Treatments for Genetic Dental Abnormalities

Symptoms and complications of genetic abnormalities affecting dentition and oral tissues range from mild to severe and even can be life threatening. People with certain genetic oral/dental abnormalities are at risk for early death, cancer and psychiatric disorders. Therefore, seeking evaluation and treatment at the first signs or indication of a genetic oral/dental abnormality is important.

Who Treats Genetic Mouth/Dental Abnormalities

Specialists and treatment options for genetic craniofacial/oral/dental abnormalities depend on the condition. However, no one specialist can provide the full range of often complex treatments required to correct the majority of genetic abnormalities and their complications.

Although your general dentist is responsible for the screening, referral and overall coordination of treatment, it may take a collaborative team of multi-disciplinary professionals who can deliver a comprehensive diagnosis, determine treatment needs and priorities, and monitor long-term planning and care for optimal results. For instance, dental/medical professionals required to treat a craniofacial deformity might include the following:

• An oral/maxillofacial surgeon for the surgical reconstructive correction of any maxillofacial skeletal deformities
• A plastic surgeon for the reconstructive/esthetic aspects
• An otolaryngologist (ear, nose and throat specialist) and audiologist (a healthcare professional specializing in hearing disorders) for any ear, nose and throat-related issues
• A speech-language pathologist to assist with speaking problems
• An orthodontist in cases requiring orthodontic correction treatments, such as braces
• A prosthodontist for multi-disciplinary care, including maxillofacial abnormalities, congenital dental disorders and edentulism (toothlessness)
• A pediatric/family dentist and dental hygienist for coordination of treatment and regular oral hygiene and maintenance
• A geneticist/genetic counselor for testing, counseling and guidance of inherited aspects of the condition
• An oncologist — a specialist in the study, diagnosis and treatment of cancerous tumors — for cases where oral cancer as the cause of oral/dental abnormalities is suspected or confirmed
• A psychologist to help the patient and family members cope with the mental, emotional and societal issues of the particular dental anomaly

Treatment Options

Symptoms, complications and possible treatment options for genetic dental/oral problems include the following:

Hypodontia: In cases where the primary teeth erupted, many dentists elect to leave the primary tooth in place to prevent malocclusion. If this isn’t possible, it may be necessary to extract the tooth and close the gap with braces or cover it with a bridge.

Cleft Lip/Cleft Palate: Cleft lip/cleft palate can be corrected with cleft and craniofacial surgery, most performed on children. Optimal management of patients with cleft and craniofacial deformities traditionally involves a multi-disciplinary team, which is necessary to coordinate all reconstructive and cosmetic procedures for the jaw and/or repositioning and recontouring facial bones, as well as speech and psychological therapy. In most cases, surgery can correct the deformity. Cleft lips typically are repaired before an infant is three months old; surgical repair of a cleft palate usually is not performed until the patient is about 18 months old to lessen the risk of damaging vital growth centers. Speech and hearing services often are included in the treatment plan.

Supernumerary Teeth: Supernumerary teeth can cause problems such as failed tooth eruption, permanent teeth displacement, crowding and pathological complications, such as cyst formations. Therefore, management of supernumerary teeth is part of a comprehensive treatment plan intended to eliminate or diminish the defect, manage pain, and alleviate the patient’s esthetic, functional and emotional concerns. Treatment – which depends on the type and position of the supernumerary teeth and how they affect adjacent teeth – may progress in multiple phases, including a program of continuing care that allows the dentist and/or physician to evaluate the treatment’s effectiveness.

Supernumerary teeth also may compromise bone grafting in patients with cleft lip/palate. Unerupted supernumerary teeth typically are removed to allow the socket to heal before bone grafting. An unerupted supernumerary tooth located in a potential dental implant site may compromise implant placement. In such cases, the supernumerary tooth may need to be removed before implant placement. If removed at the time of implant placement, bone grafting may be needed.

Removal of a supernumerary tooth that is preventing permanent tooth eruption usually results in the eruption of the tooth, provided there is sufficient space in the arch to accommodate it. If there is sufficient space, it can be maintained by fitting a simple removable appliance. If the space is insufficient, the adjacent teeth will need to be moved to create space for tooth eruption, usually by removing the primary canines at the same time as the supernumerary tooth. Where there is sufficient space and the incisor tooth fails to erupt, surgical exposure of the incisor and orthodontic traction usually are required.

Malocclusion: Orthognathic surgery is performed to correct developmental growth abnormalities of the jaws and facial bones. These problems can affect not only chewing and speech, but also the overall health of an individual, as well as the esthetic appearance of their face. Patients with these abnormalities usually have a malocclusion, and orthodontia usually corrects this problem.

Surgical treatment, usually performed by an oral/maxillofacial surgeon, is conducted in combination with orthodontic treatment by an orthodontist. During the general anesthesia surgery, the jaws are moved to the correct position to improve the patient’s occlusion and facial esthetics.

Treatments for malocclusion-induced TMJ disorders may include wearing a mouth protector to prevent teeth grinding, orthodontic treatment, medication or surgery.

Amelogenesis Imperfecta and Dentinogenesis Imperfecta: To improve the teeth’s appearance and protect them from additional damage, full crown restorations are recommended for both conditions.

Periodontal (Gum) Disease: In its early stages, treatment consisting of scaling and root planing (removing plaque from around the tooth and smoothing the root surfaces) and proper daily brushing and flossing should prove effective. In advanced stages, surgical treatment and dentures or dental implants also may be needed.

Gingival Fibromatosis: Gingival fibromatosis is treated by removing the overgrown gum tissue by gingivectomy.

Oral Cancer: Regular dental check-ups are essential for early detection of cancerous and pre-cancerous conditions. Finding and removing pre-cancerous lesions before they become cancer can be one of the most effective methods of reducing the incidence and mortality of oral cancer. Treatment of oral cancer varies depending on the staging, with advanced oral cancers often requiring a trimodal combination of surgery, radiation and chemotherapy.

Canker Sores: Canker sores usually heal by themselves after about a week. Over-the-counter topical anesthetics and antimicrobial mouth rinses may provide temporary relief. Avoid hot, spicy or acidic foods that can irritate the sore. See your dentist if the sores are painful or don’t heal. Your dentist may prescribe antibiotics to reduce the chance of secondary infection. Patients with frequent bouts of canker sores associated with certain systemic signs and symptoms may be referred to specialists for exclusion of an underlying disease and appropriate therapy.

Recovery and Post-Treatment Care

Recovery, post-treatment management and/or maintenance varies depending on the particular genetic mouth/dental abnormality. In most cases, however, all typically involve a long period — possibly years — of inter disciplinary follow-up, monitoring and related secondary care, such as speech therapy, psychological counseling and genetic testing/counseling.

Cost of Treatment

The treatment cost for the various types of genetic mouth/dental problems can be expensive based on the complexity and severity of the abnormality, the length of treatment and the number of procedures and specialists involved. Medical and dental insurance can help offset out-of-pocket expenses. In some instances, treatment may be covered by medical insurance if an oral surgeon or medical doctor — rather than a dentist — performs the procedures.