Developmental Disturbances of the Oral Region PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com

1. Developmental Disturbances of Teeth

A) Disturbances in Number :

♦ ♦ 3rd Ms; U 2; L 2 nd PM Symmetrical or haphazard Association with systemic defects Ectodermal Dysplasia Down’s syndrome Cleft /

♦ Supernumerary vs. Supplemental Site Mesiodens, Paramolars & Distomolars Association with systemic defects: Cleidocranial Dysplasia Gardner Syndrome Cleft lip/palate

B) Disturbances in the size of teeth : ♦ Localized: peg laterals & U 3 rd Ms PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Generalized: True vs. relative ♦ Localized: Isolated, Hemifacial hypertrophy Generalized: True vs. relative C) Disturbances in the form of teeth :

♦ Sharp bend of root Upper centrals Aetiology & complications

♦ PM Ms Elongated crown with apically placed furcation Aetiology

♦ Double teeth (Connated teeth) Joined by C, R or both Pm incisors PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Aetiology: Gemination or Fusion

♦ Acquired Upper PM M Follows Complications

D) Disturbances in the structure of teeth:

PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Enamel Hypoplastic vs. Hypomineralized Defect depends on many factors Types depending on extent

Focal Aetiology: Idiopathic: enamel opacities Infection/Trauma: Turner teeth Radiotherapy

Generalized enamel hypoplasia

Systemic disturbances : Nutritional deficiencies: e.g. Vit D Infections Maternal disease & premature birth Haemolytic disease of newborn Congenital heart disease Chemotherapy Excess fluoride

Endocrine disease GIT disease Inhibit Ameloblasts during development Horizontal line of small pits or groves on enamel surface PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Teeth formed in the 1 st year

►Congenital syphilis : “Hutchinson incisors” & “Mulberry molars”

► Excess Fluoride : mostly Pms, U incisors & 2 nd Ms

Fluoride mottling Mild : smooth E with white patches or striations Severe : yellow/brown/black E with pits & grooves

Hereditary Disturbances (genetic):

Affecting only Teeth :

Generalized defects including teeth : Ectodermal dysplasia & Down syndrome

Amelogenesis Imperfecta

Majority: Autosomal dominant or X-linked PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Most of E on all teeth in both dentitions Other components of teeth are normal

1. Hypoplastic type : Thin E but normally mineralized (> dentine in radiodensity) All E smooth teeth with needle-like cusps Not all E generalized roughness w pitting & vertical grooves

2. Hypomineralized/hypomaturation type :

Most common form E of normal thickness Newly erupted: normal size & shape of teeth Opaque, brown-yellow E soft chalky and easily removed → gross E = D in radiodensity

Dentine

Local causes: Turner teeth, radiotherapy PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com General causes:

Systemic disturbances: o Rickets: preD, Hypocalcified with in interglobular D o Hypophosphataemia: in interglobular D, large pulp chamber & long pulp horns with cracked E o Hypophosphatasia: preD, in interglobular D o Juvenile hypoparathyroidism: Small teeth w hypoplastic E and short roots Prominent incremental lines in D Cytotoxic agents: Prominent incremental lines in D

Dentinogenesis Imperfecta: Type I: ◊ Patients with Osteogenesis Imperfecta

◊ Autosomal dominant Type II: (Hereditary opalescent dentine) o Autosomal dominant but no OI o Clinically : Both dentitions

Bluish-gray, brown/yellowish Soft D attrition Caries

PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com o Radiographs: Short, blunt roots Obliteration of pulp with D o Histologically: Normal E Straight ADJ

Normal mantle D Rest of D: hypomineralized with , irregular, wide D tubules “ Shell teeth ”: Variant of Type II Short roots, dentine thin, pulp not obliterated

Type III: Brandywine isolate : Rare, isolated (Maryland)

Dentinal Dysplasia: o Autosomal dominant o Two types: Type I (Radicular Dentine Dysplasia): Most common Normal crowns Radiographs: Short, blunt, conical or absent roots Obliterated pulp chambers & RC Periapical radiolucencies but no caries Histologically: PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Roots: “water streaming round boulders” Type II (Coronal Dentine Dysplasia): Roots are normal Primary teeth: DI clinically Obliterated pulp chambers Permanent teeth: Normal colour Thistle-tube pulp chambers w pulp stones : Regional Anterior Delay or failure of eruption Irregular & hypoplastic enamel D is thin with interglobular D Pulp stones and widely open apices Focal calcifications in the dental follicle Radiographs: Ghost teeth

PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com :

 Hypercementosis: Periapical inflammation Occlusal forces Paget’s disease, Hyperpituitarism Idiopathic

 Hypocementosis: Cleidocranial dysplasia Hypophosphatasia

E) Disturbances in the eruption & shedding of teeth:

Premature eruption: Natal &

Premature loss of primary tooth

Hyperthyroidism & Gigantism

PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Delayed eruption/retarded eruption: Retained primary Hypothyroidism Crowding Nutritional Fibrosis Down syndrome Supernumerary/cyst/tumour Cleidocranial dysplasia Trauma Premature

Premature loss: Caries & Hypophosphatasia Palmar-Plantar hyperkeratosis

3. Developmental Disturbances of soft tissue

F) Congenital Lip Pits Autosomal D, uni/bilateral blind tracts at angle of lip

G) Double lip

Horizontal folds of mucosal tissue/inner aspect/U>L lip Goiter and skin folds above U eyelids

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H) Frenal Tag Autosomal D

U labial frenum

I) “tongue-tie”: Short & anteriorly positioned lingual frenum Complications:

J) : Congenital: Down syndrome & MEN III Acquired : Lymph/Haem/Neuro/Amyloid/GH/Cretinism

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K) Fordyce granules: Collection of sebaceous glands Mostly bilateral on BM Clinically: multiple yellowish structures (1-2m) Histologically: superficial 1-5 lobules with duct; no hair Adenomatous hyperplasia : >15 lobules & slightly elevated yellowish lesion 5-10m.

L) Lingual thyroid nodule: Thyroid tissue at mid-posterior dorsum of tongue Failure of migration Clinically: 2-3cm smooth sessile mass Apparent during puberty or adolescence Histologically: Complications:

M) Oral tonsil: Slightly elevated reddish plaques/FOM

Foliate Papilitis :

N) Sublingual varices: PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Dilated & tortuous lateral branches of sublingual veins

O) : Congenital deep fissures Complications: Melkersson-Rosenthal Syndrome

P) (Benign Migratory ): Filiform papillae Clinically: appearance, incidence, age & FH Migrate & periods of remission Asymptomatic but acidic & spicy food Other sites: Migratory Histologically: Edge: acanthosis & a dense AICI Centre: atrophy & CICI

Association: Median Rhomboid Glossitis: Appearance & site Origin: Tuberculum Impar vs. Candida PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com

4. Developmental Disturbances of :

Q) Hemifacial Hypertrophy: Significant unilateral enlargement of the face Aetiology: Associated: skin, hypertrichosis, mental retardatn, Wilms tumour Intraorally: unilateral macroglossia, teeth D. Dx: neurofibromatosis, fibrous dysplasia, A-V malformation

R) Hemifacial atrophy: Progressive unilateral decrease of face size (other parts) Aetiology Onset: 1 st or 2 nd decade Associated: hyperpigmentation & loss of facial hair Intraorally: & tongue, alveolar bone, teeth

S) Cleft Lip & palate: Cleft lip: Median nasal & maxillary process PDF Created with deskPDF PDFWriter -Trial::http://www.docudesk.com Nostril complete or incomplete Complete alveolar process & teeth M>F; 25% of cases; 80% uni; 70% on L side Cleft palate: Lateral portions of palate Degree F>M; 30% of cases Cleft lip & palate: M>F; 45% of cases Aetiology: Hereditary: 40% of CL & 20% of CP Environmental: Nutritional factors Stress Ischemia Large tongue Alcohol Drugs Toxins Infections