Developmental Disturbances (LAB 1)

In this lecture dr. Rima discussed developmental disturbances or changes of the oral region, which we already talked about in the previous lectures so this lecture is more like a summary or revision lecture. Some notes u need to know about radiopacity and radiolucency to help u understand radiographs: On the radiograph u might see white or black areas and levels of colors between these two, so the intensity of the color depends on the radio density of the object in the way between the x-ray and the film. *Hard, calcified objects appear white *Less calcified objectsmore towards black And so on.

Ok lets start with this first lesion: MICRODONTIA

IN THIS PICTURE WE CAN SEE: Changes here are in size

 Peg shaped lateral incisor. Peg lateral is one of the most common presentations of microdontia (another presentation is the third molar). ECTODERMAL DYSPLASIA

Thin hair, absent eyebrows (due to defective hair follicles formation). Hyperthermia (due to reduction in sweating cuz sweat glands are absent or deficient) Hypodontia-also known as partial anodontia in some booksand microdontia as u can see in this pic below. If we took a radiograph it will show missing teeth. Changes here are in size and number of teeth.

*Remember the reasons for missing of teeth in jaws are : Absence of teeth (no tooth germ)

 Extraction Impaction Supernumerary teeth (preventing eruption) SUPERNUMERARY TOOTH

Extra premolar It is supplemental (looks like the normal counterpart) Changes here are in number of teeth MESIODENSE

Here it is in the midline but in other cases may erupt in the nose, oral cavity or may be impacted and in the last case it is common to develop cysts or odontogenic tumors. So all of the complications that occur in impacted teeth may occur in such supernumerary teeth.

x-ray of mesiodense

Note here that air doesnt absorb rays and will reach and be exposed to the film and will appear black. Enamel is more calcified than dentin so it will prevent x-rays from reaching the film. And so enamel will look whiter than dentin. If we assume there was a cavity like nasal cavities they are going to appear black cuz they contain air, but the nasal septum which is bone (more calcified) will appear white. Also note that the x-ray on the right shows a mesiodense that is in the midline but is impacted and in an inverted position. Changes here are in the number of teeth. NATAL /NEONATAL TEETH

Ulcer due to deciduous tooth that erupted at birth or in the first month of life. Due to superficial location of the tooth germs. Changes here are due to premature eruption.

DILACERATION

Enamel and dentin appear white but the pulp looks less radio dens (more black) cuz it contains nerves and collagen (soft tissue) as well as bone marrow which contains soft tissues and thus appearing black But what u must focus on here is the curve at the end of the root which is called dilacerations. Changes here are in shape of teeth TAURODONTISM

Apical placement of furcation area so we need elevators or other instruments for extraction. Changes in shape DENS IN DENT

Pulp: radiolucent Dentin: radiopaque Enamel: more radiopaque So there is smth other than dentin lining the pulp and it is enamel. Food and debris will cause caries >>pulp exposure >>pulpitis >>localized infection in bone. If it was severe it will cause distortion of the tooth (total change in shape), which is called dilated odontome. Changes in shape MILDER DENSE IN DENTE

Only extending to one third of the root.

DENSE EVAGINATUS

The opposite of dense invaginatus Occurs between the palatal and buccal cusps. It causes malocclusion and we need to remove the pulp not just the extra cusp. Changes in shape TALON CUSP

Extra cusp occurring in upper and to lesser extend on the lower teeth, on the upper teeth the cingulum is prominent forming an extra cusp. Again we should take care of the pulp. Change in shape XRAY OF TALON CUSP

 We can see enamel covering the surface of the extra cusp it is more radiopaque than dentin. FUSION

We see big crowns we think of either fusion or germination here it is fusion. Complications are delayed eruption if the teeth are not erupted but if they were erupted (like this case) the only problem would be esthetic. Change in shape XRAY of fused teeth

Note here that there is fusion in dentin u can see no enamel between those two teeth ,,so for fusion to occur there must be at least fusion in dentin(fusion in dentin and pulp tissue might also occur we also call it fusion)but if fusion

occur only in enamel for instance we do not call it fusion. Very important! There is a Missing tooth here, only in one case there is no missing tooth and thats when fusion occur between normal tooth germ and a supernumerary tooth germ(cause we already have an extra tooth). GEMINATION

No missing teeth here Change in shape To sum it up

Fusion: two teeth are transformed into one tooth (one big crown (of the two fused teeth) are resting on 2 roots). Gemination: one tooth is incompletely divided into two teeth. (2 crowns resting on one big root).

CONCRESCENCE

Fusion in cementum between adjacent two teeth . Its not developmental. With aging chronic inflammation may occur hypercementosis and then with proximity of teeth concrescence may occur. Change in shape HYPERCEMENTOSIS

HEAVY OCCLUSAL LOAD (OVERERUPTED) OUT OF OCCLUSION CHRONIC INFLAMMATION PAGETs DISEASE OF BONE (GENERALIZED) Change in shape ENAMEL PEARL

 Normal tissue in abnormal location Change in shape Lets take the changes in the structure of enamel now TURNER TOOTH

The tooth is normal except for some pits and grooves. Environmental cause like Trauma to the primary dentition that affects the permanent dentition., so they appear hypoplastic. This cant is chronologic cuz if it was so other centrals (developing at the same time) would have been affected. DENTAL FLOROSIS

 All of the teeth labial surfaces have chalky white spots all over. Most likely environmental It gets dark with light (as u can see on the central incisors) Occurs when the child is exposed to fluoride during tooth formation before tooth eruption. CHRONOLOGICAL HYPOPLASIA

All the teeth are affected so it is chronological

AMELOGENESIS IMPERFECTA

Generalized

 Rough pattern Hypoplastic why? Because there is no loss of enamel (clinically) and we also have to take x-ray to be sure.

AMELOGENESIS IMPERFECTA LOCALIZED

It is limited to the middle third of the teeth Genetically determined Localized hypoplastic (not localized to single tooth but localized to part of the crown) AMELOGENESIS IMPERFECTA

Smooth hypoplastic, very thin layer of enamel on the periphery.

HYPOMATURATION PIGMENTED PATTERN

Mixed colors like fluorosis white and brown areas. Affecting all teeth Enamel is soft **U will not be asked to differentiate btw hypomaturation and hypocalification because both have soft enamel. HYPOMATURATION (amelogenesis) SNOW CAPPED PATTERN

 White areas at the tip of the cusps It cant be fluorosis because fluorosis doesnt have a specific pattern like this HYPOCALCIFICATION (amelogenesis)

If we were told that this patients had erupted teeth of normal size and enamel was lost easily exposing dentin (yellowish color) dentin will absorb pigmentation and will become darker and darker in color and will go away easily cuz its not as calcified as enamel. XRAY OF AMELOGENEIS
Amelogenesis imperfecta hypocalcified

 If u cant decide if it is amelogenesis or dentinogenesis imperfecta you need to see if the pulp is obliterated or not: *Obliterated=dentinogenesis *Not obliterated=amelogenesis Note that we cant see enamel at the periphery here. Lets now see some cases about the changes in structure of dentin DENTINOGENESIS IMPERFECTA

Wearing of teeth occur quickly(enamel is not well supported and no scalloped CEJ) XRAY OF DENTINOGENESIS

 Obliterated pulp Enamel is present with good density and thickness DENTINOGENESIS IMPERFECTA

Teeth have a distinct color because color of dentin is not normal and it will show through enamel . Loss of enamel and subsequently of teeth will occur. DENTIN DYSPLASIA TYPE 1

Obliterated pulp Remnants of pulp only like slits (horizontal)look at the arrow Variable length of the roots (sometimes they are short sometimes they are not) Periapicle lesions Teeth will be lost prematurely

Dentin Dysplasia I

DENTIN DYSPLASIA TYPE 2

Pulp is clear and normal but there is extension of the pulp chamber down to the root canals We can see pulp stones. DENTIN DYSPLASIA TYPE1

 Normally appearing teeth Teeth mobility without even having periodontitis Another reason for mobility of teeth is hypophosphatasia like this picture below

You can see teeth that were prematurely lost although there is good periodontal health. Disturbances in the soft tissue COMMISURAL LIP PIT

PARAMEDIAN LIP PIT

On both sides of the midline of the lower lip Associated with certain syndromes DOUBLE LIP

ankyloglossia(tongue tie)

Adhesion btw tongue to gingiva (most severe form) In other cases can be attached to the floor of the mouth. Side effects include: gingival rescission, difficulty in swallowing speaking etc.

FORDYCE GRANULES

Yellowish granules In the buccal mucosa FORDYCE GRANULES

Bilaterally in the upper lip vermilion border FORDYCE GRANULES

They are sebaceous glands (not associated with hair follicles though) LEUKOEDEMA

 There is edema inside the cytoplasm of cells. Clinically we can do a stretching test to see if the whiteness disappears it will be leukoedema. Usually incidence increases in black colored people and smokers WHITE SPONGE NEVUS

It does not go away with stretching Extend all the way to the palate where there is no trauma Keratin alterations LINGUAL THYROID NODULE

 MASS ON THE DORSUM OF THE TONGUE IN FORAMEN SECUM AREA AT THE JUNCTION BTW ANTERIOR 2/3 AND POSTIRIOR 1/3 OF THE TONGUE. HAS A SURFACE RICH IN BLOOD SUPPLY A SURGEON NEEDS TO KNOW IF HE HAVE TO REMOVE IT.(by injecting certain florescent material if it wasnt taken by any other tissue than this then it is the only thyroid gland the patient has ,and this will decide how they are gong to treat him) ORAL TONSILS

Small nodules on either sides of the lingual frenum. Remember that the oral cavity is rich in lymphoid tissue except on the attached gingiva.

 Developmental disturbances in bone

Hemifacial hypertrophy

All of the structures on the affected side are hypertrophied There are visceral tumors. PROGRESSIVE SYNDROME) HEMIFACIAL ATROPHY (PARRY_ROMBERG

The patient has seizures in the contralateral side of the body (the non affected side )

Cleft lip and palate

STAFNE BONE DEFECT

U can see some radiolucency this is not a cyst, it might contain a salivary gland tissue or even muscles nerves or might be entirely empty. FOCAL OSTEOPOROTIC BONE MARROW DEFECT

 Reduced bone density so it looks kind of radiolucent it might be filled with hematopoietic bone marrow. CLEIDOCRANIAL DYSPLASIA

If u see this pic without seeing the patient u might think of many defects like hypodontia ,impacted teeth, premature loss of teeth. So radiograph will clear things out

Multiple unerupted and impacted teeth supernumeraries so it is cleidocranial dysplasia.

and

Crouzon Syndrome

Frog like face Exophthalmos Parrot like nose Cavity under the eyes

TEACHER COLLINS SYNDROME

Retruded mandible Drop of the eyelid Important to know that the chances of having a child with such a disease are increased with the increase of the paternal age.

wish you all nothing but the best and please correct me if you find any mistakes. Done by: Narmeen Ghannam.