Opi 1-introduction-tooth abnormalities

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Oral Pathology I
Third Year

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Opi 1-introduction-tooth abnormalities

  1. 1. Oral Pathology I Aiman A. Ali DDS, PhD.
  2. 2. Oral Pathology Oral Pathology I  Abnormalities  Dental caries  Inflammatory jaw lesions  Ulcerative lesions  Vesiculo-Bullous lesions  White lesions Oral Pathology II  Cysts of head and neck  Odontogenic tumors  Non-Odontogenic tumors  Salivary gland diseases  ---  Red blue and pigmented L. --Aiman A. Ali DDS, PhD.
  3. 3. Oral Pathology I Course director: Dr. Aiman A. Ali Course contributors: Dr Louay Jaber Dr Wael Swelam Theory: Saturday 1-2 pm Laboratory: OP Lab. Saturday 2-5 pm Aiman A. Ali DDS, PhD.
  4. 4. Course content Week Date Lecturer Topic 1 Introduction to oral pathology 2 Abnormalities of teeth 3 Dental caries 4 Inflammatory jaw lesions I 5 Inflammatory jaw lesions II 6 Pathological bases of the periodontal diseases 7 Vesiculo-Bullous disease I 8 Vesiculo-Bullous disease II 9 Ulcerative conditions I 10 Ulcerative conditions II 11 White lesions I 12 White lesions II 13 Red-Blue lesions 14 Pigmentation of oral and perioral tissues 15 Advanced diagnostic methods in oral and maxillofacial pathology Aiman A. Ali DDS, PhD.
  5. 5. Evaluation Attendance ……………………………………………………….... Quizzes ………………………………………………….……………….... Midterm ……………………………………………….……………….... Continuous practical evaluation …….... Final practical exam ……… …………..…………….... Oral interview ………………………………………………….... Final Written exam ……………………….…………….... Total 5 10 20 10 10 5 40 100 Aiman A. Ali DDS, PhD.
  6. 6. Lab Book
  7. 7. Abnormalities of teeth & oral tissues Reference book: • Regezi & Sciubba. Oral Pathology: clinico-pathological correlation. • Cawson: Oral Pathology and Oral Medicine Recommended book: • Shafer, Hine & Levy. A text book of Oral Pathology. Chp 1. Aiman A. Ali DDS, PhD.
  8. 8. Abnormalities of teeth Alteration in size Alteration in shape Alteration in number Alteration in structure Alteration in color Aiman A. Ali DDS, PhD.
  9. 9. Abnormalities of oral structures Developmental disturbances of the jaws Developmental disturbances of the tongue Developmental disturbances of lip and palate Developmental disturbances of oral mucosa Developmental disturbances of salivary glands Aiman A. Ali DDS, PhD.
  10. 10. Abnormalities of teeth Alterations in size Microdontia Macrodontia Aiman A. Ali DDS, PhD.
  11. 11. Microdontia Generalized – True – Relative Focal or localized – Maxillary lateral incisor – Maxillary third molar Aiman A. Ali DDS, PhD.
  12. 12. Macrodontia Generalized – True – Relative Focal or localized – Mandibular third molar – Hemifacial hypertrophy Aiman A. Ali DDS, PhD.
  13. 13. Abnormalities of teeth Alterations in shape Gemination Fusion Concrescence Dilaceration Dens Invaginatus Dens Evaginatus Taurodontism Supernumerary roots Enamel pearls Aiman A. Ali DDS, PhD.
  14. 14. Alterations in shape Gemination Aiman A. Ali DDS, PhD.
  15. 15. Alterations in shape Fusion Aiman A. Ali DDS, PhD.
  16. 16. Alterations in shape Concrescence Aiman A. Ali DDS, PhD.
  17. 17. Alterations in shape Dilaceration Aiman A. Ali DDS, PhD.
  18. 18. Alterations in shape Dens Invaginatus Aiman A. Ali DDS, PhD.
  19. 19. Alterations in shape Dens Evaginatus Aiman A. Ali DDS, PhD.
  20. 20. Alteration in Shape Taurodontism  It is a variation of tooth form.  Elongated crown  Apically displaced furcation  Increased height of pulp chamber  Associated with Down syndrome Aiman A. Ali DDS, PhD.
  21. 21. Aiman A. Ali DDS, PhD.
  22. 22. Alteration in Shape Taurodontism  11% occurrence in middle east  It is of little clinical significance  No treatment is required Aiman A. Ali DDS, PhD.
  23. 23. Alterations in Shape Supernumerary root  Accessory roots are most commonly seen in:  Mandibular canines  Premolars  Molars  (thirds) Recognition of extra-root numbers is important for extractions or endodontic treatment Aiman A. Ali DDS, PhD.
  24. 24. Aiman A. Ali DDS, PhD.
  25. 25. Alterations in Shape Enamel pearls  Droplets of ectopic enamel, they occur most commonly on  The bi-or tri-furcation of teeth  Maxillary & mandibular molars  It may be detected on radiographic examinations  It is of significance when periodontal disease is present Aiman A. Ali DDS, PhD.
  26. 26. Alterations in Shape Enamel pearls Aiman A. Ali DDS, PhD.
  27. 27. Attrition, Abrasion & Erosion Attrition: The loss of tooth structure from tooth to tooth contact Abrasion: The loss of tooth structure due to repeated mechanical contact with objects other than teeth Erosion: Non-carious loss of tooth structure due to chemical dissolution not related to acid produced by dental plaque Aiman A. Ali DDS, PhD.
  28. 28. Attrition, Abrasion & Erosion Aiman A. Ali DDS, PhD.
  29. 29. Alterations in Shape Attrition  It is a physiologic wearing of teeth as a result of mastication  It is an age related process & varies from one individual to another  Diet, dentition, musculature & chewing habits can influence the pattern of attrition Aiman A. Ali DDS, PhD.
  30. 30. Alterations in Shape Abrasion  It is the pathologic wearing of teeth as a result of abnormal habit (abrasive substance)  Pipe smoking  Tobacco chewing  Aggressive toothbrushing  Abrasive dentifrices Aiman A. Ali DDS, PhD.
  31. 31. Alterations in Shape Erosion  It is a loss of tooth structure from a non-bacterial chemical process     Acids External: work environment or in the diet Internal: regurgitation of gastric contents (chronic vomiting) In many cases of tooth erosion, no cause is found Aiman A. Ali DDS, PhD.
  32. 32. Alterations in Number Anodontia  It is an absence of teeth that is often associated with hereditary ectodermal dysplasia  It is caused by polygenic (enviromental & genetic factors)  Complete Anodontia: All teeth are missing The prevalence of hypodontia is 4.6% Partial Anodontia: some teeth are missing Aiman A. Ali DDS, PhD.
  33. 33. Alterations in Number Aiman A. Ali DDS, PhD.
  34. 34. Alterations in Number Anodontia  Partial anodontia (hypodontia): one or several teeth are missing  Pseudoanodontia: when teeth are absent clinically  Most commonly seen in third molars, second premolars & maxillary lateral incisors Aiman A. Ali DDS, PhD.
  35. 35. Aiman A. Ali DDS, PhD.
  36. 36. Aiman A. Ali DDS, PhD.
  37. 37. Alterations in Number Impaction  It is most commonly seen in mandibular third molars & maxillary cuspids, it occurs because of:  Crowding  Physical barrier  Abnormal eruption path  Ankylosis (fusion of tooth to alveolar bone) Aiman A. Ali DDS, PhD.
  38. 38. Aiman A. Ali DDS, PhD.
  39. 39. Alterations in Number Supernumerary teeth  It results from continued proliferation of permanent or primary dental lamina  The tooth can be rudimentary & miniature  It can be an isolated event, familial or associated with syndromes Aiman A. Ali DDS, PhD.
  40. 40. Alterations in Number  Supernumerary teeth Clinical significance:       Occupy space Block eruption Delay or mal-eruption Natal teeth Post-permanent dentition Maxilla>mandible: 10:1   Anterior midline of maxilla (mesiodens) Fourth molar Aiman A. Ali DDS, PhD.
  41. 41. Alterations in tooth structure Enamel Hereditary: Amelogenesis Imperfecta Environmental: Trauma, Fluoride, Syphilis …etc. Dentine Hereditary: Dentinogenesis Imperfecta All dental hard tissues Dentine dysplasia Hereditary: Regional odontodyslasia Environmental: Resorption Pulp Aiman A. Ali DDS, PhD.
  42. 42. Defects of Enamel Environmental defects of enamel  Severe metabolic injury can cause:  Defects in the quantity & shape   Enamel hypoplasia Defects in the quality and color  Enamel hypocalcification Enamel hypoplasia Aiman A. Ali DDS, PhD.
  43. 43. Defects of Enamel Environmental defects of enamel  The extent of the defect is dependent on:  The intensity of the etiologic factor Enamel hypoplasia  The duration  The time of occurrence Aiman A. Ali DDS, PhD.
  44. 44. Defects of Enamel Environmental defects of enamel  Etiologic factors can be  Local: (Turner’s tooth)    Trauma Abscess Clinical signs  Hypocalcification or hypoplasia Aiman A. Ali DDS, PhD.
  45. 45. Environmental Defects of Enamel  Research have shown that causes are attributed to  infectious diseases  Nutritional defects (rickets)  Congenital syphilis  Birth trauma (neonatal line)  Fluoride (hypoplasia or hypocalcification)  Idiopathic factors Aiman A. Ali DDS, PhD.
  46. 46. Environmental Defects of Enamel Aiman A. Ali DDS, PhD.
  47. 47. Due to Syphilis Aiman A. Ali DDS, PhD.
  48. 48. Due to Syphilis Aiman A. Ali DDS, PhD.
  49. 49. Local infection or trauma Turner’s teeth Aiman A. Ali DDS, PhD.
  50. 50. Fever Aiman A. Ali DDS, PhD.
  51. 51. Amelogenesis Imperfecta  It is a hereditary disorders affects both primary and permanent dentitions  It can be hypocalcified or hypoplastic  Hypoplastic type   Insufficient amount of enamel (pits & grooves to aplasia) Hypocalcified type:  Soft & friable enamel (wears readily) Aiman A. Ali DDS, PhD.
  52. 52. Amelogenesis Imperfecta  The color varies from white opaque to yellow to brown  Dentin & pulp chamber appear normal  Cosmetic problem Aiman A. Ali DDS, PhD.
  53. 53. Defects in Dentin Dentinogenesis imperfecta  It is an autosomal dominant trait  It affects dentin in both primary and permanent dentitions  Type I: Occurs in pts. With osteogenesis imperfecta  Type II: Only dentin but no bone abnormalities Aiman A. Ali DDS, PhD.
  54. 54. Defects in Dentin Dentinogenesis imperfecta Type III: Only dental defects occur • Pulp exposures • Periapical radiolucencies • Variable radiographic appearance Aiman A. Ali DDS, PhD.
  55. 55. Defects in Dentin Dentinogenesis imperfecta  Clinical features:  Both dentitions exhibit translucent appearance  Yellow-brown to gray  The enamel fractures easily  Roots are shortened and blunted Aiman A. Ali DDS, PhD.
  56. 56. Defects in Dentin Dentinogenesis imperfecta  Radiographically, Type I & II exhibits identical changes:    Opacifications of dental pulps Short roots and bell shaped crowns Type III:  Dentin appears thin  Pulp chambers and root canals are extremely large (Shell teeth)  Periapical radiolucencies Aiman A. Ali DDS, PhD.
  57. 57. Defects in Dentin Dentinogenesis imperfecta  Microscopically:   Pulp replaced by irregular dentin   The dentin contains fewer but larger and irregular dentinal tubules Enamel appears normal but dentinoenamel junction is smooth Treatment is directed toward protecting tooth from wear and esthetic appearance Aiman A. Ali DDS, PhD.
  58. 58. Defects in Dentin Dentin dysplasia  It is a hereditary rare condition that has been subdivided to:  Type I (radicular type)  The color of both dentition is normal  Periapical lesions are regular features  Premature tooth loss (short roots)  Pulps are completely obliterated Aiman A. Ali DDS, PhD.
  59. 59. Defects in Dentin Dentin dysplasia  Type II (coronal type)  Primary dentition is opalescent and permanent dentition is normal  The coronal pulps are large and filled with globules of abnormal dentin  Periapical lesion are not regular features  Primary teeth appeared similar to type I but permanent teeth exhibit enlarged pulp chamber Aiman A. Ali DDS, PhD.
  60. 60. Defects in Dentin Dentin Dysplasia  Microscopically:    Enamel and immediately subjacent dentin appear normal Deeper layers of dentin shows atypical tubular patterns & amorphous, atubular areas and irregular organization Treatment is directed toward retention of teeth but prognosis is poor Aiman A. Ali DDS, PhD.
  61. 61. Defects of Enamel & Dentin Regional odontodysplasia  It is a dental abnormality that involves the hard tissues that are derived from both epithelial (enamel) and mesenchymal (dentin & cementum) components of the tooth forming apparatus Aiman A. Ali DDS, PhD.
  62. 62. Defects of Enamel & Dentin Regional odontodysplasia  A region or quadrant of the maxilla or mandibule are affected  Short roots  Open apical foramina  Enlarged pulp chambers  Poor mineralization of enamel & dentin (ghost teeth) Aiman A. Ali DDS, PhD.
  63. 63. Defects of Enamel & Dentin    Regional odontodysplasia Permanent teeth>primary teeth Maxillary anterior teeth are more affected Eruption is delayed or does not occur Aiman A. Ali DDS, PhD.
  64. 64. Defects of Enamel & Dentin Regional odontodysplasia  Cause is unknown, however:         Trauma Nutritional deficiencies Infections Metabolic abnormalities Systemic diseases Local vascular compromize Genetic influences Treatment: teeth removal because of poor quality Aiman A. Ali DDS, PhD.
  65. 65. Abnormalities of the Dental Pulp Pulp calcification  Occurs with increasing age  No apparent reason Microscopic size  Large  Linear (diffuse)  Nodular (pulp stones)   True denticle  False denticle Not source of pain  Aiman A. Ali DDS, PhD.
  66. 66. Abnormalities of the Dental Pulp Aiman A. Ali DDS, PhD.
  67. 67. Internal Resorption  It may be seen as  Inflammatory response to pulpal injury  No apparent trigger  It occurs as a result of osteoclasts activation on internal surfaces Aiman A. Ali DDS, PhD.
  68. 68. Internal Resorption  The root or crown can be perforated  In advanced cases teeth may appear pink  Treatment is root canal therapy before perforation Aiman A. Ali DDS, PhD.
  69. 69. External Resorption  It may be a result of an adjacent pathologic process  Chronic inflammatory lesion  Cysts  Benign tumors  Malignant neoplasms Aiman A. Ali DDS, PhD.
  70. 70. External Resorption  The cause has been related to:  Release of chemical mediators  Increased vascularity  Pressure Aiman A. Ali DDS, PhD.
  71. 71. External Resorption  It may be associated with:  Trauma  Reimplantation  Impactions  Idiopathic  The lesion can occur on root surfaces below the gingival epithelial attachment  It can occur at the apex Aiman A. Ali DDS, PhD.
  72. 72. Alterations in Color Exogenous stain  It is the stain that can be removed by abrasives  Dietary substances  Colored by-products of chromogenic bacteria Aiman A. Ali DDS, PhD.
  73. 73. Alterations in Color  Endogenous stain It results from deposits of systemically circulating substances during tooth development  Tetracycline  Bright yellow color  The color change with time due to oxidization Minocycline  It stains the root of adult teeth  Skin & mucosa Aiman A. Ali DDS, PhD.
  74. 74. Alterations in Color Endogenous stain  Congenital porphyria (hereditary)  Errors in porphyrin metabolism   Deposition of porphyrin in developing teeth which appear red to brown Liver disease, biliary atresia & neonatal hepatitis  It may cause discoloration of the primary teeth Aiman A. Ali DDS, PhD.
  75. 75. Tetracycline Aiman A. Ali DDS, PhD.
  76. 76. Abnormalities of oral structures Developmental disturbances of the jaws Developmental disturbances of the tongue Developmental disturbances of lip and palate Developmental disturbances of oral mucosa Developmental disturbances of salivary glands Aiman A. Ali DDS, PhD.
  77. 77. Developmental disturbances of the jaws Agnathia Micrognathia Macrognathia Facial Hemihypertrophy Facial Hemiatrophy Aiman A. Ali DDS, PhD.
  78. 78. Developmental disturbances of the tongue Aglossia Microglossia Macroglossia Ankyloglossia Cleft, bifid and fissured tongue Lingual thyroid nodule Median rhomboid glossitis Aiman A. Ali DDS, PhD.
  79. 79. Developmental disturbances of lip and palate Lip and commissural pits Clefts Double lip Aiman A. Ali DDS, PhD.
  80. 80. Developmental disturbances of oral mucosa Fordyce’s granules Focal epithelial hyperplasia Aiman A. Ali DDS, PhD.
  81. 81. Developmental disturbances of salivary glands Aplasia Atresia Aberrancy Mandibular salivary gland depression Aiman A. Ali DDS, PhD.

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