What is Developmental Disturbances of the Teeth, Anomalies of Structure?
The growth and development of teeth is a very controlled process that involves several specific and meticulous steps. Teeth are made up of a range of different inner and outer components, each originating from different stages of development and growth before birth. If any of these growth processes go wrong or happen too much, it can change the final structure of the tooth. This can be as minor as a slight overgrowth of a part of one tooth or as major as completely destroying the dental tissue as the tooth develops. Important dental growth issues we’ll discuss in this article include dens evaginatus, dens invaginatus, amelogenesis imperfecta, and dentinogenesis imperfecta.
What Causes Developmental Disturbances of the Teeth, Anomalies of Structure?
Dens evaginatus, also known as a talon cusp, is a little bump that can develop on a tooth. It usually shows up on the tongue side of a tooth but can also appear on the biting surface. These extra bumpy parts are coronal anomalies, which means they usually appear around the top part of the tooth near the gum line. The exact reason why they develop isn’t clear, but it’s thought to be a mix of genetic factors and environmental influences, like an injury to a developing tooth or local issues that affect how a tooth forms.
Dens invaginatus, or dens in dente, is another kind of tooth irregularity that happens when the developing tooth folds inward. The causes of these dental anomalies are usually a combination of genetic and environmental factors. Though its exact cause isn’t known, it’s speculated that it happens when the internal lining of a developing tooth folds into itself before the tooth hardens. Other theories suggest that it could be due to the rapid multiplication of part of the inner lining, injury, or even a lack of specific molecules needed for tooth development.
Amelogenesis imperfecta is a condition that changes how all or some of the teeth look and function. It has a genetic cause and is usually due to mutations in the genes, including AMELX and ENAM, which play a role in this condition.
Dentinogenesis imperfecta is another condition that influences the development of the teeth. It’s caused by genetic mutations that pass from parents to children and impact the structure of a substance called dentin in the teeth. The common genes affected are COL1A1 and COL1A2, which are responsible for a component called type 1 collagen.
Risk Factors and Frequency for Developmental Disturbances of the Teeth, Anomalies of Structure
Dens evaginatus, also known as talon cusps, affects 1 to 6% of people, and is more commonly found in permanent teeth. Dens invaginatus, another dental condition, occurs equally in men and women, with rates varying from 0.3 to 10% depending on the group studied. This condition is most often found in the upper side teeth and front teeth. It’s not often found in other teeth.
The occurrence of amelogenesis imperfecta, a condition that affects the formation of tooth enamel, varies widely depending on the specific genetic makeup of the group being studied. Its frequency can range from 1 in 700 to 1 in 14,000 people.
Dentinogenesis imperfecta, a disorder that affects the development of dentin (the substance under the tooth’s enamel), is seen in about 1 in 6,000 to 1 in 8,000 cases in the United States. This condition affects men and women equally.
- Dens evaginatus or talon cusps occur in 1 to 6% of individuals and are common in permanent teeth.
- Dens invaginatus is equally common in men and women, affecting 0.3 to 10% of people depending on the population studied. It is mostly found in the upper side teeth and central teeth.
- Amelogenesis imperfecta varies greatly in frequency, from 1 in 700 to 1 in 14,000 people, depending on the specific genetic makeup of the population.
- Dentinogenesis imperfecta affects approximately 1 in 6,000 to 1 in 8,000 people in the U.S and affects both genders equally.
Signs and Symptoms of Developmental Disturbances of the Teeth, Anomalies of Structure
Dens evaginatus, also known as a “talon cusp,” is an abnormal growth on a tooth, usually on the inside part of an upper front tooth. There are three major types of talon cusps. Type 1 extends about halfway from the junction of the root and tooth to the biting edge. Type 2, or “semi-talon,” is at least one millimeter, extends halfway like type 1, and tends to blend with the tooth’s surface. Type 3, or “trace talons,” are enlarged areas on the tooth that can be conical, split, or small rounded projections.
Dens invaginatus is a condition where the tooth folds inward. It varies in severity, with the Oehlers classification system commonly used to describe its extent. In Type 1, the fold doesn’t go past the tooth’s crown. In Type 2, the fold extends beyond the root-crown junction but stays within the tooth’s main root canal. In Type 3, the fold extends throughout the tooth, potentially resulting in multiple openings at the pointy end of a tooth root.
Amelogenesis imperfecta is a condition where the enamel, the outermost layer of the teeth, doesn’t form properly. It presents in three types, depending on the specific gene mutation. Type I, or hypoplastic, features thin enamel which makes the crown appear yellow or light brown, with pitted or mottled surfaces. Type II, or hypomature, has defective enamel that is whitish to brown and lacks normal transparency. Type III, hypomineralized, is the most severe form where teeth are very sensitive due to less mineral content and often display a dark yellow or brown color.
Dentinogenesis imperfecta (DI) is a condition that impairs the formation of dentin, the hard tissue under the tooth enamel. There are three types of DI based on clinical and radiographic features. DI Type 1 is found with a disorder called osteogenesis imperfecta that leads to fragile bones. DI Type II has similar features to Type I but is less severe. DI Type III features large pulp chambers and tooth color, size, and enamel pitting abnormalities.
Testing for Developmental Disturbances of the Teeth, Anomalies of Structure
Dentists might discover dens evaginatus or talon cusps, which are extra tooth outgrowths, during regular check-ups. Sometimes, these growths are so insignificant that the patients don’t know they have them. But if these extra structures start causing issues, a team of specialists may be required for treatment.
Similarly, dentists might also find dens invaginatus, where the tooth surface dips inward, during normal teeth inspections. Just like dens evaginatus, this is not always noticeable by the patient, especially in minor cases. But in severe cases, this condition might cause discomfort or be sensitive to injuries. A detailed X-ray, possibly using Cone Beam Computed Tomography (CBCT), can help determine how deep the invagination is and guide the appropriate treatment plan.
Amelogenesis imperfecta, a hereditary condition that affects the formation of tooth enamel, is typically detected during regular dental examinations. The diagnosis is generally based on a family history of the condition, physical examination findings, and noting any abnormal tooth development.
Dentinogenesis imperfecta, a condition which changes the dentin or inner part of the tooth’s color to amber, brown/blue, or opalescent brown, is also diagnosed during regular dental examinations. On an X-ray, the crowns of the affected teeth might appear bulb-like with reduced or absent pulp chambers. Additionally, the tooth roots may appear thin with small pulp canals.
Treatment Options for Developmental Disturbances of the Teeth, Anomalies of Structure
“Dens evaginatus,” also known as “talon cusps,” are special dental conditions that must be approached with a variety of strategies in mind. According to a recent study, treatment can include reducing the size of the cusp all at once, doing it gradually over time, leaving it as is, or even possibly removing the tooth. The treatment chosen depends on how severe the condition is, what issue the patient is most concerned about, whether it’s function or appearance, and also preemptively preventing any dental problems that could arise from it.
“Dens invaginatus” is another unique dental condition. To understand it better, certain types of x-rays or a specific kind of scanning called CBCT can be used to see the inside structures of the tooth. Once we have the details, the approach could be anything from just keeping an eye on it to conducting surgery, depending on the complexity of the tooth structure or how much of it is affected. Nowadays, we lean more towards preserving the tooth with specific treatments rather than extraction, thanks to advancements like CBCT.
“Amelogenesis imperfecta” is a condition that can vary in severity and this determines the treatment applied. If the case is causing symptoms or if the patient is concerned about their appearance, treatment may be necessary. This could include something as simple as fillings and veneers or more extensive treatments such as full coverage ceramic restorations, depending on how severe the condition is.
“Dentinogenesis imperfecta” is another condition that ranges in severity and thus requires different types of treatment. Patients might want more visually appealing solutions for their front teeth due to the change in their tooth color. Treatment options may include composite resin restorations or porcelain veneers. If there are associated pits in the enamel, a small, simple, and visually appealing composite restoration may be just what is needed.
What else can Developmental Disturbances of the Teeth, Anomalies of Structure be?
For certain dental conditions, there are other similar situations that dentists consider when making a diagnosis. Here are some examples:
When examining the case of Dens Evaginatus/Talon Cusp, dentists look out for the following conditions since they might be misinterpreted as Dens Evaginatus:
- Gemination – when a tooth tries to split into two
- Fusion – the joining of two teeth together
- Enamel hyperplasia – an excess growth of enamel
For Dens Invaginatus, the following are other possibilities:
- Fusion
- Enamel hypoplasia – insufficient growth of enamel
- Gemination
In the case of Amelogenesis Imperfecta, dentists explore if it could be:
- Dental fluorosis – excessive fluoride intake causes discoloration or pitting of teeth
- Chronological enamel hypoplasia – lack of enamel related to nutritional issues or illnesses during childhood
- Molar-Incisal Hypomineralization (MIH) – a condition where the teeth are discolored and more sensitive
For Dentinogenesis Imperfecta, the conditions that can be confused are:
- Dentin dysplasia – irregular formation of dentin
- Osteogenesis imperfecta – a rare condition that affects the bones and teeth
- Amelogenesis imperfecta
Dentists make these distinctions to ensure they can provide the most appropriate treatment for the patient’s specific condition.
What to expect with Developmental Disturbances of the Teeth, Anomalies of Structure
Dens evaginatus, also known as talon cusps, usually do well with the right treatment. In less serious cases, patients might not even know they have them. But, if things get more serious, they might need more intensive treatment. As long as we follow the right restoration and root canal procedures, these teeth should do well.
Similarly, teeth with dens invaginatus typically do well with the right care. Because they’re a bit different in structure, it’s important to keep a close eye on them for the first signs of tooth decay. This helps avoid the need for more serious dental procedures.
Amelogenesis imperfecta and dentinogenesis imperfecta, two disorders that affect the formation of teeth, also typically do well with the right treatment. In cases where patients have no symptoms or aren’t worried about how their teeth look, most can live a good quality life without much, or any, treatment. However, more complex cases might need more intensive or multi-disciplinary treatment, which could potentially affect the outcomes.
Possible Complications When Diagnosed with Developmental Disturbances of the Teeth, Anomalies of Structure
Talon cusps or dens evaginatus could have extra pulp tissue, based on the severity and the stage of tooth development when the abnormal growth happened. This condition might make tooth restoration treatments tricky without the appropriate root canal treatment. These cusps are also vulnerable to fractures because of their position in the chewing plane. If a fracture happens, a root canal might be necessary because the pulp could be exposed.
Dens invaginatus is more prone to cavities because its funnel shape can speed up the penetration of food particles and bacteria into the tooth. Teeth with this condition should be regularly checked for early signs of cavities. Patients are advised to maintain good oral hygiene to prevent cavities on these teeth and all their other teeth.
In the case of amelogenesis imperfecta, which can show up in different ways, a multidisciplinary treatment approach is often required. The generalized form is often linked to an underlying systemic syndrome like regional odontodysplasia, where genetic consultations or checks are needed to effectively manage the underlying condition.
Dentinogenesis imperfecta, especially type II, has more pulp tissue which may make restoration treatments tricky due to the high chances of exposing the pulp during treatment or from excessive and unnecessary grinding or clenching of the teeth.
Preventing Developmental Disturbances of the Teeth, Anomalies of Structure
All the conditions mentioned previously are caused by genetic or developmental factors, which means they can’t be truly prevented or delayed. If a patient has developmental issues affecting all their teeth, it might be due to an underlying health condition, and they should be checked for this.
The treatment of these conditions usually focuses on managing the symptoms or improving the appearance of the teeth. If you have any of these conditions, you should keep an eye out for any new symptoms or if your existing symptoms get worse. If that happens, get in touch with your dentist for an evaluation and treatment.
