Lam Tran, Carly Meriwether, and Sarah Weathers

Case 5
Our patient is a 16-year-old male, he came into our clinic for an initial
examination. During an oral examination, it was revealed that he had a
generalized brown-colored dentition. Examination of the oral soft tissues
showed no unusual finding and no bony abnormalities. The patient's
radiograph revealed teeth with thin amounts of enamel, with areas where
the enamel had fractured away. Upon further questionings, our patient stated
that his teeth had appeared brown for as long as he could remember. The
patient stated that his father also has brown-colored teeth similar to his. The
patient appeared to be in an overall good state of health at the time of his
dental visit. No significant problems were noted during the medical history
and the patient is not currently on any type of medications. The patient had
no unusual or abnormal finding.
The first diagnosis is regional odontodysplasia or (odontogenesis
imperfecta). This is an uncommon developmental abnormality of teeth,
usually localized to a certain area of mouth. It

is not hereditary nor

connected to a certain race. Females are more prone to regional

odotodysplasia. The enamel, dentin, and pulp of the teeth are all affected
and do not developed properly, resulting in brittle teeth. Radiographically,
the regional odontodysplasia affected teeth are more radiolucent than

normal and are described as "ghost teeth". Symptoms are idiopathic, with
some cases associated with syndromes, growth abnormalities, neural
disorders, and vascular malformations.
The second diagnosis is dentin dysplasia; a genetic disorder of teeth.
Dentin dysplasia is characterized by presence of normal enamel but an
absence of roots, atypical dentin, and abnormal pulpal morphology. The pulp
of dentin dysplasia can have short roots with a nearly obliterated pulp
chamber or an enlarged "thistle tube" shaped chamber with pulp stones.
Radiographic diagnosis can reveal periapical radiolucencies.
The third diagnosis is amelogenesis imperfecta; a rare heredity
disorder of abnormal enamel formation. The external layer of the teeth are
affected due to the malfunction of the proteins in the enamel. Individuals
with amelogenesis imperfecta can have abnormal teeth color (yellow, brown,
grey), fracturing of enamel, rapid attrition of teeth, extreme sensitivity to
temperature

changes,

excessive

calculus

formation,

and

gingival

hyperplasia. Radiographic finding will reveal normal dentins and pulps with
thin layer of enamels. This disorder can affect any number of teeth, and can
increase risk for dental caries.
The fourth diagnosis is dentinogenesis imperfecta; a heredity disorder
of abnormal dentin formation. Dentinogenesis imperfecta affect both primary
and permanent dentition. The color of affect teeth can be brown to blue with
an opalescent sheen. Enamel may show a hypoplastic or hypocalcified

defect. The enamel frequently fractures away from the defective dentin due
to lack of support of the demineralized dentin; leading to rapid wear and
attrition of teeth. Radiographically the teeth have bulbous crowns with
constricted short roots. The pulp chambers may be abnormally wide but will
progressively obliterate. Although the enamel seems to be normal in
structure, it tends to crack.
The fifth diagnosis is internal resorption. Internal resorption is an
unusual condition where the dentin and pulpal walls begin to resorb centrally
within the root canal. The first evidence of the lesion may be the appearance
of a pink-hue on the crown of the tooth. Main causes of internal resorption
are inflammatory response in the pulp, trauma to the tooth, its usually
idiopathic. Radiographically, the enamel and dentin look normal and the root
surface is lost.
Based on the information provided, we concluded that the most likely
diagnosis is amelogensis imperfecta. The patient has had brown teeth for as
long as he could remember with no other unusual findings or abnormal
health complications, giving us information that it could be genetic related.
Radiographic and clinical diagnosis further reveals that the patient has a thin
layer of enamel that is fracturing with a normal dentin and pulp formation.
It is not regional odontodysplasia because it is not associated with heredity,
and affects the entire teeth. The patient stated his dad also has the same

condition, which gives us an idea that his disorder might be inherited. Only
the patient's enamel was affected.
It is not dentin dysplasia because it involved the root and pulp chamber of
the teeth . The patient's enamels was affected while his roots and dentins
were normal.
It is not dentinogenesis imperfecta because it is associated with abnormal
dentin formation and affects the pulp. The healthy enamel cracks due to the
lack of support of the defective dentin. The patient's dentin and pulp are
normal radiographically, but his enamel seems to be thin and fracturing.
It is not internal resorption because it affects the root of tooth and has
evidence of a pink-hue on the crown. The patient's root does not seem to be
affected, and his teeth color is brown.

References
Ibsen, A.C. Olga, and Joan Anderson Phelan. Oral Pathology for Dental
Hygienists sixth edition. 1992. St. Louis: Duncan, 2014. print. Pg. 208-210 &
210-211
https://www.dentistry.unc.edu/research/defects/pages/di.htm
http://www.rdhmag.com/articles/print/volume-32/issue-10/columns/regionalodontodysplasia.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883336/
https://www.dentistry.unc.edu/research/defects/pages/ai.htm
http://www.dentistryiq.com/articles/2014/09/internal-resorption-a-briefreview-and-case-report.html