Lec 1 Developmental Disturbances of Teet
Lec 1 Developmental Disturbances of Teet
Lec 1 Developmental Disturbances of Teet
Tissues
INTRODUCTION
Introduced by prof.: Samia El-azab
Definitions:
Pathology : is the study of a disease. It describes the cause,
course and termination of disease.
Oral pathology: it is the science dealing with oral diseases.
Disease : describes a state in which there is a sufficient
deviation from normal state for signs or symptoms to be
produced.
Signs : describe the apparent features of the patients that
doctor see or feel during examination.
Symptoms : describe the patient’s complains.
Aetiology : the cause of the disease.
Pathogenesis : how the development of the lesion or disease
occur.
Idiopathic : unknown cause.
Predisposing factors : helping factors.
Lesion : it is the variations from normal in part of the body.
Histopathological classification of oral lesions is based on one
of the following:
o Nature of tissue e.g. fibro-osseous lesions.
o Origin e.g. odontogenic and non odontogenic.
o Sites e.g. bone diseases.
o Behaviour e.g. benign and malignant.
Syndrome : a condition in which a collection of signs or
symptoms unrelated to each other is present.
Hereditary = Genetic : any trait transmitted through genes
from parents to children
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Developmental Disturbances of teeth and Calcified Dental
Tissues
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Developmental Disturbances of teeth and Calcified Dental
Tissues
DEVELOPMENTAL DISTURBANCES OF
TEETH AND CALCIFIED DENTAL TISSUES
Morphological classification:
Bud stage.
Cap stage.
Early bell stage.
Late bell stage.
Histo-physiological classification:
Initiation stage.
Proliferation stage.
Histo and morpho-differentiation stage.
Apposition stage.
Variation from normality that may affect teeth and their calcified structure
include the following:
Variations in number.
Variations in size.
Variations in shape.
Variations in structure.
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Developmental Disturbances of teeth and Calcified Dental
Tissues
I-Variations in number
Decrease Increase
(Anodontia or hypodontia) (hyperdontia)
A) Total anodontia:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
Glands:
1. Sweat glands: absent leading to deficient sweating with intolerance
to hot weather which is the first symptom of the syndrome.
2. Sebaceous glands: absent leading to dry skin.
3. Salivary glands: absent leading to xerostomia (dry skin).
4. Mucous glands: in nose leading to rhinitis, in pharynx leading to
pharyngitis.
It may be:
True: teeth are not present clinically or radiographically due to failure
of their development.
Pseudo: teeth are not present clinically but present in the jaw as
confirmed radiographically. This is because of: failure of their eruption
due to lack of space (impaction) or due to lack of force of eruption
(embedded).
False: teeth are not present clinically or radiographically. It is due to
teeth extraction or their loss by trauma.
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Developmental Disturbances of teeth and Calcified Dental
Tissues
A) Supplemental teeth:
They are the extra teeth that resemble the normal adjacent teeth. The most
common affected teeth are:
Extra upper lateral incisor:
This may be due to complete division of enamel organ that may be
associated with cleft palate or due to extra tooth germ from the dental
lamina.
B) Supernumerary teeth:
They are extra teeth not resemble the normal adjacent (conical or peg-
shaped teeth).
Mesiodense:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
It is present in the mid line between the upper central incisors. It may
be single erupted, double erupt, impacted or inverted.
Its clinical significance:
It may cause bad aesthetic when erupted or due to separation between
the central incisors.
It may also prevent eruption of one or the two central incisors.
When it is inverted it may erupt in the floor of the nose.
Paramolar:
It is a conical shaped small tooth presents at the buccal aspect of upper
or lower molars.
It may be separate or fused to the adjacent molar appearing as an extra
cusp.
Clinical significance: the retention of food and dental caries
formation.
Distomolar:
It is peg-shaped and present distal to the third molar.
It may be separate or fused to the third molar and appearing as an extra
cusp.
Clinical significance is the retention of food and dental caries
formation.
Cleidcranial dysplasia:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
Clinical picture:
General manifestation:
Clavicle:
o There is complete or partial absence of one or the two clavicles.
o In case of bilateral complete absence of them the patient can
approximate his shoulders together at the midline.
Cranium:
o Delayed closure of the fontanels leading to broad skull.
o Prominent frontal bone.
o Depressed nasal bridge.
Maxilla: there is underdeveloped, V-shaped, high arched palate and
cleft palate.
Mandible: it is of normal size, thus there is a relative prognathism.
Dental manifestation:
Normal eruption of deciduous teeth but late or failure of shedding.
Late or failure of eruption of permanent teeth.
Radiographically,
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Developmental Disturbances of teeth and Calcified Dental
Tissues
II-Variation in size
This is due to defect occurring during proliferation stage of the tooth
development.
It may be:
Increase in proliferation leading to large-sized teeth (macrodontia). Or
Decrease in proliferation leading to small-sized teeth (microdontia).
Macrodontia:
This condition may be:
True macrodontia:
In which the teeth are actually larger than normal.
It may include single tooth as upper central or lateral incisors as well as upper and
lower third molars.
Or it may include unilaterally group of teeth in case of hemifacial hypertrophy.
Or it may be generalized as in case of gigantism.
Relative macrodontia:
In this case the size of teeth is normal but the jaw is small so the teeth
appear large.
Microdontia:
This condition may be:
True microdontia:
In which the teeth are actually smaller than normal.
It may involve single tooth like upper lateral incisor or upper and lower
third molars.
Or it may be unilaterally as in case of hemifacial hypotrophy.
Or it may be generalized as in case of dwarfism.
Relative microdontia:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
In which the size of teeth is normal but the jaw is large so the teeth
appear small.
III-Variation in shape
1) Gemination:
2) Fusion:
3) Concrescence:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
4) Dilaceration:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
The central incisor is called Hutchinson’ incisor and the first molar
may be Moon’s molar or Mulberry molar. Their enamel surfaces show
enamel hypoplasia (defect in the structure).
A) Hutchinson’s incisor:
B) Moon’s molar:
The affected teeth: the first permanent molars.
The shape: the molars have small occlusal surfaces (dome-shaped).
C) Mulberry molar:
The affected teeth: the first permanent molar.
The shape: the occlusal surface shows multiple cuspules.
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Developmental Disturbances of teeth and Calcified Dental
Tissues
7) Invaginated odontome:
8) Evaginated odontome:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
The following table is showing the difference between the two forms:
Hereditary enamel Hereditary enamel
Hypolasia hpocalcification
Defect Quantitative Qualitative
Matrix Deficient Normal
Maturation Normal Decreased
Mineralization Normal Deficient
Enamel hardness Normal Soft
Surface lustre Translucent Opaque
Surface texture Smooth Rough
Radiographically Normal radiopacity Decreased radiopacity
(indistinguishable from dentine)
A) Local factors:
Trauma:
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Developmental Disturbances of teeth and Calcified Dental
Tissues
Infection:
The periapical infection of deciduous teeth especially molars may
reach to the developing tooth germs of the underlying premolars
causing hypoplastic defect.
Irradiation
If the individual is subjected to radiotherapy during the apposion stage
of the tooth development, the teeth will suffer from horizontally
oriented hypoplastic defects.
N.B. Turner’s tooth: it is a single tooth showing hypoplastic defect
due to trauma or infection.
B) Systemic factors:
Many systemic causes may have toxic effect on ameloblasts causing
hypoplastic defects as the following causes:
1) Nutritional deficiency: especially vitamins A, D, and C as well as
minerals like calcium and phosphorous.
2) Exanthomatous fevers: these are the fevers that lead to red rash on
the skin e.g. scarlet fever, measles and chicken pox.
3) Chemicals: fluoride and tetracycline.
4) Rh incompatibility.
5) Congenital syphilis.
6) Cleidocranial dysplasia.
7) Infantile gastro-intestinal disturbances.
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Developmental Disturbances of teeth and Calcified Dental
Tissues
Tetracycline pigmentation:
Tetracycline binds to calcifying tissues like developing teeth and bones
thus staining them.
The affected teeth exhibit fluorescence under ultraviolet light.
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Developmental Disturbances of teeth and Calcified Dental
Tissues
Clinical picture
The crown is small, bulbous with constricted neck and has brown
opalescent hue.
The roots are short and stunted.
Enamel is easely chipped away from dentine and rapid wearing of the
tooth occurs.
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