What is Developmental Disturbances of the Teeth, Anomalies of Shape and Size?
The process of tooth growth is a complicated biological event that is highly controlled, and its success depends on a variety of factors. If anything interrupts this process, this can cause noticeable changes or alterations in the teeth. One of the main signs of these disruptions is a change in size, which makes teeth look bigger, smaller, or entirely different than we would expect them to be. The specific variations in tooth size that result from this disruption can include microdontia (small teeth), macrodontia (large teeth), taurodontism (elongated teeth), and fusion (two teeth joined together).
What Causes Developmental Disturbances of the Teeth, Anomalies of Shape and Size?
Microdontia is a rare dental condition that makes teeth appear smaller than usual. People showing ‘true generalized microdontia,’ a condition where all their teeth are smaller, often have other syndromes like pituitary dwarfism, oro-faciodigital syndrome, or oculo-mandibulo-facial syndrome. Younger patients who’ve been treated with radiation and chemotherapy might also have microdontia because these treatments could impact the growth of teeth. It’s very uncommon for people without genetic disorders or developmental syndromes to exhibit this condition.
Macrodontia, sometimes referred to as megalodontia, is another dental condition, where the teeth are larger than normal. The cause is still unknown, but genetics and environmental factors might play a role. Macrodontia doesn’t usually indicate a syndrome or underlying disease, unless the big teeth are present all over the mouth, in a condition called ‘generalized macrodontia.’ Some conditions linked to generalized macrodontia are insulin-resistant diabetes, otodental syndrome, and hypophyseal gigantism.
Taurodontism is when the pulp chamber of a tooth is overly large, usually due to a failure in the development of the tooth, causing excess dentin to collect there. It’s linked to several specific syndromes, including amelogenesis imperfecta, Klinefelter syndrome, and Down syndrome.
Tooth fusion is a process where two developing teeth, also known as tooth buds, join together, resulting in one large tooth formed from two distinct starting points. This typically happens when the tooth germs are too close to each other or when a developing supplemental tooth bud is too close to a regular one.
Risk Factors and Frequency for Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia is a condition more common in females, affecting about 1.5 to 2% of people. The tooth that is most frequently affected by this is the maxillary lateral incisor, often called “peg lateral.”
Macrodontia has no preference for either sex and occurs in about 0.03 to 1.9% of permanent teeth. This condition usually shows up in patients aged 8 to 13, which is when permanent teeth tend to start coming in.
Taurodontism more commonly affects males and is often associated with X-linked syndromes. The chance of having taurodont teeth is less than 1%, and this condition is particularly more common in Eskimos and Native American populations.
In a study of 1200 patients, fusion was observed in only 0.21% of cases and was seen to have no bias towards any gender.
Signs and Symptoms of Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia is a dental condition where teeth appear cone-shaped or peg-shaped. It is often linked to certain developmental conditions or syndromes. If a person has all of their teeth smaller than usual without a known underlying syndrome, this is quite unusual and they should undergo further evaluations.
On the other hand, Macrodontia is a condition where the teeth are larger than expected. This can be related to a particular syndrome or a systemic condition. An extreme form of this condition is the ‘molarization’ of premolars, where the premolars become so large they resemble molars. This scenario is extremely rare with only 36 recorded instances. Just like in microdontia, if a person presents with larger teeth all around, further evaluations are necessary to rule out an underlying syndrome or condition.
Taurodontism is a condition usually diagnosed through x-rays during routine dental check-ups. Most of the time, people don’t realize that they have this condition.
Fusion in teeth refers to a situation where two separate embryonic tooth cells join together to form one tooth. Depending on when in the development process this fusion takes place, the fusion might be complete (if the whole tooth continues to develop) or incomplete (if there’s a gap or split in the tooth surface).
Testing for Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia is a condition where teeth are smaller than usual. The types of microdontia depend on the scope and cause. When one tooth is smaller than the rest, it’s called localized microdontia. Relative generalized microdontia refers to when all teeth seem smaller because the upper or lower jaw is larger than normal. In true generalized microdontia, all teeth are indeed smaller, not just appearing so due to a bigger jaw.
Macrodontia is the opposite; teeth are larger than expected. It’s normally noticed on routine dental X-rays around the ages of 8 and 13 when permanent teeth start coming in. If just one or a few teeth are larger, treatment is usually not needed. But when all teeth are larger (generalized macrodontia), it’s often due to a genetic or developmental issue, and should be noted.
Taurodontism is when teeth have larger pulp chambers (the inside part of the tooth containing nerves and blood vessels) and shorter roots. This condition can only be observed on an X-ray, not by simple visual inspection of the teeth.
Fusion is another dental anomaly that is identified during a routine check-up or if a patient notices one big tooth in the place where two should be. Most people with this condition may not realize anything is different unless they have an aesthetic issue or complication with dental function because of it.
Treatment Options for Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia is a condition where the teeth are abnormally small, often leaving gaps between teeth. These gaps are usually fixed with braces or other orthodontic treatments. If someone has generalized microdontia, it’s important to check for other medical conditions too.
Macrodontia, on the other hand, is when teeth are larger than usual. Treating these bigger teeth typically involves a team of different dental specialists. It has to be decided if the big teeth can be kept in the mouth because of their large size or if their structure is unusual. Usually, treatment involves dental surgery to remove the teeth followed by braces to adjust the rest of the teeth.
Taurodontism presents challenges to all types of dental specialists because it results in the pulp (the soft core of the tooth) being larger and the risk of tooth decay exposing the pulp is increased. This can make root canal treatments more complex. Placing a post (used to secure a tooth after a root canal) can be very difficult and is not advised in most cases because the size of the pulp chamber is unpredictable and it’s hard to make the post fit well with the rest of the tooth.
Extracting these teeth is also tricky due to the location of the root furcation (the point where a tooth’s root splits). Interestingly, this location actually improves the tooth’s prognosis, or outcome, since it makes it less likely for gum disease to affect the root’s furcation.
Scores of restorative, gum-related, root canal, and surgical complications are detected in cases of tooth fusion. Patients should be advised to maintain excellent oral health and take good care of these teeth to avoid further complications.
What else can Developmental Disturbances of the Teeth, Anomalies of Shape and Size be?
Microdontia, which refers to smaller than usual teeth, can be linked to:
- Pituitary dwarfism: A condition that causes slower growth and development.
- Hypopituitarism: A disorder whereby the pituitary gland doesn’t produce normal amounts of some or all of its hormones.
- Defects in growth hormone: Problems with the hormone that helps stimulate growth, cell reproduction and regeneration
Macrodontia means larger than normal teeth and can be connected to the following causes:
- Gemination: A single tooth bud splits, causing the appearance of two teeth but they form a single root.
- Fusion: Two tooth buds join together leading to one larger tooth.
- Facial hemihypertrophy: A condition where one side of the face grows more than the other.
Taurodontism, referring to teeth with a larger than normal pulp, can be associated with:
- Amelogenesis imperfecta: A disorder that affects tooth enamel formation.
- Dentinogenesis imperfecta: A condition characterised by discoloured (most often a blue-gray or yellow-brown color) teeth and translucent teeth.
- X-chromosomal Aneuploidy: An abnormality in the number of chromosomes.
Fusion, or teeth merging together, can be influenced by:
- Macrodontia: Larger than normal teeth.
- Gemination: Occurrence of two teeth appearing to be ‘twinned’.
- Talon cusp: An unusual form of tooth shape with an extra cusp or ‘talon’.
What to expect with Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia, which is a developmental condition, generally has a positive outlook. It usually doesn’t affect tooth function, and any problems or concerns the patient might have can typically be resolved with dental treatments and braces.
Macrodontia also usually has a positive outlook. The function of the teeth is often unaffected, and any difficulties a patient might face can often be addressed through restoration or braces.
Taurodontism, a condition characterized by enlarged teeth, often has a good prognosis as well. It’s important for individuals with this condition to maintain good oral hygiene. Dental treatments can be made more complex due to an enlarged and possibly unpredictable tooth pulp chamber.
Similarly, tooth fusion typically has a good prognosis as long as proper dental hygiene is maintained. However, these fused teeth may need more frequent restorative treatments, gum treatments, or root canal therapy if they’re not properly cared for.
Possible Complications When Diagnosed with Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia can cause difficulties with appearance or function, depending on how severe it is. More often, related health conditions cause more issues than microdontia itself.
Macrodontia in the front upper jaw often creates problems with appearance. When macrodonts are located towards the back of the mouth, they can lead to overcrowding and complication with tooth eruption. Dentists should use radiographs, or x-rays, to watch for any abnormal tooth eruption.
Another dental condition, taurodontism, can cause numerous issues with restorative, prosthodontic, endodontic, and surgical treatments. Despite these health concerns, patients rarely know they have this condition.
Lastly, tooth fusion causes unusual shape and size of the tooth, which can be an aesthetic concern. Because of their abnormality, these teeth are more likely to decay, have gum disease, and can create difficulty with endodontic therapy.
Common Dental Conditions:
- Microdontia
- Macrodontia
- Taurodontism
- Tooth Fusion
Potential Issues caused by these conditions:
- Aesthetic concerns
- Functional challenges
- Overcrowding and complications with tooth eruption
- Dental procedure complications
- Tooth decay
- Gum disease
Preventing Developmental Disturbances of the Teeth, Anomalies of Shape and Size
Microdontia and macrodontia are conditions related to the size of the teeth that develop due to genetics, meaning they can’t be prevented. If someone is experiencing issues with how their teeth work or look because of these conditions, it’s recommended that they consult with a professional dentist. The dentist can then provide advice on various treatment options, which can include restorative procedures, surgeries, or orthodontics.
Similarly, tooth fusion is a condition that occurs while teeth are developing, and it can’t be prevented. The best way to deal with this is by maintaining top-notch oral hygiene. However, if the fused tooth is causing functional issues or affecting the appearance of the teeth, it’s best to discuss this with a professional dentist for suitable solutions.
