Anomalies of dental development: causes, symptoms and treatment

Description and causes of the disease

Both children and adults are susceptible to pathology. Depending on the etiological reasons, acquired and congenital anomalies of dental development are distinguished. The first appear throughout life as a result of various external and internal factors affecting the dental system. Congenital are formed due to the presence of unfavorable heredity, or a violation of the embryonic development of the fetus.

Main reasons:

• genetic predisposition;
• teratogenic effects of various substances on the embryo during the formation of organs and systems;
• hormonal imbalance (hypothyroidism, hypocortisolism), vitamin deficiency during pregnancy;
• infections that cause genetic mutations in the fetus (herpes, rubella, HIV, syphilis, toxoplasmosis, cytomegalovirus, etc.);
• fetal hypoxia;
• toxicosis of a pregnant woman;
• bad habits of childhood: prolonged use of a pacifier, bottle feeding, finger sucking, etc.;
• difficult childbirth, birth injuries of the jaw;
• infectious diseases, rickets, hypovitaminosis in the first three years of life, leading to impaired development of segments.

Various factors can provoke abnormalities in the development of teeth in children: alcohol, drugs used by the expectant mother before and during pregnancy, unbalanced nutrition, sudden climate change, radiation, lack of fluoride, calcium, etc.

What is transmitted genetically

Most diseases of the dental system are not 100% genetically dependent. However, there are signs that are passed on from generation to generation and can ultimately affect the condition of the teeth. These include:

• composition, thickness and shade of enamel;
• shape of dental units;
• bite geometry;
• timing of the eruption of primary and permanent teeth;
• composition of saliva and oral microflora.

Along with these characteristics, the child also inherits a predisposition to certain pathologies. But there is no fatality in this. With a reasonable, competent attitude to oral care, you can avoid the development of one or another disease, the likelihood of which is genetically predetermined.

Types of dental anomalies

Common symptoms that occur with most developmental anomalies are: discomfort in the mouth (sometimes soreness), problems with chewing food, and speech defects. Such pathologies are often accompanied by other genetic defects (cleft palate, lips, etc.).

Treatment of dentinogenesis imperfecta

Unlike the treatment of pulpitis of baby teeth or caries, with this diagnosis, mainly orthopedic rather than therapeutic dentistry is possible. If the primary teeth are completely worn down, complete plate-type dentures are made and placed over the roots. With their help, they monitor the functional load when chewing, and also provide optimal conditions for changing the bite to a permanent one. The prosthesis also maintains the myodynamic balance of the masticatory muscles, the height of the bite at the beginning of its formation, and compensates for aesthetic defects.

If the teeth are not completely worn down, individual thin-walled stamped crowns are made to maintain the height of the bite. They also cover permanent molars and incisors that have just erupted. These actions are aimed at stopping the abrasion of hard tooth tissues and increasing the height of the bite.

Once the permanent teeth have fully erupted, the temporary crowns are replaced with permanent ones. Due to obliteration of the root canals, the manufacture of pin structures is excluded, however, parapulp pins and composite materials can be used to build up missing tissues before prosthetics.

Types and classification of malocclusions

Bite is the position of the segments at the moment of tight closure of the jaw bones. Occlusion is assessed in 3 planes:

• by crown height (vertical);
• lateral arrangement of segments relative to the jaws (transvesial);
• ratio of the length of the row and the jaw (sagittal plane).

Malocclusion can be of 2 types: skeletal and dental. In the first case, the cause of pathological closure of the elements is the non-standard size of the jaws or their position in the mouth. Dental abnormal bite is formed due to dental defects (number, size, shape, etc.).

Classification of dental malocclusions:

1. Open: the segments of the top and bottom rows do not meet each other vertically. The mouth remains slightly open. Due to the defect, speech, breathing, and chewing are impaired.
2. Deep. The lower crowns are significantly (more than ½ covered by the upper ones). The face takes on a flattened shape. Often leads to injuries to the mucous membrane, rapid abrasion of teeth, and defects of the temporomandibular joint.
3. Distal (prognathic). Occurs due to disproportionately developed jaws (overdevelopment of the upper or underdevelopment of the lower).
4. Mesial: the lower row overlaps the upper segments.
5. Crossed: on one side of the jaw, the teeth are located without pathology, and on the other, the lower crowns protrude above the upper ones.

Type II dentinogenesis imperfecta

This pathology is otherwise called hereditary opalescent dentin, or “crownless teeth.” It occurs with a frequency of 1:8000, develops in an autosomal dominant pattern and has another name: Stainton-Candepont syndrome. As a rule, the disease is not combined with general diseases.

The enamel turns watery gray, amber or purple-blue, and the teeth become translucent. Sometimes the crowns take on a purple hue and are shaped like an onion. 2-4 years after teething, the enamel begins to actively chip off. The occlusal surface of the teeth is characterized by increased abrasion, and exposed dentin turns brown.

Additional clinical signs include increased electrical excitability of the pulp and a possible delay in root resorption of primary teeth. In some patients, on the contrary, early replacement of milk teeth with permanent teeth is observed, and caries is rare with this pathology.

X-ray signs:

• the roots may be shortened, with hypercementosis, with foci of clearing in the apical area;
• dental cavities are reduced, the canals are narrow or obliterated, which is a consequence of progressive calcification;
• the height of the crowns is reduced due to rapid abrasion;
• There are areas of rarefaction of bone tissue in the area of ​​the root apexes.

Pathomorphological features:

• The structure of the enamel is disrupted, the tissue becomes thinner, the number of organic plates increases, and areas of structureless enamel are noticeable.
• At the enamel-dentin junction there is a straight line.
• The structure of dentin is heterogeneous.
• The number of tubes in the peripulpar dentin is reduced; they are short, curved, expanded and grouped in several pieces.
• The amount of interglobular dentin increases.
• In dentin, the amount of mineral substances decreases (60%), while the amount of water (25%) and organic substances (15%) increases.
• Hydroxyapatite crystals are replaced by an amorphous structure.
• The dentin matrix has an atypical structure, and predentin is expanded.
• The number of odontoblasts decreases, the shape of the cell and nucleus changes, processes are absent, and in some cases the odontoblasts themselves are absent.
• The pulp has few vessels, but many denticles and fibers.
• Degenerative changes in the cement are noticeable.

Possible consequences

Improper development of teeth and abnormal bite cause uneven distribution of chewing load. This leads to the development of various complications:

• rapid abrasion of closing teeth;
• caries, pulpitis;
• gingivitis, periodontitis;
• bleeding of the mucous membrane;
• displacement of the articular head of the temporomandibular joint.

When bite deviations occur, problems arise with oral hygiene and microcirculation in the periodontal tissues is disrupted. Ultimately, cellular nutrition, gas exchange, and metabolism are disrupted. A complex of pathological processes leads to early destruction of dentin, periodontal ligaments and tooth loss. Timely consultation with a doctor will help prevent adverse consequences. In Moscow, jaw bite correction is carried out by the Center for Aesthetic Dentistry near the Otradnoye metro station.

Composition of saliva

When parents complain about bad teeth, they often do not realize that the cause may be the composition of saliva, which determines heredity. It may vary in the ratio of mineral and organic components. And this has a direct impact on dental health.

With a reduced content of oligosaccharides in saliva, the population of microorganisms increases, which settle on the surface of the enamel, creating a predisposition to caries. To avoid this disease, you need to brush your teeth at least twice a day and use special mouthwashes.

An increase in the concentration of class A immunoglobulins (IgA) in saliva, which have an antibacterial effect, protects the enamel from cariogenic bacteria.

The specialists of the Shifa clinic will help you choose toothpaste and other hygiene products to create the right environment in the oral cavity. Dentists will also give recommendations on diets that reduce the negative effects of saliva.

Methods for correction and treatment of anomalies

Treatment depends on the clinical situation and is determined by the doctor after a comprehensive dental examination. Correction of dental abnormalities may include:

• surgical removal of wisdom teeth or supernumerary units;
• prosthetics: for adentia, hypodentia;
• orthopedic correction with a crown, veneer, lumineer: for size anomalies;
• restoration with crowns, composite materials, veneers: for non-standard shapes;
• if the structure of enamel and dentin is damaged, complex therapeutic, orthodontic, orthopedic treatment, enamel mineralization, and drug therapy are prescribed;
• eruption disorders: physiotherapy, massage. Sometimes orthopedic treatment (plates, aligners), removal of a baby tooth (if a permanent tooth has formed underneath it), surgical care (for impacted segments), or orthodontic preparation (system braces) may be required in order to create conditions for stretching the segment retained in the gum.

Malocclusions are most often corrected with fixed orthodontic structures (braces, aligners) in adults. Children are mostly fitted with removable devices.

Prognosis and prevention

Consilium Dent clinic uses advanced methods of therapeutic, surgical, and orthopedic treatment of dental anomalies in patients. By skillfully combining them, experienced specialists are able to restore the aesthetics of a smile and ensure the normal functioning of the dental system, even if the degree of deviation is significant.

Prevention of anomalies in the formation and development of dental units begins during the period of intrauterine development of the fetus and is carried out throughout a person’s life. The main stages are as follows: monitoring the successful course of the prenatal period, caring for harmonious postnatal development, organizing a correct lifestyle while the baby is growing up, caring for dental health and general health throughout life. By conducting an annual preventive examination, the dentist identifies dental anomalies at an early stage, when the pathological process is still reversible.

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Classification of dental hypoplasia

There are, especially in foreign practice, many types of classifications of this pathology, and in particular, classifications of dental enamel hypoplasia . The most generally accepted classification in the form of summarized data is presented in the table below.

Among all forms of this pathology, the greatest and most overwhelming prevalence is tooth enamel hypoplasia . According to statistics, hypoplasia of the enamel of permanent teeth in a spotted form in varying degrees of damage affects up to 5-15% of children. The prevalence of symptoms of hypoplastic enamel defects among adolescents and young people, according to some data, reaches 47-50%.