Professional Documents
Culture Documents
Developmental Disorders
Dr. subhadra H. N www.dentistpro.org to find more
Outline
Disorders Of Teeth
Disturbance in Number of Teeth
Hyper/ Hypodontia
Disturbances in Structure
Dens Invaginatus
Taurodontism Dilaceration
disturbances
Outline
Hard & Soft Tissue Disorders
Congenital Lip Pits Double Lip Fissured Tongue Lingual Thyroid Lateral Soft Palate Fistulas
Fordyces Granules
Ankyloglossia Microglossia Macroglossia Median Rhomboid Glossitis
Exostoses
Stafne Defect Fissural Cysts
Outline
Other Rare Disorders
Hemifacial Hypertrophy
Terminologies
10
Maxilla CI LI canine I PM II PM
Mandible CI LI canine IPM IIPM
I II III molar
I II III molar
11
Treatment
Composite / Porcelain Veneers Autotransplantation / Implants
13
Relative Macrodontia
Classification
Diffuse /Generalized Macrodontia Regional / Localized Macrodontia Rhizomegaly / Radiculomegaly
Treatment
14
Etiology :
Genetic - Autosomal Dominant / Recessive / Sex linked Environment Evolution
15
Anodontia
16
18
Treatment
To provide adequate function Maintain the VD Restore esthetics
19
Etiology
Hereditary Autosomal dominant/ sex linked Atavism Hyperactivity of dental lamina Environmental factors Dichotomy theory (Taylor 1972)
20
23
Clinical Features
Max ant > Max 4th molar > Mand 4th molar > PM > Mand ant & unusual sites Unilateral / Bilateral Erupted -25% (perm),73%(prim) 77.6% -inverted
Diagnosis
24
Treatment
Extraction / Surgical removal
25
Classification:
Fusion (syndopdontia) Gemination Schizodontia
Etiology
Evolution C. Rose & W. Kukenthal- Multicusped Teeth - Fusion of Haplodont Trauma Crowding
26
27
Treatment
Hemi section & Endodontic treatment & reshaping OR Surgical removal & prosthetic replacement
28
Clinical features
Clinical importance
Extraction difficulty
Treatment
No treatment
29
30
31
Pathogenesis :
Proliferation & evagination of IEE (Tartman)
Etiology
Hereditary Autosomal dominant
Clinical significance
Fracture / Wear Pulpal pathosis Eruption interference Malocclusion Dilaceration Caries
33
Nonvital teeth
Apexification followed endodontic treatment
34
Pathogenesis :
Proliferation & evagination of IEE
35
Clinical Features
LI (55%)>CI(33%)> Mand incisors(6%)>
Max canine(4%)
Deciduous rare (Max CI) Conical, Bifid and talon-like.
36
syndromes
Rubinstein Taybi, Struge Weber Orofacialdigital syndrome II
D/D :
Supernumerary tooth
37
Treatment
38
Ploquel (1794) - Whales tooth Socrates (1856) - Human tooth Definition : is a deep surface invagination of the crown / root that
is lined by enamel
Classification
Coronal Radicular
39
Radicular - rare
40
Radicular
Infolding of HERS
41
Radiographic features
42
Clinical significance
Predisposition to caries Pulpal pathology Periapical pathology (Type III) Early diagnosis mandatory
43
Surgical treatment
Intentional replantation & retrograde surgery Extraction
44
Enamel pearl
Synonyms : Enamel droplet, Enamel nodule, Enamel globules, Enamel exostoses, Enameloma
True enamel pearl Entirely enamel Composite enamel pearl Enamel + Dentin
Pathogenesis
Bulging of odontoblastic layer - Prolonged contact b/w HERS & dentin
45
Clinical Features
Max 3rd molar > Mand 3rd & Max 2nd molar > Max 1st molar 1- 4 / tooth
Radiographic Features
46
47
Treatment
Meticulous oral hygiene Flattening & removal with furcation plasty
48
Pathogenesis
Failure of HERS to invaginate at the proper horizontal level
Etiology :
1. Mendelian recessive trait 2. Atavistic feature
Prevalence : 0.5 4%
no sex predilection
49
Radiographic Features
50
51
Treatment
No specific therapy
52
Etiology
Trauma Avulsion / Intrusion Neonatal laryngoscopy & endotracheal intubation Cyst, tumor, odontogenic hamartoma Idiopathic
53
Treatment
Deciduous teeth extraction Permanent teeth
Minor no treatment Delayed / abnormal eruption surgical exposure/orthodontic intervention Nonvital teeth endodontic treatment Extensive - extraction , orthodontic movement CI
54
Treatment
No treatment
55
56
Amelogenesis Imperfecta
Definitions
A group of disfiguring hereditary conditions which affect the clinical appearance of enamel of all or nearly all teeth which occur in kindred show essentially the same defect & which are unassociated with known morphologic or biochemical changes elsewhere in the body - Witkop & Rao 1971
57
Pattern
HYPOPLASTIC ------HYPOMATURATION ---HYPOCALCIFIED -HYPOMATURATION-HYPOPLASTIC HYPOPLASTIC-HYPOMATURATION
Features
Generalized pitted Localized pitted -Diffuse smooth -Diffuse rough Enamel agenesis Diffuse pigmented Diffuse Snow capped -Diffuse -Associated taurodontism --
Inheritance
AD -AR AD X AD AR AR X X AD -AR AD -59
Amelogenesis Imperfecta
Prevalence :
1: 718 1: 14,000
60
Amelogenesis Imperfecta
Hypoplastic Smooth pattern (AD)
61
Amelogenesis Imperfecta
Hypoplastic Smooth pattern (X -Linked) Lyonization
62
Amelogenesis Imperfecta
Hypoplastic Rough pattern
63
Amelogenesis Imperfecta
Hypoplastic
Enamel Agenesis
Color / shape dentin R/ F no peripheral enamel
64
Amelogenesis Imperfecta
Hypocalcified
65
Amelogenesis Imperfecta
Hypomaturation
Pigmented pattern Snow capped pattern
66
Amelogenesis Imperfecta
Hypomaturation - Hypoplastic
67
Amelogenesis Imperfecta
Clinical significance
Aestheticcs VD Caries
Treatment
Appropriate diagnosis Genetic counseling Early orthodontic assessment Preservation of VD Aesthetics
68
Acrocephalosyndactly
Palmoplantar hyperkeratosis syndrome
Infections
Direct cellular damage ameloblastic derangement
eg:- Syphilis, Rubella, Cytomegalovirus
Syphylis
Birth trauma
Prolonged labor Multiple pregnancy
74
Common
Internal hemorrhage
Billiary hypoplasia Neonatal hepatitis
Hypocalcaemia
Hypoparathyroidism Vit D deficiency rickets
75
Skin
Vit D3 cholecalciferol
Liver
kidney
Prevalence
62.3% - < 1500gm 27.3% - 1500- 2000gm 12.7% - > 2500gm
77
Critical period
Teeth Prim incisors Prim canines Perm incisors & canines IU (months) 4 5 3-5 EU 3mnths 9 mnths 7yrs
78
Clinical Features
79
Local factors
Trauma Turners hypoplasia Infection
80
81
dose
Secretory stage inhibit protien sythesis at high dose
Maturation stage delayed withdrawl of amelogenin, serine
83
Treatment
Microabrasion
18% HCL / 37% phosphoric acid
Veneers
84
Dentinogenesis Imperfecta
Synonyms : Hereditary opalecent dentin Definition : Hereditary developmental disturbance of the
dentin in the absence of any systemic disorder
Classification :
Shields
DI - I DI- II DI - III
Clinical presentation
Osteogenesis Imperfecta + Opalescent teeth Isolated opalescent teeth Isolated opalescent teeth
Witkop
DI Hereditary opalescent teeth Brandywine isolate
85
Dentinogenesis Imperfecta
Etiology :
Autosomal dominant (100% penetrance , variable expressivity)
Clinical Features
Deciduous > permanent 1st molar & incisors > PM > 2nd , 3rd molar Blue Brown discoloration Accelerated attrition
86
Dentinogenesis Imperfecta
87
Dentinogenesis Imperfecta
Radiographic Features
DI I, II
Dentinogenesis Imperfecta
Treatment
risk of cervical fracture Stainless steel crown vertical dimension Endodontic treatment difficult 30yrs complete denture/ implants
89
Dentin Dysplasia
Normal enamel , atypical dentin with abnormal pulp morphology
Classification Shield
Type I
Witkop
Radicular dentin dysplasia
Type II
90
Dentin Dysplasia
Etiology
Autosomal dominant
Clinical Features
Deciduous = permanent Type I Radicular Dentin Dysplasia (Rootless teeth) Normal appearance Normal eruption Premature exfoliation Type II coronal dentin dysplasia Blue brown discoloration deciduous teeth Normal appearance permanent teeth
91
Dentin Dysplasia
OOO 1991:119- 25
Radiographic Features
Radicular
Type I a
Type I b
Type I c
Type I d
92
Dentin Dysplasia
Coronal Thistle Tube pulp
Dentin Dysplasia
Differential Diagnosis
Fibrous dysplasia of dentin : Autosomal dominant disorder Pulpal dysplasia
Clinical significance
Premature exfoliation Pulp vascular channels close to DEJ Periapical lesions
94
Dentin Dysplasia
Treatment Type I
Preventive care Periapical lesions guided by root length Moderate -Mechanical creation of canal path Short roots Pulpal ramification Periapical curettage & retrograde filling
Type II
Endodontic therapy - accomplished readily
95
Regional Odontodysplasia
Ped Dent 2005; 34- 39
Etiology : Idiopathic
Proposed causes 1. Abnormal migration of neural crest cells 2. Local trauma/ infection 3. Local circulatory deficiency 4. Irradiation 5. Metabolic / nutritional deficiency 6. Hyperpyrexia 7. Rh incompatibility
96
Regional Odontodysplasia
Pathological conditions
1. 2. 3. 4.
5.
6.
Vascular nevi
Hydrocephalus
97
Regional Odontodysplasia
Prevalence : Uncommon
F: M = 1.4 : 1
Clinical Features
Permanent = Deciduous Max > Mand, Unilateral, Anteriors > Posteriors Yellow Brown discoloration Delay / failure of eruption Rough surface Deficient enamel & dentin Premature exfoliated
98
Regional Odontodysplasia
Radiographic Features
Regional Odontodysplasia
Clinical Significance
Predisposition to caries Pupal necrosis Premature exfoliation
Treatment
Erupted teeth Intermediate restoration - etched retained restoration / SS crown Tooth preparation CI Nonvital endodontic therapy/ extraction
100
Regional Odontodysplasia
Treatment
Unerupted teeth Undisturbed Premature exfoliation Removable prosthesis Auto transplantation
101
102
103
Disturbances in Eruption
Premature Eruption
Delayed Eruption
104
Premature Eruption
105
Etiology : unknown
Superficial positioning of the germ Infection Malnutrition Febrile state Hormonal stimulation Hereditary (AD)
106
Classification
Spouge & Feasby (1960) Mature Immature Hebling (997) Shell shaped crowns, poorly fixed, absence of root Solid crown, poorly fixed, little/ no root Incisal margin observable Unerupted ,palpable tooth, edema of gingiva,
108
Histological Features
Enamel hypoplasia Irregular dentin Absence of cementum Highly vascularized pulp
109
Clinical Significance
Dislocation & aspiration
Traumatic injury Caldarelli (1857)
Treatment
Normal / supernumerary Mobility Inconvenience during suckling
110
111
Cretinism
Trauma Fibrous tissue Supernumerary teeeth, cysts, odontoma, Retained / prematurely lost deciduous teeth Arch length deficiency Delayed tooth development
Treatment
112
Etiology
Ankylosis
Pathogenesis
Disturbances in local metabolism 2. Trauma 3. Local infection 4. Chemical / Thermal irritation
1.
113
Clinical Features
Sharp, solid sound (> 20% root ankylosed)
Radiographic Features
114
Treatment
extraction Prosthetic build up Luxation
115
Other factors
Overlying cyst / tumor Trauma Reconstructive surgery Thickened overlying bone/ soft tissue
116
117
Treatment
Molar Extraction Cuspid Extract Deciduous canine Surgical exposure & orthodontic traction
119
120
Eruption Sequestrum
Clinical Feature
Tiny irregular spicule of bone, overlying the occlusal fossa
R/F
Tiny irregular opacity, overlying the occlusal fossa
Etiology
Clinical Significance
Soreness in the area
Treatment
121
122
Clinical Features
Unilateral / Bilateral Depth 1-4 mm Fluid can be expreesed Not assoc with facial / palatal clefts Preauricular pits
123
Clinical significance
Cystic formation/ Secondary infection
Treatment
Asymptomatic no treatment Surgical excision
124
Etiology :
Persistent lateral sulci
Clinical Features
Bilateral Depth 1.5 cm Express salivary secretions
Clinical significance
Autosomal dominant + cleft lip / palate (Van der woude
syndrome)
125
126
Acquired
Oral habit / trauma
Ascher syndrome
Double lip + blepharoclasis + non toxic thyroid enlargement
127
Clinical Features
Bilateral , > upper lip Cupids Bow appearance
128
Treatment
Not indicated
129
Clinical Features
Treatment
Orthognathic correction Speech & language development normal
130
Congenital 1. Vascular malformation, (lymphatic, venous, capillary ) 2. Muscular enlargement (Hemi hypertrophy, Beckwith Weidmann syndrome) 3. Systemic disorder (mucopolysaccharide storage disorder) 4. Tumor / Cyst (Rhabdomyoma, dermoid cyst)
131
Relative macroglossia
Congenital
Systemic disorder (downs, cretinism)
Acquired
1. Functional (post op maladaptation) 2. Elevation (ludwig s angina,) 3. Systemic disorder (myxedema)
132
hemorrhage
133
134
Prevalence : 0.02- 5%
M: F = 3: 1 Orofacialdigital syndrome, Beckwith Wiedemann , X-linked Cleft palate
135
136
Treatment
Early intervention Frenotomy should not be performed before 4-5 yrs
137
Clinical Features
Site b/w foramen caecum epiglottis Asymptomatic Small nodular lesion large mass Dysphagia, Dysphonia, Dyspnea Hypothyroidism (33%)
138
Treatment
Asymptomatic periodic follow up Symptomatic
Prognosis
Malignancy 1%, > males
139
Fissured Tongue
Synonym : Scrotal tongue
Prevalence 2-5%
M>F
Clinical Features
Grooves / furrows 2-6mm Asymptomatic / mild burning sensation rarely Melkerson Rosenthal syndrome Chelitis granulomatosa, facial paralysis, scrotal tongue
140
Fissured Tongue
Treatment
No specific treatment Encouraged to brush the tongue
141
Etiology :controversial
Persistence of tuberculum impar
Baughman 10, 000 school children no cases Localized chronic fungal infection C. Albicans
Prevalence : < 1%
Common in adults M>F
142
143
Clinical Features
Common on ant tonsillar pillar
Bilateral
Asymptomatic Associated with Hypoplasia of palatine tonsil Hearing loss Preauricular fistula
Treatment
Innocuous- No treatment
144
Fordyce 1896
Etiology
Inclusion of ectoderm
Prevalence
95% - adults
Clinical Features
Bilateral Sites BM, Lips Batsaki & E L Nagar - Normal (BM) Heterotopic anomalous (other sites)
145
Treatment
No treatment required
146
148
Fibromatous Gingiva
Synonym : Elephantiasis Gingivae ,Hereditary Gingival Fibromatosis , Congenital Macrogingivae.
Familial / sporadic
Clinical Features
Dense, Diffuse, Smooth, or Nodular overgrowth , Non painful, No Hemorrhage One / both arches, Time of eruption of Permanent incisor, Few instances even at birth ,
Clinical significance
Prevent eruption of teeth ,
Treatment
Gingivectomy, Reccuence - common
149
Exostoses
Localized bony protuberance from cortical plate Common Torus palatinus Torus mandibularis Others Buccal exostoses Palatal exostoses (Palatine tubercle) Solitary exostoses Reactive subpontine exostoses (Subpontic osseous proliferation, Subpontic osseous hyperplasia)
150
Exostoses
Buccal exostoses
Palatal exostoses
subpontine exostoses
151
Torus Palatinus
Etiology :
Genetic Autosomal Dominant Environmental factors- masticatory stress Prevalence -9-60%, High in Asians F>M with age
Clinical Features
Flat torus
152
Torus Palatinus
Nodular torus
153
Torus Palatinus
Radiographic Features
Not routinely found on IOPAR
Histological Features
Dense , lamellar ,cortical bone with inner trabecular bone
154
Torus Mandibularis
Etiology :
Multifactorial
Prevalence
5-40% M>F early adult hood
Clinical Features
Above Mylohyoid line Bilateral (90%) Asymptomatic
155
Torus Mandibularis
Radiographic Features
Treatment
156
Stafne 1942
158
Diagnosis
Radographically - location Lack symptoms C T scan / MRI/ Sialograph
Histological Features
Normal submandibular gland/ muscle, blood vessels, CT, lymphoid
Treatment
159
Nasolabial cyst
Synonyms : Nasoalveolar cyst / Kelstadts cyst Rare
160
Nasolabial Cyst
Clinical Features
Radiographic Features
161
Nasolabial Cyst
Histological Features
Ciliated pseudo stratified columnar/ str sq epethilium Fibrous CT wall
D/D
Nasal furunculous Periapical abscess Dentigerous & Odontogenic Cyst
Treatment
Surgical excision Recurrence - rare
162
common
Etiology
1. Proliferation of epithelial remnants of the nasopalatine duct
Congdon (1920)
Trauma Infection
Prevalence 1%
M>F Rare in children
163
Histological Features
Respiratory epithelium/ str sq epithelium
165
Treatment
Surgical excision - via palatal flap
166
Pathogenesis
Epithelium entraped b/w palatal shelves
Clinical Features
Firm , fluctuant, swelling Frequent in young adults Asymptomatic
Treatment
Surgical excision Recurence - rare
167
Globulomaxillary Cyst
Pathogenesis
Epithelium entrapped b/w globular & max process Odontogenic
Histological Features
Str sq pseudo str ciliated columunar epithelium
Treatment
Surgical excision
169
Pathogenesis
Epithelial remnants of minor salivary gland Bohn nodule Epithelial remnants entrapped b/w palatal shelves Epstien Remnant of dental lamina
Prevalence
Common ,65 % to 85% of Neonates .
Clinical features
1 to 3 mm . White or Yellowish, raised nodule.
Treatment
No tretment
170
Dermoid Cyst
Pathogenesis
Cystic form of teratoma entraped totipotent blastomeres
Prevalence
Common in children & young adults . 15 % - congenital .
Clinical Features
Slow growing , painless , rubbery mass.
Midline of the floor of the mouth. Difficulty in eating , speaking & breathing . Double Chin appearance . Size - few mm to 12 cm .
171
Dermoid Cyst
Histological Features
Orthokeratinized str sq epithelium Lumen- keratin
Treatment
Surgical removal
Recurrence uncommon
Malignant transformation
172
Prevalence
50 % < 20 yrs , No sex predilection
Clinical Features
Foramen caecum - suprasternal notch . Painless , fluctuant , movable swelling . < 3 cm, occasionally - 10 cms. Maintain contact with hyoid
Treatment
Surgical intervention Sistrunk procedure . Thyroid adenocarcinoma < 1%
173
Pathogenesis
Remnants of the branchial clefts , or Parotid gland epithelium entrapped in upper cervical LN
Clinical Features
20 to 40 yrs , Tender , Soft , Fluctuant mass 1 to 10 cm .
Histological Features
Str sq epithelial lining CT wall lymphoid tissue with germinal centers
Treatment
Surgical removal
174
177
Hemihyperplasia
Synonyms :Hemihypertrophy
Etiology : obscure
Vascular / lymphatic abnormalities Central nervous system disturbances Endocrine dysfunction Aberrant twinning
Syndromes
Beckwith Wiedemann syndrome Neurofibromatosis Epidermal nevus syndrome Multipple exostoses syndrome
178
Hemihyperplasia
Clinical Features
Complex hemihyperplasia Simple hemihyperplasia Hemifacial hyperplasia M : F = 1:2 > Right side Mental retardation (20%) Wilms tumor , Adrenocortical carcinoma (5.9%)
179
Hemihyperplasia
Skin pigmentation, hypertrichosis, telegctasia, Unilateral macroglossia , Macrodontia, premature eruption Malocclusion Mandibular canal size
Histological Features
Thickness of epithelium CT hyperplasia
Treatment :
Periodic ultrasound examination Cosmetic surgery
180
Etiology : obscure
Malfunction of cervical sympathetic nervous system , H / O prior trauma , Viral or Borrelia infection , Hereditary .
Clinical Features:
Onset 1st two decades of life . Localized atrophy of skin & subcutaneous str. Hypoplasia of underlying bone . coup de sabre strike of the sword Enophthalmos , Localized Alopecia . Occasionally Trigeminal Neuralgia , Facial Paresthesia , Migraine .
181
Histological Features
Atrophy of epidermis , Perivascular infiltrate of lympho cytes & monocytes
Treatment
Plastic surgery cosmetic deformity. Orthodontic therapy malocclusion .
182
Conclusion
183
References
Oral & maxillofacial pathology Neville, Damm,
Allen, Bouquot A text book of oral pathology Shafer, Hine , Levy Cawsons essential of oral pathology and oral medicine R. A Cawson, E. W. Odell A text book of pediatric dentistry Cameron & Widmer
184
Klinefelter
Microcephalic dwarfism-taurodontism Oculo-dento-digital dysplasia Oral-facial-digital, type II Downs syndrome Tricho-dento-osseous, type I, II, and III Tricho-onycho-dental
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