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August 2009 | Modern Hygienist Identify anomalies Training students to harness the power of radiographs.
Photo: Stockbyte/Getty Images Radiographs play an essential role in the diagnostic process. Without a dental radiograph, many things would not be detected, such as an abnormality or even a cancer. Case Report A student takes a full mouth set consisting of 19 x-rays on her 28-year-old Filipino female patient. The patient’s health is unremarkable. No deviations from the norm are visible extra-orally. After the technical skills were evaluated by the radiology faculty, the student then reviews the interpretation with the radiologist on staff. Radiographic Findings Radiographic findings are interpreted with the radiologist; an interesting finding is noted on the periapical radiograph of No. 10, lateral incisor. Clinically the tooth appears slightly smaller; radiographically a toothlike structure appears within a tooth. The anomaly is described by the student as a “slight enlargement of the root with enamel seen in the dentin, which looks like it surrounds a radiolucent area.” Further discussion on this anomaly involves whether this lesion may be malignant or benign; it is important to distinguish components of each process. It is established that this lesion is of a benign process as there are no ill-defined margins or cortical changes, which are often seen with malignancies.  A radiographic example of a dens in dente. Discussion Working together with the student, it was established that the patient’s lateral incisor exhibits dens in dente, also called dens invaginatus, which is a developmental anomaly. This results when the enamel organ invaginates into the crown of the tooth before mineralization. Invaginate means that one portion encloses into another portion of a structure; therefore the name dens in dente.1 The reported prevalence varies from 4% to 10% of all patients, according to Neville et al.2 Dens in dente more frequently occurs in patients of Chinese, Japanese, Filipino, and Native Indian heritage.3 A maxillary predominance is seen; affected teeth include permanent lateral incisors, central incisors, premolars and canines.4 The maxillary lateral incisor is affected the most and may often look peg shaped.  Said to deliver optimal image quality and robust, hard-wearing construction in an easy-to-use design, CDR Elite digital sensors are created for high-quality diagnostic imaging. The sensors reportedly provide bold bone tribeculation, crisp lamina dura and a clear, clean DEJ. More... Dens in dente usually affect a single tooth in the mouth. Studies show the dens in dente may be susceptible to caries, pulpal infection, and may even develop necrosis because of the exchange between the oral cavity and the invagination of the tooth. In some cases a radiograph reveals a periapical lesion such as an abscess or granuloma where the tooth is often non-vital. Conclusion Dental radiographs are essential in the diagnostic process. This patient did not exhibit any problems with her anomaly nor did she present with periapical radiolucency, but this is an important finding that will be observed in the future. Kristina Okolisan-Mulligan, RDH, BS, is a contributing editor for Modern Hygienist. Reference available upon request. E-mail mh@advanstar.com.
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