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CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 134-137

Taurodontism of deciduous molars: An overview and a case report


Department of Pedodontics and Preventive Dentistry, National Dental College, Derabassi, Mohali, Punjab, India

Date of Submission08-Mar-2013
Date of Acceptance09-Nov-2013
Date of Web Publication12-Dec-2013

Correspondence Address:
Sandeep Kumar Mahajan
Department of Pedodontics and Preventive Dentistry, National Dental College, Derabassi, Mohali - 140 507, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-6944.122962

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  Abstract 

Taurodontism is a relatively rare variance of human teeth. It is characterized by elongation of pulp chambers and the apical displacement of bifurcation or trifurcation of the roots, giving it a bull-like appearance. The prevalence of taurodontism in permanent teeth is not common and it is still rare in deciduous dentition. As a taurodont tooth shows wide variation in the size and shape of the pulp chamber with varying degrees of obliteration and canal configuration, root canal therapy becomes a challenge. In this article a case with taurodontism in deciduous dentition involving all molars is reported.

Keywords: Deciduous molars, dental variance, taurodontism


How to cite this article:
Mahajan SK, Jindal R, Sharma K. Taurodontism of deciduous molars: An overview and a case report. Indian J Oral Sci 2013;4:134-7

How to cite this URL:
Mahajan SK, Jindal R, Sharma K. Taurodontism of deciduous molars: An overview and a case report. Indian J Oral Sci [serial online] 2013 [cited 2019 Nov 20];4:134-7. Available from: http://www.indjos.com/text.asp?2013/4/3/134/122962


  Introduction Top


Taurodontism (L. taurus, bull, + G. odous, tooth) according to Stedman's Medical Spellchecker 2006 is a developmental anomaly involving molar teeth in which the bifurcation or trifurcation of the roots is very near the apex, resulting in an abnormally large and long pulp chamber with exceedingly short pulp canals. [1]

Though Gorjanovic-Kramberger [2] was the first one to describe this type of a tooth in 1908, it was Sir Arthur Keith who introduced the term taurodontism in 1913. [3] In modern man, taurodontism has been reported as unilateral or bilateral; [4] in the permanent, deciduous, and both dentitions. However, this anomaly has been considered to be a retrograde or atavistic feature because of its decreasing incidence which has been reported to be lower than 1% in modern man. It is more commonly observed (3%) among the Eskimos [5] and Natives of Australia and Central America. [6] Even though listed as a "rare disease" by the office of rare diseases (ORD) of the National Institutes of Health (NIH), [7] which means that taurodontism, or a subtype of Taurodontism, affects less than 200,000 people in the US population. Also it affects permanent teeth more frequently than primary teeth. [8],[9],[10],[11],[12],[13],[14] Taurodontism is now being reported relatively more frequently in dental literature. It appears that taurodontism is more prevalent than was previously thought. [8],[9],[10],[15],[16],[17]

As a dental anomaly, taurodontism is characterized externally as a bull-like heavily bodied tooth in which crown tends to enlarge at the expense of root. The enlargement of the pulp chamber may even reach the proximity of the root apex. Due to this, the pulp chamber has a greater apico-occlusal height than in cynodont teeth witch have relatively small pulp chambers and constriction of the pulp chamber approximately at cementoenamel junction (CEJ) level. [11] As a result, the distance from the bifurcation of roots to the CEJ in taurodont teeth is greater than the occlusocervical distance. [12],[13] This leads to the apical displacement of bifurcation/trifurcation of the roots. The crown thus lacks the constriction (cervix of tooth) at the level of the CEJ giving it a heavy rectangular shape.

The etiology of taurodontism is unclear. It has diverse possible causes which include failure of the epithelial sheath diaphragm to invaginate at the proper horizontal level, resulting in a tooth with short roots, elongated body, an enlarged pulp, and normal dentine. It may also be present as a variant of the pulp chamber form, which may arise as a result of abnormal dentin development. Some recent reports have described an association between taurodontism, familial inheritance, and genetic malformations. [9],[14],[18] It is said to be more prevalent in patients with cleft lip and palate than in normal subjects. [19] Taurodontism has been associated with syndromes such as Down's, Klinefelter's, Apert's, oral-facial-digital (Mohr's syndrome), and Tricho dento-osseous. [19] However, today it is considered as an anatomic variant that could occur in otherwise normal population. [20]

Appearance of the taurodont tooth is very characteristic and the unusual nature of this condition is best visualized on the radiograph. [4],[21]

In 1928 Shaw classified subtypes of this condition as hypotaurodontism, mesotaurodontism, and hypertaurodontism based on the relative displacement of the floor of the pulp chamber [Figure 1].
Figure 1: The schematic diagram of classification given by Shaw (1928)

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This subjective, arbitrary classification led normal teeth to be misdiagnosed as taurodontism. In 1977, Feichfnger and Rossiwall stated that the distance from the bifurcation or bifurcation of the root to the CEJ should be greater than the occlusocervical distance for a taurodontic tooth.

In 1978, Shifman and Chanannel [20] proposed the following criteria for determining the presence or absence of tamodontism. Taurodontism is present, if the distance (a) from the lowest point (A) at the occlusal end of the pulp chamber to the highest point at the apical end of the chamber (B), divided by the distance (b) from the occlusal end of the pulp chamber to the apex (C) is 0.2 mm or greater, that is, a/b = 0.2 mm and if the distance from the highest point of the pulp chamber floor to CEJ is more than 2.5 mm. Though there are many classification systems to determine the severity of taurodontism, the one above proposed by Shifman and Chanannel [20] is the widely used system till now.

Taurodontism is seen more commonly in molars, whereas its incidence in premolars is very low. To consider premolars to be taurodont, they must have the following anatomical characteristics [22] such as:

  • A lower cervical constriction
  • A broad, prism-shaped root with cervical and apical thickening
  • A dilated bifurcated and slightly concave root
  • Enlargement of the pulp chamber with root bifurcation.


We wish to emphasize the need for recognition of such an uncommon dental anomaly as it poses difficulties in deciding the type of endodontic treatment

and in performing the same when required.


  Case Report Top


A 6-year-old male child reported with chief complaint of recurrent pain in the lower right back region for a period of 2 months. Physically, he appeared normal for his age and presented no contributory medical history. The intraoral examination revealed it to be a case of early childhood caries (ECC) with grossly carious 51, 52, 54, 55, 46, 62, 64, 65, 74, 84, 85, and 46. The molars seemed oversized mesiodistally and looked bulky. An intraoral periapical (IOPA) radiograph of the symptomatic tooth showed that it had an unusually long pulp chamber which had no constriction at the CEJ enlarged pulp chamber and short roots. From these radiographic findings, the tooth was diagnosed to be a taurodont [Figure 2].
Figure 2: Intraoral periapical (IOPA) X-rays depicting different taurodont teeth

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The teeth were subjected to routine clinical tests and a diagnosis of chronic irreversible pulpitis was made for 84.

A panoramic radiograph was then asked for, to evaluate the entire dentition. It revealed that the first permanent molars and deciduous second molars were taurodontic. The left lower first deciduous molar was also taurodontic, while the other Ds could not be judged properly. Also 4s and 5s could not be commented upon considering their developmental stage. No other obvious developmental anomalies were noticed in the orthopantomogram (OPG) [Figure 3].

There was no family history of taurodontism and it was further confirmed by the IOPA radiographs of father and mother taken in the molar-premolar region.
Figure 3: Orthopantomogram (OPG) showing taurodont 55, 65, 75, 85, and 74

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Differential diagnosis

The radiographic appearance of taurodonts should be differentiated from other conditions which may demonstrate enlarged pulp chamber like:

  • The "shell teeth" of dentinogenesis imperfecta (Brandywine type) which have large pulp chambers resulting from the relative absence of dentin. These teeth exhibit normal furcation, but smaller root lengths
  • The teeth in regional odontodysplasia, "ghost teeth", characteristically have very thin enamel and dentin and a large pulp chamber. The hard dental tissues will show qualitative and structural deficiencies and the teeth usually fail to erupt
  • In hypophosphatasia, the teeth are hypocalcified and harbor large horns rather than pulp chamber. These teeth get lost prematurely because of cemental agenesis. The pulp horns rather than the pulp chamber are elongated in hypophosphatasia or vitamin D resistant rickets
  • The dentinal dysplasia type 2 shows large flat-shaped pulp chambers especially in premolars
  • Pseudohypoparathyroidism teeth exhibit enlarged root canals with lack of apical closures
  • Internal resorption of teeth may also produce larger pulp chambers due to loss of pulpal dentin.



  Discussion Top


The incidence of taurodontism has been reported to be from 2.5-5.6% in adult population. It is reported to be lower than 1% in modern man and 3% in primitive man, in Eskimos and American Indians. Taurodontism can occur as an isolated case or as a component of specific syndromes. In our case, the patient had no systemic diseases or syndromes. Most reports reveal that permanent teeth are more frequently affected than deciduous teeth. In our case both the deciduous molars were involved and permanent molars could not be commented due to early developmental stage. Mandibular molars are found to be affected more often than maxillary molars. We found taurodontism affecting both the maxillary and mandibular molars. Taurodontism of the premolars was reported by Tiku et al., [22] but since the premolars were still in the developing stage they could not be evaluated. As a taurodont shows wide variation in the size and shape of the pulp chamber with varying degrees of obliteration and canal configuration, root canal therapy becomes a challenge. For this reason, greater weightage should be given to educate the preventive aspects of dentistry to the general population and inclusion of diagnostic radiographs in the examination to the dental practitioners especially dealing young population.

In conclusion, taurodontism exist in modern man, possibly more than was earlier reported.

 
  References Top

1.Stedman's Medical Spellchecker 2006 Source, 2006. Philadelphia: Lippincott Williams and Wilkins. All rights reserved.  Back to cited text no. 1
    
2.Gorjanovic-Kramberger K. Über prismatische Molarwurzeln rezenter und diluvialer Menschen. Anat Anz 1908;32:401-13.  Back to cited text no. 2
    
3.Keith A. Problems relating to the Teeth of the Earlier Forms of Pre-Historic Man. Proc R Soc Med 1913;6:103-24.  Back to cited text no. 3
    
4.Sert S, Bayrl G. Taurodontism in six molars: A case report. J Endod 2004;30:601-2.  Back to cited text no. 4
    
5.Ishikawa G, Waldron CA. Color Atlas of Oral Pathology. 4 th ed. San Luis: Ishiyaku Euro American Inc; 1987.  Back to cited text no. 5
    
6.Elvery MW, Savage NW, Wood WB. Radiographic study of the broad-beach aboriginal dentition. Am J Phys Anthropol 1998;107:211-9.  Back to cited text no. 6
    
7.Office of rare diseases, National Institutes of Health (NIH), USA. http://rarediseases.info.nih.gov/gard/5119/taurodontism/resources/1.  Back to cited text no. 7
    
8.Fuks AB, Chosack A. Taurodontism: Clinical management and report of a case. ASDC J Dent Child 1983;50:296-9.  Back to cited text no. 8
    
9.Mena CA. Taurodontism. Oral Surg Oral Med Oral Pathol 1971;32:812-23.  Back to cited text no. 9
    
10.Goldstein E, Gottlieb MA. Taurodontism: Familial tendencies demonstrated in eleven of fourteen case reports. Oral Surg Oral Med Oral Pathol 1973;36:131-44.  Back to cited text no. 10
    
11.Kosinski RW, Chaiyawat Y, Rosenberg L. Localized deficient root development associated with taurodontism: A case report. Pediatr Dent 1999;21:213-5.  Back to cited text no. 11
    
12.Llamas R, Jimenez-Planas A. Taurodontism in premolar. Oral Surg Oral Med Oral Pathol 1993;75:501-5.  Back to cited text no. 12
    
13.Durr DP, Campos CA, Ayers CS. Clinical significance of taurodontism. J Am Dent Assoc 1980;100:378-81.  Back to cited text no. 13
    
14.Mangron JJ. Two cases of taurodontism in modern human jaws. Br Dent J 1962;113:309-12.  Back to cited text no. 14
    
15.Cohen DM, Taintor JF. Bilateral taurodontism. Quintessence Int 1980;11:9-15.  Back to cited text no. 15
    
16.Ruprecht A, Batniji S, el-Neweihi E. The incidence of taurodontism in dental patients. Oral Surg Oral Med Oral Pathol 1987;63:743-7.  Back to cited text no. 16
    
17.Album MM. Taurodontia in deciduous first molars. J Am Dent Assoc 1958;6:562.  Back to cited text no. 17
    
18.Barker BC. Taurodontism: The incidence and possible significance of the trait. Aust Dent J 1976;21:272-6.  Back to cited text no. 18
    
19.Laatikainen T, Ranta R. Taurodontism in twins with cleft lip and/or palate. Eur J Oral Sci 1996;104:82-6.  Back to cited text no. 19
    
20.Shifman A, Chanannel I. Prevalence of taurodontism found in radiographic dental examination of 1,200 young adults Israeli patients. Community Dent Oral Epidemiol 1978;6:200-3.  Back to cited text no. 20
    
21.Terezhalmy GT, Riley CK, Moore WS. Clinical images in oral medicine and maxillo-facial radiology. Taurodontism. Quintessence Int 2001;32:254-5.  Back to cited text no. 21
    
22.Tiku A, Damle SG, Nadkarni UM. Kalaskar RR. Hypertaurodontism in molars and premolars: Management of two rare cases. J Indian Soc Pedo Prev Dent 2003;21:131-4.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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