Dental Anomalies Health Article

Environmental causes

Environmental anomalies are caused by external agents, including diet, that affect the teeth and gums. Extended use of the antibiotic tetracycline in young children, for example, can cause dark brown discoloration of the teeth. Fluorosis, an overabundance of fluorine in the diet, can create white or mottled spots on the teeth. This is most commonly seen in children who ingest greater-than-recommended amounts of fluoride by swallowing large quantities of fluoridated toothpaste. Teeth naturally darken with age, as the enamel thins and the dentin shows through. Coffee, tea, and red wine can also stain the teeth. Even children who swim an average of six hours or more a week in a pool may develop brown stains on their teeth.

Bulimia can cause severe decalcification of the teeth. Acid from constant regurgitation eats away at the enamel, especially in the molar region. This weakens the teeth, making them both susceptible to decay and highly sensitive. Unless the bulimia is arrested, sensitivity increases until the nerve is exposed and root canal therapy is needed or extraction is required.

Poor nutrition can also cause dental anomalies. Scurvy, a disease caused by a lack of vitamin C, affects periodontal and other connective tissue, causing purple, swollen, bleeding gums and, if untreated, tooth loss. Anemia, caused by a lack of iron in the diet, causes fiery red gum tissues. Both of these anomalies can be corrected with proper nutrition and routine care.

Other anomalies

Concrescence is the fusion of teeth above and below the gum line, although each tooth has separate roots. The teeth are united by cementum only. It may be caused by crowding or injury. Most commonly it occurs with the second premolars (bicuspids). This is a painless anomaly and treatment is required only for cosmetic reasons.

Supernumerary teeth are extra permanent teeth that may or may not erupt and can be found anywhere in the mouth. The most common is the mesiodens, a small tooth with a cone-shaped crown and a short root situated between the maxillary central incisors. Heredity may play a role in the development of supernumerary teeth, but other factors are thought to contribute as well. Supernumerary teeth can be extracted with no harm to the patient.

Diagnosis

Dental anomalies can be evidence of systemic disease and may have more than one cause. After weighing the patient's symptoms, pain (if any), health risks, family history, aesthetic considerations, treatment costs, and insurance coverage, the dentist will decide whether to treat or simply monitor the condition.

Treatment

Treatment is intended to eliminate or diminish the defect, manage pain, and alleviate the patient's concerns. Treatment may progress in multiple phases, including a program of continuing care that allows the dentist or doctor to evaluate the treatment's effectiveness.

In most cases, surgery can correct the deformity. Cleft lips are usually repaired before the infant is a month or two old, with excellent cosmetic and functional results. Surgical repair of a cleft palate, however, is not usually performed until the patient is approximately eighteen months old, to minimize the risk of damaging important growth centers. Psychological services are often included as part of the treatment along with speech and hearing services.

Depending on the severity of the anomaly, treatment can be expensive, but medical and dental insurance can help limit out-of-pocket expenses for the patient. Sometimes treatment will be covered by medical insurance if procedures are performed by an oral surgeon or medical doctor instead of a dentist.

Prognosis

Although many orofacial anomalies are currently managed, rather than treated, the rapid advance of science—such as the ability to identify mutated genes— promise future cures and treatments that will eliminate or reduce the number of defects currently seen. Gene therapy may also someday be applied to the treatment of many craniofacial anomalies, both to repair congenital defects and to accelerate healing after trauma. Gene mapping may also help doctors know which patients are susceptible to what type of anomalies.

The NIDCR is the primary sponsor of craniofacial research and training in the United States. The institute supports a variety of projects, including basic studies of cell migration and differentiation, cell signaling, patterns of gene expression, growth factor effects, tooth formation and eruption, and bone formation. These studies explore the genetic and molecular mechanisms behind craniofacial abnormalities and are intended to prevent or correct the anomaly or improve the patient's ability to function with it.