Dens in Dente: Rare Dental Anomaly

Dens invaginatus or Dens in Dente is a rare malformation where the tooth’s enamel folds into the dentin.

Therefore, it is known as a tooth within a tooth condition.

Here the tooth enamel ends up folding into the dentin while it is developing.

Dens in dente is prevalent among 0.3 to 10 percent of the population.

It is still a rare anomaly.

This article discusses the causes, symptoms and treatment of the condition. Keep reading below to know more!

 

Causes of Dens in Dente

The causes of this rare condition are still unknown.

Usually, the teeth that er most commonly affected by the condition are the maxillary lateral incisors.

These are the two teeth on the sides of the two front teeth.

The next most affected are the two front teeth i.e. the maxillary central incisors.

Rarely if ever, it affects the premolar and the canines.

Since the certain cause is unknown, it could either be due to infection or trauma and injury to the teeth during tooth development.

During the development of teeth, there can also be growth pressure on the enamel of the dental arches during odontogenesis.

It could also result from a rapid proliferation of the internal enamel epithelium that ends up invading the underlying dental papilla.

This condition is more prevalent in women than men.

Moreover, it has two types, coronal and radicular. The coronal type of condition is more common than the radicular one.

While the condition is a rare one and occurs in only about 0.3 to 10 populations, it is a large number considering that dens lesions are more common than other developmental dental abnormalities.

Its occurrence is more than the peg-shaped lateral incisors i.e. about 0.8 percent worldwide, taurodontism at 0.3 percent and germination at 0.3 percent.

While there is no way to prevent this condition from occurring, you can still look into treatment after getting a diagnosis.

But first, let’s look into its symptoms and how it presents itself.

Symptoms

Dens in Dente create a tooth within the tooth.

The unfolding of the dental papilla during invagination and tooth development.

It is the invagination of all layers of the enamel organ in the papillae.

The teeth that are affected show a deep unfolding of the enamel and that of dentin begins from the tip of the cusps and extend to the root.

Teeth that are the most affected in the process are the maxillary lateral incisors however, a bilateral occurrence is not common.

The teeth there are undergoing dens in dente are at a higher risk of developing cavities as well as periradicular pathology.

There is a thin layer of unfolding enamel and that can easily chip off.

When the protective enamel is no longer, it allows the microorganisms to enter the tooth canal.

It further causes the displacement of your teeth and other dental structure as well as abscess formation.

Hence, the cavity risk is higher when you have these teeth.

The look of dens invagination will be like a small tooth existing between a tooth.

Though, at times there may not be any symptoms.

The condition is often asymptomatic and the crowns of the teeth that are affected rarely show any deformity.

Complications and Diagnosis

The teeth are nonetheless more susceptible to cavities, infection and decay.

That is because the space present between the original tooth and in the growth due to dens in dente is especially vulnerable to cavities.

They become vulnerable because the enamel in this part can easily chip off.

Hence, spreading the cavities as well as exposing the tooth pulp which is the inner part to the bacteria.

In case the tooth pulp is infected, you can only treat it by getting a root canal.

That is the only way to save the tooth.

Moreover, if the teeth do not get prompt treatment and you leave them as it is, then there is a chance you may also develop apical periodontitis or pulpitis.

Complications such as internal resorption, cyst development, abscess formation and tooth displacement can occur over time.

Hence, reach out to your dentist as soon as possible, before the damage has worsened.

The dentist will diagnose the problem by looking into your teeth.

There can be extensive malformations that cause abnormal crown anatomy.

If patients see an abnormally shaped tooth it may be wider either distally/mesially or lingually and labially.

The diagnosis is done on the basis of the classification.

Class I: 

It is partial invagination.

This is only present on the crown and the tooth where the lesion does not pass the CEJ or the pulp.

Class II: 

While this is also partial invagination, it extends beyond the CEJ and the crown.

In fact, it may also include the pulp, however, that will retain the root anatomy.

That said, the lesion does not have any communication with the periodontal ligament.

Class IIIa: 

This is where the complete invagination begins.

It communicates with the periodontal ligament and extends through the root.

It will not involve the pulp, however, it can cause anatomical malformation.

Class IIIb: 

This is also a case of complete invagination.

There is communication with PDL through the apical foramen.

Moreover, it extends through the root.

Pulpal anatomy is also affected which can cause disruption in the dental anatomy.

However, it is not directly linked.

During diagnosis the Invagination lesions look like radiolucent pockets.

These pockets have radio-opaque enamel surrounding them.

Extensive lesions may also look like fissures.

Once, the dentist diagnoses your condition, it is time to work on your treatment.

Treatment for Dens in Dente

You can get treatment for this condition no matter how abnormally shaped your tooth looks.

However, the treatment will depend on the severity of the case and the classification of the condition.

If you have a minor case, then all you will require is sealing the crevice with the composite resin.

A sealant could work too, as long as it seals the tooth.

It will act as a barrier to prevent cavities because it does not let plaque settle in the crevice.

This is usually for Class I invaginations where the harm is minimal and an acid-etched flowable composite can prevent it from worsening.

However, in serious cases where the infection reaches the pulp, you may need a root canal treatment. 

For that, they will remove the damaged pulp. They will further clean the inner chambers.

They will be first cleaned, dried and filled with a rubber-like material and the dentist will also seal the crevice in the tooth.

However, if the shape of the tooth is irregular then the dentist will recommend you get a restoration such as a crown.

It will act as a cap that goes on top of the misshapen or damaged tooth.

However, if the tooth is in a position where it is unsalvagable then the dentist may recommend complete removal.

For Class I lesions, the dentist can simply seal them to prevent caries.

However, for Class II, caries can develop deeply.

Thus, they should not be sealed, but rather open so that the caries are removed using long-shanked burs.

For Class III if the tooth is asymptomatic without pulpal disease then sealing it would suffice.

However, if the situation is severe, the dentist will remove the pulp and it may also lead to tooth loss.

Management of Dens in Dente

When you find out that this condition exists in your teeth, it is important to see your dentist.

If it is detected early on, the dentist can minimize the vulnerabilities such as cavities.

They may seal the teeth with fissure sealants so that you do not get caries.

After that, you should take good care of your oral health to prevent bacteria from accumulating and forming plaque.

Therefore, brush twice a day and regularly floss once.

But besides that, it is also important to keep visiting the dentist so that the lesions are in check.

You may have to go through intentional replantation, periapical surgery with retrograde filling and root canal treatment with mineral trioxide aggregate.

Though, in extreme cases, your only option is to get a tooth extraction.

That will be needed if the tooth is infected enough that it is better to extract it.

Finally, 

Dens in Dente and other dental anomalies are concerning and rare to occur but they are treatable.

While there has been no discovery on how you can prevent the condition, once it happens it should get prompt treatment.

While sometimes the teeth show up as malformed, peg-shaped or wider, mostly the condition is asymptomatic.

Therefore, a dentist can only diagnose it properly with the help of an X-ray.

Sometimes there can be a small tooth branching off the bigger tooth but it is still harder to detect in normal oral exams some malformations are not even present outside.

Dental professionals may also utilize Cone beam computerized technology to diagnose the condition.

Thus, to prevent things from worsening, you have to get an immediate checkup and also keep visiting the dentist after sealing the lesions.

That will save you the trouble of getting extensive treatments.