Hypodontia

Hypodontia
Classification and external resources
ICD-10 K00.0
ICD-9-CM 520.0
MeSH D000848

In dentistry, hypodontia is the condition at which the patient has missing teeth as a result of the failure of those teeth to develop (also called tooth agenesis). Hypodontia describes a situation where the patient is missing up to five permanent teeth, excluding the 3rd molars. Missing third molars occur in 9-30% of studied populations. In primary dentition the maxilla is more affected, with the condition usually involving the maxillary lateral incisor.

The condition of missing over five (six or more) permanent teeth, excluding 3rd molars or wisdom teeth, has been called oligodontia. The condition for missing all teeth, either primary and/or permanent), is called anodontia. A similar condition is hyperdontia, in which there are more than the usual number of teeth, more commonly called supernumerary teeth.

Many other terms to describe a reduction in number of teeth appear in the literature: aplasia of teeth, congenitally missing teeth, absence of teeth, agenesis of teeth and lack of teeth.[1]

Prevalence

In persons of European ancestry, the most common missing teeth are the wisdom teeth (25-35%), the permanent upper lateral incisors (2%), the lower second premolars (3%), or the upper second premolar, with a higher prevalence in females than in males. The prevalence of missing primary teeth is found at 0.1-0.9%, with a 1:1 male to female ratio. Excluding the third molars, missing permanent dentition accounts for 3.5-6.5%. Similar trends of missing teeth can be seen in approximately 3-10% of orthodontic patients.[2][3]

30-50% of people with missing primary teeth will have missing permanent teeth, as well.

Etiology

The cause of isolated missing teeth remains unclear, but the condition is believed to be associated with genetic or environmental factors during dental development. Missing teeth have been reported in association with increased maternal age, low birth weight, multiple births and rubella virus infection during embryonic life.

There is a possible correlation between tooth agenesis and innervation.[4][5][6][7][8] A relationship was also postulated between abnormalities of the brainstem and the presence of agenesis.[9]

Hypodontia is often familial, and can also be associated with genetic disorders such as ectodermal dysplasia or Down syndrome. Hypodontia can also been seen in people with cleft lip and palate.

Among the possible causes are mentioned genetic, hormonal, environmental and infectious.

Etiology due to hormonal defects: idiopathic hypoparathyroidism and pseudohypoparathyroidism.[10][11] Exists the possibility that this defect depends on a moniliasis (candidiasis, candida endocrinopathy syndrome).[10][12][13]

Environmental causes involving exposure to PCBs (ex.dioxin),[14][15][16] radiation,[17][18][19] anticancer chemotherapeutic agents,[20] allergy [21] and toxic epidermal necrolysis after drug.[22]

Infectious causes of hypodontia: rubella,[23] candida.[24]

The Journal of the American Dental Association published preliminary data suggesting a statistical association between hypodontia of the permanent teeth and epithelial ovarian cancer (EOC). The study shows that women with EOC are 8.1 times more likely to have hypodontia than are women without EOC. The suggestion therefore is that hypodontia can serve as a "marker" for potential risk of EOC in women.[25]

Also the increased frequency of hypodontia in twins and low birth weight in twins with hypodontia suggests that environmental factors during perinatal are responsible hypodontia.[26][27]

Genetics

Genetic causes also involve the genes MSX1 and PAX9.[28][29]

Genetic associations for selective tooth agenesis ("STHAG") include:

Type OMIM Gene Locus
STHAG1 106600 MSX1 4p16
STHAG2 602639 ? 16q12
STHAG3 604625 PAX9 14q12
STHAG4 150400 WNT10A 2q35
STHAG5 610926 ? 10q11
STHAG6 613097 LTBP3 11q12
STHAGX1 313500 EDA Xq13.1

Curiosity

In the 1960s and 1970s, several studies were conducted sponsored by the U.S. Atomic Energy Commission, with the aim of finding a link between genetics and hypodontia.[17][30]

Restorative Management of Hypodontia

The oral rehabilitation of hypodontia, especially where a significant number of teeth have not developed, is often an multidisciplinary process, involving a specialist orthodontist, a consultant in restorative dentistry, and a paediatric dentist in the earlier years.[31][32] The process of treating and managing hypodontia begins in the early years of the patients dentition where absent teeth are identified and the process of maintaining the remaining teeth begins. This is largely conducted by the paediatric dentist with orthodontic input. Once all the adult teeth have erupted the orthodontist is likely to liaise with the restorative dentist regarding optimal positioning of teeth for subsequent replacement with prosthodontic methods. This may include the utilisation of a resin-retained bridge and implants for spaces or composite resin, veneers or crowns where teeth are diminutive or misshaped.

References

  1. ↑ Fekonja A (October 2005). "Hypodontia in orthodontically treated children". European Journal of Orthodontics 27 (5): 457–60. doi:10.1093/ejo/cji027. PMID 16043466.
  2. ↑ Medina AC (2012). "Radiographic study of prevalence and distribution of hypodontia in a pediatric orthodontic population in Venezuela.". Pediatr Dent. 34 (2): 113–116. PMID 22583882.
  3. ↑ Vahid-Dastjerdi E, Borzabadi-Farahani A, Mahdian M, Amini N; Borzabadi-Farahani; Mahdian; Amini (2010). "Non-syndromic hypodontia in an Iranian orthodontic population". J Oral Sci. 52 (3): 455–461. doi:10.2334/josnusd.52.455. PMID 20881340.
  4. ↑ Chávez-Lomeli M E, Lory J M, Pompa J A, Kjær I.; Mansilla Lory; Pompa; Kjaer (1996). "The human mandibular canal arises from three separate canals innervating different tooth groups" (PDF). J Dent Res 75 (8): 1540–4. doi:10.1177/00220345960750080401. PMID 8906121.
  5. ↑ Kjær I, Kocsis G, Nodal M, Christensen L R.; Kocsis; Nodal; Christensen (1994). "Aetiological aspects of mandibular tooth agenesis—focusing on the role of nerve, oral mucosa, and supporting tissues". Eur J Orthod 16 (5): 371–5. doi:10.1093/ejo/16.5.371. PMID 7805810.
  6. ↑ Jacobsen J, Jørgensen J B, Kjær I.; Jørgensen; Kjaer (1991). "Tooth and bone development in a Danish medieval mandible with unilateral absence of the mandibular canal". Am J Phys Anthropol 85 (3): 15–23. doi:10.1002/ajpa.1330850104. PMID 1853939.
  7. ↑ Kjær I. (1995). "Human prenatal craniofacial development related to brain development under normal and pathologic conditions". Acta Odontol Scand. 53 (3): 135–43. doi:10.3109/00016359509005963. PMID 7572088.
  8. ↑ Kjær I. (1997). "Can the location of tooth agenesis and the location of initial bone loss seen in juvenile periodontitis be explained by neural developmental fields in the jaws?". Acta Odontol Scand. 55 (1): 70–72. doi:10.3109/00016359709091945. PMID 9083580.
  9. ↑ Linderstrom A, Samuelsson L, Huggare J.; Samuelsson; Huggare (2002). "Is tooth agenesis related to brainstem anomalies in myelomeningocele patients with Chiari II malformations?". Acta Odontol Scand. 60 (6): 337–340. doi:10.1080/000163502762667351. PMID 12512882.
  10. 1 2 Sutphin, A., Albright, F., McCune, D. J.; Albright; McCune (1943). "Five cases (3 in siblings) of idiopathic hypoparathyroidism associated with moniliasis". J. Clin. Endocr. 3 (12): 625–634. doi:10.1210/jcem-3-12-625.
  11. ↑ Jensen SB, Illum F, Dupont E; Illum; Dupont (February 1981). "Nature and frequency of dental changes in idiopathic hypoparathyroidism and pseudohypoparathyroidism". Scandinavian Journal of Dental Research 89 (1): 26–37. doi:10.1111/j.1600-0722.1981.tb01274.x. PMID 6262903.
  12. ↑ Muriel M. McLean (1954). "Chronic Idiopathic Hypoparathyroidism Associated with Moniliasis". Arch Dis Child. 29 (147): 419–421. doi:10.1136/adc.29.147.419. PMC 2011654. PMID 13208313.
  13. ↑ Ritchie GM. (1965). "Dental manifestations of pseudohypoparathyroidism". Arch Dis Child. 40 (213): 565–572. doi:10.1136/adc.40.213.565. PMC 2019454. PMID 5830003.
  14. ↑ Alaluusua S, Lukinmaa PL, Torppa J, Tuomisto J, Vartiainen T; Lukinmaa; Torppa; Tuomisto; Vartiainen (January 1999). "Developing teeth as biomarker of dioxin exposure". Lancet 353 (9148): 206. doi:10.1016/S0140-6736(05)77214-7. PMID 9923879.
  15. ↑ Alaluusua S, Calderara P, Gerthoux PM, et al. (September 2004). "Developmental dental aberrations after the dioxin accident in Seveso". Environmental Health Perspectives 112 (13): 1313–8. doi:10.1289/ehp.6920. PMC 1247522. PMID 15345345.
  16. ↑ Guo YL, Lambert GH, Hsu CC, Hsu MM; Lambert; Hsu; Hsu (April 2004). "Yucheng: health effects of prenatal exposure to polychlorinated biphenyls and dibenzofurans". International Archives of Occupational and Environmental Health 77 (3): 153–8. doi:10.1007/s00420-003-0487-9. PMID 14963712.
  17. 1 2 Niswander JD, Sujaku C; Sujaku (December 1963). "Congenital anomalies of teeth in Japanese children". American Journal of Physical Anthropology 21 (4): 569–74. doi:10.1002/ajpa.1330210413. PMID 14185534.
  18. ↑ Sevbitov AV (2004). "[Remote effects of the Chernobyl accident: evaluation of the maxillodental status of the children]". Stomatologiia (in Russian) 83 (1): 44–7. PMID 15021876.
  19. ↑ Kaste SC, Goodman P, Leisenring W, et al. (December 2009). "Impact of radiation and chemotherapy on risk of dental abnormalities: a report from the Childhood Cancer Survivor Study". Cancer 115 (24): 5817–27. doi:10.1002/cncr.24670. PMID 19834960.
  20. ↑ Näsman M, Forsberg CM, Dahllöf G; Forsberg; Dahllöf (April 1997). "Long-term dental development in children after treatment for malignant disease". European Journal of Orthodontics 19 (2): 151–9. doi:10.1093/ejo/19.2.151. PMID 9183064.
  21. ↑ Yamaguchi T, Tomoyasu Y, Nakadate T, Oguchi K, Maki K; Tomoyasu; Nakadate; Oguchi; Maki (December 2008). "Allergy as a possible predisposing factor for hypodontia". European Journal of Orthodontics 30 (6): 641–4. doi:10.1093/ejo/cjn043. PMID 18687988.
  22. ↑ Fréderick Gaultier; Juliette Rochefort; Marguerite-Marie Landru; Laurence Allanore; Adrien Naveau; Jean-Claude Roujeau; Bruno Gogly (October 2009). "Severe and Unrecognized Dental Abnormalities After Drug-Induced Epidermal Necrolysis". Arch Dermatol. 475 (11): 1332–1333. doi:10.1001/archdermatol.2009.233. PMID 19917972.
  23. ↑ Charlene Chun-Lam Wu, Ricky Wing-Kit Wong, Urban Hägg (2007). "A review of hypodontia: the possible etiologies and orthodontic, surgical and restorative treatment options—conventional and futuristic" (PDF). Hong Kong Dental Journal 4: 113–21.
  24. ↑ Kinirons MJ. (June 1983). "Candidal invasion of dentine complicating hypodontia". British Dental Journal 154 (12): 400–1. doi:10.1038/sj.bdj.4805102. PMID 6576802.
  25. ↑ Chalothorn LA, Beeman CS, Ebersole JL, et al. (February 2008). "Hypodontia as a risk marker for epithelial ovarian cancer: a case-controlled study". Journal of the American Dental Association 139 (2): 163–9. doi:10.14219/jada.archive.2008.0132. PMID 18245684.
  26. ↑ "THE RELATIONSHIP BETWEEN BIRTH WEIGHT AND HYPODONTIA IN TWINS, 12 MAY 1969". NAVAL DENTAL RESEARCH INST GREAT LAKES ILL by Keene,Harris J. Retrieved 2010-05-22.
  27. ↑ Kindelan JD, Rysiecki G, Childs WP.; Rysiecki; Childs (1998). "Hypodontia: genotype or environment? A case report of monozygotic twins". Br J Orthod. 25 (3): 175–178. doi:10.1093/ortho/25.3.175. PMID 9800013.
  28. ↑ Nieminen P (June 2009). "Genetic basis of tooth agenesis". Journal of Experimental Zoology. Part B, Molecular and Developmental Evolution 312B (4): 320–42. doi:10.1002/jez.b.21277. PMID 19219933.
  29. ↑ De Coster PJ, Marks LA, Martens LC, Huysseune A; Marks; Martens; Huysseune (January 2009). "Dental agenesis: genetic and clinical perspectives". Journal of Oral Pathology & Medicine 38 (1): 1–17. doi:10.1111/j.1600-0714.2008.00699.x. PMID 18771513.
  30. ↑ C M Woolf; John, SA; Revel, JP (May 1971). "Missing maxillary lateral incisors: a genetic study". American Journal of Human Genetics 21 (3): 289–296. PMC 1706719. PMID 5089845.
  31. ↑ Borzabadi-Farahani; A (December 2012). "Orthodontic considerations in restorative management of hypodontia patients with endosseous implants.". Journal of Oral Implantology 36 (6): 779–791. doi:10.1563/AAID-JOI-D-11-00022. PMID 21728818.
  32. ↑ Borzabadi-Farahani A, Zadeh, HH (October 2013). "Adjunctive orthodontic applications in dental implantology.". Journal of Oral Implantology 41: 501–8. doi:10.1563/AAID-JOI-D-13-00235. PMID 24175964.
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