Small Teeth (Microdontia) – Treatment, Causes, Definition Meaning, Baby Teeth, Smile

Microdontia is a dental condition where a person has abnormally small teeth, which can be either localized to a single tooth or generalized, affecting all the teeth. It is a relatively rare condition, with varying degrees of severity and implications for oral health and aesthetics.

Key Facts

• Microdontia refers to a dental condition where one or more teeth are smaller than the usual size
• This condition is relatively rare, but the exact prevalence varies based on the type of microdontia
• There are three primary types of microdontia, which differ based on the number and location of affected teeth: True generalized, Relative generalized, and Localized (focal)

What is Microdontia (Small Teeth)?

Microdontia is a dental condition characterized by the development of teeth that are smaller than their typical size. While the overall structure of the tooth remains the same, its size is notably smaller compared to the average. It can affect a single tooth (localized microdontia) or multiple teeth. The term micro means small, and dontia pertains to teeth. While the precise cause remains unknown, genetics appears to play a significant role. People with microdontia might find their smaller teeth less aesthetically pleasing, but this condition doesn’t generally affect the function of the teeth. However, the smaller size can sometimes lead to spacing issues or other orthodontic challenges.
The most common teeth affected by microdontia are the maxillary lateral incisors, often presenting as peg shaped or noticeably smaller than normal. Other teeth that can be affected include the third molars (wisdom teeth) and mandibular molars. In some cases, even deciduous teeth (baby teeth) can show signs of microdontia.

Epidemiology of Microdontia (Small Teeth)

Microdontia is a relatively uncommon dental condition. Its prevalence varies across different populations, and specific prevalence rates can be challenging to pinpoint due to varying definitions and classifications. However, microdontia seems to occur more often in certain populations and ethnic groups. It’s essential to note that while some cases of microdontia are isolated occurrences, others can be linked to broader syndromes or genetic factors.

Types and Characteristics of Microdontia (Small Teeth)

Microdontia can be classified into three main types: True generalized microdontia, localized microdontia, and relative generalized microdontia.

True Generalized Microdontia

This extremely rare form involves all the teeth being uniformly smaller than normal. It is often seen in systemic conditions like Down’s syndrome.
This is a rare type of microdontia where all the teeth in the mouth are smaller than average. The dentition appears proportionally smaller overall, but the relationship between the teeth remains consistent.
Causes: It is generally linked to genetic disorders or conditions that impact overall growth, such as pituitary dwarfism.

Relative Generalized Microdontia

Occurs when the teeth are of normal size, but appear small in comparison to relatively large jaws.
The teeth are of a standard size, but they appear small in relation to a larger than average jaw. In other words, the teeth are regular-sized, but the jawbone has grown disproportionately. This often results in spacing between the teeth or other orthodontic issues, as the dental arch is bigger than required for the size of the teeth.
Causes: Often hereditary in nature, this type might be related to factors that cause an overgrowth of the jawbone.

Localized (Focal) Microdontia

More common than generalized microdontia, this type affects only one tooth or a few teeth. The maxillary lateral incisor is one of the most common teeth affected, often presenting as peg shaped teeth.
Only one or a few teeth are smaller than their typical size. The most commonly affected tooth is the upper lateral incisor. It can lead to aesthetic concerns or spacing problems in the localized area. The affected teeth might be less effective at their intended function, especially if they are molars.
Causes: The exact cause isn’t always known, but it could be linked to trauma during tooth development or specific genetic factors.

Causes of Microdontia (Small Teeth)

Microdontia is a condition in which one or more teeth appear smaller than normal.
There are several causes and syndromes linked to microdontia. Let’s explore some of the potential causes:

• Pituitary Dwarfism: This condition occurs due to a deficiency in growth hormone produced by the pituitary gland. The deficiency affects overall growth, leading to shorter stature and can influence the size of the teeth, resulting in microdontia.
• Chemotherapy or Radiation: Treatment involving chemotherapy or radiation, especially at a young age when teeth are still developing, can disrupt the normal growth and development of the teeth, leading to microdontia or other dental anomalies.
• Cleft Lip and Palate: These are congenital deformities that can influence the development and positioning of teeth. The dental anomalies associated with clefts can include microdontia.
• LAMM Syndrome (Congenital Deafness with Labyrinthine Aplasia, Microtia, and Microdontia): This is a rare condition where individuals have hearing loss, abnormalities in the inner ear, small or absent external ears, and small teeth.
• Down Syndrome: Individuals with Down syndrome often have various dental anomalies, including microdontia, especially in the upper lateral incisors.
• Ectodermal Dysplasias: These are a group of genetic disorders affecting the development of ectodermal tissues, which include the skin, hair, nails, and teeth. Microdontia is a common dental feature in these conditions.
• Fanconi Anemia: This is a rare genetic disorder affecting the bone marrow, leading to decreased blood cell production. It can also have associated anomalies like microdontia.
• Gorlin-Chaudhry-Moss Syndrome: This rare syndrome involves craniofacial abnormalities, including those of teeth. Microdontia can be one of the dental manifestations.
• Williams Syndrome: People with Williams syndrome often have cardiovascular issues, developmental delays, and unique facial features. Dental abnormalities, including microdontia, can also be present.
• Turner Syndrome: A condition affecting only females where they have a single X chromosome instead of two. Dental anomalies, such as microdontia, can be associated with this syndrome.
• Rieger Syndrome: This is a genetic condition characterized by eye abnormalities, facial abnormalities, and dental issues, including microdontia.
• Hallermann-Streiff Syndrome: This rare genetic disorder comes with several craniofacial abnormalities, including a smaller-sized head, bird-like face, and dental anomalies like microdontia.
• Rothmund-Thomson Syndrome: This rare genetic condition is characterized by skin rashes, skeletal abnormalities, and a higher risk of certain cancers. Dental anomalies like microdontia can be associated.
• Oral-Facial-Digital Syndrome: A group of genetic disorders characterized by malformations of the face, oral cavity, and digits. Microdontia is one of the potential dental manifestations.

While the above syndromes and conditions might be associated with microdontia, it’s essential to understand that not every individual with these conditions will necessarily have small teeth. Genetics, environmental factors, and other issues can all play roles in the presentation of this dental anomaly.

Other Causes of Small Teeth

Teeth that appear smaller than usual can be attributed to several reasons. Some are congenital and related to genetic factors as discussed above, while others might develop later in life due to various conditions or behaviors:

• Nutritional Deficiencies
  A deficiency of certain nutrients during the developmental phase can influence tooth size. Lack of nutrients like calcium, vitamin D, and phosphorous can hinder the proper development of teeth.
• Exposure to Drugs or Harmful Substances
  Exposure to specific medications or toxins during pregnancy can affect fetal tooth development. This can lead to discoloration, enamel defects, and size alterations. Examples: Tetracycline staining or exposure to high levels of fluoride can affect tooth size and structure.
• In-utero Trauma
  Any trauma or injury during the fetal stage can have an impact on tooth size and structure. Teeth might develop smaller, or in severe cases, might not develop at all in the affected area.
• Early Childhood Illness or Trauma
  Serious illnesses, high fevers, or traumatic injuries during the developmental years (when teeth are still forming) can affect tooth size. Illness or trauma can lead to enamel hypoplasia (underdeveloped enamel), which may manifest as smaller teeth, weak teeth, or teeth that are more susceptible to decay.
• Premature Loss of Primary Teeth
  If primary (baby) teeth are lost prematurely, due to decay or trauma, it can influence the development and eruption of the permanent teeth. Permanent teeth may erupt improperly or might appear smaller due to lack of proper space.
• Bruxism (Teeth Grinding)
  Chronic teeth grinding can wear down the enamel and decrease the size of teeth. Over time, this can make teeth appear smaller and also increase sensitivity.

When to see a dentist or doctor?

It’s essential to maintain regular dental check-ups for various reasons, but if you suspect you or your child may have microdontia or any dental abnormality, specific signs might indicate it’s time to visit your dentist:

• Spacing Issues: If you notice significant gaps between teeth that aren’t due to missing teeth, it might be because of smaller teeth. These spaces can cause functional and aesthetic concerns.
• Difficulty with Chewing: Smaller teeth might not have the typical surface area needed for efficient grinding of food.
• Self-Consciousness: Feeling self-conscious or unhappy about the appearance of your teeth is a valid reason to seek consultation. Everyone deserves to feel confident in their smile.
• Orthodontic Concerns: If there are issues with bite alignment or jaw alignment, this could be partly due to the size of the teeth.
• Routine Dental Check-ups: Even if you don’t notice any problems, regular dental visits are essential. Your dentist can identify and address potential issues before they escalate.

Microdontia Treatments – Restorative Dentistry

For single tooth microdontia, especially in cases of microdont maxillary lateral incisors or peg shaped lateral incisors, restorative treatments such as dental implants or composite bonding can be effective. If multiple teeth are affected, as in generalized microdontia, a more comprehensive and personalized treatment plan may be required. This plan might include orthodontic treatment to align the teeth and improve bite function, along with restorative approaches to address size discrepancies.
In cases where microdontia leads to missing teeth, like a missing maxillary lateral incisor or mandibular mesiodens, dental implants can be an excellent option to restore functionality and aesthetics. The treatment plan should also consider the long-term oral health of the patient, ensuring that any restorative work is durable and can withstand excessive wear.

If you or your child has been diagnosed with microdontia, several treatment options can enhance function and aesthetics:

Veneers

Thin shells of porcelain or composite material that cover the front surface of teeth.

• Application: Custom-made to fit the tooth and colored to match surrounding teeth. They are bonded to the tooth surface to improve the appearance.
• Benefits: Provides a natural appearance, and the porcelain material is stain-resistant. It’s a less intrusive option compared to crowns.

Crowns

A tooth-shaped cap that’s placed over the tooth, covering it to restore its shape, size, strength, and appearance.

• Application: The dentist will prepare the tooth, take an impression, and a crown will be custom-made in a lab. Once ready, it’s cemented onto the existing tooth.
• Benefits: Crowns encase the entire visible portion of a tooth and provide more strength than veneers. They’re especially useful if the tooth is weak or worn down.

Composite Bonding

A type of dental bonding that involves applying a tooth-colored composite resin to the tooth.

• Application: The dentist will roughen the tooth surface, apply a conditioning liquid, and then apply the resin. Once the resin is molded and smoothed to the desired shape, it’s hardened with an ultraviolet light or laser.
• Benefits: It’s one of the least expensive cosmetic dentistry options. The procedure is simple and can usually be done in one office visit.

Testing for an Underlying Genetic Cause

While many dental anomalies might arise due to environmental factors, certain conditions like microdontia could have genetic roots. Here’s how the genetic link is determined:
Family Dental History: One of the first steps in identifying a genetic link is by examining the dental history of close family members. If there’s a trend of microdontia in the family, it suggests a genetic component.
Genetic Testing: Modern medicine allows for the examination of one’s genetic makeup. These tests can determine mutations or changes in genes associated with dental anomalies:
– Procedure: A simple blood test or cheek swab is generally used to collect DNA.
– Results: Through laboratory analysis, the sample can provide insights into any genetic markers or mutations associated with dental abnormalities.
Evaluation of Other Symptoms: Sometimes, microdontia can be a part of a broader genetic syndrome that affects multiple body systems. Comprehensive medical evaluations can be useful to identify these syndromes.
Consultation with a Geneticist: If a genetic cause is suspected, consultation with a geneticist can be beneficial. They can provide a more detailed analysis and may help in understanding the implications, potential risks for future offspring, and any associated health concerns.
Prenatal Genetic Testing: For families with a history of genetic dental anomalies, prenatal testing might be an option to determine if the fetus has the condition. This knowledge can prepare parents for potential treatments and interventions after birth.

Microdontia ICD-10

In the International Classification of Diseases, Tenth Edition (ICD-10), microdontia is classified under:
Code K00.2: Abnormalities of the size and form of teeth.
This classification helps in standardizing the diagnosis and treatment of microdontia across different healthcare settings globally.

Bottom Line

Microdontia, characterized by smaller-than-average teeth, can have both genetic and environmental causes. While aesthetic and functional treatments like veneers, crowns, and bonding offer solutions to the physical manifestation of the condition, understanding its root can be crucial, especially if there’s a suspected genetic component. If microdontia runs in the family or if it presents alongside other symptoms, genetic testing might be a worthy consideration. This not only aids in a more holistic treatment approach but also in understanding and potentially predicting the dental health of future generations. Regardless of the cause, with today’s advanced dental practices, everyone can achieve a healthy and confident smile.

This article is complete and was published on October 17, 2023, and last updated on December 29, 2023.