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Taurodontism
dental radiology Editor: LINCOLN R. MANSON-HING, D.M.D., American Academy of Dental Radiology School of Dentistry, University 1919 Seventh Avenue South Birmingham, Alabama 35233
M.S.
of Alabama
Taurodontism Report
of sixteen
cases
in Israel
A. Shifman, D.M.D.,* and A. Buchner, D.M.D., M.S.D.,** Tel Aviv, Israel STOMATOLOGIC OF MEDICINE,
INSTITUTE, TEL
AVIV
SHEBA
MEDICAL
CENTER,
AND
SACKLER
SCHOOL
UNIVERSITY
Taurodontism is generally considered a very rare dental anomaly in modern man. Sixteen new cases of taurodontism in Israel are described in patients presenting for routine treatment in a dental center. The majority of affected teeth occurred singly, and the mandibular second molar was the tooth most frequently involved. It would appear that taurodontism is a great deal more common than was previously thought. The clinical aspects of the condition are discussed with regard to endodontic and periodontal therapy.
A
t the beginning of the century, Keith1 described several skulls of ancient man which displayed an unusual dental anomaly characterized by large pulp chambers. He named this anomaly “taurodontism” because of the similarity of the affected teeth to those of ungulates. Keith regarded the special form of the teeth as distinctly characteristic of the type of ancient skulls he described. ShawZ subsequently discovered further cases of taurodontism in South African races. He classified the anomaly according to the extent of the enlargement of the pulp chamber, calling the mean mesotaurodontism and using the terms hypotaurodontism and hypertaurodontism to describe the less and more affected teeth, respectively. In his attempt to relate the degree of taurodontism to the “Stomatologic Institute, Sheba Medical Center, Tel Hashomer, Israel. **Senior Lecturer, Department of Pathology, Sackler School of Medicine, and Head of Section of Oral Pathology and Oral Medicine, School of Continuing Medical Education, Dental Division, Tel Aviv University.
400
Taurodontism
Volume 41 Number 3
401
Table I. Classification of sixteen casesof taurodontism Case No.
Affected teeth
:
tt:
:
A? il
2 i 9 t: 12 13 14 15 16 Total
Single-tooth cases + + +
Multiple-teeth Unilateral
1 Bilateral
+
(
Degree of anomaly
1 HYPO
t
t + z + t + t +
8
Hoer t +
+ + + +
+ +
t +
t t +
+ +
3Q431 31: 32 2, 3, 14, 15, 18, 19.30, 31
Meso
t
3,?4 4, 13 18,31 l&31 :;
cases
3
t
+
5
5
I
4
skull type, his anthropologic findings were inconclusive and are a source of controversy to this day. Hamner and associates3described the controversy in detail and concluded that taurodontism was not specifically related to the skull of ancient man. Taurodontism was at first thought to occur solely in “primitive” races, and several investigators were. working only in this direction-Pedersen4 with Greenland Eskimos, Moorree@ with Aleuts, and TratmanG with Mongoloid teeth. However, in the last 10 years there have appeared reports of taurodontism in patients of Caucasian origin. Goldstein and Gottlieb’ described eleven cases of taurodontism in the United States and reviewed the literature. The present report describes sixteen new casesof taurodontism in Israeli patients. FINDINGS
Sixteen cases of taurodontism were detected in radiographs of patients presenting for routine treatment at the Chaim Sheba Medical Center Dental Clinic in Tel Hashomer from 1969 to 1974. The patients with the anomaly were all young adults of European (Caucasian) origin. Apart from taurodontism, there were no other significant findings. Table I summarizes the findings of the sixteen cases. In one case eight teeth were affected, in seven cases two teeth were involved, and in eight cases only one tooth was affected A total of thirty teeth were involved with taurodontism. The involvement ranged in degree from minor to gross and covered all three of Shaw’s categories : hypertaurodontism in four cases (Fig. 1)) mesotaurodontism in seven cases (Fig. 2)) and hypotaurodontism in five cases (Fig. 3). In cases where more than one tooth was affected in the same mouth the degree of severity of the anomaly was always the same. Table II classifies the anomaly according to the particular tooth affected. The
402 Xhifman
and Buchner
Fig. 1. Hypertaurodontism second premolar (B).
affecting
_Fig. 8. Mesotaurodontism first molar (B).
the mandibular
molar
(A) and the maxillary
second molar
(A) and the maxillary
first
---. affecting
the mandibular
mandibular second molar was found to be the most prone to taurodontism, being involved in 50 per cent of all cases. DISCUSSION
Taurodontism refers to a condition in which the pulp chamber of the molar tooth is enlarged apico-occlusally. The floor of the pulp chamber and the root furcation are situated more apically, resulting in shortened root canals. Clinically, the crowns of these tooth do not display abnormal morphologic characteristics and therefore taurodontism may be diagnosed only radiologically. No extensive survey on the incidence of taurodontism has been undertaken, but it would appear that the condition is not as rare as was generally believed, especially in regard to cases tending toward hypotaurodontism. The differentiation of the three types of taurodontism according to Shaw’s classification is somewhat problematical. Blumberg and colleagues” made a comprehensive survey of taurodontism using controlled biometric methods. Their findings suggest that in many cases precise biometric methods are essential in diagnosing taurodontism. Our cases exhibited all three types of taurodontism according to Shaw’s’
Taurodontism
Volume 41 Number 3
Fig. 9. Hypotaurodontism
Table
403
affecting the mandibular second molar.
II. Incidence of tooth affected Type
of tooth
Mandibular first molar Mandibular secondmolar Mandibular third molar Maxillary first molar Maxillary secondmolar Maxillary secondpremolar
No.
of cases 3 11 : :
No.
of teeth affected 4 15 2 : 2
classification. Mesotaurodontism occurred in the majority of our cases. The mandibular second molar was the most commonly involved tooth. The greater proneness of this tooth to taurodontism has not been reported. It is interesting that this tooth is also especially prone to morphologic variationqs of which the cone-shaped tooth with wide pulp cavity is the most common.g One of the distinguishing features of taurodontism is usually described as absenceof narrowing of the pulp chamber at the cervical region of the tooth.3ylo Our study shows that this is not always the case and that different variations exist in the morphology of pulp chambers of taurodont teeth. In some cases narrowing occurs at the cervical region of the tooth (Fig. 3, B) , and in many casessome degree of narrowing occurs in the middle region of the pulp chamber (Figs. 1, A and 2, A). Occasionally, the mesial and the distal walls of the pulp chamber are straight (Fig. 3, A). Little attention was paid in the literature to the premolar teeth in regard to taurodontism. Our study includes a case of bilateral hypertaurodontism of the maxillary second premolar (Fig. 1, B) . A similar anomaly is known to exist in the mandibular premolars, whereby a fairly large proportion of these teeth have a double root which might be associated with enlargement of the pulp chamber in the apical direction (Fig. 4). This anomaly resembles taurodontism and is not uncommon. Several reports have been published recently in which taurodontism appears as a part of various syndromes11-13or together with amelogenesis imperfecta.13sI7 Our cases showed no other associated findings. Some reports suggest that taurodontism may be genetically transmitted. 7slo The families of our patients were
404
Shifmas
a,& Buchwr
Fig. 4. Morphologic
variations
Oral Surg. March, 1976
of the pulp cavities
of mandibular
premolar
teeth.
not available for examination, and WCtherefore cannot relate to this possibility. Taurodontism has hitherto not received sufficient attention from clinicians, despite its clinical implications in endodontic and periodontal therapy. Access to the root canal orifices is easily obtained as the floor of the pulp chamber is not affected by the formation of “reactional” dentin as in normal teeth. It is desirable to complete root canal therapy as rapidly as possible, as lengthy delays may result in caries of the pulp chamber floor which will then render the tooth unfit for further endodontic treatment. In casesof hypertaurodontism vital pulpotomy instead of the routine pulpectomy may have to be considered as the treatment of choice. From the periodontal standpoint, taurodont teeth may in specific cases offer a more favorable prognosis; where periodontal pocketing or gingival recession occurs, the chances of furcation involvement, are considerably less than in normal teeth. REFERENCES
A.: Problems Relating to the Teeth of the Earlier Forms of Prehistoric Man, Proc. R. Sot. Med. (Odontol. Sec.) 6: 103-119, 1913. Shaw, J. C. M.: Taurodont Teeth in South African Races, J. Anat. 62: 476-499, 1928. Hamner, J. E., Witkop, C. J., and Metro, P. A.: Taurodontism: Report of a Case, ORAL SURG.18: 409-418, 1964. Pedersen, P. 0.: The East Greenland Eskimo Dentition, Meddellsen, Om Gronland 142: l-256, 1949. Moorrees. C. F. A.: A Correlative Studv of Dental Characteristics in an Eskimoid Peoale. I , Cambridge, 1957, Harvard University Piess. Tratman, E. K.: A Comparison of the Teeth of People of Indo European Racial Stock, Dent. Rec. 70: 63-88, 1956. Goldstein, E., and Gottlieb, M. A.: Taurodontism-Familial Tendencies Demonstrated in Eleven of Fourteen Case Reports,, ORAL SURG.36: 131-144, 1973. Wheeler, R. C.: Dental Anatomy, Physiology and Occlusion, ed. 5, Philadelphia, 1974, W. B. Saunders Company, p. 290. Blumberg, J. E., Hylander, W. L., and Goepp, R. A.: Taurondontism-A Biometric Study, Am. J. Phys. Anthropol. 34: 243-256, 1971. Witkop, C. J.: Manifestations of Genetic Diseases in the Human Pulp, ORAL BURG. 32: 278-316, 1971.
1. Keith,
2. 3. 4. r D. 6. 7. a. 9. 10.
Taurodontism
Volume 41 Number 3
405
11. Mena, C. A.: Taurodontism, ORAL SURG. 32: 812-822, 1971. 12. Sauk. J. J., and Delaney, J. R.: Taurodontism. Diminished Root Formation and Microcephdic Dwarfism, ORAL-&G. 36: 231-235, 1973: in the Tricho-Dento-Osseous 13. Jorgenson, R. J., and Warson, R. W.: Dental Abnormalities Syndrome, ORAL SURG. 36: 693-700, 1973. 14. Stay, P. J.: Taurodontism Associated With Other Dental Abnormalities, Dent. Pratt. Dent. Rec. 10: 202-205, 1960. 15. Crawford, J. L.: Concomitant Taurodontia and Amelogenesis Imperfecta in the American Caucasian. J. Dent. Child. 37: 83-87. 1970. Amelogenesis Imperfeeta 16. Winter, d. B., Lee, K. W., and johnson, N. W.: Hereditary in the American Caucasian, Br. Dent. J. 127: 157-164, 1970. 17. Stewart, R. W., Loden, E. W., and Wyandt, H. E.: Unusual Dental Findings in a Patient With a Rare Bone Dysplasia (Dyschondrosetosis) and a Chromosomal Anomaly, ORAL SURG. 32: 596-604, 1971. Reprint
requests
to :
Dr. A. Buchner School of Continuing Dental Division Tel Aviv University Ramat Aviv, Israel
Medical
Education
M.S.
of Alabama
Taurodontism Report
of sixteen
cases
in Israel
A. Shifman, D.M.D.,* and A. Buchner, D.M.D., M.S.D.,** Tel Aviv, Israel STOMATOLOGIC OF MEDICINE,
INSTITUTE, TEL
AVIV
SHEBA
MEDICAL
CENTER,
AND
SACKLER
SCHOOL
UNIVERSITY
Taurodontism is generally considered a very rare dental anomaly in modern man. Sixteen new cases of taurodontism in Israel are described in patients presenting for routine treatment in a dental center. The majority of affected teeth occurred singly, and the mandibular second molar was the tooth most frequently involved. It would appear that taurodontism is a great deal more common than was previously thought. The clinical aspects of the condition are discussed with regard to endodontic and periodontal therapy.
A
t the beginning of the century, Keith1 described several skulls of ancient man which displayed an unusual dental anomaly characterized by large pulp chambers. He named this anomaly “taurodontism” because of the similarity of the affected teeth to those of ungulates. Keith regarded the special form of the teeth as distinctly characteristic of the type of ancient skulls he described. ShawZ subsequently discovered further cases of taurodontism in South African races. He classified the anomaly according to the extent of the enlargement of the pulp chamber, calling the mean mesotaurodontism and using the terms hypotaurodontism and hypertaurodontism to describe the less and more affected teeth, respectively. In his attempt to relate the degree of taurodontism to the “Stomatologic Institute, Sheba Medical Center, Tel Hashomer, Israel. **Senior Lecturer, Department of Pathology, Sackler School of Medicine, and Head of Section of Oral Pathology and Oral Medicine, School of Continuing Medical Education, Dental Division, Tel Aviv University.
400
Taurodontism
Volume 41 Number 3
401
Table I. Classification of sixteen casesof taurodontism Case No.
Affected teeth
:
tt:
:
A? il
2 i 9 t: 12 13 14 15 16 Total
Single-tooth cases + + +
Multiple-teeth Unilateral
1 Bilateral
+
(
Degree of anomaly
1 HYPO
t
t + z + t + t +
8
Hoer t +
+ + + +
+ +
t +
t t +
+ +
3Q431 31: 32 2, 3, 14, 15, 18, 19.30, 31
Meso
t
3,?4 4, 13 18,31 l&31 :;
cases
3
t
+
5
5
I
4
skull type, his anthropologic findings were inconclusive and are a source of controversy to this day. Hamner and associates3described the controversy in detail and concluded that taurodontism was not specifically related to the skull of ancient man. Taurodontism was at first thought to occur solely in “primitive” races, and several investigators were. working only in this direction-Pedersen4 with Greenland Eskimos, Moorree@ with Aleuts, and TratmanG with Mongoloid teeth. However, in the last 10 years there have appeared reports of taurodontism in patients of Caucasian origin. Goldstein and Gottlieb’ described eleven cases of taurodontism in the United States and reviewed the literature. The present report describes sixteen new casesof taurodontism in Israeli patients. FINDINGS
Sixteen cases of taurodontism were detected in radiographs of patients presenting for routine treatment at the Chaim Sheba Medical Center Dental Clinic in Tel Hashomer from 1969 to 1974. The patients with the anomaly were all young adults of European (Caucasian) origin. Apart from taurodontism, there were no other significant findings. Table I summarizes the findings of the sixteen cases. In one case eight teeth were affected, in seven cases two teeth were involved, and in eight cases only one tooth was affected A total of thirty teeth were involved with taurodontism. The involvement ranged in degree from minor to gross and covered all three of Shaw’s categories : hypertaurodontism in four cases (Fig. 1)) mesotaurodontism in seven cases (Fig. 2)) and hypotaurodontism in five cases (Fig. 3). In cases where more than one tooth was affected in the same mouth the degree of severity of the anomaly was always the same. Table II classifies the anomaly according to the particular tooth affected. The
402 Xhifman
and Buchner
Fig. 1. Hypertaurodontism second premolar (B).
affecting
_Fig. 8. Mesotaurodontism first molar (B).
the mandibular
molar
(A) and the maxillary
second molar
(A) and the maxillary
first
---. affecting
the mandibular
mandibular second molar was found to be the most prone to taurodontism, being involved in 50 per cent of all cases. DISCUSSION
Taurodontism refers to a condition in which the pulp chamber of the molar tooth is enlarged apico-occlusally. The floor of the pulp chamber and the root furcation are situated more apically, resulting in shortened root canals. Clinically, the crowns of these tooth do not display abnormal morphologic characteristics and therefore taurodontism may be diagnosed only radiologically. No extensive survey on the incidence of taurodontism has been undertaken, but it would appear that the condition is not as rare as was generally believed, especially in regard to cases tending toward hypotaurodontism. The differentiation of the three types of taurodontism according to Shaw’s classification is somewhat problematical. Blumberg and colleagues” made a comprehensive survey of taurodontism using controlled biometric methods. Their findings suggest that in many cases precise biometric methods are essential in diagnosing taurodontism. Our cases exhibited all three types of taurodontism according to Shaw’s’
Taurodontism
Volume 41 Number 3
Fig. 9. Hypotaurodontism
Table
403
affecting the mandibular second molar.
II. Incidence of tooth affected Type
of tooth
Mandibular first molar Mandibular secondmolar Mandibular third molar Maxillary first molar Maxillary secondmolar Maxillary secondpremolar
No.
of cases 3 11 : :
No.
of teeth affected 4 15 2 : 2
classification. Mesotaurodontism occurred in the majority of our cases. The mandibular second molar was the most commonly involved tooth. The greater proneness of this tooth to taurodontism has not been reported. It is interesting that this tooth is also especially prone to morphologic variationqs of which the cone-shaped tooth with wide pulp cavity is the most common.g One of the distinguishing features of taurodontism is usually described as absenceof narrowing of the pulp chamber at the cervical region of the tooth.3ylo Our study shows that this is not always the case and that different variations exist in the morphology of pulp chambers of taurodont teeth. In some cases narrowing occurs at the cervical region of the tooth (Fig. 3, B) , and in many casessome degree of narrowing occurs in the middle region of the pulp chamber (Figs. 1, A and 2, A). Occasionally, the mesial and the distal walls of the pulp chamber are straight (Fig. 3, A). Little attention was paid in the literature to the premolar teeth in regard to taurodontism. Our study includes a case of bilateral hypertaurodontism of the maxillary second premolar (Fig. 1, B) . A similar anomaly is known to exist in the mandibular premolars, whereby a fairly large proportion of these teeth have a double root which might be associated with enlargement of the pulp chamber in the apical direction (Fig. 4). This anomaly resembles taurodontism and is not uncommon. Several reports have been published recently in which taurodontism appears as a part of various syndromes11-13or together with amelogenesis imperfecta.13sI7 Our cases showed no other associated findings. Some reports suggest that taurodontism may be genetically transmitted. 7slo The families of our patients were
404
Shifmas
a,& Buchwr
Fig. 4. Morphologic
variations
Oral Surg. March, 1976
of the pulp cavities
of mandibular
premolar
teeth.
not available for examination, and WCtherefore cannot relate to this possibility. Taurodontism has hitherto not received sufficient attention from clinicians, despite its clinical implications in endodontic and periodontal therapy. Access to the root canal orifices is easily obtained as the floor of the pulp chamber is not affected by the formation of “reactional” dentin as in normal teeth. It is desirable to complete root canal therapy as rapidly as possible, as lengthy delays may result in caries of the pulp chamber floor which will then render the tooth unfit for further endodontic treatment. In casesof hypertaurodontism vital pulpotomy instead of the routine pulpectomy may have to be considered as the treatment of choice. From the periodontal standpoint, taurodont teeth may in specific cases offer a more favorable prognosis; where periodontal pocketing or gingival recession occurs, the chances of furcation involvement, are considerably less than in normal teeth. REFERENCES
A.: Problems Relating to the Teeth of the Earlier Forms of Prehistoric Man, Proc. R. Sot. Med. (Odontol. Sec.) 6: 103-119, 1913. Shaw, J. C. M.: Taurodont Teeth in South African Races, J. Anat. 62: 476-499, 1928. Hamner, J. E., Witkop, C. J., and Metro, P. A.: Taurodontism: Report of a Case, ORAL SURG.18: 409-418, 1964. Pedersen, P. 0.: The East Greenland Eskimo Dentition, Meddellsen, Om Gronland 142: l-256, 1949. Moorrees. C. F. A.: A Correlative Studv of Dental Characteristics in an Eskimoid Peoale. I , Cambridge, 1957, Harvard University Piess. Tratman, E. K.: A Comparison of the Teeth of People of Indo European Racial Stock, Dent. Rec. 70: 63-88, 1956. Goldstein, E., and Gottlieb, M. A.: Taurodontism-Familial Tendencies Demonstrated in Eleven of Fourteen Case Reports,, ORAL SURG.36: 131-144, 1973. Wheeler, R. C.: Dental Anatomy, Physiology and Occlusion, ed. 5, Philadelphia, 1974, W. B. Saunders Company, p. 290. Blumberg, J. E., Hylander, W. L., and Goepp, R. A.: Taurondontism-A Biometric Study, Am. J. Phys. Anthropol. 34: 243-256, 1971. Witkop, C. J.: Manifestations of Genetic Diseases in the Human Pulp, ORAL BURG. 32: 278-316, 1971.
1. Keith,
2. 3. 4. r D. 6. 7. a. 9. 10.
Taurodontism
Volume 41 Number 3
405
11. Mena, C. A.: Taurodontism, ORAL SURG. 32: 812-822, 1971. 12. Sauk. J. J., and Delaney, J. R.: Taurodontism. Diminished Root Formation and Microcephdic Dwarfism, ORAL-&G. 36: 231-235, 1973: in the Tricho-Dento-Osseous 13. Jorgenson, R. J., and Warson, R. W.: Dental Abnormalities Syndrome, ORAL SURG. 36: 693-700, 1973. 14. Stay, P. J.: Taurodontism Associated With Other Dental Abnormalities, Dent. Pratt. Dent. Rec. 10: 202-205, 1960. 15. Crawford, J. L.: Concomitant Taurodontia and Amelogenesis Imperfecta in the American Caucasian. J. Dent. Child. 37: 83-87. 1970. Amelogenesis Imperfeeta 16. Winter, d. B., Lee, K. W., and johnson, N. W.: Hereditary in the American Caucasian, Br. Dent. J. 127: 157-164, 1970. 17. Stewart, R. W., Loden, E. W., and Wyandt, H. E.: Unusual Dental Findings in a Patient With a Rare Bone Dysplasia (Dyschondrosetosis) and a Chromosomal Anomaly, ORAL SURG. 32: 596-604, 1971. Reprint
requests
to :
Dr. A. Buchner School of Continuing Dental Division Tel Aviv University Ramat Aviv, Israel
Medical
Education