Malformed Teeth Research Articles

A Case of a Dentigerous Cyst with a Malformed Tooth in the Mandible of a Child

A Case of a Dentigerous Cyst with a Malformed Tooth in the Mandible of a Child

Successful complete oral rehabilitation of a patient with osteopetrosis with extensive pre-treatments, bone grafts, dental implants and fixed bridges: a multidisciplinary case report

BackgroundOsteopetrosis comprises a group of inherited disorders that are rare and result in abnormal bone structure. Bone remodeling is extremely inhibited because osteoclasts are nonfunctional or lacking. This condition causes overgrowth of bone with disappearance of the bone marrow, leading to aplastic anemia; obstruction of nerve passages in the skull leads to blindness and often hearing impairment. In most cases, osteopetrosis results in oral complications such as tooth deformation, hypomineralization, and delayed or absent tooth eruption. The only curative treatment is hematopoietic stem cell transplantation (HSCT). The main treatment of the oral complications during childhood and adolescence consists in protecting the erupted teeth against caries disease through prophylactic treatment aimed at optimal oral hygiene through frequent regular dental visits throughout life. Many patients with osteopetrosis require major oral rehabilitation to treat complications of the disease. Improved results of HSCT increase the likelihood that dental professionals will encounter patients with osteopetrosis.Case presentationIn this case report, we show that individuals with osteopetrosis who have severe oral complications can be treated successfully if they are treated for osteopetrosis at an early age. The boy had his dental care in pedodontics, and regular multidisciplinary meetings were held for future treatment planning. At the age of 15, he was then referred for rehabilitation. The initial evaluations revealed no further growth in the alveolar bone. The rehabilitation was done stepwise, with extraction of malformed and malpositioned teeth. Initially, the patient received a removable partial denture followed by reconstruction of the width of the alveolar process, titanium implants, temporary fixed bridges, and finally screw-retained titanium–ceramic bridges with titanium frames for the upper and lower jaws.ConclusionsThe three-year follow-up after loading indicated a stable marginal bone level and optimal oral hygiene as a result of frequent professional oral hygiene care. The patient showed no signs of symptoms from the temporomandibular joint and has adapted to the new jaw relation without any functional or phonetical issues.

Restorative approaches for managing dental anomalies

Dental anomalies, which stem from a complex interplay of genetic and environmental factors during the phases of tooth development, can have multifaceted effects on the appearance, function, and alignment of teeth within the upper and lower jaw. These anomalies are primarily categorized into four main types based on the variations in the number, size, shape, and eruption timing of teeth. They manifest in diverse forms, such as missing teeth, supernumerary teeth, malformed teeth, and irregular tooth positioning. Restorative dentistry serves as a crucial avenue to rectify these anomalies, aiming to not only enhance the functionality but also the aesthetics of affected teeth, thus bolstering the overall oral health and quality of life of patients. It is of particular significance to consider temporary restorative treatments for children with dento-facial abnormalities, not only to address physical concerns but also to mitigate potential psychological trauma and bullying. Additionally, dental anomalies can heighten the susceptibility to dental caries, periodontal diseases, and occlusal irregularities, potentially necessitating intricate and costly dental interventions over time. The research project, initiated on October 12th, 2023, stems from a comprehensive exploration of existing academic literature, encompassing databases such as PubMed, web of science, and Cochrane. Restorative treatment options in modern dentistry offer a comprehensive approach to addressing structural, functional, and aesthetic irregularities in teeth. Prosthodontic solutions, including crowns, bridges, dental implants, and veneers, restore form and function while enhancing aesthetics. Endodontic and operative procedures, such as root canal therapy and dental fillings, preserve teeth, alleviate discomfort, and prevent complications. Orthodontic treatments like braces and Invisalign correct misalignments, improving both function and aesthetics. Surgical approaches, such as orthognathic surgery and impacted tooth removal, are reserved for severe cases. Treatment choices depend on the specific anomaly, emphasizing early intervention for improved oral health and overall well-being.

Dental Management in Children with Incontinencia Pigmenti (Bloch-Sulzberger Syndrome): Case Reports and Literature Review

Introduction: Incontinentia Pigmenti (IP) is a multisystem genodermatosis characterized by cutaneous, neurologic, ophthalmologic, and dental abnormalities. Skin alterations are the main characterestic of IP. They can change and even disappear over time, in contrast, dental ones are permanent and considered as the most frequent extra cutaneous signs. The aim of this work is to present two rare clinical reports of Incontinentia Pigmenti and to adress its frequent orofacial manifestations in the dental litterature. Case Reports: In this paper, we report two clinical cases of incontinencia pigmenti in two female patients, five and nine years old, who were first examined by a dermatologist due to skin changes and then referred to our pediatric dentistry department in la Rabta hospital for oral examination. We managed these cases in collaboration with the pediatric department. We also conducted a research in the following electronic databases: PubMed and google scholar using the following keywords: ("Incontinentia Pigmenti" AND "Child" AND "Tooth Abnormalities”), from 2011 to 2021, to compare dental findings in our patients with literature. Discussion: The most representative dental features of IP are: delayed tooth eruption, agenesis, high arched palate, peg like and malformed teeth, affecting both primary and permanent teeth. Therapeutic management of our patients consisted in the replacement of absent teeth with an aesthetic and functional space maintainer. The assessment of orofacial manifestations in Children with Bloch Sulzberger syndrome indicates that it appears almost exclusively in females and is usually lethal in males. The clinical expression of this disease found in our patients reflects the Data reported in the literature. The latter showed that the presence of symptoms other than skin changes is important if dermatological signs are subtle, which is in accordance with both our patients’ clinical expression. The most relevant finding of this review is the observation that most IP patients with odontological findings had the congenital absence of six or more teeth opposed to our second patient who had only one absent tooth. Conclusions: Incontinencia pigmenti is of a good prognosis but it may affect patients' quality of life hence the importance of knowing this syndrom and its oro-facial characteristics in order to obtain a correct diagnosis and apply an appropriate approach treatment.

New observation of severe tooth malformation in a female patient with ectodermal dysplasia due to the EDA splice acceptor variant c.742-2A>G.

Ectodermal dysplasias are inherited disorders, which are characterized by congenital defects in two or more ectodermal structures such as skin, sweat glands, hair, nails, teeth, and mucous membranes. Here, we describe a new observation of significant oligodontia in a female patient with the EDA gene variant c.742-2A>G. The results strongly suggest that the EDA gene variant c.742-2A>G is pathogenic. The oligodontia in the proband was exceptionally severe. We demonstrate that the very rare splice acceptor variant EDA c.742-2A>G is associated with severe oligodontia even in females. Our study points that this variant is pathogenic. An early identification of this variant is crucial for planning adequate treatment and follow-up in time by a multidisciplinary team.

Ablepharon-macrostomia syndrome

Introduction. Ablepharon-macrostomia syndrome (AMS) — rare ectodermal dysplastic congenital disease. This syndrome ectodermal dysplasia due to genetic disorders includes malformations of skin, hair, nails, sweat glands, and teeth. AMS typical anomalies are mostly developed in the facial part of the skull and rarely in the internal organs. Characteristic lacks are or eyelid hypoplasia, oral defect (macrostomia), ear abnormalities, dry and rough skin, or excessive folds of skin, absence or sparse pieces of hair, delay intellectual and motor development, variable anomalies of mamillaae, genitalia, dactylion of the fingers and toes, short stature. 
 Aim: to consider, based on a clinical case, the effect of mutations in AMS on the formation of external genitalia.
 Materials and methods. A description of a clinical case of AMS in a 10-year-old patient admitted to the gynecological department is presented. Since birth, the child has been diagnosed with AMS at the place of residence. The patient is observed by a neurologist, ophthalmologist, otolaryngologist, maxillofacial surgeon.
 Results. Despite the characteristic clinical picture during external examination, difficulties may arise in the differential diagnosis for the gender due to the possible influence of mutations on the structure of the external genitalia.
 Conclusion. It is quite difficult to diagnose this pathology. The clinical picture may be different, which is why it is so important to conduct genetic testing in doubtful cases. This method allows identifying point mutations.

Restorative considerations in children with congenital dental anomalies

Children with congenital dental manifestations may have to endure challenges due to their abnormal tooth development, altered skeletal growth, compromised masticatory and speech function and poor aesthetics. This may further lead to psychosocial problems. These children may have deficient ridge height and volume in edentulous areas, missing teeth, malformed or malpositioned teeth and often the added complication of xerostomia. These anomalies complicate conventional treatment and have led clinicians to consider alternative restorative treatment options. Recent literature suggests that Osseo integrated implant therapy may be a viable option for children with congenital dental defects. However, studies are scarce, with no standardization of success or survival criteria, and little long-term follow-up results. This paper explores the various restorative options and highlights the need for a multidisciplinary team. approach.

Tmem2 Deficiency Leads to Enamel Hypoplasia and Soft Enamel in Mouse

Teeth consist of 3 mineralized tissues: enamel, dentin, and cementum. Tooth malformation, the most common craniofacial anomaly, arises from complex genetic and environmental factors affecting enamel structure, size, shape, and tooth eruption. Hyaluronic acid (HA), a primary extracellular matrix component, contributes to structural and physiological functions in periodontal tissue. Transmembrane protein 2 (TMEM2), a novel cell surface hyaluronidase, has been shown to play a critical role during embryogenesis. In this study, we demonstrate Tmem2 messenger RNA expression in inner enamel epithelium and presecretory, secretory, and mature ameloblasts. Tmem2 knock-in reporter mice reveal TMEM2 protein localization at the apical and basal ends of secretory ameloblasts. Micro–computed tomography analysis of epithelial-specific Tmem2 conditional knockout (Tmem2-CKO) mice shows a significant reduction in enamel layer thickness and severe enamel deficiency. Enamel matrix protein expression was remarkably downregulated in Tmem2-CKO mice. Scanning electron microscopy of enamel from Tmem2-CKO mice revealed an irregular enamel prism structure, while the microhardness and density of enamel were significantly reduced, indicating impaired ameloblast differentiation and enamel matrix mineralization. Histological evaluation indicated weak adhesion between cells and the basement membrane in Tmem2-CKO mice. The reduced and irregular expressions of vinculin and integrin β1 suggest that Tmem2 deficiency attenuated focal adhesion formation. In addition, abnormal HA accumulation in the ameloblast layer and weak claudin 1 immunoreactivity in Tmem2-CKO mice indicate impaired tight junction gate function. Irregular actin filament assembly was also observed at the apical and basal ends of secretory ameloblasts. Last, we demonstrated that Tmem2-deficient mHAT9d mouse ameloblasts exhibit defective adhesion to HA-containing substrates in vitro. Collectively, our data highlight the importance of TMEM2 in adhesion to HA-rich extracellular matrix, cell-to-cell adhesion, ameloblast differentiation, and enamel matrix mineralization.

Crown root ratio and angulation of various permanent teeth in patients with and without cleft lip/palate

ABSTRACT Aims and Objectives: The purpose of this study was to analyze parameters of tooth in subjects with nonsyndromic cleft lip and palate (CLCP) and to compare the findings with the control groups. Teeth in the cleft-affected and nonaffected side in the same unilateral cleft lip and palate (ULCP) patient were also compared. Materials and Methods: The study included 200 subjects in the age group of 12–37 years who were divided into two groups: nonsyndromic CLCP and control group. The control group was further subdivided into skeletal Class I, II, and III subgroups based on ANB, AO-BO, and overjet, respectively. Crown height, root length, total tooth length, crown root ratio (C/R ratio), and tooth angulations of maxillary permanent central incisors, canines, 1st premolars, and 1st molar were measured on orthopantomograms using both ITK SNAP software and manual tracing. Results: Crown heights significantly increased while root lengths significantly decreased in the CLCP patients when compared to control groups. Total tooth lengths of central incisor, canine, and 1st premolar in CLCP patients were found to be decreased significantly. C/R ratios of all the teeth of nonsyndromic CLCP group irrespective of the cleft affected or nonaffected side was found to be increased as compared to the control groups. There was a significant difference seen in crown height, root length and mesiodistal tooth angulations in the cleft affected side when compared to the non affected side in a UCLCP patient’s dentition. However the total tooth length and the C/R ratio were not affected. Conclusion: Common findings of CLCP are aberrant teeth development, altered tooth morphology, and malformed teeth. The severity of cleft has an impact on the tooth development and morphology as it was observed that delayed root development and short roots, decreased total tooth length, increased C/R ratio and variations in teeth angulations in CLCP patients were affected by the presence and severity of cleft.

The esthetic challenge of a malpositioned peg-shaped lateral incisor and a missing contralateral maxillary tooth: report of a case.

A peg-shaped maxillary lateral incisor is an underdeveloped, small, malformed permanent tooth that erupts following the loss of a primary tooth. The maxillary lateral irregularly shaped incisor may be unilateral, on both sides of the central incisors, or accompanied by a missing lateral tooth on the contralateral side of the arch. Peg-shaped maxillary lateral incisors receive a great deal of attention, play a significant role in the displayed smile, and present a treatment challenge during all stages of a patient's life. Clinicians are called to plan the treatment and the timing from as early as the beginning of growth and development. Careful diagnosis may dictate postponing a treatment to later stages of life, especially if the tooth is malpositioned in the arch. The goal of this clinical report was to present a combined treatment for a case with a palatal malpositioned peg-shaped maxillary lateral incisor and a missing contralateral permanent maxillary lateral incisor, creating an esthetic challenge. Moving the malpositioned peg-shaped lateral tooth to the arch simplified and eased the final prosthetic treatment procedure, increasing the treatment predictability. The presented sequence of therapy further stresses the importance of incorporating minor tooth movement, without referring to a specialist, in the daily practice of a prosthodontic-oriented general clinic, by simple accessible means.

An evaluation of 1654 premolars transplanted in the posterior region-A retrospective analysis of survival, success and complications.

The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age. This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method. Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10-year follow-up is 83.3%. Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.

Three-Dimensional Pulp Volume Analysis in Lip and Palate Cleft Population

Aim: Cleft lip and palate (CLP) patients have a greater predisposition to tooth malformation, which could affect pulp volume. The aim of this study is to evaluate the dental pulp volume of central incisors in 3D images between individuals with and without CLP. Materials and Methods: This retrospective case-control study is single-centered and was recruited between January 2016 and October 2022. Ninety-four patients who were followed in the Institute of Orthodontics were evaluated and divided into two groups: a control group of patients without CLP and a test group of patients with CLP. The 3D data were imported by 3D image semi-automatic segmenting software named ITK-SNAP to calculate tooth pulp volume. Results: The dental pulp volume for both groups, control and CLP, did not show statistically significant differences. In the cleft group, when comparing the pulp volume between the cleft side and the non-cleft side, the cleft side showed a smaller volume. Regarding age and sex, no statistically significant differences were observed. Conclusions: Although there are no differences in mean pulp volume between patients with and without CLP, there is a pulp volume reduction in the teeth on the cleft side when compared to the unaffected contralateral side.

奇形歯に伴う歯原性囊胞の1例

We report a case of an odontogenic cyst which developed from a malformed tooth in a six-year-old boy. Preoperative radiography and computed tomography revealed that the cystic lesion was 30 x 25 mm in diameter, with a mixed radiolucent and radiopaque lesion. Upon the provisional diagnosis of odontogenic cyst, the lesion was surgically removed under general anesthesia. Macroscopic analysis showed a cystic lesion with tooth-like hard tissue. Histopathological inspection revealed an inverted malformed tooth with a cyst covered in enamel epithelium. The pathological diagnosis was an odontogenic cyst suspected of being dentigerous. Because of atypical findings in both clinical and X-ray imaging, it was difficult to make an accurate diagnosis before operation. About 18 months have passed since the operation, and no complication has been observed. The patient made favorable progress after the surgery. The pathogenesis of the malformed tooth and its role in cyst formation is still unclear, because only three similar cases have been reported to date. Therefore, we inferred the origins of the cyst based on the etiology of odontogenic cysts in the past. A greater accumulation of cases and analyses will be required to form a general opinion. Moreover, additional cooperation of clinician and pathologist teams will be necessary to ensure accurate diagnosis.

Occurence of Dens Invaginatus in Two of the Four Impacted Mesiodentes - A Rare Case Report

Supernumerary teeth are defined as excess number of teeth as compared to normal dental formula. Mesiodens is a supernumerary tooth in the central region of premaxilla between two central incisors. Multiple Mesiodens are called Mesiodentes. This additional tooth structure may cause disturbance in eruption or position of adjacent teeth. Dens Invaginatus (DI) is a rare tooth malformation showing an infolding of enamel and dentin of affected tooth sometimes extending deep into the pulp cavity and root portion. This paper aims to present a rare association of DI in two of the four impacted Mesiodentes in a 10-year-old girl patient causing eruption disturbance and unaesthetic appearance in anterior maxilla.

Congenital Nail Disorders among Children with Suspected Ectodermal Dysplasias.

We report on a cohort of 204 children referred between January 2017 and January 2022 to the German Center for Ectodermal Dysplasias, Erlangen. The most frequent reasons for referral were tooth malformations and lack of multiple teeth leading to the suspicion of an ectodermal dysplasia. Many patients also suffered from being unable to perspire. Nail abnormalities, in contrast, represented a much rarer finding, albeit the impact on some individuals was large. As ectodermal dysplasias are congenital genetic conditions affecting the development and/or homeostasis of two or more ectodermal derivatives, including hair, teeth, nails, and certain glands, we analyzed congenital nail disorders detected in these patients. Dystrophic or otherwise abnormal nails were evident in 17 of 18 subjects with pathogenic WNT10A or GJB6 variants but in none of 161 children with EDA variants underlying X-linked hypohidrotic ectodermal dysplasia. However, 2 of 17 children who carry mutations in EDAR or EDARADD, two other genes involved in the ectodysplasin A signaling pathway, showed nail abnormalities, such as brittle or hypoplastic nails. TP63 variants were regularly associated with nail disorders. In one girl, anonychia congenita caused by a compound heterozygous variant of the R-spondin-4 gene (RSPO4) was diagnosed. Thus, nail dysplasia is rarer among patients with ectodermal dysplasia than commonly thought.

Prevalence of Dental Anomalies in Taiwanese Children with Cleft Lip and Cleft Palate

The aim of this study was to investigate the prevalence of tooth agenesis, tooth malformation, and eruption patterns of upper canines/first premolars in Taiwanese children. A total of 132 cleft lip and cleft palate (CLCP) patients (82 boys and 50 girls) underwent alveolar bone grafting (ABG) between 2012 and 2022. The patients’ dental records and X-ray images were inspected. We examined dental anomalies, including congenital missing teeth, microdontia, and transposition from the upper canines to the upper first premolars in these CLCP patients. Additionally, we investigated the mean ABG operation age (9.27 ± 0.76 years) of our patient; 40.9% of them received pre-ABG orthodontic treatment at 8.72 ± 0.70 years. Among the 132 cleft subjects, the prevalence of tooth agenesis is 73.5% (97/132). The most frequently missing teeth are the maxillary lateral incisors (right side: 46.2%; left side: 47.0%). In this study, microdontia are found in all the upper incisors, of which the highest percentage (18.9%) is observed in the upper left lateral incisors. The prevalence of upper canine and first premolar transposition is 10.6%. The pattern of tooth agenesis and microdontia of the upper lateral incisors shows a strong correlation with the cleft sites of these CLCP patients in our study. These results may support the idea that the patterns of dental anomalies in CLCP patients are region-specific.

Rare compound heterozygous variants of LAMB3 and histological features of enamel and oral mucosa

Junctional epidermolysis bullosa (JEB) is a group of autosomal recessive disorders characterized by amelogenesis imperfecta (AI) and fragility of the skin and mucous membranes. The purpose of this study was to identify pathogenic gene variants and investigate the phenotypic characteristics of abnormal enamel structure and mucocutaneous lesions in a patient with JEB. Clinical examination of the patient revealed hypoplastic AI, skin lesions, and oral ulcers, whereas her parents were normal. Whole-exome sequencing (WES) and cDNA cloning identified compound heterozygous variants of LAMB3 in the proband: c.125G>C in exon 3, c.1288 + 1G>A in intron 11, and c.1348C>T in exon 12. Among these, c.125G>C was inherited from her father, and the other two variants were inherited from her mother. Functional prediction indicated that the variants might change protein structure and cause disease. Scanning electron microscopy (SEM) examination of the primary and permanent teeth revealed abnormal enamel morphology and microstructures. Hematoxylin-eosin (HE) and immunofluorescence (IF) staining showed significantly abnormal and disorganized epithelial cells in the gingival mucosa. Our results showed that this was a case of intermediate JEB1A (OMIM #226650) with autosomal recessive inheritance. The proband carried rare compound heterozygous variants of LAMB3. Our results broaden the variant spectrum of the LAMB3 gene and JEB cases. Moreover, this is the first study to identify histological malformations of the primary teeth and oral mucosa in LAMB3-related patients.

Ectodermal dysplasias: New perspectives on the treatment of so far immedicable genetic disorders.

The past decade has witnessed an expansion of molecular approaches facilitating the differential diagnosis of ectodermal dysplasias, a group of genetic diseases characterized by the lack or malformation of hair, teeth, nails, and certain eccrine glands. Moreover, advances in translational research have increased the therapeutic opportunities for such rare diseases, and new dental, surgical, and ophthalmic treatment options are likely to offer relief to many individuals affected by ectodermal dysplasias. In X-linked hypohidrotic ectodermal dysplasia (XLHED), the genetic deficiency of the signaling molecule ectodysplasin A1 (EDA1) may even be overcome before birth by administration of a recombinant replacement protein. This has been shown at least for the key problem of male subjects with XLHED, the nearly complete absence of sweat glands and perspiration which can lead to life-threatening hyperthermia. Prenatal treatment of six boys by injection of an EDA1 replacement protein into the amniotic fluid consistently induced the development of functional sweat glands. Normal ability to sweat has so far persisted for >5 years in the two oldest boys treated in utero. Thus, timely replacement of a missing protein appears to be a promising therapeutic strategy for the most frequent ectodermal dysplasia and possibly additional congenital disorders.

Hypomineralized Teeth and Their Impact on Oral-Health-Related Quality of Life in Primary School Children.

Background: Molar–incisor hypomineralization (MIH) has a strong negative effect on oral-health-related quality of life (OHRQoL). Malformed teeth can be hypersensitive, and the discoloration might affect children’s appearances, reducing their well-being. The purpose of the study was to investigate how hypomineralized incisors and molars differ in children’s perceived OHRQoL. Materials and Methods: 252 children aged 7–10 years old were included and subdivided into three equal groups (n = 84). Group A included children with asymptomatic molars and affected incisors. Group B included children presenting only affected molars. Group C was the control group, with children showing no MIH. All participants were asked to complete the German version of the Child Perceptions Questionnaire (CPQ-G8-10) to measure OHRQoL. Results: Participants in the posterior group showed a median total CPQ of 13.4 (±1.7), which was significantly higher than scores in the anterior and control group, which showed a median total CPQ of 8.4 (±1.4) and 4.2 (±0.7), respectively. Children in the posterior group suffered more from oral symptoms and functional limitations, whereas the anterior group dealt more with social and emotional well-being problems. Conclusions: The position of the MIH-affected teeth causes different influences on perceived OHRQoL.

Cleidocranial Dysostosis- A Case Report

Objective: First report of cleidocranial dysostosis (CCD), a rare genetic disorder, in Ghana. Case report and intervention: The condition presented in a 13 year old boy with most of the classical features. He had cranial features in the form of open fontanelles, underdeveloped paranasal air sinuses and hypertelorism. Thoracic features were severelyunderdeveloped clavicles which allowed him to appose both shoulders in the midline. He had an open bite, several unerupted permanent teeth and several retained teeth most of which were discoloured which was why he was seen at the Dental department. After restoration of some of these teeth the patient was very satisfied.Conclusion: Though the definitive treatment in these patients can be sophisticated major craniofacial surgery, early restoration of malformed teeth can help ease patient’s anxiety and improve quality of life.