Signs and Symptoms
- Misalignment of neighboring teeth and overcrowding
- Malocclusion resulting in severe jaw joint pain
- Cavities development due to irregular tooth shape
- Significant self-esteem and confidence issues related to physical appearance
Causes
- Associated with genetic syndromes such as otodental syndrome, insulin-resistant diabetes, facial hemihyperplasia, KGB syndrome, and 47 XYY syndrome
- Genetic mutations regulating tooth growth can cause abnormal growth
- Hormonal imbalances, likely related to the pituitary gland, can result in deviant tooth growth
- Factors during early childhood, such as diet and exposure to toxins or radiation, can increase the likelihood of macrodontia
Pathophysiology
- Gigantism, caused by excessive growth hormone secretion, can lead to macrodontia
- Growth hormone stimulates the synthesis of insulin-like growth factor 1 (IGF-1) which controls body growth
- Mutant form of the Gs protein in growth hormone-secreting adenomas results in overexpression of growth hormone and overgrowth of teeth
- KBG syndrome, caused by a mutation in the ANKRD11 gene, leads to macrodontia due to abnormal regulation of dental development
Diagnosis
- Diagnosis is obtained through observation, measurement, and comparison with standard tooth size
- Radiological investigation, such as X-rays, can indicate macrodontia of erupted and unerupted teeth
- Level 1 radiographic examination should consider medical records, clinical signs, and risk/benefits of radiation exposure
- Orthopantomography and intraoral radiography may be recommended as imaging techniques
- CBCT (3D imaging) is used when two-dimensional imaging is insufficient
Types of Macrodontia
- True generalized macrodontia is when all teeth grow larger than normal, often associated with pituitary gigantism
- Localized macrodontia affects specific teeth or tooth groups
- Fusion macrodontia occurs when two teeth fuse together, resulting in an enlarged tooth
- Gemination macrodontia is when a single tooth appears as two separate teeth due to incomplete tooth division
- Dilaceration macrodontia is characterized by abnormal tooth curvature or angulation
Treatment:
- Diagnosis by a dental specialist
- Recommendation to visit a cosmetic dentist
- Three main procedures for improving the look of affected teeth: orthodontics, teeth shaving, and teeth removal
- Orthodontics can straighten teeth and expand the jaw if necessary
- Braces and a retainer can help minimize misalignment caused by macrodontia
Prognosis:
- Macrodontia does not affect life expectancy or likelihood of remission
- Implications include misalignment, jaw pain, and crowding issues
- Complications of untreated macrodontia include bite alignment issues and dental caries
- Overgrown teeth can have lasting impacts on bite mechanics
- Dental caries can lead to tooth degradation and infections
Epidemiology:
- Macrodontia affects 0.03% of the population
- Higher prevalence in males (1.2%) compared to females (0.9%)
- Disruptions of regular tooth growth usually occur around ages 11-12
Research Direction:
- Lack of understanding regarding pathophysiological mechanisms of macrodontia
- Imaging techniques used for diagnosis
- Treatment options concentrated in cosmetic dentistry
- Correlation between genetic mutations and macrodontia
- No current clinical trials for treatment
Macrodontia is a type of localized gigantism in which teeth are larger than normal. Macrodontia seen in permanent teeth is thought to affect around 0.03 to 1.9 percent of the worldwide population. Generally, patients with macrodontia have one or two teeth in their mouth that is abnormally large; however, single tooth growth is seen in a number of cases as well.
Macrodontia (tooth) | |
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Other names | Megadontia, megalodontia |
Specialty | Dentistry |
The three types of macrodontia are true generalized macrodontia, relative generalized macrodontia, and macrodontia of a single tooth. True generalized macrodontia is very rare while Macrodontia of a single tooth is much more commonly seen. Macrodontia should not be confused with other oral conditions such as taurodontism (bull teeth), fusion (double tooth), or the jaws being relatively small, giving the appearance of macrodontia.