Clinical case
A 4-year-old child is referred because no primary teeth have erupted. The parents report that the child has sparse hair and becomes dangerously hot in warm weather because they do not sweat normally. Examination shows no erupted teeth and reduced alveolar ridge development.
The most likely diagnosis is anodontia associated with hypohidrotic ectodermal dysplasia.
Pathophysiology
Anodontia results from complete failure of tooth germ development. Since teeth are essential for normal alveolar process development, the alveolar ridges may be poorly developed when teeth are absent.
In severe cases, loss of vertical dimension gives the face an aged appearance. Lack of alveolar bone may make conventional dentures less stable and implant placement more difficult.
Epidemiology and Risk Factors
Non-modifiable | Modifiable |
|---|---|
Ectodermal dysplasia | No modifiable risk factors |
Family history | |
Sex (X-linked hypohidrotic ectodermal dysplasia mainly affects males) |
Clinical Features
Anodontia is the congenital absence of all teeth meaning that no teeth develop.
Symptoms | Signs |
|---|---|
No teeth erupting | Poorly developed alveolar ridges |
Difficulty chewing | Reduced vertical dimension |
Speech difficulties | Sparse hair (suggests hypohidrotic ectodermal dysplasia) |
Poor aesthetics | Reduced sweating (suggests hypohidrotic ectodermal dysplasia) |
Investigations
Primary investigations:
Full dental and medical history
Family history
Clinical examination
Radiographs: OPG to confirm absence of tooth germs
Paediatric assessment: to evaluate growth, nutrition and syndromic features