Professional Documents
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Variation of teeth has been an enduring interest to the clinical practitioner and the
laboratory scientist. No two teeth are alike. The day-to-day variation of teeth that we see
is the norm. It is the odd, peculiar, and strange group of teeth to which we focus our
attention here. They are called anomalies.
Some texts describe them as developmental disturbances, recognizing that they are best
understood from a developmental viewpoint. They are the more extreme variations from
the norm.
Reproduced below is the life cycle of the tooth, taken from the classic text by Schour and
Massler used by a generation of dental
students.
These few facts about tooth development will assist us in understanding tooth variation:
(1) Teeth form from the cooperative interaction of two germ layers--ectoderm and
ectomesenchyme (a neural crest derivative).
-Macrodontia refers to teeth that are larger than normal. Generalized macrodontia is
rare, seen infrequently in conditions such as pituitary gigantism. It can be localized
involving just one or a few teeth. Macrodontia is much less common than microdontia.
You may occasionally see the term 'megadontia' used for this condition.
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-True anodontia is an extremely rare occurrence. When this does occur, it is usually
part of a more generalized disorder ectodermal dysplasia, an inherited defect of all
ectodermally derived structures.
-Partial anodontia is the failure of one or more teeth to develop. It is much more
common than complete anodontia. Third molars, lower second premolars, and upper
lateral incisors (in that order) are the most common congenitally absent teeth. (Note this
very well: congenital absence of a deciduous tooth is not common. When it does occur, it
is most often the upper lateral incisor that is absent. When a deciduous tooth is absent, its
permanent successor is usually missing also.)
This is a note on terminology: Terms such as oligodontia or hypodontia are
occasionally used in British journals to describe the condition of partial anodontia. These
terms don't appear in American dictionaries; therefore, the terms are not always
consistent in usage if they appear in journals from our country. You are safe just to know
that they mean 'a few teeth are missing.'
-Supernumerary teeth are 'extra' teeth. Most (90%) occur in the maxilla. Their presence
in the deciduous dentition is quite rare. Two terms occasionally used to describe this
condition of having extra teeth are polydontia or hyperdontia. The most common of all
supernumerary teeth is the mesiodens which is a supernumerary that forms in the midline
between and lingual to the roots of the maxillary central incisors. Most supernumerary
teeth do not erupt; they often are unknown until detected on X-ray films. Fourth molars,
themselves a rare occurrence are infrequently called 'paramolars' or 'distomolars.'
Supernumerary teeth occur less often than do missing teeth.
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-This occlusal landmark can appear with varying degrees of intensity either as a cusp or
pit. These conditions are known collectively as the Carabelli trait. Clinically it is worth
checking out during a dental exam: it is frequently a site of early dental caries. It is a
heritable trait most commonly seen in European populations. The Carabelli trait is best
understood as a variation, not an anomaly.
(4) One other variation of the upper first premolar is the 'Uto-Aztecan' upper premolar. It
is a bulge on the buccal cusp that is only found in Native American Indians, with highest
frequencies of occurence in Arizona. The name is not a dental term; it comes from a
regional linguistic division of Native American Indian language groups.
(5) Peg-sbaped lateral incisors have already been discussed above.
(6) No discussion of 'disturbances in shape' is complete without mention of root
variation. Certain teeth exhibit a variation in the number of roots.
Incidentally, most root variation is in the distal third of the root. Sometimes roots can be
blunted or shortened. It tends to occur without apparent cause. On occasion, root
resorption and root blunting can be unfortunate consequence of orthodontic treatment
with fixed appliances. A few patients are very susceptible to this condition, and the
practitioner's heart sinks when it is found--without warning--on the post treatment X-ray
films. Below is a brief discussion of extra or fused roots.
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