Developmental disturbances of the oral region

Developmental disturbances of the oral region are discussed under three categories: 1- disturbances affecting teeth 2- disturbances limited to soft tissue 3- disturbances affecting bone.

Disturbances affecting the teeth

A -Disturbances in the size:
1- Microdontia: Mean tooth or teeth smaller than the normal, either localized or generalized. In generalized its either true or relative: True: small teeth with normal size jaw bone & this occur in dwarfism. Relative: the jaw bone is larger than normal which lead to spacing between teeth giving picture of false microdontia. *in localized microdontia, usually one tooth affected & mostly in lateral incisor (peg lateral) & max third molar.

 2- macrodontia: Mean tooth or teeth larger than the normal, it may be generalized or localized In generalized its either true or relative True: large teeth in normal jaw bone size, occur in Giantism. Relative: normal teeth in small size jaw, cause crowding of teeth & give false picture of macrodontia. *in localized macrodontia, usually affect one side of jaw such in hemifacial hypertrophy.

B- Disturbances in number:
1- Anodontia: Complete absence of teeth (deciduous & permanent) It usually occurs in association with a generalized disorder such as hereditary ectodermal dysplasia. Therefore, all tissues derived from ectoderm are absent such as teeth, hair follicle, sweat gland, sebaceous gland. The patient suffer from smooth, thin & dry skin, cant tolerate heat due to absence of sweat glands. However, sometimes some teeth are present such as cuspids & molars

 2- Hypodontia: (partial anodontia) Mean congenital absence of one or more teeth. Although any tooth can be congenitally absent, but the most common are the 3rd molars, followed by the max, lateral incisors & the 2nd premolars Familial tendency for congenitally absent teeth is recognized. 3- Supernumerary teeth: Teeth in excess of the normal number They are more common in max, than in the mand A supernumerary tooth located between max, central incisors referred to as a mesiodens. The 4th molar called paramolar. A supernumerary tooth may resemble the corresponding normal tooth, or it may be smaller or conically shaped, bearing little or no resemblance to its normal counterpart. Supernumerary teeth may be single or multiple & erupted or impacted Multiple supernumerary teeth, which are generally impacted, are characteristically seen in Cleidocranial dysplasia.

C- Disturbances in eruption:
1- Premature eruption: Teeth erupt earlier than its normal eruption time Usually involves only one or two teeth, most commonly the deciduous mand, central incisors, & usually are part of the normal complement of deciduous teeth, they are not supernumerary tooth & should therefore be retained if possible. We have 2 types: Natal teeth: deciduous teeth present at birth Neonatal teeth: deciduous teeth that erupt during the 1st 30 days of life.

2- Delayed eruption: Teeth fail to erupt at its normal time & it may be associated with: Systemic conditions like, Cleidocranial dysplasia, cretinism & rickets. Local conditions like, gingival fibromatosis, insufficient space in the dental arch, abnormal position of tooth germ, & supernumerary teeth which prevent eruption of original one. 3- Impacted teeth: Teeth that continue to form within bone but fail to erupt, the causes same that of delayed eruption We have 3 types: *complete impaction: impacted tooth that is totally surrounded by bone *partial impaction: the tooth partly in bone & partly in soft tissue *retained (embedded) tooth: teeth that fail to erupt due to unknown reason 4- Eruption sequestrum: This occurs as small spicule of bone that is extruded through the alveolar mucosa that overlies an erupting molar.

D- Disturbance in shape
1- Dilaceration: A sharp bend or angulation of the root
portion of a tooth. Cause difficulty in extraction & root canal therapy.

2- Taurodontism: A molar with an elongated crown &

apically placed furcation of the roots, resulting in an enlarged rectangular coronal pulpal chamber, (bull like) teeth. There is no constriction at the area of crown & root (cementoenamel junction).

3- Dens invaginatus: A focal area of the crown of a

max, lateral incisor is folded inward (invagination) which lead to small opening & accumulation of food debris, then caries. Sometimes this condition called dens in dentin which mean tooth inside the tooth.

4- Dens evaginatus: Is a developmental abnormality

that primarily affects premolars. Its characterized by the development of an abnormal nodular or globe-shaped projection appearing as an extra cusp centrally located on the occlusal surface between the buccal & lingual cusps of premolars, although any tooth may be involved

 5- Talon cusp: A form of supernumerary cusp,

typically seen on the lingual aspect of max, incisors, is called a talon because its resembles an eagles talon.

6- supernumerary roots: Additional roots, more than

the expected number, are termed supernumerary roots. This is common in mand, premolars & cuspids.

7- Gemination: Is a developmental anomaly that

affects anterior teeth, they result from partial division twinning of a single tooth germ, resulting in a tooth with two separated or partly separated crowns & a single root & root canal.

8- Fusion: Result from the union of two normally

separated tooth germs, it can be complete or incomplete. * we can differentiate between gemination & fusion clinically by counting the teeth in each arch, if one tooth is missing mean fusion, but if with normal number mean gemination.

 9- Concrescence: Is a type of fusion of two teeth

through cementum. The condition is thought to occur as a result of traumatic injury to the area or crowding where interseptal bone is lost, allowing close proximation of the tooth roots.

10- Hypercementosis: Excess cementum at the root

area (usually at the apex) & known as bulbous root.

11- Cervical enamel projection: A focal apical

extensions of the coronal enamel beyond the cervical margin (cementoenamel junction) & onto the root of the tooth. Their clinical significant is that they could contribute to periodontal pocket formation. present usually at the bifurcation or trifurcation area of the molars; its also called Enameloma.

12- Enamel pearls: Globular droplets of enamel that