Author Name: Dr. Sandra Thompson
Dens invaginatus develops due to the folding-in of a portion of the outer surface of the developing tooth before its complete formation. The folded portion may consist of enamel, the protective layer forming the outer surface of the tooth, and dentin, the layer below enamel. From the dental X-ray view, this inward folding may appear as another tooth in the existing one. Because of this feature, dens invaginatus is often referred to as "a tooth within a tooth."
Dens invaginatus usually affects upper permanent lateral incisors, the teeth that are situated right next to the two front teeth in the mouth. However, the condition may also occur in any other teeth. Dens invaginatus usually develops in permanent teeth but it may happen rarely in deciduous teeth. In some children, this developmental anomaly occurs in more than one tooth, including homologous teeth on both sides of the mouth.
Dens invaginatus is an unusual development anomaly. Frequency rates for this condition differ from one population to another as well as depend on examination technique. Shallow dens invaginatus can be asymptomatic and only detected during the dental examination or by means of dental X-ray.
It differs from a regular cavity because the folded-inward surface occurs before the tooth erupts and a cavity occurs as a result of decay caused by acid from the bacteria after the tooth eruption. Dens invaginatus differs from a cracked tooth that has a crack or fracture in it and an enamel defect where there is a problem with the quality of the enamel. Parents can learn more about tooth enamel in children and the role it plays in protecting developing teeth. Dens evaginatus is one more developmental abnormality but it has a protruded surface rather than a folded one.
As the tooth has an opening and there is a possibility that bacteria could reach the dental pulp, early diagnosis will allow the dentist to prevent any further problems.
Dens invaginatus is a developmental disorder of the tooth that develops prior to the eruption of the tooth. Dens invaginatus is when a portion of the tooth structure involutes into the tooth to create an internal hollow space in the tooth. The exact cause of this developmental anomaly is unknown.
Several theories have been advanced regarding what may cause this to occur. These include uneven development or irregular folding of the tooth, pressure on the tooth bud, and a temporary disturbance during enamel and dentin formation. Other causes such as genetic or developmental factors may also be responsible for certain instances. There is currently no theory that can explain why all occurrences of dens invaginatus happen.
The causes of dens invaginatus are not related to lack of brushing, bad food, bottle feeding, or mistakes made by the parents.
Some children have dens invaginatus in more than one tooth. When a pediatric dentist identifies the condition, they may examine the matching tooth on the opposite side of the mouth and other teeth with unusual shapes or grooves. This helps ensure that additional affected teeth are not overlooked.
The appearance and symptoms of dens invaginatus can vary. A child with a shallow invagination may have no pain or visible problems. Many cases are discovered during a routine pediatric dental examination or when dental X-rays are taken for another reason.
An affected tooth may have:
The outer surface of the tooth may also appear normal. In light of this, the extent to which the tooth is folded inward can never be determined just from examining the appearance of the tooth. Research has shown that the teeth affected exhibit either a palatal pit or an abnormal crown shape.
When plaque and bacteria enter a deep opening, the child may develop:
Parents who notice discomfort with hot, cold, or sweet foods may also find it useful to understand the common causes of tooth sensitivity in children.
The presence of bacteria in the dental pulp may cause either inflammation or infection. Possible symptoms include swollen gums, swollen face, a small pimple on the gums, discharge or pus, and foul taste around the tooth. Even in situations where there isn’t a noticeable cavity in the outer surface of the tooth, the tooth can still get infected.
Dens invaginatus is different from some conditions that may appear similar to it. A normal cavity is caused by the action of bacteria acids on the teeth. A cracked tooth will have a fracture on it whereas enamel defects affect the development, thickness, or strength of the enamel. Dens evaginatus is also a dental problem but the result is the formation of an external protrusion rather than an internal one.
A pediatric dentist may diagnose dens invaginatus by combining a visual examination with dental imaging and tests of the tooth’s health. The goal is to determine how deeply the abnormal space extends and whether decay, pulp damage, or infection is present.
Dental X-rays can show the internal folded structure that is not visible during an examination. They may help the dentist determine whether the invagination is limited to the crown or extends toward the tooth’s root. X-rays can also reveal decay, changes around the root, or signs that an infection has reached the surrounding bone. Parents can review this parent’s guide to pediatric dental X-rays to learn more about how imaging is used to evaluate developing teeth.
Treatment for dens invaginatus depends on how deeply the inward fold extends, whether the dental pulp remains healthy, and whether decay or infection is present. The dentist will also consider the child’s age, the tooth’s root development, and whether the tooth can be restored successfully. Treatment may range from preventive sealing to root canal treatment in more advanced cases.
Sealant could be an appropriate method if the invagination has a relatively open entry and the pulp is healthy. A protective covering is applied over the entry point so that bacteria, food debris, and other materials are unable to enter into the tooth.
The dental sealants for children do not alter the structure of the tooth internally but form a covering for the weak portion. It is important that the sealant be reviewed periodically since it can get worn out, chipped, or even damaged over time. Sealants have been used as a preventive measure before the occurrence of pulp disease. Parents can also read more about dental sealants for kids and how they help protect vulnerable tooth surfaces.
If the pulp of a tooth has become irreversibly inflamed or infected or is otherwise in poor condition, root canal treatment could be required. During this procedure, the dentist or endodontist cleans out the problematic pulp tissue and disinfects and seals off the problematic parts to prevent further infection.
There are several challenges that may arise in performing a root canal treatment if there is dens invaginatus in a tooth, as the internal structure of a dens invaginatus tooth tends to have narrow and irregular spaces or multiple spaces. If the root of a child’s permanent tooth is incomplete, the treatment can vary depending on the condition of the tooth.
If infection develops around the tooth, parents may also want to understand the symptoms and treatment considerations associated with a tooth abscess in children.
Parents should schedule a pediatric dental examination when a child’s tooth has an unusually deep pit, narrow groove, enlarged crown, or irregular shape. An appointment is also appropriate when food repeatedly becomes trapped in the tooth or the child develops sensitivity, pain, or discoloration.
Further evaluation may be recommended when:
Discovering the problem in one tooth will mean that the dentist has to check the corresponding tooth in the other jaw, as well as all teeth that have any odd shape and grooves.
Parents can consult a children dentistry team when they notice unusual tooth development, persistent sensitivity, or other changes that need professional evaluation.
Families can also learn more about pediatric dental care for growing smiles available through Desert Kids Dental. Parents who are concerned about a child’s tooth shape, sensitivity, pain, or possible infection can contact Desert Kids Dental to arrange an examination.
The parents should take their child to a dentist immediately if there is any continuous pain in the child’s teeth, swelling of gums around the tooth, swelling of the face around the tooth, pus, or discharge around the tooth. If there is fever with swelling of the teeth, then this means that the infection has spread, and the case needs immediate attention.
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