Abnormalities of Teeth

Eruption, Structure, Form,

Number, and Size
Natal Teeth
Occasionally one or more teeth are erupted at birth.
They members of normal series. Not supernumerary.
Most commonly found in the mandibular incisor
region.
Loosely attached root (rootless) and enamel is
hypoplastic.
Treatment :
Do not remove unless it is causing the mother
discomfort (if the baby is breast fed) or if is so loose
that there is fear of inhalation.
Root growth takes place normally after birth and the
attachment of the root gradually improves.
Teething
Usually primary teeth begin to erupt in the fifth or
sixth month of the child’s life.
The first appearance is eagerly awaited by the parent
since it represents an important milestone in
development.
In most cases it causes no distress but sometimes it
can cause local irritation which might be severe
enough to interfere with the child’s sleep.
Molars cause trouble.
Signs of Teething :
-LOCAL – redness or swelling of the gingiva over the
erupting tooth.
- Patches of erythema on the cheeks.
- SYSTEMIC- mild fever, general irritability and
crying, loss of appetite, sleeplessness, increased
salivation, leading copious dribbling.
Treatment :
- Local :
- Teething toys, rattles, rings, and keys are available in
mothercraft shops.
- Well made smooth toys. Other rough and poorly
made are to be avoided.
- Teething foods- hard rusk or biscuits used c.f. toys –
not to contain sugar.
- Topical medicaments – ointments and jellies.
-Analgesics – e.g salicylates
Systemic :
A- analgesics to relieve pain : paracetamol elixir
paediatric (5ml contains 120mg, up to one year old,
5ml at bed time. 1-5 ys old, 10ml at bedtime)
B- Hypnotics and sedatives.
Submerged Primary Molars
The one that has failed to maintain its position relative to
adjacent teeth in the developing dentition and is therefore below
the occlusal level.
- 3%-4% of children in the age range of 5-11 ys have at least one
submerged molar.
- First primary molar affected more than second.
Treatment :

When to interfere ?
1- If it interferes with the eruption of premolar- radiographic sign.
2- Adjacent tooth tilting.
3- Below the gingival level.
Ectopic Eruption of first Permanent Molars
Eruption of first permanent molar into the roots of
second primary molar.
 Sometimes temporary.
High tooth-tissue ratio.
Treatment : to disimpact the tooth. If not successful
extract the second primary molar.
- Soft brass ligature 0.5-0.7 mm diameter – local
anesthesia given. Review every 2 weeks and retighten.
- Orthdontic ttt ??
Delayed Eruption of Permanent Teeth
Considerable normal variations between children.
Down’s syndrome.
A delay of 1-2 month of the contralateral gives for
concern.
Eruption cyst
Develops in relation to an erupting primary tooth.
The normal follicular space around the crown is
dilated by accumulation of tissue fluid or blood
forming a type of dentigerous cyst.
Usually occur over the large occlusal surfaces of
primary molars.
First bluish area but later may be bitten by the
opposing tooth to cause discomfort.
Treatment :
 Spontaneous rupture.
 Incision and drainage.
 Elliptical incision to avoid recurrence.
Abnormalities of Tooth Structure
1. Enamel hypoplasia and hypominerlaisation >> local
or systemic.
2. Treatment of anterior teeth.
3. Treatment of posterior teeth.
4. Amelogenesis imperfecta and Dentinogenesis
imperfecta.
5. Intrinsic staining
Enamel hypoplasia and Hypominerlisation
Dental tissues are formed in two stages :
1. Deposition of organic matrix.
2. Mineralization.
- Disturbance of matrix deposition will lead to hypoplasia – it
becomes irregular in thickness or deficient in structure.
- Defects range from small pits or grooves in enamel surface to
gross deficiency.
- Disturbance in mineralization >>hypominerlisation – enamel is
of normal thickness but at least part of it is poorly mineralized.
- LOCAL causes – developing permanent teeth may be
damaged by trauma or infection associated with their
predecessor – these teeth are sometimes called (Turners teeth)
SYSTEMIC :
- Milk teeth begin to form in utero.
- Until birth, protection is from the mother.
- Prenatal enamel is usually regular and homogenous –
neonatal line demarcates them clinically.
- Conditions that may affect tooth formation postnatal are :
1.Premature birth
2. neonatal jaundice.
3. rhesus incompatibility.
4. neonatal hypocalcaemia.
5. gross nutritional deficiency
6. exanthematous fever
Other systemic Factors :
Enamel formation is also disturbed by :
- Gastrointestinal upset.
- Prenatal syphilis.
- Excessive dietary flouride may cause mottling of
enamel.
- Teeth under development are affected by serious
metabolic disturbances.
- Hypomineralisation or hypoplasia shown as bands
across the crowns.
Hypomineralised type :
Enamel normal in thickness and has a smooth surface
unless it is chipped and worn away.
May be opaque white, dull yellow or light brown in
color.
Both primary and permanent dentitions are affected
in almost most cases.
Treatment of anterior teeth :
Composite – microfilm versus porcelain crowns,
zirconium, etc
Acrylic crowns
Are they obsolete ?
Treatment of posterior teeth :
Amalgam, composite, GIC.
Stainless steel crowns.
Cast veneers for premolars.
Amelogenesis Imperfecta
A group of rare hereditary conditions in which the
enamel structure is defective.
A number of genetically distinct types have been
described – the most common have an autosomal
dominant gene.
They can be subdivided into : a. Hypoplastic. B.
Hypomineralised.
 In hypoplastic enamel may be thin but otherwise of
normal appearance or it may be pitted, grooved or
grossly deficient in structure.
Treatment :
Aims :
a. To improve appearance
b. To relieve pain and discomfort caused by exposed
dentine and to prevent attrition.
It is important to reassure the child and the parent
who may be demoralized by the appearance of the
teeth.
Restoration vis extraction.
Dentinogenesis Imperfecta
Hereditary dentinal defect that may occur alone or in
association with the skeletal condition of osteogenesis
imperfecta.
Alternative names – Hereditary opalscent dentine,
describes aptly the appearance of the teeth- color
varies from grey to brownish blue.
The crowns are bulbous, constricted cervically.
The enamel is usually normal is poorly supported by
the defective dentine tends to flake away.
The defective dentine will wear quickly to the gum
level (attrition).
Radiographs show thin short roots with obstructed
pulp chambers and canals by pulp stones.
Both dentitions are affected but the permanent teeth
are less affected.
Premolars, second and third molars may be normal.
Intrinsic staining of teeth
Teeth may stained or discolored by a variety of intrinsic
stains.
Tetracycline drugs are well known cause and produce
discoloration ranging from yellow-orange to grey-brown.

Treatment :
- May be masked by composite resin veneers with or
without prefabricated facings.
- Minor staining may be effectively masked with a layer of
composite resin.
An alternative method is bleaching.
Abnormalities of Teeth Form
1. Double Teeth.
2. Malformation of the maxillary lateral Incisor.
3. Dilaceration
Double Teeth
May be formed either by fusion of two developing
tooth germs or by gemination (partial dichotomy) of
one tooth germ.
Double teeth occur most frequently in the incisor and
canine regions and are more common in the primary
dentition than the permanent.
The abnormal tooth may be indicated by notching of
the incisal edge, longitudinal groove in the crown or by
partial or complete separation of the roots.
Treatment :
 No treatment is required for the primary teeth but in
the permanent teeth parents and patients request
improvement of the appearance.
 One pulp or separate ?
 If separate – it is possible to separate the crowns
using a fine diamond bur and then to make one or two
crowns – porcelain, zirconium, to look like normal
teeth.
- Wait till late teenages to allow some recession of pulp
horns to occur, thus reducing the risk of pulp exposure
during crown reduction or preparation. Sometimes
endodontic treatment and post crowns .
Wait at least till root formation is complete (11years).
Malformation of the maxillary lateral Incisor
Often abnormal in size or shape.
Most common anomaly is peg-shaped crowns and
deep palatal invagination.
Palatal pits, dens in dente.
Caries and quick pulp involvement.
Treatment :
- If there is crowding it is extracted as part of
orthodontic treatment.
- Crown – composite restoration.
Dilacerations
Defined as the tooth that has a distorted crown or root.
Affects only permanent teeth.
Maxillary central incisor is the most commonly affected.
Severe trauma to the maxillary primary incisor is the may
cause dilaceration of the crown or root of the permanent
successor or simply reflects abnormal development.
Maxillary centrals develop palatal and very near to the
root apices of the primary incisors.
Stage of development dictates the crown movement –
palatal or labial ? 4.5 yr age or younger.
Hypoplastic enamel or not.
No hypoplasia, if there is no trauma.
The tooth fails to erupts.
Sometimes erupts in an abnormal position and causes
displacement of adjacent teeth.
Treatment :
- Unerupted displaced teeth are usually extracted, but
sometimes it is possible to bring a tooth into the arch
by surgery and orthodontics.
- Erupted in an abnormal positions are also usually
extracted because they are difficult to moved
orthodontically.
- After the extraction, the space must be maintained
either with a prosthesis or closed by orthodontic
treatment or nowadays with an implant, so that tilting
of the adjacent teeth is minimised.
Abnormalities of Tooth
Number
Anodontia
Hypodontia (oligodontia)
Ectodermal Dysplasia
Hyperdontia
Supernumerary Teeth
ANODONTIA
implies complete failure of the teeth to develop. It is a
rare condition.
Although agenesis of permanent teeth is often
referred to as congenital absence, they would not, of
course, be expected in the oral cavity at birth anyway.
An overlay denture is often the treatment of choice.
HYPODONTIA (OLIGODONTIA)
Agenesis of some teeth is referred to as hypodontia,
which is preferable to the term partial anodontia.
Oligodontia is sometimes used when only a few teeth
develop.
Hypodontia may occur without a family history of
hypodontia, although it is often familial. It may also be
found as a part of a syndrome, especially in an
ectodermal dysplasia, although it usually occurs alone
(isolated).
Any one of the 32 permanent teeth may be missing.
However, those most frequently missing in children
are the mandibular second premolars, maxillary lateral
incisors, and maxillary second premolars. The absence
of teeth may be unilateral or bilateral.
(Palatally displaced canine)
Recently it has been realized that hypodontia may be
an indicator of susceptibility for developing cancer.
Ectodermal Dysplasia
The congenital absence of primary teeth is relatively rare.
When a number of the primary teeth fail to develop, other
ectodermal deficiencies are usually evident.
There are more than 100 types of ectodermal dysplasia with
varying anomalies of ectodermal derivatives, including both
the primary and permanent teeth, hair, nails, and skin.
Children with a number of missing primary and
permanent teeth may have some or all of the signs of a
type of ectodermal dysplasia and should undergo further
evaluation.
One of the more common types of ectodermal dysplasia is
X-linked recessive hypohidrotic ectodermal dysplasia
(XLHED), also called anhidrotic ectodermal dysplasia and
Christ-Siemens-Touraine syndrome.
Hypodontia and dental hypoplasia, as well as
hypotrichosis, hypohydrosis/anhidrosis, and asteatosis are
characteristic of XLHED.
Secondary characteristics include a deficiency in salivary
flow, protuberant lips, and a saddle-nose appearance. The
skin is often dry and scaly, and there is fissuring at the
corners of the mouth.
Because the absence of teeth predisposes the child to a
lack of alveolar process growth, the construction of
dentures is complicated.
For children with a large number of missing primary
teeth, partial dentures can be constructed at an early
age. Two-year-old and 3-year-old children have worn
partial dentures successfully. Their ability to masticate
food increases, and their nutritional status may
improve. A partial denture can be adjusted or remade at
intervals to allow for the eruption of permanent teeth.
If the permanent teeth erupt in good position and in
favorable relationship to each other, partial dentures
may serve until the child is old enough for implants or
a fixed partial denture. Orthodontic and surgical
procedures may be necessary before the prosthodontic
treatment.
Bonding techniques have improved the ability to
provide aesthetic interim restorations and greater
function for patients with conical teeth with or
without oligodontia or hypodontia.
When maxillary lateral incisors are missing, the
occlusion and arches must be analyzed carefully to
determine whether there is sufficient room within the
arch to maintain space and to provide fixed
bridgework. If space for a normal-sized lateral incisor
replacement is insufficient, the clinician may
sometimes choose to move the canine forward into the
lateral position and reshape it to make it appear more
like a permanent lateral incisor.
HYPERDONTIA AND CLIEDOCRANIAL DYSPLASIA
Hyperdontia: extra teeth, same as supernumerary teeth,
may be single or multiple as in CCD.
CCD is inherited as an autosomal dominant trait, the gene
maps to chromosome #6. The gene encodes a protein
called Core Binding Factor Alpha 1 (CBFA1). This protein
is essential for the formation of a normal skeleton but its
role in tooth formation is not yet known.
Main features of the phenotype include hyperdontia,
small or missing clavicles, delayed closure of the cranial
fontanelles (soft spots) and short stature.
SUPERNUMERARY TEETH
When located in the midline between the two
permanent central incisors, they are referred to as
mesiodens.
Extra molar tooth (a paramolar).
supernumerary bicuspid tooth.
THESE ARE THE MOST COMMON (IN ORDER)
Abnormalities of Tooth
Size
MACRODONTIA
MICRODONTIA
MACRODONTIA
Any tooth or teeth appear larger than normal for that
particular type of tooth.
True macrodontia involving the entire dentition is
rare.
Due to a disturbance of morphodifferentiation.
 Pseudo macrodontia- the jaws relatively smaller
relative to normal tooth size
Associated with gigantism.
MICRODONTIA
Smaller than normal teeth.
Types of microdontia:
True generalized microdontia –all teeth involved
(pituitary dwarfism)
Relative generalized microdontia – large jaw, normal
teeth
Localized - few teeth involved
Single tooth involvement -upper lateral incisors and third
molars
• The affected teeth may be of normal or abnormal
morphology.