EXAMINATION OF THE TEETH: PATHOLOGIC CONDITIONS AFFECTING DEVELOPMENTAL DISTURBANCES AND

ANOMALIES

EXAMINATION OF THE TOOTH

ColorColor is determined by translucency and thickness

of the enamel and by thickness and color of the underlying dentin

Discoloration may result from developmental disturbances whereby the normal pattern of enamel prisms and dental tubules is disturbed.

COLORDiscoloration due to Developmental Disturbances Amelogenesis Imperfecta Dentinogenesis Imperfecta Brown hereditary teeth Dental fluorosis or mottling

COLORDiscoloration from intrinsic pigments Pigments arising from hemolysis or associated

with jaundiceo May be considerably green, yellow-brown, or

black. Tooth Non-vitality

o May be Gray, yellow-brown, or orange-yellow Internal Resorption

o May be Pink or black

COLORDiscoloration from medicaments during Endodontic therapy Staining

From permeation of medicaments into dentinal tubules during sterilization of cavity prep

Metallic staining From ingestion or inhalation of metals or their

salts

Tobacco use Most frequent cause of staining

SIZE Macrodontia microdontia

NUMBER Supernumerary teeth Complete or partial anodontia

FORM AND STRUCTURE Developmental disturbances of form:

Geminated teethFused teethConcrescenceEnamel pearlsDens in dente

FORM AND STRUCTURE Developmental disturbances of form:

Turner’s teethOdontomasHutchinson’s teethMulberry molarAccessory cuspsHypoplastic defects

FORM AND STRUCTURE Hereditary disturbances of form:

Enamel hypoplasiaDentinogenesis imperfectaDentin dysplasiaAmelogenesis imperfecta

Extrinsic or environmental alterations responsible for variations after teeth have fully formed are manifested as erosion, abrasion, caries or extensive attrition

ENAMEL DYSPLASIA

ENAMEL DYSPLASIA- refers to the hypoplasia and

hypomaturation of the enamel.- result of any disturbance in the

formation of enamel matrix.

Hypomaturation- occurs from incomplete crystallization of the enamel.

Hypocalcification- result from any disturbance that interferes with the normal deposition of calcium.

HYPOCALCIFICATION

CAUSE Local - Periapical inflamation, Truma,

Surgical procedure. Systemic - Nutritional deficiencies,

endocrine disturbances, and other systemic disease.

Hereditary disease – various hereditary defects of the enamel are seen,

such as amelogenisis imperfecta, brown teeth, and other hypoplasia of enamel.

ENAMEL HYPOPLASIAAppears as a localized alteration of one or

several or may involve all the teeth.Consist of the absence of enamel and

dentin or of enamel only.

ENAMEL HYPOPLASIA

CLINICAL APPEARANCE Depends on the stage of amelogenisis. Central incisors show well defined

horizontal lines of pits and grooves. Single or multiple chalky white opaque

spots may be present on the teeth.- opaque may also be caused by

faulty matrix apposition which changes the index of refraction

DIFFERENCE BETWEEN HYPOCALCIFIED AND DECALCIFIED ENAMEL

Hypocalcified Decalcified

White and opaque Glazed Smooth

White and opaque Granular Rough Soft surface

ENDEMIC DENTAL FLOUROSIS (MOTTLED ENAMEL)

Resulting from consumption of water containing an excess of flourine.

Maybe mild to severe in character.

CLINICAL MANIFESTATION Cloudy opaque areas of yellow or brown

areas if extrinsic material has pigmented the areas.

HUTCHINSON’S INCISORS Results from hypoplasia of the central

developmental lobe with a collapse of the lateral developmental lobe.

Screw driver shape appearance.

COMMON ERROR REGARDING HUTCHINSON’S INCISORS

Examiner attributes notching of the incisors teeth of central developmental lobe rather than loss of tooth structure from trauma.

COMMON ERROR REGARDING MULBERRY MOLARS Mulberry molars are also sugestive of

congenital syphilis. They are characterized by normal buccal and lingual surfaces but have occlusal surfaces analogous to a mulberry.

Localized defects of the occlusal surface of the molar teeth have at times been incorrectly diagnosed as mulberry molars

MULBERRY MOLARS

AMELOGENESIS IMPERFECTAAmelogenesis imperfecta in which the

enamel is apparently of normal thickness and surface consistency is hereditary brown teeth.

In this condition it is not hard as normal and tends to chip on the Incisal and occlusal surfaces.

Extension of brown color throughout the enamel and involvement of all the teeth.

AMELOGENESIS IMPERFECTA

DENTINOGENESIS IMPERFECTA Opalescence Abnormal coloration Absence of pulp canals Poorly calcified dentin Constricted roots

DENTIN DYSPLASIA Clinically manifested by:

- wandering teeth- malposed teeth

Radiographically- absence of pulp canals- decreased density of dentin- short narrow roots- radiolucent apical area

DENTIN DYSPLASIA TYPE 1

SUPERNUMERARY TEETH Refers to the increase in the normal

number of teeth present in dentition. Supernumerary teeth may interfere with

normal eruption. Can be seen radiograhically in person

with cleidocranial dysostosis.

SUPERNUMERARY TEETH In addition to the dental defect,

defective ossification of the clavicles and bones of the skull can be noted.

SUPERNUMERARY

EROSION Result from a chemical process, and the

defects are usually limited to the labial and buccal surfaces of teeth.

Vary in shape from suacerlike depression to deep wedge-like groves

EROSION

ABRASION May occur anywhere on the enamel

surface or the cervical area of root Mechanical wearing of the tooth

structure by physical agents such as toothbrushes, abrasive powders, hairpins, nails, clay pipestems, glass, toothpick, dental tape, sand, and thread.

FRACTURES Involves both the crown and the roots. Root fractures require radiographic

evaluation.

FRACTURETwo factors that must be determined in

evaluation of fractered tooth:

1. Fracture involves the pulp2. Pulp has been secondarily involved by

injury at the apex.