Prevention of oral disease in children: concepts and practices

Many of the dental traits exhibit continuous variation due to the multifactorial nature of dental development. Genetic and environmental disorders can result in further variation in specific dental traits. Identification of a dental anomaly can, at times, lead to the initial diagnosis of an underlying disorder and portend the patient's future health risks. Examples include the specific pattern of hypodontia seen before the development of iris dysplasia in Rieger syndrome, and the presence of supernumerary teeth and facial osteomas preceding malignant transformation of intestinal polyps in Gardner syndrome. In addition, dental anomalies can be useful in evaluating a patient's past medical history. A horizontal line of structural alteration in teeth can be used as a kymographic record of the causative metabolic disturbance and help pinpoint the active period of the disturbance. Normal eruption times of primary and permanent teeth also show a broad range of individual variation. Many disorders can cause extreme alterations in the eruption times of primary and permanent teeth or act to cause their premature exfoliation through disruption of their supporting tissues. The disruption of the eruption and integrity of the dentition can function as an indicator of the existent disease state. For example, the early exfoliation of primary teeth may be the presenting symptom of a patient with leukemia. Recognition of dental anomalies, distinct from normal variation can, therefore, be useful to the physician in the diagnosis of a patient's underlying condition and lead to a more thorough understanding of the mechanism of these disorders.