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Cloning of Tabby, the murine homolog of the human EDA gene: evidence for a membrane-associated protein with a short collagenous domain.

X-Linked hypohidrotic ectodermal dysplasia (XLHED) is a human congenital disorder resulting in abnormal tooth, hair and sweat gland development. A candidate gene for the disorder has been cloned, but the function and full size of its putative protein product is unclear. We have identified a candidate cDNA for the mouse Tabby gene (Ta), which, based on phenotype and syntenic mapping, is postulated to represent the analogous murine disorder. Mutations have been identified in three different Ta alleles and Northern analysis indicates that the gene is expressed at increasing levels during embryogenesis (11-17 days p.c.), the period when affected structures develop. The putative protein product encoded by exon 1 is highly homologous (87% identical) to the predicted EDA protein product (135 amino acids), including the presence of a single transmembrane domain. However, the murine cDNA also encodes an additional 246 amino acids, which contains a short collagenous domain (Gly-X-Y)19. This predicted structure is similar to a number of membrane-associated proteins with either single or multiple collagenous domains in their extracellular C-terminal regions. Since mutations can only be identified in 10-15% of families with XLHED, it is likely that additional homologous exons exist for the human EDA gene. Hybridization of YACs from the EDA region with the Ta cDNA support this hypothesis. The predicted extracellular collagenous domain of this membrane protein may play a key role in epithelial-mesenchymal interactions, defects of which are thought to underlie the Ta/XLHED phenotype.

Amino Acid Sequence↗

Severe Infra-occlusion and failed eruption of deciduous molars associated with eruptive and developmental disturbances in the permanent dentition: a report of 28 selected cases.

Retrospective analysis of 28 children suffering from severe infra-occlusion and/or primary failure of eruption of deciduous molars revealed an association with eruptive and developmental disturbances in the permanent dentition, including ectopically placed teeth and aplasia of teeth. Taurodont permanent molars were evident in 19 of the 28 selected cases which suggests a possible developmental relationship between these factors. Problems in relation to treatment of these cases are discussed.

Adolescent↗

Dental rotation in cleft lip.

In patients with untreated cleft lip and permanent dentition, the central superior incisors are usually rotated. We use a technique that we call "dental rotation" to adjust these teeth into normal position and occlusion. This technique avoids having a hard structure (a rotated tooth) press against the mucosal sutures in a lip closure. In addition, a better aesthetic appearance of the dental arch results.

Child↗

Maxillofacial considerations for diagnosis and treatment in Gorlin's syndrome: access osteotomies for cyst removal and orthognathic surgery.

Gorlin's syndrome is a complex hamartomatous/neoplastic syndrome with multisystemic manifestations involving the skin, central nervous system, and bony skeleton. The purpose of this article is to describe how a patient with Gorlin's syndrome was managed with a multipronged approach that included exposure osteotomies for keratocyst removal combined with orthognathic surgery. This case demonstrates the advantages of standard maxillofacial osteotomies to gain access for the removal of odontogenic cysts and benign tumors.

Adult↗

A four generation hidrotic ectodermal dysplasia family: an allelic variant of Clouston syndrome?

A four generation Scottish family with hidrotic ectodermal dysplasia affecting predominantly teeth, skin and hair is described. Hypo- or oligodontia of the secondary dentition by late adolescence was characteristic and two individuals had multiple natal teeth. Flexural acanthosis nigricans during childhood and early adolescence is a feature in some of the women. All affected individuals produced sweat, but heat tolerance was variable. Hypoplasia of the pilosebaceous units was found on light microscopy in one subject. Scalp hair was thin and slow growing (but adult females described much improved quality during pregnancy) and body hair was scanty. Scanning electron microscopy of hair samples showed abnormal cuticular appearances consistent with a primary defect affecting keratin structure. The nails were normal. Relative macrocephaly due to hyperostosis of the cranial vault was variably present. Short stature (5-10th centile) present in some cases is possibly a separate familial trait. The family demonstrates overlapping features with Clouston syndrome. In Clouston syndrome, however, alopecia can be severe, palmarplantar hyperkeratosis is usually present, and hypo/oligodontia is not a prominent feature.

Adult↗

Endodontic management of dens evaginatus of maxillary central incisors: a rare case report.

Dens evaginatus is a disturbance in tooth development that produces a tubercle of hard tissue on the surface of the tooth. While prophylactic pulp capping is recommended for vital teeth, teeth with necrotic pulps require endodontic therapy or extraction. This rare case of a 24-yr-old Indian male with affected maxillary central incisors demonstrates the clinical consequences of dens evaginatus.

Adult↗

A founder COL17A1 splice site mutation leading to generalized atrophic benign epidermolysis bullosa in an extended inbred Palestinian family from Israel.

PURPOSE: Generalized atrophic benign epidermolysis bullosa is a nonlethal form of junctional EB with an autosomal recessive inheritance. There is generalized cutaneous blister formation at sites of trauma, atrophic alopecia affecting scalp, eyelash and eyebrow, dystrophic nail changes, and tooth abnormalities. In this study, we have studied a five-generation Palestinian family affected with generalized atrophic benign epidermolysis bullosa. METHODS: We have performed linkage analysis to genes that are mutated in generalized atrophic benign epidermolysis bullosa, followed by direct sequencing of patient genomic DNA. RESULTS: We have shown that the disease is caused by a newly detected homozygous donor splice site mutation, IVS51+1G>A, in the type XVII collagen gene, COL17A1. CONCLUSION: The effect of a founder mutation introduced 3 to 4 generations before a disease appearance is demonstrated in this inbred family.

Autoantigens↗

Long-term effects of chemotherapy on orodental structures in children with non-Hodgkin's lymphoma.

The aim of this study was to investigate the late effects of treatment for childhood non-Hodgkin's lymphomas (NHL) on oral health and dental development. Thirty-six long-term survivors that had been treated with chemotherapy of childhood NHL were included in this study and 36 volunteers with similar age and sex distribution served as controls. Both groups underwent a complete orodental examination for decayed, missing and filled teeth and surfaces, gingival and periodontal health according to the Loe-Silness Gingival Index and Sillnes-Loe Plaque Index, enamel defects and discolorations, root malformations, eruption status, agenesis, premature apexifications and microdontia. The severity of these disturbances related to age at the time of NHL diagnosis were also evaluated by creating two groups as < 5 yr and > 5 yr. Although none of the parameters altered with age, patients had significantly higher plaque index, more enamel discolorations and root malformations than did the controls. The results show that long-term survivors of NHL patients exhibit some orodental disturbances that may be attributed to the chemotherapy regimens.

Adolescent↗

The radiographic incidence of multiple roots and canals in human mandibular premolars.

The aim of this study was to investigate the incidence in mandibular premolars of multiple roots and root canals that could be demonstrated radiographically. The images of mandibular premolar teeth as seen on intraoral full-mouth radiographic surveys (547) taken with the paralleling technique were examined. In 99 patients (18.1%) there was at least one premolar tooth with either divided canals or roots. First premolars were involved in 15.7% of patients, and second premolars in 7%.

Bicuspid↗

Bilateral buccal radicular groove in maxillary incisors: case report.

AIM: To present the rare localization of a radicular groove on the buccal aspect of a tooth and to discuss the pathology and management of the concomitant endo-periodontal defect. SUMMARY: Bilateral buccal radicular grooves were found on the maxillary central incisors of a 60-year-old female Caucasian. One groove was associated with deep local pocketing resulting in pulp necrosis and the formation of a periodontal-endodontic lesion. After endodontic treatment of the affected tooth, periodontal surgery was performed during which an apicoectomy was carried out on the root-filled tooth. Both the buccal grooves were removed by grinding, the roots were planed with curettes and a guided-tissue regeneration technique applied using amelogenin (Emdogain, Biora, Sweden). Following a period of 2 years, re-examination showed excellent healing with the complete elimination of the periodontal pocket on both incisors and significant radiographic evidence of bone regeneration. KEY LEARNING POINTS: Deep radicular grooves can predispose to pulp necrosis and the establishment of combined periodontal-endodontic lesions. Evaluation of clinical signs and appropriate diagnostic tests are of paramount importance in order to prevent incorrect diagnosis and treatment. Endodontists must be capable of performing advanced periodontal regeneration techniques during endodontic surgery.

Alveolar Bone Loss↗

Compound odontomes associated with impacted maxillary primary central incisors: report of two cases.

Odontomes associated with primary teeth are rare. This report describes two cases of compound odontome associated with impacted maxillary primary central incisors in patients aged 1 year 8 months and 1 year 2 months, the latter being the youngest to have been reported with the condition. The odontomes were removed under local anaesthesia. Histological examination revealed immature dental tissues in both cases, but no evidence of root formation. Case 1 revealed 'ghost cells' within the enamel epithelium. The impacted incisors erupted following removal of the odontomes; in Case 2 the crown had an unusual ridge on its labial surface, extending from the gingival margin to a few millimetres from the incisal edge.

Female↗

The prevalence of developmental anomalies of teeth and their association with tooth size in the primary and permanent dentitions of 1650 Japanese children.

The prevalence of microdontia, macrodontia, peg-shaped tooth, Carabelli's tubercle, protostylid, paramolar tubercle, central tubercle and palatal accessory cusp were examined in Japanese children. This study included 905 children with primary dentitions (mean age 4 years 7 months) and 745 high-school students with permanent dentitions (mean age 16 years 8 months). Microdontia, macrodontia, Carabelli's tubercle, protostylid and paramolar tubercle were more frequent in the primary dentition, whereas peg-shaped tooth, central tubercle and palatal accessory cusp were more frequent in the permanent dentition. The association between the presence of developmental anomalies and the size of the remaining teeth was significant in permanent dentitions. Both the literature and this study indicate that developmental anomalies of tooth number, size and morphology should be studied as a group rather than as isolates.

Adolescent↗

A review of 47 cases of unerupted maxillary incisors.

OBJECTIVES: To study the prevalence of aetiological factors associated with unerupted maxillary incisors and to follow the outcome of treatment in a study of 47 cases. DESIGN: A retrospective study. SETTING: The Dental Department, St Luke's Hospital, Malta, the School Dental Clinic of Malta and the private practices of two orthodontists in Malta. SAMPLE AND METHODS: Forty-seven patients with a total of 53 unerupted maxillary incisors were classified according to the aetiological factors causing non-eruption. The relative prevalence of the various aetiologies were ascertained, and the outcome after treatment was recorded to assess the efficacy of the treatment methods being used. RESULTS: The most common cause of lack of eruption was the presence of supernumerary teeth (47% of patients). The other 53% of cases were distributed more or less equally between the remaining aetiological factors, which were odontomes (9%), dilacerations (9%), tooth germ malposition (12%), crowding (4%), one case of a calcifying odontogenic cyst (2%) and one case of trauma to the preceding deciduous tooth (2%). The aetiology of 15% of cases could not be ascertained. Once supernumerary teeth were removed, maxillary incisors usually erupted successfully with the help of conventional treatment methods such as surgical exposure and orthodontics. A relatively large number of incisors that failed to erupt due to other aetiological factors had to be extracted. CONCLUSIONS: Maxillary incisors that fail to erupt due to the presence of supernumerary teeth have a better prognosis than unerupted incisors with less common aetiologies.

Adolescent↗