In congenital and hereditary hypodontia, one to five permanent teeth of the jaw are not attached, with the non-attachment of six teeth or more being referred to as oligodontia and the absence of all tooth attachments being referred to as anodontia. Hypodontia can also be acquired, in which case it is often due to damage and atrophy of the tooth germ or to environmental factors such as irradiation.
What is hypodontia?
Hypodontia is a technical term used in dentistry and refers to the lack of attachment of one or more permanent teeth. To be distinguished from the term is the expression of oligodontia. This is a special case of hypodontia, in which more than five teeth are missing. A second special case is anodontia, the patients of which suffer from non-attachment of all teeth. Hypodontia spuria or feigned hypodontia, as distinct from true hypodontia, always occurs when the missing teeth are attached but do not erupt. While true hypodontia corresponds to a congenital anomaly of the dentition, dentistry understands fake hypodontia as an acquired dentition anomaly that also manifests itself in missing teeth.
Causes
Congenital hypodontia is one of the most common anomalies of the dentition. Missing anlagen for wisdom teeth and incisors are among the most common forms. In general, congenital hypodontia are hereditary and are passed on in part via an autosomal dominant mode of inheritance with variable expressivity and incomplete penetrance. All genes involved in tooth development may carry the defect. However, true hypodontia may occur in some circumstances as a result of a developmental disorder and thus may be associated with certain diseases. In addition to hemolytic anemia and Down syndrome, diseases such as Curtius syndrome or Bloch-Sulzberger syndrome can also be associated with hypodontia. Acquired and spurious hypodontia, on the other hand, often result from accidental damage to the dentition that caused premature tooth loss. Equally well, damage to the bone marrow or increased x-ray irradiation may be related to acquired hypodontia. Less commonly, the cause is central dislocation of deciduous teeth, which may damage and stunt attached tooth germs. If radiation therapy has occurred prior to the formation of the adult dentition, this may also have triggered hypodontia. Presumably, apart from those mentioned, many other environmental factors prior to the formation of the adult dentition are capable of promoting hypodontia.
Symptoms, complaints, and signs
When multiple teeth are not established, this multiple nonestablishment is often accompanied by additional dental symptoms. Shape anomalies are most notable in this regard. Dysplastic posterior teeth of the upper dental arch are just as much a part of this as the aplasia of other tooth nuclei, which indicates a general weakness in the formation of the dental arch. Under certain circumstances, a crossbite may also occur if the teeth of the upper dental arch are missing. If, on the other hand, the lower jaw is affected, a lowering of the bite may occur. Tilting of the remaining teeth may indicate general dental ridge lability and may occur as accompanying symptoms of any hypodontia. Which symptoms are associated with hypondontia in individual cases is strongly related to the number as well as localization of the missing tooth attachments.
Diagnosis and course of the disease
In most cases, the diagnosis of hypodontia takes place by x-ray diagnosis. On imaging, the missing attachment of teeth is usually readily apparent. Hypodontia remains static for the rest of the patient’s life, so that in the strict sense there is no question of a disease progression. However, the success of treatment strongly depends on which and how many teeth are affected. Untreated hypodontia often results in severe malocclusions of the jaw and in this context can trigger malocclusions that cause additional symptoms such as severe and chronic headaches. Since hypodontia is also an aesthetic problem, untreated patients sometimes suffer from psychological problems. Therefore, early treatment in hypodontia is particularly crucial for a positive outcome.
Complications
Hypodontia results in significant malformations and deformities of the mouth and jaw.Patients suffer from missing teeth, so that in most cases either five or six teeth are not present. The remaining teeth are also deformed or not in the right places. It is not uncommon for a so-called crossbite to occur. The stability of the teeth is reduced, so that they can break off more easily and are damaged. Due to the hypodontia, the daily life of the affected person is extremely limited, as there is discomfort when eating. In this case, the affected person is often dependent on liquid food, as they are unable to chew solid food. Furthermore, the toothache can also lead to headaches or earaches. In most cases, the malformations can be treated surgically so that there are no further restrictions or complications in everyday life. However, this treatment is only possible in adulthood. In childhood, children may suffer from teasing or bullying and develop psychological symptoms as a result. The life expectancy of the affected person is not limited by hypodontia.
When should you go to the doctor?
Hypodontia must always be treated by a doctor. There is no self-healing in this disease and usually serious limitations in the life of the affected person if the disease is not treated in time. The doctor should be consulted when the affected person is missing teeth. The number and position of the missing teeth can vary greatly. In most cases, the symptoms become noticeable in childhood. The dentist can detect them. In some cases, hypodontia also causes the other teeth to be tilted or misaligned, which can result in pain when taking food. The quality of life of the affected person is significantly reduced by hypodontia. In the case of hypodontia, a dentist or an orthodontist should be consulted first and foremost. The latter can usually treat hypodontia relatively well. Early diagnosis and treatment has a positive effect on the course of the disease and can prevent possible complications.
Treatment and therapy
Hypodontia of any type can be treated with orthodontic, prosthetic, implantologic, and oral surgical measures. While oral surgery measures are primarily intended to prevent malocclusion, malocclusion, and avoidance postures due to the missing teeth, surgery can also be used to perform implant placement or grafting, for example. In addition, impacted teeth may be exposed during surgery. General tooth replacement treatments can also make sense and lead to the desired result. However, the planning of the treatment measures and the coordination of the individual steps can only be carried out for the individual case. Both the number of unattached teeth and the condition of the teeth and the position of the entire dentition influence the planning of the treatment measures. The size of the jaw and the position of the jaw as well as existing diseases of other kinds cannot be ignored either. Treatment planning must also take into account financial aspects, which may preclude some of the available measures from the outset.
Prevention
While the congenital form can hardly be prevented, acquired hypodontia may be preventable. Sparing use of x-ray radiation and measures to reduce the risk of dislocation in deciduous teeth may play a role in this regard.
Follow-up care
There are no targeted prevention and aftercare options for the congenital form of the disease. However, acquired hypodontia can be prevented in aftercare by taking certain measures. Among other things, using X-rays as sparingly as possible is helpful. Reducing the risk of dislocation in primary teeth can also have a positive effect on health. Even after the malocclusion has been treated, the dentist should make regular check-up appointments to examine the teeth closely and to monitor changes. If necessary, he will add further measures to the actual treatment in order to optimize the correction. The patients themselves should take special care of their teeth during this time and use the care products recommended by the dentist. He often also gives advice on a sensible change in diet. By abstaining from stimulants and following a diet, patients avoid possible bleeding.Immediately after treatment, coffee, tea, nicotine and alcohol can interfere with wound healing. Spicy foods and extremely cold or hot stimuli also have an unfavorable effect on the healing process. Instead, soothing herbal teas are helpful. The doctor gives patients useful advice on the foods allowed, which are particularly gentle in porridge form. In the case of a pronounced deformity, patients often feel psychologically affected and need supportive psychotherapy.
What you can do yourself
Individuals suffering from hypodontia should first have the malocclusion examined by a dentist. Depending on the severity of the hypodontia and the assessed treatment method, the therapy can be supported by some measures. After surgery, the patient should take it easy and treat the teeth with special care products according to the doctor’s instructions. Since the oral cavity is usually still very irritated, the diet must be changed temporarily. Coffee, alcohol, tea and nicotine should be avoided during the first few days, otherwise bleeding or disturbance of wound healing may occur. Spicy foods as well as hot and cold foods should also be avoided. Porridge-like foods and soothing herbal teas are recommended. Which foods are allowed in detail is best answered by the doctor in charge. Hypodontia must be treated medically in any case. At most, treatment is not necessary for very mild malocclusions. However, the cosmetic blemish can lead to mental discomfort, which must be treated by a therapist. Should pain, inflammation and other discomfort develop, a visit to the dentist or orthodontist is indicated.
