Disorders of the teeth & bone Dent 555 Dr. Jumana Karasneh

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Disorders of the teeth bone

• Dent 555
• Dr. Jumana Karasneh

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Disorders of teeth

• Poor indicator of general health
• Structural abnormalities reflect changes during
  tooth formation
• Caused by
• Developmental
• Environmental conditions

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I- Variation in number

• Anodontia
• Hereditary ectodermal dysplasia
• Hypodontia / oligodontia
• 3rd molars, Second premolars, Lateral incisors
• Supernumerary teeth
• More common in maxilla than mandible
• Supplemental / conical shape
• Mesiodens
• paramolars

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II- Variation in size

• Determined by inherited factors NOT hormonal /
  environmental
• Micordontia
• Generalized / localized
• True or relative
• Macrodontia
• Generalized / localized
• gemination / fusion
• True or relative

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III- Disturbance in shape

• Dilacerations
• Taurodontism
• Dens invaginatus
• Supernumerary cusp
• Dens evaginatus
• Talon cusp

• Supernumerary root
• Gemination
• Fusion
• Concrescence
• Hypercementosis
• Cervical enamel projection
• Enamel pearl

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IV- Disturbance in Eruption

• Early body development is associated with early
  development of teeth
• Premature Eruption
• Rare in permanent teeth
• Delayed Eruption
• Endocrine deficiency (rickets)
• Downs syndrome
• Local factors (hereditary gingival fibromatosis)
• Impacted teeth
• Partial / complete
• Caused by
• Crowding
• Physical barrier (cyst, tumour)

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V- Disturbance in structure

• Hypoplasia is a general term used clinically to
  describe a wide range of diseases
• Defect could occur in enamel, dentin or both
• Defect in enamel could occur in one stage of
  formation or all

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V- Disturbance in structureclinical
classification

• Enamel or dentine developmental defect result
  from localized disturbance
• Turner tooth
• Enamel or dentine developmental defect result
  from generalized disturbance
• Genetically determined defects of enamel or
  dentine formation

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Generalized factors

• Infections (chicken pox, syphilis)
• Chemicals (fluoride, drugs,)
• Malnutrition (general, Vit. D)
• Metabolic disorders (hypoparathyroidism inducing
  hypocalcemia , celiac disease)
• Ectodermal disease (EB)
• Chronological bands usually visible unless
  causing factor was permanent

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Generalized factors

• Infections (chicken pox, syphilis)
• Chemicals (fluoride, drugs,)
• Malnutrition (general, Vit. D)
• Metabolic disorders (hypoparathyroidism inducing
  hypocalcemia , celiac disease)
• Ectodermal disease (EB)
• Chronological bands usually visible unless
  causing factor was permanent

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Genetically determined defects

• Disturbance of enamel structure
• Amelogenesis imperfecta
• Disturbance of dentin structure
• Dentinogenesis imperfecta

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Disturbance of enamel structure Amelogenesis
imperfecta

• Affects all teeth of both dentitions
• Results from defective amelogenin genes on X
  chromosomes and autosomes
• At least 16 variants noted based upon inheritance
  pattern, enamel qualities, and radiographic
  features

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Amelogenesis imperfecta Clinical Presentation

• Enamel hardness varies depending upon type of
  defect
• Hypoplastic Normal hardness but deficient
  amounts of enamel
• Hypocalcified soft but normal amounts of enamel
• Hypomaturation normal thickness of enamel but
  reduced hardness

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Disturbance in dentin structureDentinogenesis
imperfecta
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Developmental disorder of teeth Disturbance in
dentin structureDentin dysplasia

• Type I (rootless teeth)
• Normal ? bluish enamel
• Might exfoliate prematurely

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Developmental disorder of teeth Disturbance in
dentin structureDentin dysplasia
Type II

• Both primary permanent teeth are affected
• Deciduous with bluish-gray / yellow
• Normal permanent
• Pulp stones

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Developmental disorder of teeth Regional
odontodysplaia (ghost teeth)

• Abnormal enamel, dentin and pulp
• idiopathic
• Affect one region

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Non-carious tooth surface loss
abrasion
erosion
attrition
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Erosion

• Extrinsic acids
• Beverages
• Foods
• Industrial processes
• Intrinsic acids
• Gastro-oesophagial reflux disease
• Bulimia nervosa
• Morning sickness in pregnancy

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Discoloration of teeth

• Extrinsic
• Bacterial staining
• Tobacco
• Restorative material
• Intrinsic
• Tetracyclin
• Hyperbilirubinemia - related

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Disorders of Bone
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Classification of bone disorders

• Inherited developmental
• Cleidocranial dysplasia
• Fibrous dysplasia
• Albrights syndrome
• Metabolic endocrine
• Gigantism acromegaly
• Hyperparathyroidism
• Hypoparathyroidism
• Osteoporosis
• Rickets osteomalacia
• Disorders of unknown aetiology
• Pagets disease

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Inherited developmental bone disordersCleidocra
nial dysplasia

• Clinical presentation
• Lack of clavicle calcification
• Hypodontia
• Some with high arched palate
• Diagnosis
• Clinical presentation
• Radiographic findings

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Inherited developmental bone disordersCleidocra
nial dysplasia Diagnostic radiographic findings

• Ablasia or hypoplasia of clavicle
• Wormian bones of the skull
• Multiple impacted teeth

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Inherited developmental bone disordersFibrous
dysplasia

• Replacement of normal bone by partially calcified
  fibrous mass
• Affect one bone (monostotic)
• Affect multiple bones (polystotoic)
• Unknown aetiology
• Diagnosis
• Clinical symptoms
• Radiological appearance
• Biochemical investigation (Ca, phosphate,
  alkaline phosphatase)

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Inherited developmental bone disordersMonostoti
c fibrous dysplasia

• Clinical Presentation
• Asymptomatic, self limiting slow-growing
• Typically starts at childhood arrest at
  adulthood
• Affect maxilla more often than mandible
• Facial asymmetry a frequent presenting sign
• Tooth displacement and malocclusion
• Radiographic Findings
• Variable
• Diagnosis
• Clinical
• Radiographic
• No changes in blood chemistry
• Treatment
• Cosmetic contouring when growing completed

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Inherited developmental bone disordersPolystoti
c fibrous dysplasia

• Clinical Presentation
• Usually associated with other systems (Albrights
  syndrome)
• Polystotic fibrous dysplasia
• Multiple fractures
• Skeletal deformity
• Café au lait spots
• Precocious puberty in female
• Diagnosis
• Clinical
• Radiographic
• changes in blood chemistry (?Ca, ?Alk phosph)

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Metabolic endocrineGigantism acromegaly

• Hypersecretion of growth hormone
• Usually associated with adenoma of anterior
  pituitary gland
• In children with open epiphyses ? gigantism
• After epiphyses closure ? acromegaly

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Metabolic endocrineAcromegaly

• Clinical picture
• Renewed growth of mandible, hands feet
• Prognathism
• Malocclusion spacing
• TMJ pain
• Coarsening of facial features
• Macroglossia
• Rare complication
• Increased intracranial pressure ? Headaches
• Blindness
• Facial pain
• Cardiomyopathy
• Treatment
• Surgery (remove tumor)
• Radiotherapy
• Corrective surgery

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Metabolic endocrineHyperparathyroidism

• ? PTH due to
• Adenoma in parathyroid gland (Primary)
• ? Ca level due to renal failure or coeliac
  disease (Secondary)
• PTH ? osteoclastic activity
• Clinical picture
• Asymptomatic in mild cases
• Life threatening in severe cases
• Diagnosis
• Blood chemistry (? Ca, ? PTH )
• Radiograph
• Well defined radiolucencies
• Loss of lamina dura

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Metabolic endocrineHypoparathyroidism

• Cause
• Trauma during thyroid surgery
• Autoimmune disease
• Clinical picture
• All calcified tissues might be affected including
  teeth (during development)
• Hypoplastic enamel (hypocalcification,
  hypomaturation)
• Hypomineralized dentine
• Tingling lips, fingers, and toes
• Muscle cramps
• Pain in the face, legs, and feet
• Diagnosis
• Blood chemistry (? Ca, ? PTH )

? PTH ? ? Ca level
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Metabolic endocrineOsteoporosis

• Reduction in bone mass per unit volume (matrix
  Ca)
• Clinical picture
• Very common
• High risk people
• Old age
• women mainly with early menopause
• Pt on steroid therapy (5mg prednisolon/day for 3
  months)
• Immobalization
• hyperparathyroidism
• Fracture in response to minor trauma
• Rapid resorption of alveolar ridge
• Normal serum biochemistry
• Treatment
• Ca supplement and Bisphophonate

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Metabolic endocrineRickets

• Deficient calcification of bones ( teeth) in
  children due to lack of vit D (nutritional
  deficiency, malabsorption or impaired metabolic
  process)
• Clinical picture
• Badly shaped bones
• Some reports of hypoplasia
• Osteomalcia is the adult equivalent of the
  condition usually caused by pregnancy,
  malabsorption, renal disease

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Pagets disease

• Affect old age
• Imbalance of osteogenic oseolytic processes in
  bone formation
• Can affect any bone including skull
• Clinical presentation
• dentures become tight
• Spacing between teeth
• Hypercementosis ? difficult extraction
• Bone pain
• Cranial nerves might be affected
• Normal Ca phosphate levels

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Pagets disease

• Radiographic presentation
• Loss of normal bone trabeculation
• Areas of sclerosis in later stage
• Cotton wool appearance

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Pagets disease

• Diagnosis
• Clinical picture
• Radiograph
• Blood chemistry (?Alk. Phosph)
• Treatment
• No treatment if asymptomatic
• Bisphosphonate (anti osteoclastic)
• Ca Vit D supplement
• Surgery if deformity is present
• Oral consideration
• Difficult extraction due to hypercementosis
• Postoperative haemorrhage due to
  irregular/increased blood supply
• More susceptible to infection ? antibiotic cover
• Bisphosphonate before any surgical treatment