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PEDI TRIC DENTISTRY

Topic

Cards

LEG ND

Topic

abnormal teeth

1 4

primary dentition

behavior management

5 10

pulp treatment

diseases

conditions

11 31

restorative

drugs

32 34

tooth development

fluoride

35 43

tooth trauma

general information

44 57

space management

miscellaneous

58 60

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abn of teeth

Radiographs of a preschool child with

will show obliteration

of the pulp chambers with secondary dentin, a characteristic finding.

amelogenesis imperfecta

dentinogenesis imperfecta

fluorosis

enamel hypoplasia

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dentinogenesis imperfecta

Dentinogenesis imperfecta

(DI) is an autosomal dominant trait, its frequency of occurrence is about I in 8000.

This inherited dentin defect originates during the histodifferentiation stage of tooth development. The predentin

matrix is defective resulting in amorphic, disorganized, and atubular circumpulpal dentin. Teeth are blue-gray

or brown and abrade rapidly. Occasionally, these teeth become abscessed as a result of exposure of pulp horns

caused by w ear. Full coverage is the treatment of choice. Both the primary and permanent den titions are affected

in dentinogenesis imperfecta. Important: Radiographs of a preschool child with dentinogenesis imperfecta will

show obliteration of the pulp

chambers with secondary dentin, a characteristic finding. Roots of teeth usually

are narrower and appear more fragile. Crowns generally appear more bulbous than usual due to the smaller

roots. Dentinogenesis imperfecta can be subdivided into three basic types:

Shields Type I:

occurs with osteogenesis imperfecta. As a result of an inherited defect in collagen forma-

tion, there is brittle bones, bowing of the limbs, and blue sclera. Periapical radiolucencies, bulbous crowns,

obliterated pulp chambe rs, and root fractures are common. Teeth hav e

amber translucent color. Primary teeth

affected more than perma nent teeth.

Shields Type II:

also known as

hereditary opalescent

dentin, tends to occur as a separate entity apart from

osteogenesis imperfecta. Same characteristics as Type I. Both primary a nd perma nent teeth affected equally.

Shields Type III: quite rare, demonstrates teeth with a shell-like appearance and multiple pulp exposures.

Seen exclusively in a triracial isolated group in Maryland known as the Brandywine population.

Amelogen esis imperfecta is one of the m ajor defects of enamel. It is a hereditary disease characterized by faulty

development of the enamel. There is normal pulpal and root morphology. There are four major categories ac-

cording to the stages of tooth developm ent in which each is thought to occu r.

Hypoplastic Type: occur in the histodifferentiation stage of tooth development. There is an insufficient

quantity of enamel formed due to areas of the enamel organ that are devoid of inner enamel epithelium, caus-

ing a lack o f cell differentiation into ameloblasts. Affects both primary a nd perm anent dentitions. The affected

teeth appear small with open contacts; clinical crowns contain very thin or nonexistent enamel.

Hypomaturation Type: defect in enamel matrix apposition and is characterized by teeth having normal

enamel thickness but a low va lue of radiodensity and mineral content.

Hypoplastic or Hypom aturation Type

with Taurodontism: is an example of inherited defects in both

ap-

position and histodifferentiation stages in enamel formation. The enamel appears mottled with a yellow-

brown color and is pitted on the facial surfaces. Molar teeth demo nstrate taurodontism.

Hypocalcification Type: is an example of inherited defect in the calcification stage of enamel formation.

Quantitatively, the enamel is normal, but qualitatively, the matrix is poorly calcified. The enamel is soft and

fragile and is easily fractured., exposing the underlying dentin, which produces an unesthetic appearance.

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abn of teeth

is a process in which a single tooth germ splits or shows an

attempt at splitting to form two completely or partially separated crowns.

concrescence

gemination

fusion

dens in dente

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gemination

Gemination is a process in which a single tooth germ splits or shows an attempt at splitting to form two

completely or partially separated crowns. This process results in incomplete formation of two teeth. Like

fusion, it is also more common in the primary dentition. It results in a bifid crown with a single pulp

chamber. It most frequently occurs in the incisor region. Concrescence

is a twinning anomaly involv-

ing the union of two teeth by cem entum only. Its etiology is thought to be trauma or adjacent tooth mal-

position.

The term dens-in-dente (also called dens invaginatus)

means a

tooth within

a tooth and results from

the

invagination

of the inner enamel epithelium. Most frequently involves the maxillary lateral inci-

sors. The clinical significance of this anomaly results from potential carious involvement through com-

munication of the invag inated portion of the lingual surface of the tooth with the outside environm ent.

The enam el and dentin in the invaginated portion can be both defective and absent, allowing direct ex-

posure of the pulp.

Dens evaginatus

is an extra cusp, usually in the central groove or ridge of a posterior tooth and in the

cingulum area of central and lateral incisors. In incisors, these cusps appear talon-shaped.

It results

from the evagination

of inner ename l epithelial cells. This extra portion contains not only enam el but

also dentin and pulp tissue; therfore, care must be taken with any operative procedure.

Fusion of teeth is a condition produced when two tooth buds are joined together during development and

appear as a macrodont (a single large crown). It is more comm on in the primary dentition. It may involve

the entire length of two teeth

(enamel, dentin, and cementum)

or just the root

(dentin and cementum). This

condition is usually seen in the incisor area. Although fused teeth can contain two separate pulp cham -

bers, many appe ar as large bifid crowns with one cham ber.

Note: A radiograph is needed to confirm

whether there is fusion or gemination.

1 Taurodont teeth are characterized by a significantly elongated pulp cham ber with short

Notes

stunted roots resulting from the failure of the proper level of horizontal invagination of Her-

twig epithelial root sheath.

2

Dilaceration refers to an abnormal bend of the root during its development;

it is thought

to result from a traumatic episode, usually to the primary dentition. It is a consistent finding

in children with congenital ichthyosis.

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enamel hypoplasia

erythroblastosis fetalis

nursing bottle caries

dentinal dysplasia

abn of teeth

What condition is depicted below?

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