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Abnormal development of the apical ectodermal ridge and polysyndactyly in Megf7-deficient mice.

Megf7/Lrp4 is a member of the functionally diverse low-density lipoprotein receptor gene family, a class of ancient and highly conserved cell surface receptors with broad functions in cargo transport and cellular signaling. To gain insight into the as yet unknown biological role of Megf7/Lrp4, we have disrupted the gene in mice. Homozygous Megf7-deficient mice are growth-retarded, with fully penetrant polysyndactyly in their fore and hind limbs, and partially penetrant abnormalities of tooth development. The reason for this developmental abnormality is apparent as early as embryonic day 9.5 when the apical ectodermal ridge (AER), the principal site of Megf7 expression at the distal edge of the embryonic limb bud, forms abnormally in the absence of Megf7. Ectopic expression and aberrant signaling of several molecules involved in limb patterning, including Fgf8, Shh, Bmp2, Bmp4 and Wnt7a, as well as the Wnt- and Bmp-responsive transcription factors Lmx1b and Msx1, result in reduced apoptosis and symmetrical dorsal and ventral expansions of the AER. Abnormal signaling from the AER precedes ectopic chondrocyte condensation and subsequent fusion and duplication of digits in the Megf7 knockouts. Megf7 can antagonize canonical Wnt signaling in vitro. Taken together, these findings are consistent with a role of Megf7 as a modulator of cellular signaling pathways involving Wnts, Bmps, Fgfs and Shh. A similar autosomal recessive defect may also occur in man, where polysyndactyly, in combination with craniofacial abnormalities, is also part of a common genetic syndrome.

Animals↗

Dyskeratosis congenita: report of a case.

Dyskeratosis congenita is a rare multisystem condition involving mainly the ectoderm. It is characterized by a triad of reticular skin pigmentation, nail dystrophy and leukoplakia of mucous membranes. Oral and dental abnormalities may also be present. Complications are a predisposition to malignancy and bone marrow involvement with pancytopenia. The case of a 14-year-old girl is described who presented with several of the characteristic systemic features of this condition, together with the following oral features: hypodontia, diminutive maxillary lateral incisors, delayed dental eruption, crowding in the maxillary premolar region, short roots, poor oral hygiene, gingival inflammation and bleeding, alveolar bone loss, caries and a smooth atrophic tongue with leukoplakia. Although this condition is rare, dental surgeons should be aware of the dental abnormalities that exist and the risk of malignant transformation within the areas of leukoplakia.

Adolescent↗

Oral findings in patients with autosomal dominant hypophosphatemic bone disease and X-linked hypophosphatemia: further evidence that they are different diseases.

Oral examinations were performed on 5 patients with hypophosphatemic bone disease (HBD) (2 males and 3 females), 14 patients with X-linked hypophosphatemia (XLH), and 4 affected XLH relatives (6 males and 12 females). The control subjects were the unaffected siblings and parents of the patients and unrelated healthy, gender- and age-matched subjects. Serum phosphorus values were the same by disease type and gender in patients with HBD and XLH. They shared certain dental abnormalities, in particular pulpal necrosis and large pulp spaces. However, only patients with XLH had Class III malocclusions and mild enamel defects, and males with XLH had more severe occlusal and enamel defects than females with XLH. Different dental phenotypes are further evidence that XLH and HBD are different diseases. The dental abnormalities were not prevented by treatment, instituted early in life, which raised serum phosphorus to the near normal range.

Adolescent↗

Taurodontism, an unreported dental finding in Wolf-Hirschhorn (4p-) syndrome.

Presented is a case report describing clinical and radiographic dental findings in a patient with Wolf-Hirschhorn (4p-) syndrome. There is only one case study in the literature that describes dental findings in a patient with this disorder. There are no case reports that include radiographic documentation of dental abnormalities in patients with 4p- syndrome. This report presents a case of taurodontism in a patient with 4p- syndrome, an unreported dental finding.

Adolescent↗

Dental characteristics in Williams syndrome: a clinical and radiographic evaluation.

Williams syndrome is a rare congenital syndrome with distinctive craniofacial features, cardiovascular abnormalities, and behavior characteristics including mental retardation. The dental abnormalities have received scant attention in previous literature. The aim of this study was to describe dental characteristics in individuals with Williams syndrome. In a group of 41 individuals more than 10 years of age, 40.5% had agenesis of one or more permanent teeth and 11.9% had agenesis of 6 permanent teeth or more. The mesio-distal and labio-lingual dimensions of permanent tooth crowns were measured on 31 dental study casts from individuals older than 12 years. The mesio-distal and labio-lingual dimensions were significantly smaller compared with a reference sample. An analysis of tooth morphology was performed on the same dental study casts revealing altered tooth morphology. A high proportion of maxillary and mandibular incisors was tapered or screwdriver shaped. An evaluation of taurodontism on mandibular permanent molars was performed using a metric crown-body/root ratio. However, most of the molars rated as being taurodontic had short or extremely short total tooth lengths and could thus be rated taurodontic without meeting the classical definition. The results of this study indicate that although there is variation in dental development in individuals with Williams syndrome, agenesis of permanent teeth in combination with aberrations in tooth size and morphology may affect dental esthetics and complicate orthodontic and prosthodontic treatment.

Adolescent↗

Dental caries and dental anomalies in children treated by chemotherapy for malignant disease: a study in the north of England.

Fifty-two children in remission from childhood cancer and 41 siblings underwent a full clinical and radiographic dental examination. All the children had received chemotherapy. The leukaemic patients had received radiotherapy also, but not involving the jaws. There was no significant difference in dental caries experience between the treated children and the siblings, but significantly more dental anomalies were detected radiographically in the treated group.

Abnormalities, Drug-Induced↗

Dental anomalies in mental patients.

Fifty-three patients were examined for dental abnormalities at an institution specializing in care of the mentally deficient in Bauru, São Paulo State. The incidence of teeth with abnormal morphology, mainly second molars with an abnormal number of cusps, was extremely high. Enamel hypoplasia was frequently found in anterior teeth, and the percentage of fractured maxillary incisors was significantly higher than that observed in normal individuals.

Adolescent↗

Gingival biopsy in diagnosis of inborn storage diseases: a case of aspartylglycosaminuria.

The case described is that of a 9-yr-old girl presenting with aspartylglycosaminuria. Diagnosis of this lysosomal storage disease was guided by histologic study of gingival specimen sampled in the course of dental care. Transmitted electron microscopy (TEM) revealed many vesicles and cellular inclusions, altered collagenic formations, associated with abnormal extracellular matrix. Gingival biopsy is easily performed, is noniatrogenic, leaves nor scar, and could be properly used to help diagnose metabolic diseases in children.

Acetylglucosamine↗

[The late results of using evicrol and stomadent for eliminating dental tissue defects in children].

Clinical analysis of the efficacies of evikrol and stomadent used to replace dental hard tissue defects in children has shown similar results, but stomadent is preferable because the filling made of it virtually does not change its color. The authors claim that the development of such complications as caries recurrence, change of the color of the filling in sites of their union with dental tissues, abnormal edge union is related to the technique of enamel acid tanning of immature children's teeth, that should be modified.

Adolescent↗

Rosette formation of impacted molar teeth in mucopolysaccharidoses and related disorders.

The radiographic features of the jaws in the mucopolysaccharidoses and related disorders (MPS) have been reviewed and three further cases are reported here, with particular reference to a novel dental anomaly, not previously described in detail, in two of them. The dental changes appear to be fully developed by the third decade and are characterized by bilateral multiple impacted molar teeth, which conglomerate in a single follicle to form a characteristic rosette of teeth. Rosetting was present only in relatively mature cases of MPS. However, it was also seen in the fourth patient, where we could not detect any other abnormal clinical or radiographic features. We therefore propose that since multiple rosetting of molar teeth can also occur in an isolated form, it is only suggestive of MPS.

Adolescent↗

Inherited dental anomalies and abnormalities.

A considerable body of evidence exists to suggest that genes play a dominant role in the etiology of the dental anomalies reviewed. It has been postulated that some kind of genetically controlled interrelationship may exist for some of these coincidental dental anomalies, as evidenced by their frequency of association. It has also been speculated that a "common genetic defect" may give rise to different phenotypic manifestations, including missing, malformed, and even ectopic and malpositioned teeth. The maxillary teeth that develop in the critical marginal areas of the dental lamina, namely the lateral incisors, canines and second premolars, seem most susceptible. Such dental anomalies may be symptoms of an inheritable developmental disturbance of tooth structures. Knowing that these dental anomalies can be inherited, a familial history and early clinical or radiographic detection of one anomaly, could alert parents and clinicians to the high likelihood of detection of other defects in the same individual and similar defects in other family members. Early diagnosis is important so that interceptive pediatric and orthodontic opportunities in relation to missing, malformed and ectopically erupting teeth are not overlooked. Further family studies are necessary to reveal the mode of inheritance of some of these dental anomalies and twin studies comparing monozygous and dizygous twins would enable an estimation of the extent of their inheritance.

Anodontia↗

[Problems raised by the use of tetracyclines in the first years of life].

Tetracyclines administered during the first years of life may produce serious unwanted side-effects, such as intracranial hypertension and, chiefly, abnormalities of the teeth and bones. The tetracyclines have a special affinity for certain metal cations, notably calcium, with which they form relatively stable complexes. When given to children or pregnant women they stain the deciduous and permanent teeth a lasting yellowish-brown or give rise to dental abnormalities; they may also slow down skeletal growth. For these reasons tetracyclines should not be prescribed to children and pregnant women unless absolutely necessary, and other classes of antibiotics should be preferred whenever possible.

Age Factors↗