Goodlettsville Dental Services

Other Common Dental Problems

Dens Evaginatus

Dens invaginatus, also known as dens in dente, is a condition found in teeth where the outer surface folds inward. There are coronal and radicular forms, with the coronal form being more common.

Dens invaginatus is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. Affected teeth show a deep infolding of enamel and dentine starting from the foramen coecum or even the tip of the cusps and which may extend deep into the root. Teeth most affected are maxillary lateral incisors and bilateral occurrence is not uncommon. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Root canal therapy may present severe problems because of the complex anatomy of the teeth. Aetiology, prevalence, classification, and therapeutic considerations including root canal therapy, apical surgery and prevention of pulpal involvement are reviewed

Enamel Pearl

An enamel pearl is a condition of teeth where enamel is found on locations where enamel is not supposed to be, such as on a root surface. They are found usually in the area between roots, which is called a furcation, of molars. Enamel pearls are not common in teeth with a single root.

Macrodontia

Macrodontia is a condition in which any tooth or teeth appear larger than normal for that particular type of toot. True macrodontia that involving the entire dentition and is rare. It is more commonly that there is an enlargement of a single tooth due to a disturbance of morphodifferentiation. It should not be confused with either taurodontism (bull teeth), fusion (double tooth) or the jaws being relatively small, giving the appearance of macrodintia. It is commonly associated with gigantism.

Microdontia

Microdontia is a condition in which teeth appear smaller than normal. In the generalized form, all teeth are involved. In the localized form, only a few teeth are involved. The most common teeth affected are the upper lateral incisors and third molars. The affected teeth may be of normal or abnormal morphology 

Dilaceration

Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth.

Description

The condition is thought to be due to trauma during the period in which tooth is forming. The result is that the position of the calcified portion of the tooth is changed and the remainder of the tooth is formed at an angle.

The curve or bend may occur anywhere along the length of the tooth, sometimes at the cervical portion, at other times midway along the root or even just at the apex of the root, depending upon the amount of root formed when the injury occurred.

Such an injury to a permanent tooth, resulting in dilaceration, often follows traumatic injury to the deciduous predecessor in which that tooth is driven apically into the jaw. 

Regional Odontodysplasia

Regional odontodysplasia is an uncommon developmental abnormality of teeth, usually localized to a certain area and nonhereditary. No predilection for race, but females are more likely to get regional odontodysplasia. The enamel, dentin, and pulp of teeth are affected, and on radiographs the teeth are described as "ghost teeth". Most cases are considered idopathic but some cases are associated with syndromes, growth abnormalities, neural disorders, and vascular malformations. Permanent teeth usually show effects of regional odontodysplasia if the deciduous tooth was affected. Many of these teeth don’t erupt with an increased risk for caries and periapical inflammation.

Treatment/Prognosis is usually based upon keeping these teeth and preserving the alveolus. For erupted teeth, Endodontics is an option if the tooth is devitalized and restorable. For unerupted teeth, function can be restored with a removable partial denture until all major growth has been completed and a final restoration can be placed.  

Dentin Dysplasia

Dentin dysplasia is a genetic disorder of teeth, commonly exhibiting an autosomal dominant inheritance. It is characterized by presence of normal enamel but atypical dentin with abnormal pulpal morphology. There are two types. Type I is the radicular type, and type II is the coronal type. In the radicular type, the roots of teeth are shorter than normal and the pulp chamber may be nearly gone. The pulp chamber is sometimes described as having a "crescent shaped" appearance. In the coronal type, the pulps are enlarged and are described as having a "thistle tube" appearance, in permanent dentition. In the deciduous dentition, coronal dentin dysplasia bears a resemblance to Dentinogenesis Imperfecta type II.

Radiographic Features

Type 1: Roots are short, blunt and conical. In deciduous teeth, pulp chambers and root canals are completely obliterated in permanent they may be crescent shaped.

Type 2: The pulp chamber of the deciduous teeth become obliterated in deciduous teeth. While in permanent teeth, large pulp chamber is seen in coronal portion of the tooth – referred to as thistle tube appearance.Pulp stones may be found.

Histologic Features

Type 1: Normal dentinal tubule formation is blocked and new dentin forms around obstacles…known as lava flowing around bould

Attrition (Dental)

Attrition is the loss of teeth structure by mechanical forces from opposing teeth. Attrition initially affects the enamel and, if unchecked, may proceed to the underlying dentin. Once past the enamel, attrition quickly destroys the softer dentin. Erosion is a very important contributing factor to the loss of tooth substance by attrition. (A. Johansson et al. 2008)

The most common cause of attrition is bruxism. Functional habits are those such as chewing and swallowing, which usually puts very little force on opposing teeth. Parafunctional habits, such as clenching and clicking the teeth together nervously, place greater amounts of forces on opposing teeth and begin to wear the teeth. As expected, wear usually begins on the incisal or occlusal surfaces.

Characteristic Features: Development of a facet (flat surface with circumscribed and well defined border). Opposing tooth facets will match perfectly in occlusion.

Interproximal Attrition: Occurs at proximal surfaces of adjacent teeth when they move against one another on occlusal loading. Movement of teeth is in the vertical direction.

Abrasion (Dental)

Abrasion is the loss of tooth structure by mechanical forces from a foreign element. If this force begins at the cementoenamel junction, then progression of tooth loss can be rapid since enamel is very thin in this region of the tooth. Once past the enamel, abrasion quickly destroys the softer dentin and cementum structures.

Possible sources of this wearing of tooth are toothbrushes, toothpicks, floss, and any dental appliance frequently set in and removed from the mouth. The appearance is commonly described as V-shaped when caused by excessive pressure during tooth brushing.

The teeth most commonly affected are premolars and canines.

In Archaeology

Archaeologists utilize evidence of dental abrasion as indication of dietary and other health issues of prehistoric peoples. There are a number of examples of cranial recoveries dating thousands of years before present, where abrasion of teeth is used to analyze age and lifestyle of prehistoric peoples.

Periapical Abscess

A periapical abscess is the result of a chronic, localized infection located at the tip, or apex, of the root of a tooth.

To achieve resolution, endodontic therapy must be performed to debride the root canal or canals and remove pathogens.

Cementoblastoma

Cementoblastoma, or benign cementoblastoma, or cementoma, is a relatively uncommon benign neoplasm of the cementum of the teeth.

Clinical features

Cementoblastoma usually occurs in people under the age of 25, often involving the mandibular molars or premolars. The involved tooth usually has a vital pulp. It is attached to the tooth root and may cause its resorption, may involve the pulp canal, grows slowly, tends to expand the overlying cortical plates, and, except for the enlargement produced, is usually asymptomatic.

Radiographic features

A cementoblastoma in a radiograph appears as a well defined, markedly radiopaque mass, with a radiolucent peripheral "line", which overlies and obliterates the tooth root. There is usually apparent external resorption of the root where the tumor and the root join. Severe hypercementosis and chronic focal sclerosing osteomyelitis are lesions to consider in the diagnosis.

Treatment

Surgical excision of the lesion is done, and depending upon the clinical circumstances, this may or may not involve removal of the involved tooth.

Central Odontogenic Fibroma

The central odontogenic fibroma is a rare benign odontogenic tumor. It is more common in adults, with the average age being 40. It is twice as likely to affect women than men. It is usually found either in the anterior maxilla or the posterior mandible. Radiographically it presents with either radiolucency or mixed radiolucency/opaque. In the simple type you will see delicate fibrillar stroma of collagen containing fibroblasts, and in the WHO type you will see more mature fibrillar stroma of collagen. Treatment is by surgical removal

Cemento-Osseous Dysplasia

Cemento-osseous dysplasia is a benign condition of the jaws that may arise from the fibroblasts of the periodontal ligaments. It is most common in African-American females. The three types are periapical cemental dysplasia (common in blacks), focal cemento-osseous dysplasia (caucasians), and florid cemento-osseous dysplasia (blacks

Central Ossifying Fibroma

Central ossifying fibroma is a benign neoplasm that may arise from the fibroblasts of the periodontal ligaments. It is more likely to affect women in their third and fourth decades. Central ossifying fibromas are more common in the mandible around premolars and molars.

Condensing Osteitis

Condensing osteitis is an area of bone sclerosis under teeth which show signs of inflammation. The most common site is near premolars and molars. On radiographs, condensing osteitis appears a radiopaque or lighter area around the roots of a tooth. There is no associated bone expansion.

Description

Condensing osteitis is a reaction to infection. It differs from other periapical inflammatory diseases in that there is a bone production rather than bone destruction. The result is a radiopaque lesion. This sclerotic reaction is apparently brought about by good patient resistance coupled with a low degree of virulence of the offending bacteria. It is more commonly seen in the young and seems to show special predilection for the periapical region of lower molars. The associated tooth is carious or contains a large restoration. Whether or not the pulp is irreversibly diseased is not known. Current level of knowledge suggests that the pulp is irreversibly inflamed. Uncommonly, condensing osteitis occurs as a reaction to periodontal infection rather than dental infection. Etiology: Infection of periapical tissues by organisms of low virulence. Treatment: General protocol is to treat only those cases which are symptomatic. This is done by endodontic therapy or extraction. In those cases which are asymptomatic in which there is no obvious caries in the associated tooth, we follow them with periodic x-ray examination. Prognosis: In those cases in which the offending tooth is extracted, the area of condensing osteitis may remain in the jaws indefinitely. Differential diagnosis: Idiopathic osteosclerosis and cementoblastoma. An abnormal result with electric pulp testing strongly suggests condensing osteitis and tends to rule out osteosclerosis and cementoblastoma. "treatment"-endodontic treatment is indicated.

Congenital Epulis

The congenital epulis is a proliferation of cells on the upper jaw at birth. This is more commonly found on female babies. The cause of the disease is unknown.

Crossbite

Crossbite is an occlusal irregularity where a lower tooth has a more buccal or lingual position than the antagonist upper tooth. Crossbite can involve a single tooth or a group of teeth. It can be classified in anterior or posterior and bilateral or unilateral.

An anterior cross bite can also be referred as negative overjet, and is typical of class III skeletal relations (Progenism).

Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior cross-bite can be unilateral or bilateral. Unilateral cross-bite often determines a lateral shift of the mandibular position, which can become structural if left untreated for a long time during growth, leading to skeletal asymmetries.

There are several therapies that can be used to correct a cross bite: braces, quad helix, removable plates, Invisalign, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

Cusp

The teeth of the right side of the mouth, shown contacting the teeth in the opposing jaw with their cusp tips.

A cusp is an occlusal or incisal eminence on a tooth.

Canine teeth, otherwise known as cuspids, each possess a single cusp, while premolars, otherwise known as bicuspids, possess two each. Molars normally possess either four or five cusps. In certain populations the maxillary molars, especially first molars, will possess a fifth cusp situated on the mesiolingual cusp known as the Cusp of Carabelli.

Epulis Fissuratum

Epulis fissuratum (also known as "Granuloma fissuratum is an oral pathologic condition that appears in the mouth as an overgrowth of fibrous connective tissue. Also referred to less commonly as inflammatory fibrous hyperplasia, denture epulis, and denture induced fibrous hyperplasia, it is associated with the edges of a denture that does not fit well. The word, "epulis", can be used to describe any gingival tumor, but it is widely used in association with this specific condition.

Epulis fissuratum appears as a single or multiple fold of tissue that grown in excess around the alveolar vestibule, which is the area where the gums meet the inner cheek. Usually, the edge of the denture rests in between two of the folds. The excess tissue is firm and fibrous, and ulcerations may be present. The size of the affected tissue varies widely, since almost the entire length of tissue around a denture can be affected. More commonly found in women, it can appear in either the mandible or maxilla (upper jaw) but is more commonly found in the anterior portions of the mouth rather than in the posterior. Women during pregnancy can also present with an epulis, which will resolve after birth. Fibroepithelial polyps, pedunculated lesions of the palate beneath an upper denture, are associated with this condition. An epulis fissuratum in a patient without dentures can also be diagnostic of Crohn’s disease.

The appearance of an epulis fissuratum microscopically is an overgrowth of cells from the fibrous connective tissue. The epithelial cells are usually hyperkeratotic and irregular, hyperplastic rete ridges are often seen.

Treatment consists of surgical removal with the fixing of a denture in a process called a "reline" or with making a new denture.

Eruption Cyst

An eruption cyst, or eruption hematoma, is a bluish swelling that occurs on the soft tissue over an erupting tooth. It is usually found in children.

The fluid in the cyst is sometimes clear creating a pale coloured cyst although often they are blue.

Fissured Tongue

Fissured tongue (also known as "scrotal tongue," "lingua plicata," "Plicated tongue", and "furrowed tongue") is a benign condition characterized by deep grooves (fissures) in the dorsum of the tongue.

Fissured tongue is seen in Melkersson-Rosenthal syndrome, in most patients with Down syndrome, and in association with geographic tongue.

Giant Cell Fibroma

Giant cell fibroma is a type of fibroma not associated with trauma or irritation. It can occur at any age and on a mucous membrane surface. The most common oral locations are on the gingiva of the mandible, tongue, and palate. It is a localized reactive proliferation of fibrous connective tissue.

Giant cell fibroma (GCF) is a benign non-neoplastic lesion first described by Weathers and Callihan (1974). It occurs in the first three decades of life and predominates in females (Houston, 1982; Bakos, 1992). Clinically, the GCF presents as an asymptomatic, papillary and pedunculated lesion. The most predominant location is the mandibular gingiva (Houston, 1982; Bakos, 1992). Histologically, the GCF is distinctive, consisting of fibrous connective tissue without inflammation and covered with stratified squamous hyperplastic epithelium. The most characteristic histological feature is the presence of large spindle-shaped and stellate-shaped mononuclear cells and multinucleated cells. These cells occur in a variety of lesions, such as the fibrous papule of the nose, ungual fibroma, acral fibrokeratoma, acral angiofibroma and desmoplastic fibroblastoma (Swan, 1988; Pitt et al., 1993; Karabela-Bouropoulou et al., 1999; Jang et al., 1999). Despite many studies, the nature of the stellated multinucleate and mononuclear cell is not clear (Weathers and Campbell, 1974; Regezi et al., 1987; Odell et al., 1994; Magnusson and Rasmusson, 1995).

Gigantiform Cementoma

Gigantiform cementoma is a rare, autosomal dental tumor. It is benign, but without intervention it can result in severe disfigurement of the jaw. The cause of this tumor is currently unknown. This is an exceedingly rare tumor with only a handful of documented cases worldwide. The most famous case is of Novemthree Siahaan (who died on September 15, 2005), a young Indonesian boy from Batam Island who received medical care in Haulien, Taiwan through a Buddhist missionary from the Tzu Chi Foundation, which was documented on the Discovery Health Channel. Another famous case is a young Korean girl named Ayun Lee (August 26, 2003~) whose case has shown that the tumor can be heritable. She is currently under treatment, which she may need to continue until her growth stops in her early 20s.

The term has been used in the past to describe florid cemento-osseous dysplasia, but it is now reserved for an autosomic dominant condition affecting the maxillae. It affects mostly Caucasian people under the age of 10. Treatment is difficult. Surgical removal of the affected bone is needed, and has to be followed by reconstruction

Gingival Cyst of the Adult

The gingival cyst of the adult is a cyst which arises from the rest cells of the dental lamina. It is most common in the mandible near the canines and premolars. Middle-aged adults are more likely to be affected. It appears as a bluish swelling on attached gingiva or interdental papilla.

Idiopathic Osteosclerosis

Idiopathic osteosclerosis is a condition which may be found around the roots of a tooth. It is usually painless and found during routine radiographs. It appears as a radiopaque (light area) around a tooth, usually a premolar or molar. There is no sign of inflammation of the tooth.

Lateral Periodontal Cyst

The lateral periodontal cyst is a cyst that arises from the rest cells of the dental lamina. It is more common in middle-aged adult males. Usually, there is no pain associated with it, and it usually appears as a unilocular radiolucency (dark area) on the side of a canine or premolar root. Microscopically, the lateral periodontal cyst appears the same as the gingival cyst of the adult.

Leukoedema

Leukoedema is a normal variation of the buccal mucosa, or inside surface of the cheek. It presents as a white-bluish tinge of the buccal mucosa but the color disappears when the cheek is stretched. This aids to differentiate this lesion from other similar looking conditions which could be premalignant, such as leukoplakia. It is more prevalent in people who have dark skin and can be more intense in smokers.

Histologically, the white appearance is caused by water within the spinous cells causing the light to reflect back as whitish.

Stomatognathic Disease

Stomatognathic disease refers to the diseases of the mouth ("stoma") and [[jaw]] ("gnath"). The etymology is similar to that of the term Gnathostomata. It is the term used by MeSH (along with the synonym dental diseases), but other organizations use different terms.

The American Dental Association uses the term "oral and maxillofacial pathology", and describes it as "the specialty of dentistry and pathology which deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes and effects of these diseases."

The World Health Organization uses the term "Diseases of oral cavity, salivary glands and jaws

Osteoporotic Bone Marrow Defect

Osteoporotic bone marrow defect is a condition which may be found in the body of the mandible. It is usually painless and found during routine radiographs. It appears as a poorly defined radiolucency (dark area) where there was a previous history of an extraction of a tooth. It may resemble a metastatic diseas

Pulp Polyp

A pulp polyp is found in an open carious lesion, fractured tooth or when a dental restoration is missing. Due to lack of intrapulpal pressure in an open lesion pulp necrosis does not take place as would have have occurred in a closed caries case. Also a good vascular and immune supply is necessary, therefore found in adults.

Riggs’ Disease

Riggs’ disease, also known as pyorrhea of a toothsocket or gingivitis expulsiva, is a purulent inflammation of the dental periosteum named after American dentist John W. Riggs (1811–1885).

Riggs’ disease produces the progressive necrosis of the alveoli and looseness of the teeth. The teeth may become very loose and fall out of the sockets.

Secondary Palate

The secondary palate is an anatomical structure that divides the nasal cavity from the oral cavity in many vertebrates.

In human embryology, it refers to that portion of the hard palate that is formed by the growth of the two palatine shelves medially and their mutual fusion in the midline. It forms the majority of the adult palate and meets the primary palate at the incisive foramen.

Clinical significance

Secondary palate development begins in the sixth week of pregnancy and can lead to cleft palate when development goes awry.

There are three major mechanisms known to cause this failure:

1. Growth retardation – Palatal shelves do not grow enough to meet each other.  
2. Mechanical obstruction – Improper mouth size, or abnormal anatomical structures in the embryonic mouth prevent fully grown shelves from meeting each other.  
3. Midline epithelial dysfunction (MED) – The surface mucosa of embryonic shelves is impaired, which causes a failure of palatal fusion.  

Shovel-Shaped Incisors

Shovel-Shaped incisors: Incisors that have a scooped out lingual surface because of lingual marginal ridges, crown curvature, or a basal tubercle, either alone or in combination.

Shovel incisors are more common in East Asian populations and dramatically more common in Native American populations.

Squamous Odontogenic Tumor

The squamous odontogenic tumor is a rare odontogenic tumor found in any area of the alveolar bone. Usually, there is a painless swelling with adjacent teeth becoming mobile. On radiographs, it presents as a radiolucency (dark area) between the teeth in a triangular shape. Clinically, it may present similar to periodontal disease.

Stafne Defect

The Stafne defect is a depression of the mandible on the side nearest the tongue. It was previously known as a latent bone cyst and static bone cyst but is now known as a pseudocyst. The depression usually allows for the presence of a salivary gland.

Radiographically, it is a well-circumscribed radiolucency with a sclerotic border, and presents without any symptoms. It is usually a developmental defect of the jaw.

Superior Mouth

A superior mouth is a mouth that opens upward, with the lower jaw more anterior than the upper jaw. This is an effect typically seen in fish. Some humans are born with this defect, often making their face resemble a shark’s.

Talon Cusp

A talon cusp, also known as an "eagle’s talon", is an extra cusp on an anterior tooth. The term refers to the same condition as dens evaginatus, but the talon cusp is the manifestation of dens evaginatus on anterior teeth. The incidence has been found to range from less than 1% to 6% of the population. Of all cases, 55% occur on the permanent maxillary lateral incisor, and 33% occur on the permanent maxillary central incisor. They are found rarely in primary teeth

Traumatic Neuroma

A traumatic neuroma is a type of neuroma which results from trauma to a nerve, usually during a surgical procedure. The most common oral locations are on the tongue and near the mental foramen of the mouth. They are relatively rare on the head and neck.

It is also known as "pseudoneuroma".

Witch Boil

Witch boil is an archaic British word for a dental disease, which causes the teeth and tongue to swell. The disease was highly dangerous in the 1870s but since 1892 there have been no recorded cases of the condition, so it has never been given a scientific name. One theory states that this is not a disease, but the state people’s teeth go into when a tooth clashes with the current tooth, causing swelling.

Treponema Denticola

Treponema denticola
Scientific classification
Kingdom:	Eubacteria
Phylum:	Spirochaetes
Class:	Spirochaetes
Order:	Spirochaetales
Family:	Treponemataceae
Genus:	Treponema
Species:	T. denticola

Treponema denticola is a motile and highly proteolytic bacterium. The Gram-negative oral spirochete is associated with the incidence and severity of human periodontal disease. Treponema denticola levels in the mouth are elevated in patients with periodontal diseases and the species is considered one of the main etiological agents of periodontitis.

T. denticola dwells in a complex and diverse microbial community in the oral cavity and is highly specialized to survive in this environment.

T. denticola is related to the syphilis-causing obligate human pathogen, Treponema pallidum subsp. pallidum.

Vermillion Border

This left cheek incision extends from the left commissure towards the left ear and it breaches the vermillion border. In order to maintain esthetics as best as possible, the first suture was placed at or near the vermillion border to ensure a contiguous line upon healing.

Xylophagia

Xylophagia is a condition involving the consumption of wood. It is one form of the eating disorder known as pica. People who suffer from this eating disorder usually consume things like paper, pencils, tree bark or other items made of wood. In addition to psychological disorders, people may eat wood as part of their religious beliefs.

Young children may exhibit xylophagia, but it is not normally associated with psychological issues; it is typical of the standard oral fixation of infants.

The most popular form of xylophagia is the consumption of paper.

Human behavior

Pencil chewing is sometimes related to xylophagia, due not so much with pencils being wood, but to the soft resilient character of the wood. At various ages, the behavior easily substitutes teething rings, pacifiers, folded paper, plastic tokens, rods, pens, hard cloth objects, hanks of hair, finger nails, and fingers. It is also sometimes associated with dental pain from dental root or ligament damage or infection, in which case tap sensitivity can be noted. It is rarely associated with diurnal bruxism & jaw pain or headache. See pediatric dentistry.