Dracula tooth: A very rare case report of peg-shaped mandibular incisors.

Microdontia is a term used to describe teeth which are smaller than normal. Peg-shaped teeth are type of microdontia, a developmental disturbances of teeth mainly due to congenital reasons. Most commonly affecting single teeth, that is maxillary lateral incisors. Incidence of peg shaped tooth in maxillary laterals are usually seen and reported. But in mandibular arch it is very rare. Present case, it affected all the incisors of mandibular arch and also the laterals of maxillary arch which is rarest of condition. This case report presents a non syndromic, peg shaped mandibular incisors in a 11 year old male patient.

Introduction

People of all ages are increasingly concerned about their smile and overall appearance. Dental anomalies such as alterations in shape, size, position, color, or texture may have a negative influence on the harmony of smile.[1] Dental anomalies can result from numerous genetic and environmental factors. Even though both prenatal and postnatal period are blamed for anomalies in tooth dimensions, position, and number; events in the prenatal period has the most influence on these defects.[2]

Peg-shaped laterals are dental anomalies that are likely to be connected to defects in certain genes. There is a strong component of heredity, and peg-shaped lateral incisors have been linked genetically with tooth agencies.[34] A peg-shaped incisor has a marked reduction in diameter, extending from the cervical region to the incisal edge.[5]

Peg shaped incisors are commonly seen affecting the maxillary lateral incisors. The prevalence reported varies from 0.8% to 8.4% of the population.[6] The prevalence rates are higher among Mongoloid people, orthodontic patients, and women. Although the prevalence of unilateral and bilateral lateral incisors are the same, the left side of arch is twice as common as the right side.[7]

Peg shaped mandibular incisors are mostly associated with syndromes [Table 1].[8] Very few case reports have mentioned peg-shaped central or lateral incisors in the mandible. This case report will help clinicians to look at a different possibility of occurance of peg-shaped tooth in a non syndromic condition and will help to explore more. We present a very rare case report of nonsyndromic peg shaped mandibular incisors and maxillary lateral incisors in an individual.

Table 1

Syndromes associated with mandibular peg shaped incisors

Case Report

A healthy 11-year-old boy reported to our dental clinic with a complaint of his pointy shaped front tooth. Ethical clearance was taken from a local review board of Indian Dental Association and Informed consent was taken from the parent especially mentioning for the publication purpose. All of his classmates ridicule him by calling him “Dracula tooth” which emotionally disturbs the boy. His past medical history was not contributory, and family history revealed that his maternal uncle had congenitally small sharp teeth.

The patient had no history of trauma or extraction. Extra- and intra-oral examinations showed no abnormalities. Clinical examination showed normal skin, nail, and hair. Intraoral hard tissue examination revealed a mixed dentition stage.

In his mandible, peg-shaped permanent central, lateral, and right permanent canines are present. The left permanent canine is partially erupted hence there is no confirmation of that tooth being peg shaped. In the maxilla, permanent lateral incisors are peg shaped; central incisors were of normal shape with mamelons. Based on these findings, it was diagnosed as nonsyndromic bilateral microdontic peg-shaped mandibular incisors [Figures 1 and 2].

Figure 1

Peg-shaped maxillary incisors

Figure 2

Peg-shaped mandibular incisors

Permission from his parents for orthopantomogram (OPG) to be taken for further diagnosis and given the treatment options as composite restorations to improve the esthetics of the tooth. Parents refused the treatment. Parents advised that a periodic check up every 6 months to follow-up the eruption and fate of the canine and other permanent teeth should be scheduled.

Ethical clearance was taken from a local review board of Indian Dental Association and also informed consent was taken from the parent to publish this rare case.

Discussion

Anomalies of tooth number, structure, and morphology can occur within human dentition secondary to genetic and epigenetic influences. These aberrations can manifest as microdontia, macrodontia, hypodontia, and oligodontia.[9] Koch et al.[10] defined tooth size as abnormal, when dimensions deviate two standard deviations from average. This size abnormality can manifest either as macrodontia or microdontia. Microdontia is used to describe teeth which are smaller than normal, i.e. outside the usual limits of variation. The deciduous dentition appears to be affected more by maternal intrauterine influences; while the permanent teeth seem to be more affected by the environment.[5] Single tooth microdontia is a common condition. One of the most common forms of localized microdontia is that which affects the lateral maxillary incisors, called a “peg lateral.”[5] Peg-shaped teeth are anterior teeth in the primary or permanent dentition with a crown diameter that decreases markedly from cervical margin to incisal edge, thus resulting in the characteristic peg shape.[11]

The endocrine disturbances may affect the size/form of the crown of teeth in utero or in the first year of life. Size and shape of the root, however, may be altered by disturbances in later periods. Disturbances in morphodifferentiation may affect the form and size of the tooth without impairing the function of the tooth and the function of ameloblasts/odontoblasts, thus, the result may be a peg-shaped/malformed tooth with enamel and dentine that may be normal in structure.[11] Documentation of discrepancies helps in assessing the evolutionary structural and morphological changes in human dentition.[1112]

The reports of peg-shaped laterals in the maxilla is more prevalent than any other tooth as 1.8% of incidence is seen[7] and 2.15% in the Turkish population,[13] 4.3% in the Iranian population,[7] and 2.58% in the Indian population.[14]

Many studies report maxillary teeth being peg shaped yet only five cases report that the mandibular tooth is affected. Four studies report mandibular central incisor being peg shaped[8151617] and one study reports the mandibular lateral incisor being affected.[18] The treatment aspect of these peg shaped tooth is always esthetic and orthodontic corrected [Table 2].[19]

Table 2

Treatment options for peg shaped laterals

The present case report highlights the alteration of the shape of mandibular incisors, which can affect the psychological well-being of the patient if not treated at an early stage. Since dental esthetics is known to affect the overall quality of life, it is important that a multidisciplinary approach is adopted in the treatment of patients with tooth deformity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.