Pathology of the Hard Dental Tissues

Albert H B Schuurs PhD is an associate lecturer at the Academic Center for Dentistry in Amsterdam (ACTA). During his career at ACTA and in his clinical practice, he has developed particular expertise in the field of oral hard tissue pathology.

Introduction vii

Prior to and during the development of the teeth within the jaws vii

During the eruption of teeth vii

After the eruption of the teeth vii

Genetics vii

Interpretation of family trees viii

SECTION I: DEVELOPMENTAL ANOMALIES 1

1 Anomalies of Number 3

1.1 Introduction 3

1.2 Hypodontia 3

1.3 Hyperdontia 11

1.4 Fusion and partial schizodontia 19

1.5 Concrescence 26

2 Deviations in Tooth Morphology and Size 27

2.1 Introduction 27

2.2 Compression 27

2.3 Dens invaginatus 27

2.4 Palato-gingival groove 32

2.5 Dilaceration 32

2.6 Enamel pearls and enamel extensions 33

2.7 Fused roots 35

2.8 Macro- and microdontia 36

2.9 Other developmental anomalies of the tooth crowns 39

2.10 Extra cusps 40

2.11 Supernumerary roots 44

2.12 Taurodontism 47

2.13 Consequences 49

3 Developmental Structural Anomalies of Enamel and Dentine 50

3.1 Introduction 50

3.2 Developmental and acquired structural anomalies of the enamel 52

3.3 Hereditary amelogenesis imperfecta 79

3.4 Developmental structural anomalies of the dentine 86

SECTION II: ANOMALIES OF ERUPTION 97

4 Deviations in Timing and Site of Eruption 99

4.1 Eruption 99

4.2 Abnormal eruption times 102

4.3 Anomalies of site of eruption 114

SECTION III: POST-ERUPTION HARD TISSUE PHYSIOLOGICAL CHANGES AND PATHOLOGICAL CONDITIONS 121

5 Caries 123

5.1 Introduction 123

5.2 Bacteria in caries 123

5.3 The substrate 127

5.4 The initial lesion (enamel) 127

5.5 Progression of the carious lesion 130

5.6 Root caries 132

5.7 Some risk factors 133

5.8 Identifi cation of carious lesions 136

5.9 Rate of progression of the carious process 139

5.10 Epidemiology 140

5.11 Prevention 142

5.12 Curative treatment 151

5.13 Preparation/excavation techniques 153

6 Erosion 156

6.1 Introduction 156

6.2 Aetiology 157

6.3 Epidemiology 164

6.4 Appearance and diagnosis 165

6.5 Prevention 168

6.6 Treatment 169

6.7 Alleviation of cervical hypersensitivity 170

7 Tooth Resorption 173

7.1 Introduction 173

7.2 Physiological external root resorption: deciduous teeth 174

7.3 Transient external root resorption: both dentitions 174

7.4 Progressive resorption: both dentitions 176

7.5 Prevention and treatment of progressive external resorption 188

8 Tooth Wear and Other Signs of Ageing 191

8.1 Introduction 191

8.2 Ageing 191

8.3 Nomenclature 194

8.4 Physiological and progressive tooth wear 194

8.5 Pathological tooth wear in mutilated dentitions 199

8.6 Bruxism and tooth clenching 200

8.7 Cervical lesions caused by tooth brushing 204

8.8 Other causes of tooth wear 208

9 Tooth Fractures and Traumatic Dentoalveolar Injuries 210

9.1 Introduction 210

9.2 Abuse 210

9.3 Spontaneous cracks and fractures of the teeth 211

9.4 Traumatic tooth fractures 217

9.5 Traumatic periodontal injury 225

9.6 Epidemiology 231

9.7 Prevention 233

9.8 Splints 233

10 Discoloration of Teeth 235

10.1 Introduction 235

10.2 Endogenous discoloration 236

10.3 Exogenous discoloration 243

10.4 Discoloration due to breakdown 248

10.5 Prevention 248

10.6 Treatment 250

SECTION IV: SYNDROMES 267

11 Congenital Syndromes with Dental Anomalies 269

11.1 Introduction 269

11.2 Autosomal dominant syndromes 271

11.3 Autosomal recessive syndromes 286

11.4 X-linked syndromes 290

11.5 Chromosomal syndromes 291

References 293

Introduction and Chapter 1: Anomalies of Number 293

Chapter 2: Deviations in Tooth Morphology and Size 308

Chapter 3: Developmental Structural Anomalies of Enamel and Dentine 319

Chapter 4: Deviations in Timing and Site of Eruption 344

Chapter 5: Caries 356

Chapter 6: Erosion 373

Chapter 7: Tooth Resorption 382

Chapter 8: Tooth Wear and Other Signs of Ageing 393

Chapter 9: Tooth Fractures and Traumatic Dentoalveolar Injuries 402

Chapter 10: Discoloration of Teeth 413

Chapter 11: Congenital Syndromes with Dental Anomalies 422

Appendix: Chronology of Dental Development 431

Index 433