Diagnosis of Dentofacial Anomalies

*Mahesh Kaggere Puttaraju, Prasanna Srinivasa Despandae and Viveka S*

## **Abstract**

It is very challenging to understand and analyse anomalies of dentofacial region. Diagnosis plays a very important role in the further treatment of any condition related to orofacial anomalies. Diagnosis includes taking complete history and required investigations and conclusion. History gives more information towards clinical path, and investigation will lay more emphasis on conclusion. Anomalies involving dentofacial region may be related to tooth, maxilla, mandible, soft tissue anomalies and syndromic conditions. Dentofacial anomalies not only involve the dentofascial region but can spread to various other vital organs, so sometimes correlating the systemic problem will be of prime importance. When the other body is involved, the varied presentation will be a challenge in diagnosis. Multiple organs should be investigated for an diagnostic conclusion. Brining diagnostic information of anomalies is the aim of the chapter. Here, we cover various clinical features, diagnostic criteria, and investigation protocols of dentofacial anomalies.

**Keywords:** dentofacial anomalies, tooth, syndrome, diagnosis, disturbances in structure of teeth

## **1. Introduction**

Societal forces define norms for an acceptable physical appearance and equate to a good smile. Significant aesthetic and functional issues in both jaws are included in dental abnormalities. It has been discovered that certain syndromes and systemic disturbances are connected with changes in craniofacial form, structure or function to the point where these changes can be categorised as the essential characteristics of such illnesses. It is crucial that the clinician is aware of any dysmorphologic alterations to the orofacial structures in order to consider specific disease entities and rule out the participation of any other tissues or organ systems that might be syndromically connected. Dental appearance with success in life plays an important role. An increased concern for dental appearance has been observed during adolescence and early adulthood. One among them is malocclusion that is described as an irregularity of the teeth or a poor relationship of the dental arches beyond the range of what is accepted as normal. Malocclusion can impact quality of life causing psychosocial limitations (awkwardness in the social context or reduced career opportunities) and functional disturbances (affecting mastication, swallowing and speech; increasing susceptibility to trauma; and increasing prevalence of dental caries, periodontal disease and temporomandibular joint disorders). Even though the malocclusion is not a dentofacial anomalies, it is a part of various dentofacial anomalies.

**Figure 1.** *Distribution of dentofacial anomalies.*

For any individual defect, there may be variation in phenotype, associated anomalies and cause. To help organise these various disorders, dysmorphologists have grouped them into 'syndromes', 'sequences' and 'associations' based on our level of understanding of their aetiologies as shown in **Figure 1**.

#### **2. Developmental anomalies of teeth**

In the course of their lifetime, humans produce two sets of teeth: the primary dentition and the permanent dentition. By the age of 12, the primary dentition is fully replaced by permanent teeth that last for lifetime, as opposed to many animals, which have numerous sets of teeth that erupt depending on how and when a functional tooth is used and exfoliated.

Human teeth begin to develop during foetal development and continue growing until 10 years after birth. Teeth abnormalities develop for a number of reasons, such as poor nutrition, systemic illnesses, genetic problems, that influence a person throughout this time.

The developmental disturbances of teeth can be classified as anomalies affecting the following features:


#### **2.1 Microdontia**

When teeth are physically smaller than usual, the term 'microdontia' should be used. As one or more developing lobes of a tooth germ fail, resulting in microdonts, the condition can also cause aberrant form.

Both generalised and localised microdontia exist. Generalised microdontia is typically linked to a growth hormone or pituitary dysfunction-related developmental disorder. A single tooth in the arch is typically affected by localised microdontia. The maxillary lateral incisors (peg laterals) and third molars are the most commonly afflicted teeth. Usually, a size comparison between the neighbouring and opposing teeth makes the diagnosis simple.
