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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 27  |  Issue : 2  |  Page : 249-252

Bulls' teeth: An insight through CBCT


Department of Oral Medicine and Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India

Date of Submission23-Nov-2014
Date of Acceptance04-Oct-2015
Date of Web Publication21-Nov-2015

Correspondence Address:
Nandika Babele
Department of Oral Medicine and Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.170147

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   Abstract 

Taurodontism is a morphologic alteration in the shape of the tooth, in which there is an enlargement of the pulp chamber with apical displacement of the pulpal floor and lack of the normal constriction at the level of the cemento-enamel junction. Although its developmental etiology is evidential and well documented, it occurs as a part of multiple syndromes as well as several developmental anomalies. This review compiles different facets of origin of taurodontism, rather than viewing it just as a developmental malformation, cited so far in the literature. A case report in which all the first permanent molars are being affected with taurodontism is also presented.

Keywords: Bull′s teeth, etiology, syndromes associated, taurodontism


How to cite this article:
Gupta A, Babele N, Phulambrikar T, Singh SK. Bulls' teeth: An insight through CBCT. J Indian Acad Oral Med Radiol 2015;27:249-52

How to cite this URL:
Gupta A, Babele N, Phulambrikar T, Singh SK. Bulls' teeth: An insight through CBCT. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Dec 16];27:249-52. Available from: http://www.jiaomr.in/text.asp?2015/27/2/249/170147


   Introduction Top


Taurodontism is a morpho-anatomical alteration in the shape of the tooth, in which the body of the tooth is enlarged at the expense of the roots. The term originates from the Latin word "tauro0" meaning bull and the Greek term "dont" meaning tooth, thus also known as "bull's teeth" because of the morphologic analogy of the affected tooth to those of ungulates, particularly the bull. The term taurodontism was coined by Sir Arthur Keith in 1913 [1] and was defined by Witkop as "teeth with large pulp chambers in which the bifurcation or trifurcation is displaced apically, so that the chamber has greater apico-occlusal height than in normal teeth and lacks the constriction at the level of cemento-enamel junction (CEJ). The distance from the trifurcation or bifurcation of the root to the CEJ is greater than the occluso-cervical distance." [2] It was first reported in the remnants of prehistoric hominids by de Terra in 1903, and later by Gorjanovic-Kramberger and Adloff in 1907 while Pickerill in 1909 published a report of taurodontism in modern man's dentition and used the term "radicular dentinoma" for it. [3]


   Case Report Top


A 27-year-old male patient presented to the Department of Oral Medicine and Radiology with a chief complaint of decayed tooth and occasional pain in his lower right back tooth region since 2-3 months. The patient's medical history was non-contributory. On examination, root stump of 48 was present clinically. Intraoral periapical radiograph (IOPA) with respect to 48 was advised, wherein we accidentally found morphologically altered 46 with its enlarged pulp chamber extending beyond the cervical area and the absence of normal bifurcation suggesting hypertaurodontism (due to the prismatic or cylindrical form where the pulp chamber nearly reaches the apex and then breaks up into two or four channels). Intraoral periapical radiograph on the contralateral side was advised as it was suspected to be present bilaterally, and it revealed similar appearance on the opposite side as well [Figure 1] and [Figure 2].
Figure 1: IOPA of 46 showing absence of normal cervical constriction with an elongated pulp chamber

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Figure 2: IOPA of 36 showing similar appearance as 46

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Following this, we did a full-volume cone beam computed tomography (CBCT) scan for the patient to evaluate the entire dentition for the presence of teeth with altered morphology. The CBCT scan revealed the presence of hypertaurodontism in the permanent first molars of all the four quadrants. The bifurcation of pulp chamber was 3.5-3.8 mm short of apex, which was evident on the coronal section with all the molars. It lacked the normal cervical constriction, giving the appearance of bull's teeth. Microdontia was associated with 18, while 28 was clinically missing (patient denied any history of extraction). The teeth with taurodontism appeared clinically normal. No other remarkable dental findings were observed clinically or radiographically. General physical examination did not reveal any significant findings. The patient was referred to the Department of Oral Surgery for extraction of 48 [Figure 3] [Figure 4] [Figure 5].
Figure 3: CBCT image showing the presence of hypertaurodontism in the permanent first molars of all the four quadrants

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Figure 4: Coronal section of 16 and 46 showing the bifurcation of pulp chamber 3.5-3.8 mm short of the apex and lacking the normal cervical constriction

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Figure 5: Coronal section of 26 and 36 showing similar appearance

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   Discussion Top


The etiology of taurodontism is diverse, but the primary consensus is that it is a developmental alteration within the Hertwig's epithelial root sheath which is necessary for root formation. The failure of Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level results in a tooth with short roots, an enlarged and elongated pulp chamber with much greater apico-occlusal height than normal, and with the apical displacement of the furcation area. [4] In 1928, Shaw [5] classified the taurodont teeth as follows:

  1. Hypotaurodont: Moderate enlargement of the pulp chamber at the expense of the roots.
  2. Mesotaurodont: Pulp is quite large and the roots short, but still separate.
  3. Hypertaurodont: Prismatic or cylindrical forms where the pulp chamber nearly reaches the apex and then breaks up into two or four channels [Figure 6].
Taurodontism has been found to occur either as an isolated, singular trait or in association with other syndromes and anomalies. Thus, the etiology of taurodontism can be categorized under the following headings:
Figure 6: Classifi cation of taurodont teeth: (a) Cynodont (b) Hypotaurodont (c) Mesotaurodont (d) Hypertaurodont

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  1. Genetic factors- There have been several theories regarding the etiology of taurodontism. It has been suggested that the anomaly represents a primitive pattern, a mutation, a specialized or retrograde character, an atavistic feature, an X-linked trait, and a familial or an autosomal dominant trait. Although taurodontism has been reported in association with certain syndromes and some genetic defects, its true significance is still obscure. [3]
  2. Syndrome associated- A number of syndromes are known to be associated with taurodontism, which have several oral and systemic manifestations: [6],[7]


    • Down syndrome.
    • Klinefelter syndrome (XXY).
    • Smith-Magenis syndrome.
    • Lowe syndrome (oculo-cerebro-renal syndrome).
    • Tricho-dento-osseous syndrome (TDO).
    • Williams syndrome.
    • McCune-Albright syndrome.
    • Wolf-Hirschhorn syndrome.
    • Mohr syndrome (oral-facial-digital II syndrome).
    • Van der Woude's syndrome.


  3. Developmental anomalies- [8]


    • Tooth agenesis.
    • Hypodontia/oligodontia.
    • Amelogenesis imperfecta (hypoplastic-hypomaturation with taurodontism).
    • Pulpal calcification.
    • Cleft lip or palate.
    • Triad of microdontia-taurodontia-dens invagination.
    • Triad of hyperphosphatasia-oligophrenia-taurodontism.
    • Ectodermal dysplasia.
    • Thalassaemia major.
  4. Miscellaneous- [9]


    • Infection (osteomyelitis).
    • Disrupted developmental homeostasis.
    • High-dose chemotherapy.
    • History of bone marrow transplantation.

   Conclusion Top


The case presented here shows accidental diagnosis of teeth with taurodontism, depicting that clinically, the crowns of these teeth have normal characteristics and, therefore, taurodontism may be diagnosed only radiologically. These teeth usually do not produce any symptoms, but may have an implication when they need to be treated endodontically or have to be extracted because of the impact of the morphology on the location of orifices, instrumentation, and obturation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Keith A. Problems relating to the teeth of the earlier forms of prehistoric man. Proc R Soc Med 1913;6:103-24.  Back to cited text no. 1
    
2.
Witkop CJ Jr. Manifestations of genetic diseases in the human pulp. Oral Surg Oral Med Oral Pathol 1971;32:278-316.  Back to cited text no. 2
[PUBMED]    
3.
Manjunatha BS, Kumar KS. Taurodontism - A review on its etiology, prevalence and clinical considerations. J Clin Exp Dent 2010;2:e187-90.  Back to cited text no. 3
    
4.
Tsesis I, Shifman A, Kaufman AY. Taurodontism: An endodontic challenge. Report of a Case. J Endod 2003;29:353-5.  Back to cited text no. 4
    
5.
Shaw JC. Taurodont teeth in South African races. J Anat 1928;62:476-98.  Back to cited text no. 5
    
6.
Jafarzadeh H, Azarpazhooh A, Mayhall JT. Taurodontism: A review of the condition and endodontic treatment challenges. Int Endod J 2008;41:375-88.  Back to cited text no. 6
    
7.
Neville BW, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology. 3 rd ed. New Delhi, India: Saunders; 2008. p. 94-6.  Back to cited text no. 7
    
8.
Mark TJ, Carl J, Witkop CJ Jr. Taurodontism, an isolated trait associated with syndromes and X-chromosomal aneuploidy. Am J Hum Genet 1980;32:396-413.  Back to cited text no. 8
    
9.
Gomes RR, Habckost CD, Junqueira LG, Leite AF, Figueiredo PT, Paula LM, et al. Taurodontism in Brazilian patients with tooth agenesis and first and second-degree relatives: A case-control study. Arch Oral Biol 2012;57:1062-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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