Clinical case
A 10-year-old child is referred because many permanent teeth have not erupted. Clinical examination shows multiple retained primary teeth and spacing. A dental panoramic radiograph confirms absence of eight permanent tooth germs, excluding third molars. Hair, sweating and nails appear normal.
Pathophysiology
Oligodontia reflects a more extensive disturbance of tooth germ initiation than hypodontia. It may be inherited and can involve genes important in epithelial-mesenchymal interactions during odontogenesis.
Oligodontia may also be syndromic, particularly in:
Cleft lip and palate syndromes
Down syndrome
The absence of multiple teeth can reduce alveolar bone development and complicate later prosthodontics rehabilitation.
Epidemiology and Risk Factors
Non-modifiable | Modifiable |
|---|---|
Family history | Childhood cancer therapy |
Syndromic disease | |
Craniofacial anomalies |
Clinical Features
Oligodontia is defined as missing 6 or more developing teeth (excluding wisdom teeth). The congenital absence of 5 or less developing teeth is called hypodontia.
Symptoms | Signs |
|---|---|
Missing 6 or more teeth (excluding wisdom teeth) | Retained primary teeth |
Delayed eruption | Reduced alveolar ridge development |
Speech concerns | Reduced lower facial height (in severe cases) |
Difficulty chewing | Peg-shaped teeth (suggests ectodermal dysplasia) |
Investigations
Primary investigations:
Full dental and medical history
Family history
Clinical examination
Radiographs: OPG to confirm number and distribution of missing teeth
Orthodontic assessment
Gold standard investigation:
Diagnosis is based on clinical examination with radiographic confirmation of 6 or more developmentally absent teeth.