formation
• Clinically teeth are lost prematurely and appear
to be shed off without apparent cause
• Usually found in hereditary metabolic disease
called hypophosphatasia
9. Enamel Pearls
• Are round masses of enamel that are attached to
the external surface of a tooth and are usually
seen in furcation or maxillary molar (external
enamel pearl)
• Or may found within the coronal dentin called
internal enamel pearl