lecture 2 761 pediatric dentistry 2011

8/13/2019 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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Radiographs:Opacified pulps

Short rootsBell-shaped crownsConstricted CEJ

Type II & III

Shell-like teethMultiple pulp exposuresMcDonald 124 7-28


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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


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



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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


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

lecture 2 761 pediatric dentistry 2011

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