38: Dentinogenesis imperfecta

38 Dentinogenesis imperfecta

Summary

Siobhan is 9 years old. She and her parents are concerned because her permanent teeth are darker than normal and she is getting teased at school. What is the cause of the discoloration? How would you treat it?

History

Siobhan’s mother says she noticed that when the permanent teeth erupted they looked darker. Siobhan is very unhappy at school and refuses to smile for any photographs. When she talks she has the habit of covering her mouth with a hand so it is impossible to see her teeth. What can you see in Figure 38.1A? What key questions do you need to ask?

image

Fig. 38.1 (A) Dentinogenesis imperfecta.

image Was there any systemic illness from birth until early childhood?

No. Siobhan had no illness.

image Were the primary teeth similarly affected?

The primary teeth erupted normally but very quickly chipped away becoming worn to gum level.

image Is anyone else in the family similarly affected?

Siobhan’s brother and her father have a problem with their teeth. Siobhan’s brother is 14 and he has needed crowns on his back teeth and veneers on his front teeth. Siobhan’s father needed a lot of treatment when he was younger and has had some teeth crowned. Many of his posterior teeth, however, were extracted.

Even before you have examined the mouth, the history suggests that Siobhan has an inherited defect. Figure 38.1A confirms your suspicion that this is dentinogenesis imperfecta (DI).

image Why is this DI and not amelogenesis imperfecta (AI)?

The teeth are translucent.

The enamel is poorly adherent to the underlying dentine and easily chips and wears. The remaining primary canines and molars in Figures 35.1A, B are worn to gingival level and have a translucent opalescent appearance.

image What investigations do you need to do to confirm your suspicions?

Dental panoramic tomogram

If this is DI, the dental panoramic radiograph will probably show the following:

• Bulbous crowns with pronounced cervical constriction.
• Shortened roots.
• Progressive pulp chamber and canal obliteration (Fig. 38.2 (different case)).
• Spontaneous periapical abscess formation.
image

Fig. 38.2 Obliteration of root canals and pulp chambers in dentinogenesis imperfecta.

Family examination

• Family examination of affected members.
• Dentine defects like those of enamel may be subdivided by cause into two main groups based on whether they are of genetic or environmental origin.
• Dentine anomalies that are genetically determined may appear to be limited to the dentitio/>

Related posts:

  1. 27: Facial swelling and dental abscess
  2. 39: Gingival bleeding and enlargement
  3. 3: Absent upper lateral incisors
  4. 6: Palatal canines
  5. 14: Posterior crossbite
  6. 2: Unerupted upper central incisor

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 38: Dentinogenesis imperfecta

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