Published online: 2019-09-30 Frequency of Developmental Dental Anomalies in the Indian Population Kruthika S Guttala Venkatesh G Naikmasurb Puneet Bhargavac Renuka J Bathid ABSTRACT Objectives: To evaluate the frequency of developmental dental anomalies in the Indian population. Methods: This prospective study was conducted over a period of 1 year and comprised both clinical and radiographic examinations in oral medicine and radiology outpatient department. Adult patients were screened for the presence of dental anomalies with appropriate radiographs. A comprehen- sive clinical examination was performed to detect hyperdontia, talon cusp, fused teeth, gemination, concrescence, hypodontia, dens invaginatus, dens evaginatus, macro- and microdontia and taur- odontism. Patients with syndromes were not included in the study. Results: Of the 20,182 patients screened, 350 had dental anomalies. Of these, 57.43% of anoma- lies occurred in male patients and 42.57% occurred in females. Hyperdontia, root dilaceration, peg- shaped laterals (microdontia), and hypodontia were more frequent compared to other dental anoma- lies of size and shape. Conclusions: Dental anomalies are clinically evident abnormalities. They may be the cause of vari- ous dental problems. Careful observation and appropriate investigations are required to diagnose the condition and institute treatment. (Eur J Dent 2010;4:263-269) Key words: Dental anomalies; Hyperdontia; Microdontia; Taurodontism. a Assistant Professor, Department of Oral Medicine and INTRODUCTION Radiology, SDM Dental College and Hospital, Developmental dental anomalies are marked Sattur, Dharwad, India. deviations from the normal color, contour, size, b Professor and Head, Department of Oral medicine and number, and degree of development of teeth. Lo- Radiology, SDM Dental College and Hospital, Sattur, Dharwad, India. cal as well as systemic factors may be responsible c Former Postgraduate, Department of Oral medicine for these developmental disturbances. Such influ- and Radiology, SDM Dental College and Hospital, ences may begin before or after birth, hence de- Sattur, Dharwad, India. d ciduous or permanent teeth may be affected. Ab- Former Professor, Department of Oral medicine and Radiology, SDM Dental College and Hospital, errations in the normal number of teeth include Sattur, Dharwad, India. supernumerary teeth (hyperdontia), i.e. excess teeth or hypodontia (teeth missing from the nor- Corresponding author: Kruthika S Guttal Department of Oral Medicine and Radiology mal compliment) while oligodontia is a develop- SDM Dental College and Hospital, Sattur, Dharwad, mental absence of six or more teeth excluding the Karnataka, India. 3rd molars. Phone: +91 836 2468142 Fax: +91 836 2467612 Anomalies of shape of teeth include microdon- Email: [email protected] tia and macrodontia. Microdontia refers to teeth July 2010 - Vol.4 European Journal of Dentistry 263 Developmental dental anomalies in adults that are physically smaller in size than usual and the outpatient department were screened for the macrodontia in turn refers to teeth that are physi- presence of anomalies. A comprehensive clinical cally larger in size than normal. Anomalies of examination was carried out to identify the pres- shape include dens invaginatus (DI), talon cusp, ence of hyperdontia, hypodontia, talon cusp, fused dens evaginatus, gemination, fusion, root dilac- teeth, gemination, concrescence, dens invagina- erations, taurodontism, and concrescence.1 DI is tus, dens evaginatus, macro- and microdontia and an anomaly resulting from invagination in the sur- taurodontism. face of a tooth crown or rarely the root and which Radiographs such as intra-oral periapical ra- is lined by enamel and dentin.2 Dens evaginatus diographs, orthopantomographs, and occlusal ra- is a focal area of the crown, projecting outward diographs were advised if the condition demanded. and giving rise to a horn-like protuberance on the In addition, radiographs referred to the radiology affected surface that appears as an extra cusp.3 section were also examined for the presence of Talon cusp is an accessory cusp usually located on anomalies. the lingual surface and rarely on the facial surface of permanent or deciduous incisors. It arises from Exclusion criteria the cingulum area, or cemento-enamel junction The following groups were excluded from the (CEJ) of maxillary or mandibular anterior teeth, study: in both the primary and permanent dentition.4 • Patients belonging to the pediatric age group Fusion and gemination have been referred to as (under the age of 14 years). double teeth which appear as larger than normal • Patients with syndromes such as Down’s sized teeth. Gemination is defined as a single en- syndrome, ectodermal dysplasia, etc. larged tooth or joined (double) tooth in which the • Patients having cleft lip and palate. tooth count is normal when the anomalous tooth • Dental anomalies secondary to structure, i.e. is counted as one.3 Fusion is defined as a single hypoplasia secondary to amelogenesis imperfec- enlarged tooth or joined (double) tooth in which ta, dentinogenesis imperfecta, or dental fluorosis. the tooth count reveals a missing tooth when the anomalous tooth is counted as one.3 RESULTS Taurodontism is a developmental anomaly of A total of 20,182 patients were screened and molar teeth in which the body of the affected teeth of these, 350 patients had dental anomalies. This is very large and the associated roots are short- group was composed of 201 (57.43%) male patients ened, with bifurcation near the apex.3 Concres- and 149 (42.57%) females. The distribution of vari- cence is the union of two adjacent teeth by cemen- ous anomalies among male and female patients tum.5 Dilaceration is an abnormal bend in the root is outlined in Table 1. Hyperdontia was the most or crown of a tooth. The bend is more frequent in common dental anomaly followed in descending the root but may be present anywhere along the order by root dilacerations, taurodontism, micro- length of the tooth.3 dontia, hypodontia, talon cusp, fusion, dens evagi- These anomalies not only affect the esthetic natus, dens invaginatus, concrescence, gemina- appearance of teeth but also pose difficulties dur- tion and macrodontia. The distribution of various ing dental treatment and sometimes are the cause anomalies is outlined in Figure 1. of dental problems. The present study was per- formed to evaluate the frequency of occurrence DISCUSSION of dental anomalies of size, number, and shape in Dental anomalies of developmental origin re- the adult population and their implications in the flect a change either in the number, size, shape, or treatment of such conditions. location of teeth, or structural changes. MATERIALS AND METHODS Hyperdontia This prospective study was conducted dur- Various reports of hyperdontia are mostly in 6 ing the period from December 2004 to November children or the adolescent population. Its preva- 6 2005 and was composed of both clinical and ra- lence ranges from 0.1 to 3.8% but it is increas- diographic examinations. All patients attending ingly common in patients with cleft lip and cleft European Journal of Dentistry 264 Guttal, Naikmasur, Bhargava, Bathi palate. Salcido-garcía et al have reported a higher port of Ranta8 where supernumerary teeth and prevalence in males than in females.6 This was agenesis of teeth were observed simultaneously also noted in the present study. Among the various more often in permanent dentition than in decidu- supernumerary teeth, mesiodentes are the most ous dentition. commonly found followed by 4th molars, premo- lars and maxillary lateral incisors.6 In the present Microdontia study, there was a higher occurrence of paramo- Teeth commonly affected are maxillary lateral lars followed by mesiodentes and supernumerary incisors and third molars. The prevalence of this teeth in the anterior region. Impacted supernu- condition ranges from 0.8% to 8.4% in various merary teeth had equal occurrence in maxilla and populations.1 When lateral incisors are affected, mandible and occurred in the anterior rather than there is a reduction in mesiodistal diameter and the posterior region. convergence towards the incisal edge and this is referred to as peg shaped incisors. The condition Hypodontia is largely of genetic origin. In the present study, This occurs in permanent dentition in 0.3% of microdontia constituted 9.14% of total anomalies the population.7 In the present study, it was noted with a majority of peg shaped lateral incisors. that missing teeth constituted 10.6% of all of the anomalies. Congenitally missing teeth most com- Macrodontia monly occur with maxillary laterals, 2nd premolars Typically only a few teeth are larger than nor- and mandibular central incisors and can be unilat- mal. Diffuse true macrodontia is observed in pi- eral or bilateral. Radiographs confirm the absence tuitary gigantism and pineal hyperplasia.1 In this of missing teeth. The etiology is believed to be he- study, only one patient presented with macrodon- reditary or developmental. In this study, mandibu- tia affecting the maxillary central incisors. lar central incisors dominated the list compared to premolars and it was noted more in females. Dens invaginatus Missing third molars were not considered in the This presents clinically as pit or fissure on the study sample. lingual surfaces of anterior teeth. The classical Treatment generally requires a multidisci- radiographic appearance of coronal DI is as a pear plinary approach including