disorder of the teeth and bone

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

2. Disorders of teeth
 Poor indicator of general health
 Structural abnormalities reflect changes during
tooth formation
 Caused by:
1. Developmental
2. Environmental conditions

3. I- Variation in number
1. Anodontia
 Hereditary ectodermal dysplasia
1. Hypodontia / oligodontia
 3rd
molars, Second premolars, Lateral
incisors
1. Supernumerary teeth
 More common in maxilla than
mandible
 Supplemental / conical shape
 Mesiodens
 paramolars

4. II- Variation in size
 Determined by inherited factors
NOT hormonal / environmental
1. Micordontia
 Generalized / localized
 True or relative
1. Macrodontia
 Generalized / localized
 gemination / fusion
 True or relative

5. III- Disturbance in shape
1. Dilacerations
2. Taurodontism
3. Dens invaginatus
4. Supernumerary cusp
5. Dens evaginatus
6. Talon cusp
7. Supernumerary root
8. Gemination
9. Fusion
10. Concrescence
11. Hypercementosis
12. Cervical enamel projection
13. Enamel pearl

6.  Early body development is associated with early
development of teeth
1. Premature Eruption
 Rare in permanent teeth
1. Delayed Eruption
 Endocrine deficiency (rickets)
 Down’s syndrome
 Local factors (hereditary gingival fibromatosis)
1. Impacted teeth
 Partial / complete
 Caused by:
 Crowding
 Physical barrier (cyst, tumour)
IV- Disturbance in Eruption

7. 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

8. V- Disturbance in structure
clinical classification
1. Enamel or dentine developmental defect result
from localized disturbance
1. Turner tooth
2. Enamel or dentine developmental defect result
from generalized disturbance
3. Genetically determined defects of enamel or
dentine formation

9. Generalized factors
1. Infections (chicken pox,
syphilis)
2. Chemicals (fluoride, drugs,
…)
3. Malnutrition (general, Vit. D)
4. Metabolic disorders
(hypoparathyroidism inducing
hypocalcemia , celiac disease)
5. Ectodermal disease (EB)
 Chronological bands
usually visible unless
causing factor was
permanent

10. 1. Infections (chicken pox,
syphilis)
2. Chemicals (fluoride, drugs,
…)
3. Malnutrition (general, Vit. D)
4. Metabolic disorders
(hypoparathyroidism inducing
hypocalcemia , celiac disease)
5. Ectodermal disease (EB)
 Chronological bands
usually visible unless
causing factor was
permanent
Generalized factors

11. Genetically determined defects
1. Disturbance of enamel structure
1. Amelogenesis imperfecta
2. Disturbance of dentin structure
1. Dentinogenesis imperfecta

12. 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

13. 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

14. Disturbance in dentin structure
Dentinogenesis imperfecta

15. Developmental disorder of teeth
Disturbance in dentin structure
Dentin dysplasia
Type I (rootless teeth)
•Normal → bluish enamel
•Might exfoliate prematurely

16. Developmental disorder of teeth
Disturbance in dentin structure
Dentin dysplasia
 Both primary & permanent teeth are affected
 Deciduous with bluish-gray / yellow
 Normal permanent
 Pulp stones
Type II

17. Developmental disorder of teeth
Regional odontodysplaia (ghost teeth)
 Abnormal enamel,
dentin and pulp
 idiopathic
 Affect one region

18. Non-carious tooth surface loss
erosion
attrition
abrasion

19. Erosion
 Extrinsic acids:
 Beverages
 Foods
 Industrial processes
 Intrinsic acids:
 Gastro-oesophagial reflux disease
 Bulimia nervosa
 Morning sickness in pregnancy

20. Discoloration of teeth
1. Extrinsic
1. Bacterial staining
2. Tobacco
3. Restorative material
2. Intrinsic
1. Tetracyclin
2. Hyperbilirubinemia - related

21. Disorders of Bone

22. Classification of bone disorders
1. Inherited & developmental
1. Cleidocranial dysplasia
2. Fibrous dysplasia
3. Albright’s syndrome
2. Metabolic & endocrine
1. Gigantism & acromegaly
2. Hyperparathyroidism
3. Hypoparathyroidism
4. Osteoporosis
5. Rickets & osteomalacia
3. Disorders of unknown aetiology
1. Paget’s disease

23. Inherited & developmental bone
disorders
Cleidocranial dysplasia
 Clinical presentation
1. Lack of clavicle calcification
2. Hypodontia
3. Some with high arched
palate
 Diagnosis:
 Clinical presentation
 Radiographic findings

24. Inherited & developmental bone disorders
Cleidocranial dysplasia
Diagnostic radiographic findings
1. Ablasia or hypoplasia
of clavicle
2. Wormian bones of the
skull
3. Multiple impacted
teeth

26. Inherited & developmental bone
disorders
Fibrous 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)

27. Inherited & developmental bone disorders
Monostotic 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

28. Inherited & developmental bone
disorders
Polystotic fibrous dysplasia
Clinical Presentation
 Usually associated with other systems (Albright’s 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)

29. Metabolic & endocrine
Gigantism & acromegaly
 Hypersecretion of growth hormone
 Usually associated with adenoma of
anterior pituitary gland
In children with open epiphyses → gigantism
After epiphyses closure → acromegaly

30. Metabolic & endocrine
Acromegaly
Clinical picture
1. Renewed growth of mandible, hands & feet
1. Prognathism
2. Malocclusion & spacing
3. TMJ pain
2. Coarsening of facial features
3. Macroglossia
4. Rare complication
1. Increased intracranial pressure → Headaches
2. Blindness
3. Facial pain
4. Cardiomyopathy
Treatment
 Surgery (remove tumor)
 Radiotherapy
 Corrective surgery

31. Metabolic & endocrine
Hyperparathyroidism
 ↑ PTH due to:
1. Adenoma in parathyroid gland (Primary)
2. ↓ 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

32. Metabolic & endocrine
Hypoparathyroidism
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

33. Metabolic & endocrine
Osteoporosis
 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

34. Metabolic & endocrine
Rickets
 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

35. Paget’s 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

36. Paget’s disease
Radiographic presentation
Loss of normal bone trabeculation
Areas of sclerosis in later stage
Cotton wool appearance

37. Paget’s disease
Diagnosis:
 Clinical picture
 Radiograph
 Blood chemistry (↑Alk. Phosph)
Treatment
1. No treatment if asymptomatic
2. Bisphosphonate (anti osteoclastic)
3. Ca + Vit D supplement
4. 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