10: Dental Anomalies

Chapter 10 Dental Anomalies

Learning Objectives

1. Recognize variations in tooth number
2. Identify variations in tooth size
3. Identify variations in tooth shape
4. Know variations in tooth structure
5. Recognize acquired defects in teeth
6. Identify eruption problems
7. Recognize altered tooth positions
8. Classify impactions

Goal

To understand and recognize dental anomalies as seen in intraoral and panoramic images

Instructions

In this section you will find one or more examples of the conditions listed in the learning objectives. When answering the questions, try first to identify the condition from memory. Most of these conditions are common. Because they can impact on patient management, these disorders are an important group. Of course, the order in which these entities are presented here will be scrambled. Okay, here we go!

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CASE 10-1 Most of this 22-year-old woman’s teeth looked like this.

1. What iatrogenic treatment did she receive?
2. What condition is present?

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CASE 10-2 This 23-year-old man lost his 1st molar at a young age.

1. What term best describes the abnormal position of the 2nd premolar?

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CASE 10-3 Look carefully at this posterior quadrant and notice the tiny tooth.

1. What two terms used together best describe this anomaly?

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CASE 10-4 Take a look at the lower 2nd molar.

1. What term best describes its shape?
2. Is there anything characteristic about the pulp or root canal spaces?
3. Is this usually a solitary finding, or is it associated with other problems?
4. Can this condition affect the primary dentition?

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CASE 10-5 This 22-year-old man complains that several of his front teeth have begun to chip.

1. What condition is present?
2. List the characteristic radiographic features seen here and several others not seen here.
3. With what condition of bones is this dental finding sometimes associated?

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CASE 10-6 Take a look at the right central incisor.

1. What term describes the altered root shape?
2. How did it get this way?

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CASE 10-7 A and B represent two children (Andrew and Billy, respectively) of the same age. One of them is going to have a crowding problem with regard to the eruption of the permanent teeth.

1. Which one is going to have the crowding problem?
2. How did you figure that out?
3. What would you do about it?

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CASE 10-8 Study these teeth carefully. Notice that all three teeth have a radiolucent line in the cervical area. Clinically, the areas appeared V-shaped and were partially subgingival.

1. What is the differential diagnosis?
2. What condition do you think is present?
3. What is the cause, and how is it managed?

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CASE 10-9 The lower right lateral incisor of this hockey player was avulsed last year during practice. The tooth was cleaned and sealed with a retrograde amalgam and then reimplanted and splinted with 009 wire and composite for several months.

1. What has happened to the root of this tooth?
2. What is the prognosis for the tooth?
3. How would you manage this case?

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CASE 10-10 Take a look at the lateral incisor.

1. What term(s) best describe(s) this tooth’s morphology?
2. How would you manage this?

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CASE 10-11 Several permanent teeth of this 23-year-old man “exfoliated” spontaneously. All of his remaining teeth look like this. Notice the relative lack of root formation, the pulp is completely obliterated, and the apical radiolucencies may develop as a result of periodontal inflammation.

1. Exactly what condition is present?
2. How would you manage this?

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CASE 10-12 This patient complained of mild pain associated with the erupting 3rd molar.

1. See if you can identify the problem.
2. What would you do about it?

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CASE 10-13 Note the pulp spaces in the central and lateral incisors. The teeth are vital.

1. What are these pulpal radiopacities called?
2. With what developmental dental problem can they be associated?
3. Does this developmental problem exist here?
4. What (if any) is the significance of this finding?

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CASE 10-14 This middle-aged man has a habit that causes a factitial injury to one of his teeth. Clinically the area on the distal of the 1st molar was hard and shiny and has been a definite “meat catch” for many years.

1. Comment on the whole situation concerning the 1st molar.
2. What is the meaning of factitial?

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CASE 10-15 Study this radiograph carefully.

1. What eruption problem has occurred here?
2. How can this be managed?

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CASE 10-16 This patient is a healthy, attractive 15-year-old female. Examine her teeth carefully. Look again before going to the answer.

1. Report what you see. Be complete.

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CASE 10-17 This older patient wears upper and lower dentures.

1. Exactly what do you see here (if anything)? Be specific.

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CASE 10-18 Gina is the youngest sibling among three others. Mom was a dental assistant before she married the boss (don’t laugh, Denyse was my dental assistant!). The appearance of this tiny spiked tooth provoked Mom to take the brood to the dental office to get a radiograph taken.

1. What anomaly did we all discover?
2. What (if anything) should be done about it?

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CASE 10-19 This patient is a healthy teenager.

1. Comment on the pulps of these teeth. Once again, look closely.

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CASE 10-20 This patient is a 6-year-old girl.

1. What problem is seen here?
2. What would you report to her parents regarding the present and future management of this problem?
3. What other developmental anomaly would you suspect in this patient?

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CASE 10-21 This 11-year-old boy was sick with high fevers earlier in his life. Now he is normal and healthy.

1. What condition affects the permanent 1st molars?
2. At what time in this boy’s life did this occur?

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CASE 10-22 Believe it or not, this gentleman was 80 years old and had never been to the dentist. He was currently having a little discomfort because of the class 1 furcal involvement and a “meat catch” in the area. He would probably have ignored this but his favorite granddaughter was now a hygienist and insisted upon his dental visit.

1. What anomaly do we see in association with these teeth?

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CASE 10-23 This patient is being considered for esthetic veneers in the anterior 1 × 6 of her dentition.

1. What anomaly (anomalies) can you see here?

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CASE 10-24 This patient is in his late 30s. He is asymptomatic.

1. Can you pick out the non-vital tooth?
2. What are the radiographic signs of this non-vitality?
3. How would you treat this?

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CASE 10-25 This patient’s nickname in high school was “fang.” Now in her mid-20s and a burgeoning chartered public accountant, she has decided to go ahead with the orthodontics.

1. What term best describes the malposition of the canine?
2. What other preventive procedure would you initiate for this patient ASAP? State your reason.

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CASE 10-26 This 26-year-old man has a couple of unesthetic lower anterior restorations. Note the periapical radiolucencies in the area and the shape of the pulp chambers of the incisors. Right there you have the unique features of this anomaly.

1. What anomaly is present? Be specific.
2. What material are the centrals restored with? (That’s a lot of clues!)

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CASE 10-27 This 7-year-old boy is in for a check up.

1. What treatment has the primary 2nd molar received?
2. What condition affects the developing 2nd premolar?
3. Is there any connection between questions 1 and 2? (That’s a hint!)

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CASE 10-28 This is a 20-year-old man. He complains he does not like the looks of one of his bottom front teeth. He has never had an extraction. Starting at the patient’s posterior right side (left side of the figure) we see the canine, a very wide incisor, the left central and lateral incisors, and the left canine.

1. Identify the anomaly present in the large incisor.
2. What clinical term best describes the large tooth?
3. Define the term you have selected.

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CASE 10-29 This middle-aged white man has periodontal disease. The 1st premolar is restored with an older radiolucent composite for esthetics. The right lateral incisor is a dark yellowish brown color, and he wants something done about it.

1. What condition affects the apical region of the right lateral incisor? Be complete.
2. How would you manage this case?

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CASE 10-30 This patient came in with a broken lower partial denture. He wears a complete upper denture, which he was very satisfied with. Because of this, he was wondering if he should get a complete lower denture. If so, this tooth would need to be extracted.

1. What factor would you consider regarding the removal of this tooth?
2. Of what use (if any) would percussion be in the clinical evaluation of this tooth?

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CASE 10-31 Just after the big Thanksgiving turkey meal, the mother of 6-year-old Julie noticed that Julie had not lost her 2nd front baby tooth. The tooth was not even loose at this point. “All she wants for Christmas is her two front teeth” quoted Julie’s mom to her hygienist several days later.

1. Can you state what the problem is?
2. What would you do?
3. What about the two front teeth for Christmas?

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CASE 10-32 Lee Ong is a 12-year-old female of Asian extraction. Upon looking at this radiograph and subsequently examining the patient, the hygienist reported an unusual finding to the dentist.

1. What unusual finding was reported?
2. What is the significance of this discovery?

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CASE 10-33 This patient is a 58-year-old man.

1. What term best describes the position of the lower 3rd molar with respect to the other teeth.
2. What generalized change in the teeth can we see here?

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CASE 10-34 This patient is a 12-year-old male.

1. What condition affects these teeth?

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CASE 10-35 While doing endodontic therapy on an adjacent tooth, it was discovered the lateral incisor looked different.

1. What condition affects the lateral incisor?
2. How would you manage this case?

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CASE 10-36 This patient received radiation therapy. The radiation was collimated to include the posterior maxilla and exclude the anterior jaws.

1. What term(s) best describe(s) the teeth in this area?
2. Will they erupt?
3. How would you manage this case?

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CASE 10-37 This patient has an anomaly that is hard to see in the photographic print.

1. Look carefully at these molars and see if you can identify it.

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CASE 10-38 Here’s an interesting phenomenon. Follow these instructions carefully: Look at the posterior bitewing (A) and note the round, radiopaque structure (lower 1st molar). Before looking anywhere else, think about what this might be. Now look at the anterior bitewing (B) taken the same day. Presto! The thing you thought you saw has disappeared!

1. What entity did you think the little round radiopacity represented?
2. What is this phenomenon called, and what is the cause?
3. What is the significance of recognizing this phenomenon?

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CASE 10-39 This patient is a 68-year-old woman. She takes very good care of her teeth these days. The teeth have obliterated pulps in the pul/>

Related posts:

  1. 9: Radiation Health
  2. 2: Materials and Foreign Objects
  3. 8: Panoramic Digital Imaging
  4. 11: Assessment/Interpretation of Pathology of the Jaws
  5. 1: Normal Anatomy
  6. 13: Radiographic Assessment and Interpretation

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 10: Dental Anomalies

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