Last lecture we discussed Dental notation system.

We are very aware of how to name deciduous and permanent teeth according to different notation systems. Its important that you remember these are not the only Dental notation systems but these are the most famous or widely used in Dental notation systems, and we have other Dental notation systems that are proposed but they are not very much accepted or used. These Dental notation systems are approved by important help organization across the world, like world help organization and FDI. Now, we will talk about the chronology of tooth development (the timing of tooth development).

This model shows permanent and deciduous teeth at the same time.
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* Remember that permanent teeth are 32 in number (16/jaw, 8/quadrant) compared to 20 deciduous teeth (10/jaw, 5/quadrant), so we have 8 permanent teeth per quadrant while 5 per quadrant teeth deciduous that means not all permanent teeth are successor teeth, only 5 of these permanent teeth per quadrant are called successor teeth; because they succeed teeth existing before them. -the teeth that succeed are called successor teeth. -the teeth that exist before and will be succeeded are called predecessor teeth. *We have non-successor teeth that are permanent teeth which erupt without any tooth before them. And these are 1st, 2ndand 3rd permanent molar.

** Remember!
1) Incisors succeed Incisors, canines succeed canine but premolars succeed deciduous molars. Thats why we refer to premolars without the term permanent; because we dont have deciduous premolars. 2) Each tooth consist of a crown and a root. - Crown: the structure that is visible in the mouth. - Root: the structure that is buried inside bone. 3) Teeth are attached by soft tissue to the surrounding bone called the periodontal ligament. Only the root is attached to the bone, the crown is not attached.

**How permanent teeth replace deciduous teeth??

For the permanent tooth, to succeed deciduous tooth it has to move in a way to resorb the root of the deciduous tooth until its totally lost, then it wont be attached to the bone anymore so it will only remain attached to the soft tissue and later on when the permanent tooth moves up it even releases the deciduous tooth from its attachment. ((it become very loose and it can be removed easily while eating or by the Dr, parents or child him/herself)).

The eruption of teeth is organized & timed. Each permanent or deciduous tooth has a specific time to erupt and specific sequence of development. Chronology is the science of timing of tooth development.

This is a skull of a child, before the age of 6 showing deciduous teeth and permanent teeth at the same time
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-Notice that the permanent teeth are bigger than the deciduous teeth; because of that they have to appear at different times. * If we imagine that the size and number of deciduous teeth is the same as the size and number of permanent teeth, In this way if we want to replace deciduous teeth with permanent teeth, we can replace them at once, In that time we really dont need deciduous teeth (This case is imaginary not real!!). In real, they are different in size and upper and lower jaw will grow but the teeth won't grow once they are formed, So the teeth will be replaced one by one as we don't have a space for permanent to appear in the mouth.

This picture shows the right teeth and part of the left teeth, they are deciduous teeth (A-E), and above them we have the permanent teeth (1-6).

-Notice the permanent teeth are developing at different stages. For examples, while the 1st molar is at the stage of crown completion, some teeth like the 2nd molar is at the stage of very early formation of the cusp.

This picture is imp for the dental lab quiz in the 4th week; the Dr said that he will bring it.

In this picture all the teeth are erupted into the mouth (1-8), this usually happens approximately after the age of 18. - The Earliest timing for appearance of 3rd molar is 16 years old and the average is about 22-23 years old.

When the tooth erupts in the mouth, the root is not really fully formed (not completed) as the root completion is responsible for pushing the root upward. *P.S. if the root completed the formation before eruption, it wont erupt later. So once the tooth erupts, the root of permanent tooth will need 2-3 years to be completed, while the root of deciduous teeth needs about 1-1.5 years. This means usually at the age of 25 years we will have completed dentition.

This slide is a summary of different stages of tooth formation. ** At the age of 3 years, - Central permanent incisor 1/3 of the crown is formed. - 1/4 of lateral incisors are formed. - Less than that for canine & much less than that for premolars. But notice that the crown of the 1st molar is fully completed but the 2nd molar is at the beginning of its formation. ** At the age of 4 years, -Complete formation of the crown and some formation of the root for the central incisor. -Lateral incisor and canine half of it is formed.
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-Less than half for premolar & just nearly the cusp for the 2nd molar. -Notice the 1st molar is really advanced in development of the crown and the root. This means that the 1st tooth that starts to develop is the 1st molar not the central incisor (for permanent tooth!!).

**At the age of 6 years, we start to see the 1st permanent tooth in the mouth which is the 1st molar. **At the age of 8 years, -Most of the root of the 1st molar is fullyformed. -The roots of the central incisors are 2/3 formed. So at this year, we start to see the permanent incisors in the mouth.

** Eruption of teeth is like a race, but in an organized way!!

**At the age of 10 years, - We start to see the beginning of formation of the 3rd molar. -Also, we have complete closure of the 1st molar roots. ** At age of 9-10 years, -The 1st permanent tooth is completed.

*Remember* The root of the tooth shouldnt be fully-formed ( 2/3 is formed only) so that the tooth can erupt and the other 1/3 will complete its formation after eruption. * Approximately, what happens in the maxillary is the same as the mandible; the only difference is the time of development of the upper & lower canines. Usually, the lower canine erupts at the age of 10 years, while the upper canine at the same age is still not erupted yet, so usually we have difference about 2 years between erupting of lower and upper canine. *Usually, time of development of lower jaw teeth is less than the upper jaw (difference is small except for the canine as we said before). For example, the 1st molar at lower jaw will appear at the age of 6 years, while the one on the upper jaw at the age of 6 years and 3 months .

* Deciduous Dentition *
1) Prenatal (intra- uterine) stage:
* Deciduous teeth start developing while fetus is still in uterus. So, we have intra-uterine stage, this happens at the age of 5 months of pregnancy. * At 3-4 months of pregnancy, we have the 1st evidence of calcification of deciduous teeth, while at 5 months there are some developing teeth. * At 7 months of pregnancy, the teeth are at different stages of development. - Notice that the central incisors they are more advanced than others, because they will appear in the mouth before other deciduous teeth.

2) Infancy stage:
* When the child is born, -The crown of central incisors is completed and part of the root is formed. -The lateral incisor is at the stage of crown completion. -The deciduous canine is still at the stage of early formation of the tip of the cusp. - Notice the 1st deciduous molar is more advanced than the
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deciduous canine, thats why it erupts before canine. - Also, we have the beginning formation of the cusp of the 2nd molar. ** At age of 6 months, -The 1st tooth inside the mouth appears ((for European people but the average in Jordan is at the age of 7-8 months)). Usually the 1st tooth is the mandibular central incisor, followed by the maxillary central incisor, then the mandibular lateral incisor and so on (they erupt by following specific sequence). - Notice at 6 months we have the formation of the 1st permanent molar and later on we can see the permanent incisors as well. ** At age of 9 months, all incisors are there. - Notice the appearance of permanent incisors, canines & 1st molars formation. ** At the age of 1 year, we see the deciduous molar.

3) Early childhood (pre-school) stage:

** At age of 2 years, all deciduous teeth appear in the mouth but not all of them are in occlusion (occlusion means meeting surface to surface), there is still space between posterior teeth.

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** At the age of 3 years, all deciduous teeth are erupted and in contact, so this is the beginning of the functional deciduous tooth stage. They are called functional; because the child starts to function on these teeth.

** At the age of 4 years, some of deciduous teeth start to have their root resorbed.

** At age of 6 years, most of the roots of the incisors have been lost, this means permanent incisors are very close to be erupted. But remember that we have other teeth that dont succeed other, which appears in the mouth. ((At the age of 6 years the 1st permanent teeth appears which is the 1st permanent molar))

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4) Mixed Dentition (late childhood school age) stage:

** At the age of 7 years, we have the eruption of permanent incisors. Sometimes, some people think that the 1st permanent tooth is the central incisor, as most of the children eat usually a lot of sweets and may dont brush their teeth so that may lead to formation of caries in the 1st permanent molar that has been newly erupted and the parents dont worry about it as they think its a deciduous molar that will be replaced later! Pay attention that the 1st permanent molar is important for the establishment of the dentition and for functioning in mastication, chewing and eating. Thats why if you lose these teeth or have problem inside them too early, which is really a big problem. Because of that we instruct our kids to brush their teeth. When incisors appear in the mouth, they look really very ugly and widely spaced; this stage is called the ugly duckling stage.

** At the age of 10 years, the ugly

duckling stage ends by the movement of the incisors until they are in contact. Notice that many deciduous teeth are succeed by permanent teeth except some of deciduous molars and the upper canines.

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5) Permanent dentition stage (Adolescence and adulthood):

** At the age 12 years, all deciduous teeth have been lost, but still the permanent teeth are not in full function, because the 2nd molars are not in complete occlusion (they are at the beginning of the eruption). The last successor tooth to erupt is the permanent canine (pay attention last successor not last permanent tooth!!). Thats why some people who doesnt have enough space in the upper jaw, their canine has to erupt buccally (outwards), this is common in Asian people as they have big teeth but small jaws especially in the upper arch. Because of that, the tooth that is going to lose, is the last tooth to erupt (canines) So, when we see a permanent canine that has erupted buccally, that it has delayed to appear in the mouth.

** At the age of 15 years, all permanent teeth except 3rd molar are in contact. Because usually 3rd molar is not counted for functional dentition (because it doesnt have a main function in chewing and
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sometimes are really missing) so thats why the age of 15 years when these teeth are in contact- we call this stage the functional permanent dentition stage, until the appearance and occlusion of 3rd molar, then we call it the full-functional permanent dentition stage.

* Summary of the Dentition stages *

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* P.S!
1) Usually mixed dentition stage: - Is the stage from the eruption 1st permanent tooth & ends with the lost of the last deciduous tooth (maxillary deciduous canine). - Is divided into 2 phases. * In phase 2 we said and/or 2nd molar; because sometimes it
erupts after the last deciduous tooth is lost and sometimes the 2nd molar erupts while we still have some deciduous teeth are not lost yet.

* We have about 2 years between the 2 phases; because the last incisor (maxillary lateral incisor) it erupts at the age of 8 years and the 1st permanent canine (mandibular canine) erupts at the age of 10 years. 2) Some people stop at the functional dentition stage as they dont have 3rd molar. 3) Sometimes, 3rd molar completes the formation inside the bone and there is something preventing it from erupting, because of that they are still exist inside the bone. 4) For old people, its not necessary to lose their teeth (losing their teeth dont have a specific sequence). Loss of teeth is caused by periodontitis (inflammation of the tissue surrounding the tooth) and this depends on the person him/herself if he/she takes care of their teeth. For sure, if the teeth remain, they wont be as functional as before, but it will perform the main function. 5) The more roots the tooth has and the longer, the more time it will stay in the mouth (more time to be lost). Thats why incisors are the 1st tooth to be lost when we get old (because they have single & short roots), while upper molars & canine usually are the last teeth to be lost as they have long & large roots.
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* Sequence of Emergence of primary teeth* & * Eruption of the secondary teeth*

** Inter-arch!

** Intra-arch!

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- We will use the term emergence instead of eruption (Dr will explain why next lec.) - The numbers that are shown here describe the sequence of emergence/eruption, they are not palmer notation! - The teeth that have been given the same number for the time of emergence, means that they emerge during a period of time, without statistically significant different. - In the eruption of permanent teeth, remember we have 2 years gap between the eruption of the lateral incisors and canines (phase 1 and phase 2).

* Im not telling you it is going to be easy * * Im telling you its going to be worth it *

Best of Luck
Forgive me for any mistake Done by: Carmen Daghistane Special thanks For Shadi Masoud for his help

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