1.8.6 Differential Diagnosis
Dentinogenesis imperfecta
Osteogenesis imperfecta
Conditions that cause premature loss of teeth
1.8.7 Diagnosis
Family history
Clinical examination
Radiography
1.8.8 Management
Symptomatic and preventive care and meticulous oral hygiene
1.9 Regional Odontodysplasia (Ghost Teeth)
1.9.1 Definition/Description
A rare non‐hereditary dental anomaly involving enamel, dentin and cementum of both dentitions, but mostly the teeth of one quadrant
1.9.2 Frequency
A rare disorder
1.9.3 Aetiology/Risk Factors
Unknown
Probably alteration in vascular supply in the jaws around developing teeth
1.9.4 Clinical Features
Female predilection (female to male ratio 1.7 : 1)
Both dentitions are involved
Mostly one but rarely two quadrants are involved
Age at diagnosis: 2–4 years for deciduous teeth and 7–11 years for permanent teeth
Maxillary predominance (ratio of maxillary to mandibular width 1.6 : 1)
Failure of tooth eruption is common
Erupted teeth exhibit small brown crowns
Pulp necrosis is common
Early tooth exfoliation
1.9.5 Radiographical features
Thin enamel and dentin appear surrounding enlarged radiolucent pulp chamber (hence the name ghost tooth)
Pulp stones are occasionally detected on radiography
1.9.6 Differential Diagnosis
Oculodentodigital dysplasia
Segmental odontomaxillary dysplasia
Odonto‐onychodermal dysplasia
Odontochondrodysplasia
1.9.7 Diagnosis
History
Clinical examination
Radiography
1.9.8 Management
Unerupted teeth to remain without any interference
Erupted teeth: steel crowns
Non‐salvageable teeth to be extracted
1.10 Delayed Tooth Eruption
1.10.1 Definition/Description
Delayed tooth eruption is the emergence of a tooth into the oral cavity at a time that deviates significantly from norms established for different races, ethnic groups and sexes
1.10.2 Frequency
Delayed eruption is relatively common; racial and gender variations exist
Failure of eruption is less common
Agenesis of teeth cause failure of eruption
1.10.3 Aetiology/Risk Factors
Local causes associated with delayed tooth eruption:Supernumerary teethMucosal barrier scar tissue due to trauma/surgery/gingival hyperplasiaTumours: odontogenic or non‐odontogenic tumoursAnkylosis of deciduous teethEnamel pearlsInjuries to primary teethRegional odontodysplasiaEctopic eruptionImpacted permanent teethEmbedded primary teethOral cleftsRadiation damage
Systemic causes associated with delayed tooth eruption:Nutritional deficienciesVitamin D‐resistant ricketsHypoparathyroidismHypopituitarismLong‐term chemotherapyCerebral palsyPrematurity or low birth weightPhenytoin useGenetic disorders
1.10.4 Clinical and Radiographical Features
Local factors causing delayed tooth eruption are frequently detected by radiography
Systemic factors causing delayed tooth eruption are detected by systemic clinical features and laboratory findings
Failure of tooth eruption: congenital absence of teeth (third molars, mandibular second premolars and maxillary lateral incisors) results in failure of tooth eruption
Radiographical evidence of absence of teeth is diagnostic
1.10.5 Diagnosis
History
Clinical examination
Radiography (panoramic view is ideal)
Laboratory tests if systemic factors are suspected
1.10.6 Management
Patient with eruption delay of more than 12 months (delayed eruption) of the normal age range should be referred to a paediatric dentist for further evaluation
Identification of the causes and their elimination is important
Surgical exposure followed by orthodontic treatment may be required for some patients with delayed eruption
1.11 Tooth Impaction (Impacted Teeth)
1.11.1 Definition/Description
Teeth that are completely or partially retained in the jaws beyond their normal date of eruption
1.11.2 Frequency
Common; variations in incidence and prevalence exist
The mandibular third molars are the most common impacted teeth, with their prevalence ranging from 27% to 68.8% in various parts of the world
The reported prevalence of impacted teeth of canines and second premolars ranges from 2.9% to 13.7%