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Life cycle of the tooth: Eruption Stage

McDonald Chapter 9 174-202 Italicized notes have been questioned on the Dental Decks

Life cycle: Initiation/Bud; Cap; Bell; Apposition; Calcification, Eruption, Attrition Human Dentition Formulae Average Eruption Chronology Lingual Eruption of Mandibular Incisors Teething Eruption anomalies Neonatal and Natal teeth Anomalies in Newborns Premature loss teeth and space maintenance

Human Dentition Formulae

Review Primary Dentition 2 1 2 I --- C --- M --- =10x2=20 2 1 2

Permanent Dentition 2 1 2 3 I --- C --- B --- M ---=16 x2=32 2 1 2 3 Recall that the formula is for the left or right half of the mouth an then needs to be multiplied by 2.

Average Eruption Chronology

Normal variance--+/- 6 months Eruption phases
1. Pre-eruptive (developmental) phase 2. Pre-functional eruptive phase 3. Functional eruptive phase

Pre-eruptive phase
Bud/Cap/Bell/Apposition/C alcification Ends when root development begins

Influences on Eruption:
Root formation 75% Thyroid and growth hormones Parathyroid-hormone-related-protein Proliferation of Hertwigs epithelial root sheath (HERS) Proliferation of the connective tissue of dental papilla Simultaneous growth of the jaw Pressure from muscular action Apposition and resorption of bone Interplay of osteoblasts, osteoclasts, regulatory genes and dental follicles

Pre-functional Eruptive phase

Eruption begins when crown formation is 100% and root development is 75% complete No gender difference in first 3 stages of crown formation/calcification Girls ahead by 1/3 yr for crown completion in 4 teeth Girls ahead by yr for root development Interplay of osteoblasts, osteoclasts, regulatory genes, and dental follicles to cause eruption

Prefunctional Eruptive phase - continued

Eruption is related to root formation rather than chronological or skeletal age Eruption of permanent teeth causes osteoclasts to resorb primary teeth

Functional Eruptive phase

Tooth is in occlusion

Attrition Stage
A tooth will continue to erupt as it wears Super-eruptioneither lack of opposing tooth or excessive wear results in continued eruption of a tooth

Review Primary DentitionCalcification begins

Centrals 14 w iu 13 to 16 w iu Laterals16 w iu 14 2/3 to 16 w iu 1st molars 15 w iu 14 -17 w iu Mx canines 17 w iu 15-18 w iu Md canines17 w iu 16-17 w iu Md 2nd molars18 w iu 16-23 w iu Mx 2nd molars19 w iu 16-23 w iu All teeth have begun to calcify by 4-6 mo iu. McDonald p. 52 4-1; p 178
Researchers disagree over chronology. We will use McDonalds as our reference. Primary teeth begin to calcify at about 4 mo iu

Review Primary Dentition Calcification Complete

Mx central 1.5 mo Mx lateral Md central 2.5 mo M lateral 3 mo Md 1st molars 5.5 mo Mx 1st molars 6 mo Canines 9 mo Md 2nd molar 10 mo Mx 2nd molar 11 mo Researchers disagree over chronology. We will use McDonalds as our reference.

Primary Dentition Eruption

Md central 8 mo *1st Primary to erupt Mx central 10 mo Mx lateral 11mo Md lateral 13 mo Md 1st molar 16 mo Mx 1st molar 16 mo Mx canine 19 mo Md canine 20 mo Md 2nd molar 27 mo Mx 2nd molar 29 mo Researchers disagree over chronology. We will 12 use McDonalds as our reference. P.178

Six/Four Guide to help parents/guardians 6 months of age4 new teeth

6 mo - 4 primary Md incisors 12 mo 4 primary Mx incisors 18 mo 4 primary 1st molars 24 mo 4 primary canines 30 mo 4 primary 2nd molars A mom would expect an 18 month old to have 12 teeth; she would be waiting for canines and second molars.

Cultural awareness: Ugandan and Sudanese practice of ebino

Patients coming from Uganda or the Sudan may have experienced ebino Ebinogouging of unerupted canine toothbuds (they look like a maggotmilky, flexible and are thought to cause diarrhea) Occurrence-33% of children in Uganda Instruments usedknitting needles, bicycle spokes, razor blades, scissors, broken glass and finger nails shaped just for this purpose. Complications-septicemia, anemia, osteomyelitis, AIDS, damage to permanent canine/malposition. Educational efforts are underway.

Chronology of Primary Teeth

By 19 w iu, all primary crowns start to calcify (By the beginning of 3nd trimester; by 3/4 of the 2nd trimester, by 6 months iu) 1 y, all crowns have completed formation 2.5 y, all primary teeth erupted 1.5-2 months from clinical eruption to occlusal 3 y, all primary root formation and calcification complete Researchers disagree with dates, we will use McDonalds as our reference (p178)

Primary teeth exfoliation

Centrals Laterals 1st molars Md Canines Mx Canines 2nd molars 6-7 y 7-8 y 9-11 y 9-12 y 10-12 y 10-12

Researchers disagree over chronology. We will use McDonalds as our reference. 1st molars begin to calcify at birth; 3rd molars at 8-10 y.

Permanent Dentition Calcification begins

1st molars 0 (birth) Centrals, Md laterals 3-4 mo Canines 4-5 mo Mx laterals 10-12 mo Mx 1st premolars 1.5-1.75 y Md 1st premolars 1.75-2 y Mx 2nd premolars 2-2.25 y Md 2nd premolars 2.25-2.5 y 2nd molars 2.5-3 y Mx 3rd molars 7-9 y Md 3rd molars 8-10 y Tooth buds after birth: premolars, 2nd, 3rd molars. Researchers disagree over chronology. We will use McDonalds as our reference. 1st molars begin to calcify at birth; 3rd molars at 8-10 y.


Permanent Dentition Calcification complete

1st molars 2.5-3 y 1st perm to calcify Centrals, laterals 4-5 y 1st premolars 5-6 y Canines, 2nd premolars 6-7 y 2nd molars 7-8 y 3rd molars 12-16 y

Researchers disagree over chronology. We will use McDonalds as our reference. 18

Permanent Dentition Eruption

Md centrals, 1st molars 6-7 y Md laterals, Mx centrals 7-8 y Mx laterals 8-9 y Md canines 9-10 y Mx 1st premolars 10-11 y Md 1st premolars 10-12 y Mx 2nd premolars 10-12 y Mx canines 11-12 y Md 2nd premolars 11-12 y Md 2nd molars 11-13 y Mx 2nd molars 12-13 y 3rd molars 17-21 y 1st succedaneous to eruptMd central Researchers disagree over chronology. We will use McDonalds as our reference.

McDonald 179 9-2


Desirable and most common sequence for permanent teeth:

Md canines before premolars Mx 1st premolar, before Mx 2nd premolar, before Mx canine 2nd premolars before 2nd molars

McDonald 179 9-2


Desirable and most common sequence for permanent teeth: Mx: 1st molars centrals laterals 1st premolars 2nd premolars (canines) 2nd molars

McDonald 179 9-2


Desirable and most common sequence for permanent teeth: Md: 1st molars centrals laterals canines 1st premolars 2nd premolars 2nd molars

McDonald 179 9-2


Activity: Create an eruption sequence with the specific tooth number or letter distributed. We will form a simulated mouth as eruption times are called.
McDonald 179 9-2


Determining Dental age

Erupted teeth present Amount of Primary Root resorption Amount of Permanent teeth development Purpose: to determine if there is dental delay and possible causes for the delay such as a medical condition or supernumerary teeth; also to determine approximate age in forensic dentistry

Rule of Fours for Permanent Teeth

excludes 3rd molars

Birth-1st molars initiated calcification 4 y--all crowns initiated calcification 8 y--all crowns complete 12 y--all crowns emerge 16 y--all roots complete
Excludes 3rd molars

Root formation completed

First Molars 9-10 y Mandibular Incisors 9-10 y Maxillary Incisors 10-11 y Completion of apex: 2 to 3 y after eruption Can a root canal procedure be done on a first molar or incisor on a child with a dental age of 11 years old? YESroot closure has occurred

Teething Eruption of Primary Teeth

Excessive salivation/ Drooling Desire to chew
Hand or fingers in the mouth Chill teething rings

Irritable Disturbed eating Disturbed sleeping Possible elevated temperature

Unsubstantiated with research Obtain medical consult if it continues

No evidence of relationship with vomiting, diarrhea, or rhinitis


Eruption hematoma (Eruption cyst)

Location: alveolar mucosa generally primary 2nd molar/1st perm molar Self-limited, no treatment necessary unless symptomatic:
Child refuses food Facial swelling Fever

If symptomatic, uncover tooth Be sensitive to parents anxiety

McDonald 182 9-5


Eruption sequestrum
Small spicule of calcified tissue extruded through the alveolar mucosa over an erupting molar Can be easily removed May not be bone but tooth tissues
McDonald 182 9-6


Natal and Neonatal Teeth

Natal teeth- present at birth Neonatal teeth- erupt between 0-30 days old Prevalence- from 1:3667 to 1:716 (often in pairs) 85%--mandibular incisor area Some are the actual teeth Remainder--may resemble normal teeth or be poorly developed, small, conical, yellow brown, opaque, hypermobile Nursing problems possible TX: none unless symptomatic in which case, extract (hypermobile/concern of

McDonald 184 9-9


Anomalies in the newborns mouth

Inclusion cyst- 3 different types:
Epsteins pearls- epithelium in mid-palatine raphe Bohns nodules- along the buccal and lingual aspects of the dental ridges and on the palate away from the raphe Dental lamina cyst- along the crest of the ridges

Found in 75% of neonates No TX necessary;usually slough 0-3 months


Epstein pearls palate raphe

Along mid-palatine raphe Epithelial tissue trapped along the raphe Occur in 56% neonates No TX necessary Disappear spontaneously in few months


Bohn nodules Buccal/lingual

Formed along the buccal and lingual aspects of the dental ridges and on the palate away from the raphe Remnants of mucous gland tissue No TX necessary

Dental lamina cysts

Found on the Mx and Md edentulous ridges Originated from remnants of the dental lamina Similar to gingival cyst in an adult No TX necessary
McDonald 185 9-11


Overview: Considerations in Managing the developing occlusion

Premature loss of primary molars Lingual eruption of incisors Ectopic eruption Supernumerary teeth Congenitally missing teeth Ankylosed teeth Frenum problems

Premature loss of primary molars and space maintenance

Eruption of the premolar teeth will be delayed in children who lose primary molars at 4 or 5 years or earlier
Space maintenance is important

At 8, 9, 10, premolar eruption resulting from premature loss of primary teeth is greatly accelerated
Space maintenance may not be needed


Determining when to place space maintainers

Time elapsed since loss of a tooth Dental age of the patient Amount of bone covering the unerupted tooth Sequence of the eruption of teeth Delayed eruption of the permanent tooth Congenital absence of the permanent tooth Actively erupting teeth next to the space often causes more space loss

Overview of Space maintainers

Band and loop Distal shoe Fixed appliances Acrylic partial denture Lingual arch Removable partial dentures/appliances

Researchers disagree about space maintenance at an early age


Distal shoe
Directs eruption of the 1st permanent molar when 2nd primary molar is prematurely lost

McDonald 639 27-14


Upper lingual or Nance appliance

Space maintenance appliance that crosses the midline

McDonald 644 27-47


Lingual arch


Lingual Eruption of Mandibular Permanent Incisors

Common/normal for Md permanent incisors to erupt lingually Remove over-retained primary incisors only if firm and the root had failed to resorb (8.2y for centrals/ 8.4 for laterals) Spontaneous correction of lingually erupted permanent incisors is likely

McDonald 180 9-3


Interceptive Orthodontic corrections: Crossbites

Occur in the anterior and posterior:
Treat or Obtain orthodontic consult

McDonald 654 27-36


Hawley appliance with a helical spring to treat a crossbite


Next week we will continue with appliances related to eruption disturbances