Lecture 2 761 Pediatric Dentistry 2011
Transcript of Lecture 2 761 Pediatric Dentistry 2011
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Enamel andDentin Defects(Continued);
Abnormalitiesof the tongue
McDonald & Avery, Dentistry for the Child andAdolescent, 7th ed., Chapter 7 pp123-147.
Italicized notes have been questioned on
the Dental Decks
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Inherited Defect--Dentinogenesis Imperfecta
Prevalence : 1/8000Bell Histodifferentiation thru apposition phases
defect primary odontoblasts degenerate changingpredentin matrix
Presentation:Weak dentin--Red brown to gray opalescent color
Undermineralized Slender roots/small pulp chambers-fracture easily
Sound enamel bulbous crowns no support fromdentinEnamel fractures easily without the supportExposed dentin abrades rapidly
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Inherited Defect--Dentinogenesis Imperfecta Shields classification -
Type I DI- always with Osteogenesis Imperfecta
Type II DI- isolated trait, older terminology:
Hereditary opalescent dentinDSPP gene mutation. DSPP codes for:Dentin Sialo-protein (DSP) matrix protein andDentin Phospho-protein (DPP)
Type III DI type seen in an isolated Brandywinetriracial group in Maryland
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Shields Type I DI Autosomal dominantOsteogenesis ImperfectaCollagen defect
brittle bones(osteoporotic)bowing limbsbitemporal bossing
blue scleraPrimary dentition-more
severely affected
McDonald 124 7-27
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Shields Type II DI Older term: Hereditary
opalescent dentin Autosomal dominant
Isolated traitReddish brown to gray
opalescent colorPrimary & permanent
dentitions equallyaffected
McDonald 125 7-29
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Shields Type III DI Isolated population in
Brandywine, Maryland(near DC) population
Shell-like appearance
(radiograph)Multiple pulp exposuresPremature exfoliation
Thin layer of normal dentinnext to enamel andcementum, then layer ofdisorganized dentin with
few tubules.McDonald
124 7-28
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Dentinogenesis Imperfecta
From Pediatric Dentistry,Linda Shaw, 1994.
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Dentinogenesis Imperfecta
Radiographs:Opacified pulps
Short rootsBell-shaped crownsConstricted CEJ
Type II & III
Shell-like teethMultiple pulp exposuresMcDonald 124 7-28
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Dentinogenesis Imperfecta
TX:Protect tooth from wear
Consider SSC on primary molarsRestore/protect with crowns and veneersDo not use as abutments
Consider overdentureExtract if root fractures (fractures commonly
occur)
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Dentin Dysplasia
Rare disturbance of dentinformation related to DI 2,3
Type I- Radicular (root) dentindysplasiaNormal crown; short, pointed
roots; rippled dentinNormal color (sometimesblue/brown/opalescent)
Absent/Chevron-shapedcoronal pulp
Periapical radiolucenciesPrimary and Permanent teethaffected
Autosomal dominant
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Dentin Dysplasia
Type II- Coronal dentin dysplasiaPrimary teeth-OpalescentObliterated pulp chambers
Permanent teeth--Normal colorNormal length rootsPulp chamber--pulp
stonesMutation of DSPP (related toType II,III DI)
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Dentin Dysplasia
Type I- Radicular
Type II- CoronalThistle tubepulp shapewith pulpstones
From Contemporary oral and maxillofacial pathology 1997
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Enamel Developmental Defects
Amelogenesis Imperfecta GeneticClinical presentation:
Primary and permanent teeth1/14,000Skeletal anterior open bite associationPulp and root normal3 major categories 14 subcategories
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Amelogenesis Imperfecta (AI) p127
Researchers disagree over classifications. We will useMcDonalds
Hypoplastic imperfect enamel matrix (bell stage)calcification is deficient less, but hard, enamelenamel rough /stains or smooth
Smooth hypoplastic-defective enamelin gene
Local hypoplastic-defective enamelin geneHypomatured-imperfect calcification (apposition stage)Hypocalcified enamel matrix thickness is normal;
imperfect calcification (calcification stage)
enamel rough/stains soft enamel
Contemporary Oral and Maxillofacial Pathology 1997
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HypoplasticHistodifferentiation Type1
Timing: Bell stage
Thickness: thin enamelthicknessSurface: rough, pitted or
smoothHardness: normal enamel
hardness (calcifiesnormally)Radiographically: enamel
contrasts normally withdentin
Contemporary Oral and Maxillofacial Pathology 1997
McDonald 127 7-32
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Hypomaturation : Type IITiming: Apposition PhaseThickness: normal enamel
thicknessSurface: Chipped, porous,
stained/mottled--enamel softHardness: less enamel hardness
Radiographically: enamel hasdensity of dentin
Differential diagnosis: oftenconfused with fluorosis askabout diet, family history
Contemporary Oral and Maxillofacial Pathology 1997
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Type III- HypocalcifiedTiming: calcification phaseThickness: normal enamel
thicknessSurface: smoothRadiographically: Enamel is
less radiopaque than dentinpoor quality of enamel
Fractures easily leaving dentin
cores
Contemporary Oral and Maxillofacial Pathology 1997
McDonald 127 7-33
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Treatment for AmelogenesisImperfecta
(remember, dentin is normal)Depends on severity
Esthetic improvementFull coverage restorations
(dentin is normal)
Bonded veneer restorationsPorcelain laminate veneer restorations
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Aplasia--Enamel & Dentin Aplasia
Similar to DI and AIControversy over terminology (Also called Odontogenesis Imperfecta)Both enamel & dentin are affected
Normal boneLittle or no enamelLarge pulp chambers
Acellular cementumNo secondary dentinTX:SSC on erupting permanent molars McDonald p 129 7-36
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Collaboration Activity Handout
Consult with student sitting next to you about the cases on the handout
Intrinsic Discoloration of Teeth
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Intrinsic Discoloration of Teeth Timing: embryonic and beyond(Pigmentation of Teeth) as the result of:
Hyper-Bilirubinemia (yellow-green) caused by:Biliary atresiaPremature birth
ABO incompatibilityNeonatal complications
Erythroblastosis fetalis (Rh factor)Porphyria Heme pathway compromised
Cystic FibrosisTetracycline TherapyTreatment: Primary teeth generally not treated
may consider composite veneersMcDonald has report of bleaching a 4 yo
Permanent teeth-microabrasion and/or bleaching withcarbamide peroxide Bleaching protocol at WVU case by case basis
child must be caries-free
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Erythroblastosis Fetalis
Mother Rh-Transplacental passage of
maternal antibody activeagainst RBC antigens of infant
Increased rate of fetal RBCdestruction Infant is anemic and jaundicedDiscoloration of primary teeth
result blue green/brown
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Porphyria
Enzymes of heme pathwaycompromised
Excess porphyrinRed urineChild is hypersensitive to
light subepidermalbullous lesions whenexposed to light
Porphyrin accumulates inthe primary andpermanent teeth-
Pink/purple/brown; butscarlet in UV
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Cystic FibrosisInherited chronic
multisystem disorderMany die young- 20s Many airway infectionsMany digestive problems
Unknown if teeth arediscolored by thedisease or therapeutics forit
Yellow-gray to brown Mice studies indicate
abnormal enamel genehandling salt most reliablediagnostic tool is the sweat
test/ salty skin
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Rare now physicians avoid it duringtooth-forming and calcifying yearsand during pregnancy (it crossesplacenta)
Tetracycline chelates calcium salts Adult onset has been reported with
minocycline (3-6%) blue-graycrowns; black-green roots Sanchez, 2003 IJDermatology
Incorporates into bones and teeth(mostly dentin, some enamel)
Yellow to brownSeverity--dose relatedTX: Vital bleaching with carbamide
peroxide Bleaching may takeseveral months or restore
Tetracycline Stains
McDonald 134 7-40
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Tetracycline-anterior teeth induced discolorationPrimary dentition will be
affected by tetracycline from:Mx central 14 w iu to 1.5 monthsMd central 14 w iu to 2.5 monthsMx lateral 16 w iu to 2.5 monthsMd lateral 16 w iu to 3 monthsMx/Md canine 17 w iu to 9 months
Permanent dentition will be affected from Mx/Md central; Md laterals--3-4 mo to 4-5 yMx/Md canines 4-5 mo to 6-7 yMX lateral 10-12 mo to 4-5 y(Premolars 12 years so avoid tetracylineprenatally thru 12 years) Adult onset has been reported with minocycline
(3-6%) blue-gray crowns; black-green roots Sanchez, 2003 IJDermatology
McDonald-135
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Anomalies of the tongue, etc.Macroglossia (large tongue)
Ankyloglossia (Tongue-tie)
Geographic tongue (Benign migratoryglossitis)Coated tongue
Median rhomboid glossitisInjuries to the tongue
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Macroglossia Jaw development
concerns: Cl IIIOcclusion conerns:
flared lower ant. Associated with:
Hypothyroidism
FissuredExtend from mouth
Down SyndromeTx: surgical reduction
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Geographic tongue (Benignmigratory glossitis)
Fissures on dorsum of tongueGenerally clinically insignificant
Associated with
Vitamin B deficiencyDown syndromeHypothyroidism
No treatment is requiredSelf-limiting.
McDonald 139 7-45
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Coated Tongue local factors, debris,
TX: clean tongue
McDonald 140 7-46
Median Rhomboid Glossitis
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Median Rhomboid Glossitis
asymptomatic chronic candida infection
TX--anti-fungals
Example prescription for teens and older who are not allergic orhypersensitive to Nystantin or any component of the formulation.
Rx: Nystantin Oral Suspension 100,000 units/ mlDispense: 250 ml
Sig: Swish and swallow 1 teaspoon 4 times a day for 10 days.Label, no refills
Wynn, RL. Drug Information Handbook for Dentistry, 12 th edition
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Injuries to the TongueCauses:Traumas/Falls/Piercings
Management:AirwayMay need sutures forHemorrhage control
Piercing complications: Airway compromiseInfections-brain abscess
endocarditistetanus
Fractured teeth/abrasion/recession
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Ankyloglossiashort lingual frenum
limits movementpossible speech
problemspossible gingival
strippingTX: surgery
laser surgeryMcDonald p1387-43 7-44