Pediatric dentistry

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Pediatric dentistry

• School of Dentistry
• Wuhan University
• 2006
• Hong Qian

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Abnormality of tooth development

• Abnormality of tooth number
• congenital absence of teeth
  supernumerary tooth
• Abnormality of tooth form
• double teeth geminated teeth fused
  teeth concrescence of teeth peg-shaped
  lateral incisor dens invaginatus dens
  evaginatus
• dilaceration taurodontism
• Abnormality of tooth structure
• enamel hypoplasia and hypomineralisation
  dentinogenesis imperfecta intrinsic
  staining of teeth
• Abnormality of tooth eruption
• natal and neonatal teeth delayed eruption
  submerged teeth ectopic eruption retained
  teeth

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Abnormality of tooth numberCongenital absence of
teeth

• Total anodontia congenital absence of all teeth
• Partial anodontia (hypodontia, oligodontia)
• congenital absence of one or more teeth

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AnodontiaTreatment

•  Depends on severity of the case      
•  No treatment       
• Prosthetic replacement
• Prognosis good 

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Supernumerary toothDefinition

• Additional to normal series and can be found in
  almost any region of dental arch.
• Etiology
• ? A dichotomy of tooth bud.
• ? Local, independent, conditioned
  hyperactivity of
• dental lamina.
• ? Heredity. More common in relatives of
• affected children than in general
  population.

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Supernumerary toothPrevalence

• 0.8 of primary dentitions and 2.1 of permanent
  dentitions.
• Single or multiple, unilateral or bilateral,
  erupted or impacted, and in one or both jaws.
• Associated with cleft lip and palate,
  cleidocranial dysplasia, and Gardner syndrome.

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Supernumerary toothConical

• Root formation ahead of or at an equivalent stage
  to that of permanent incisors.
• Found high and inverted into palate
• or in a horizontal position.
• Mostly long axis of tooth is normally inclined.
  Can result in rotation or displacement of
  permanent incisor, rarely delays eruption.

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Supernumerary toothTuberculate

• More than one cusp or tubercle
• Barrel-shaped and may be invaginated
• Root formation delayed
• Often paired and rarely erupt and frequently
  associated with delayed eruption of incisors
• Commonly located on palatal aspect of central
  incisors

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Supernumerary toothSupplemental

• Duplication of teeth in normal series and found
  at the end of a tooth series.
• Most common permanent maxillary lateral incisor.
• Majority found in primary dentition are of the
  supplemental type and seldom remain impacted.

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Supernumerary toothOdontoma

• Tumor of odontogenic origin.
• Lesion composed of more than one type of tissue
  and called a composite odontoma.
• Complex composite odontoma diffuse mass of
  dental tissue which is totally disorganized.
• Compound composite odontoma malformation which
  bears some superficial anatomical similarity to
  normal tooth.

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Problems associated with supernumerary tooth

• Failure of Eruption
• Displacement
• Crowding
• Pathology dentigerous cyst formation
• Alveolar bone grafting
• Implant site preparation
• Asymptomatic

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Indications for supernumerary removal

• central incisor eruption delayed or inhibited
• evident altered eruption or displacement of
  central incisors
• there is associated pathology
• active orthodontic alignment of an incisor in
  close proximity to supernumerary is envisaged
• its presence would compromise secondary alveolar
  bone grafting in cleft lip and palate patients
• present in bone designated for implant placement
  
• spontaneous eruption of supernumerary occurred.

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Abnormality of tooth formDouble teethgeminated
teeth

• Make two teeth from one enamel organ.
• Two completely or incompletely separated crowns
  with a single root and root canal.
• Causes trauma and familial tendency.
• Seen in deciduous and permanent dentition.

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Double teethfused teeth

• Joining of two tooth germs results in a single
  large tooth.
• Involve entire length of teeth, or only roots.
• Shared or separate root canal.
• Causes trauma and familial tendency.
• In deciduous and permanent dentition.
• Difficult to differentiate fusion of
  supernumerary teeth from gemination.

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Double teethconcrescence of teeth

• Concrescence is fusion of adjacent already-formed
  teeth by cementum.
• Take place before or after eruption.
• A form of fusion where teeth are united by
  cementum only.
• Causes trauma or crowding of teeth.

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Peg-shaped lateral incisor

• Reduced mesio-distal diameter and proximal
  surfaces converging markedly in incisal
  direction.
• Prevalence 1 to 2.
• Associated with other dental anomalies like tooth
  agenesis, maxillary canine-first premolar
  transposition, palataly displacement of maxillary
  canine teeth and mandibular lateral incisor-
  canine transposition.

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Peg-shaped lateral incisorTreatment

• Moving maxillary canines forward and reshape them
  with acid etch technique and bonded composite
  resin to simulate lateral incisors.
• Restoring missing tooth structure by increasing
  size of a peg-shaped lateral incisor.
• Placing full-coverage crown on lateral incisors.

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Dens evaginatusDefinition

• A developmental anomaly in which focal area of
  crown projects outward and produces a nodule
  composed of pulpal horn and normal layers of
  enamel and dentin.
• The nodule (talon cusp) can result from abnormal
  proliferation of enamel epithelium from interior
  of stellate reticulum of enamel organ .
• Its etiology is unknown.
• North American Indian and Asian background

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Dens evaginatus

• Problem fairly soon after tooth eruption this
  extra cusp can be ground off during mastication,
  resulting in pulp exposure.
• Early pulpal necrosis leads incomplete root
  development and open apex situation, the most
  difficult endodontic cases to apexify.
• Surgical treatment is very difficult because of
  minimal root length and thin dentinal walls.

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Dens evaginatusClinical features

• Primarily premolars   
• Usually bilateral   
• Conical, tuberculated projection from central
  fissure of occlusal surface   
• Can interfere with tooth eruption thus causing
  tooth displacement   

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DilacerationDefinition

• A sharp bend or angulation of root portion of a
  tooth.
• Etiology
• Trauma during tooth development or idiopathic

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DilacerationClinical features

• Rare in deciduouos teeth   
• History of trauma or presence of a cyst, tumor,
  or odontogenic hamartoma   
• Many are nonvital and associated with periapical
  inflammatory lesions   
• Frequently maxillary incisor or mandibular
  anterior dentition

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DilacerationTreatment

• Extraction for normal eruption of succedaneous
  teeth   
• Usually no therapy for dilaceration of permanent
  teeth   
• Orthodontic therapy for grossly dilacerated
  teeth 
• Prognosis good

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Abnormality of tooth structureEnamel hypoplasia
and hypomineralisation

• Local
• Developing permanent teeth may be damaged by
  trauma or by infection associated with their
  predecessors.
• Systematic
• genetically-transmitted factors, inborn
  errors of metabolism, neonatal disturbances,
  endocrinopathies, gastrointestinal disease, liver
  disease and excessive ingestion of fluoride.
• Hereditary

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Enamel hypoplasia and hypomineralisationDistribut
ion

• Permanent teeth
• First molars -occlusal 1/3
• Central incisors and mandibular lateral
  incisors -incisal 1/3
• Canines -tips of cusps
• Primary teeth
• Molars -cervical-middle 1/3
• Canines -cervical-middle 1/3
• Incisors -cervical 1/3

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Enamel hypoplasiaClinical features

• pits, grooves, lines or larger areas of missing
  enamel surface   
• reduction in enamel thickness   
• possible occlusal distortion, aesthetic problems,
  sensitivity   
• yelllowish or brownish discoloration   
• may be localized or present on numerous teeth and
  all or part of surfaces of each affected tooth
  may be involved

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Enamel hypomineralisation

• Poor appearance of anterior teeth
• Chipping of enamel, leaving rough surfaces
• Attrition of occlusal enamel
• Exposure of dentinetooth sensitivity
• Attrition of dentine

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Dentinogenesis imperfectadefinition

• A hereditary defect consisting of opalescent
  teeth composed of irregularly formed and
  undermineralized dentin that obliterates coronal
  and root pulpal chambers.

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Dentinogenesis imperfectaTreatment

• composite resin restorations, laminate veneers,
  stainless steel crowns on molars, and over
  dentures 
• Prognosis 
• good with early diagnosis

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Intrinsic stains

• Intrinsic Stains
• Located within tooth anatomy, can be of
  varied origin.
• May result from pre-eruptive or post-eruptive
  causes.

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Intrinsic stainsHereditary conditions

• Hereditary conditions such as porphyria and
  phenylketonuria can result in a deposition of
  colored materials in teeth.
• Other pre-eruptive staining include amelogenesis
  imperfecta and dentinogenesis imperfecta.

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Tetracycline Staining

• Use of tetracycline during period of tooth
  formation - including last half of in utero
  development - leads to its incorporation into
  tooth structure.
• Resulting appearance depends both on intensity of
  use and type of tetracycline employed.
• Tetracycline can be transferred through placenta
  and enter fetal circulation.
• Discoloration may be generalized or limited to a
  specific part of individual teeth that were
  developing.

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Ingestion of fluoride

• Ingestion of excessive amounts of fluoride during
  tooth formation can lead to areas of lighter
  appearing enamel. These spots are chalky white
  and cannot be bleached to match surrounding
  enamel. Referred to as 'mottled enamel'.
• Whitening does not remove white spots but
  lightens background so they are less noticeable.
  Secondary stains around these white areas are
  readily bleached to produce appearance less
  noticeable.

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Abnormality of tooth eruptionEarly
eruption-natal tooth and neonatal tooth (1)

• Natal teeth already present at the time of birth.
  
• Neonatal teeth erupt during first 30 days after
  birth.
• Associated Conditions
• Cleft Palate
• Ellis-van Crevald Syndrome
• Hallermann-Streiff Syndrome
• Pachyonychia Congenita Syndrome

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Natal tooth and neonatal tooth (2)

• ? Incidence varies from 11000 to 130 000.
• ? Either a premature eruption of normal teeth (up
  to 95) or supernumerary (5).
• ? Removed only if they are extremely mobile.
• ? Supernumerary teeth need extraction if
  confirmed by radiography.

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Natal tooth and neonatal tooth (3)

• Generally develop on lower gum where central
  incisors will be.
• Little root structure and attached to margin of
  gum by soft tissue and often wobbly.
• Not well formed but firm enough, may cause
  irritation and trauma to infant's tongue while he
  is nursing.

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Natal tooth and neonatal tooth Home care and
treatment

• If not removed, keep them clean by gently wiping
  gums and teeth with clean, damp cloth. Examine
  infant's gums and tongue frequently to make sure
  teeth are not causing injury.
• See a dentist if
• an infant with natal teeth that develops a
  sore tongue or mouth
• other symptoms develop.

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Delayed eruption of deciduous or permanent
teethEtiology for incisors

• Delayed resorption of a primary incisor following
  trauma and death of pulp.
• Dilaceration
• Supernumerary teeth
• Very early loss of a primary tooth, followed by
  formation of bone in tooth socket.

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Delayed eruptionEtiology for canines and
premolars

• Abnormal eruption path of maxillary permanent
  canines.
• Impaction against other teeth due to abnormal
  angulation or crowding.
• Retarded resorption of a primary molar.
• Submerged primary molars

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Delayed eruptionEtiology for molars

• Impaction against other teeth, especially
  affecting third molars.
• Other conditions, such as a dentigerous cyst, may
  affect any tooth.

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Delayed eruptionTreatment for maxillary
permanent canines (1)

• Extract maxillary primary canines and surgically
  expose crowns of permanent canines in a child
  aged 10-13 years
• if permanent canine might have erupted
  normally following extraction.

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Delayed eruptionTreatment for maxillary
permanent canines (2)

• Retain maxillary primary canines and extract
  permanent canines
• If position of a maxillary permanent canine is
  unfavourable
• If its root development has reached an
  advanced stage, prognosis is poor for normal
  eruption or for repositioning following
  extraction of its predecessor.

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Delayed eruptionTreatment for maxillary
permanent canines (3)

• Extract maxillary primary canines and transplant
  permanent canines
• if position of maxillary permanent canine is
  unfavorable for orthodontic alignment.

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Ectopic eruption of first permanent
molarsDefinition

• Ectopic eruption is a developmental disturbance
  in eruption pattern of permanent dentition.
• Molar erupts at a mesial angle to normal path of
  eruption, results in cessation of eruption and
  atypical resorption of neighboring primary molar.
  
• Permanent tooth may get locked in this position
  (irreversible) or correct itself without
  treatment and erupt into normal position
  (reversible).

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Ectopic eruptionPrevalence

• Prevalence approximate 4 rate
• Almost 60 were reversible.
• Mostly seen in maxilla, unilateral or bilateral.
• Could not identify significant differences
  between different racial groups.
• More frequent occurrence in cleft lip and palate
  patients

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Ectopic eruptionEtiology

• Mesial angle of first permanent molar is clearly
  increased. Extraction of second deciduous molar
  had no influence on angulation. Cause of this
  pronounced mesial inclination could not be
  established.
• Width of first permanent molar is increased
  compared to children with normal eruption. Size
  of central incisors cannot be used to predict
  ectopic molar eruption.

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Ectopic eruptionClinical implication

• A 3-6 month observation period
• if resorption on primary molar is not too
  severe.
• Cases that self correct usually correct
• before 7 years of age.

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Ectopic eruptionTreatment

• Treatment goals for irreversible ectopic eruption
  are movement of permanent molar distally in order
  to regain space and correction of mesial tipping
  of permanent molar to allow normal eruption.
• Disimpact tooth using soft brass ligature wire if
  tooth is impacted against crown rather than root
  of primary molar.
• Distal slicing of primary molar is not indicated
  because it will result in space loss and
  permanent molar erupt in tipped position that
  favor development of malocclusion.

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Retained deciduous toothDefinition

• Deciduous teeth retained beyond time of
  exfoliation are diagnosed as retained deciduous
  tooth.
• Causes absence of bud of permanent tooth or
  abnormal displacement of bud in embroyonic life.