1. PEDODONTICS 1-5
Dr. Abdullah Abumoamar

2. Eruption Teeth

3. Eruption Teeth
Kronfelld in 1935 first described the chronology of human dentition (Both deciduous and permanent )
The process of eruption involves the movement or change of position of the tooth from the deeper portion of the jaws into the oral cavity until it achieves occlusal contact with adjacent and opposing teeth.

4. Eruption Teeth
- A tooth begins its movement once its crown formation is completed (It takes about 5 years from crown completion to complete eruption of an individual tooth)
- Tooth emergence is also associated with the formation of root.

5. Eruption Teeth
a tooth erupts into the oral cavity, approximately ¾ of the root is formed and reaches the occlusion before the complete formation.

6. Factors influence the timing of eruption
1.Genetic factor
2. Sex
3. Hormones and vitamins
4. Birth weight
5. Systemic disorders
6. Socioeconomic conditions
7. Local cause

7. Factors influence the timing of eruption
1.Genetic factor :
Genes play a definite role in tooth eruption and have been estimated to be about 78%.

8. Factors influence the timing of eruption
2. Sex
- It is observed that the teeth of girls erupt slightly earlier than those of boys.
- The average amount of tooth development for girls is about 3% ahead that of boys.
- The difference may vary from 2 months [first molar] to 10 months (maxillary canine)..

9. Factors influence the timing of eruption
2. Sex
- Initially during the formation stage, there was no sex difference up to the stage of calcification, and the difference begins only from the crown completion stage.

10. Factors influence the timing of eruption
3. Hormones and vitamins :
Thyroid, pituitary [growth hormone], and parathyroid hormones are essential for normal eruption of teeth. Vitamins like vitamin B complex, A, C and D aid either directly or indirectly for tooth eruption.

11. Factors influence the timing of eruption
4. Birth weight
- Low birth weight has been associated with delayed emergence of permanent teeth and conversely early eruption has been associated with increased birth weight.

12. Factors influence the timing of eruption
5. Systemic disorders
Precocious eruption is rare and is observed less commonly than retarded eruption.
Delay in permanent tooth eruption is associated with
Down’s syndrome,
Cleidocranial dysostosis,
hypothyroidism,
hypopituitarism
hemifacial atrophy

13. Factors influence the timing of eruption
5. Systemic disorders
Precocious eruption is seen in
- precocious puberty,
- hyperthyroidism,
- hemifacial hypertrophy,
- Sturge-Weber syndrome
- hyperpituitarism.

14. Factors influence the timing of eruption
6. Socioeconomic conditions :
Socioeconomic levels are known to affect eruption. Retarded eruption of anterior teeth and accelerated emergences of the posterior dentition has been linked to low socioeconomic status in all racial groups.

15. Factors influence the timing of eruption
7. Local cause
Dental caries and periapical infection of primary teeth, resulted in early eruption of the corresponding permanent tooth.
Very early extraction of a primary molar delays gingival eruption of the successor.
Ankylosis of primary teeth delays the eruption of permanent tooth.

16. Eruptive movements The eruptive movements of tooth can be divided as:
Pre-eruptive tooth movements
Eruptive movements
Posteruptive tooth movements

17. Eruptive movements The eruptive movements of tooth can be divided as:
Pre-eruptive tooth movements
These are the movements made within the bone before the tooth begins to erupt.

18. Eruptive movements 2- Eruptive movements :
Eruption normally starts when the root formation begins.

19. Eruptive movements
3- Posteruptive tooth movements : they are the movements made by the tooth after it has reached its functional position in the occlusal plane.
Posteruptive tooth movements help in readjustment of the tooth in the socket.
This is achieved by the formation of new bone at the alveolar crest and on the socket floor to keep pace with the increasing height of the jaws.
Such movements can be in axial, mesial or distal directions.

20. problems during eruption teeth
In most children, the eruption of primary teeth is preceded by
- increased salivation
- put the hand and fingers into the mouth.
- Some children become fretful
- increase in the amount of finger sucking or rubbing of the gum
- loss of appetite

21. problems during eruption teeth
Symptoms often associated with teething are:
• Irritability (most prevalent)
• Restlessness
• Drooling
• Disturbed sleep
• Decreased food consumption
• In creased fluid intake
• Rash

22. problems during eruption teeth
It is coincidentally associated with
diarrhea,
fever
Even convulsions.
All these features may be due to mouthing of contaminated toys or teethers which the children use to rub the gums.

23. problems during eruption teeth
- Local conditions observed during teeth eruption are
- gum inflammation,
- ulcer in mouth,
- cheek flush and cheek rash.
- Inflammation of the gingival tissues before complete emergence of the crown may cause a temporary painful condition that subsides within a few days.

24. problems during eruption teeth
- Treatment for teething is symptomatic and palliative.
If the child is having extreme difficulty, the application of a non irritating topical anesthetic gel may bring temporary relief.
- The parent can apply the anesthetic gel to the affected tissue over the erupting tooth 3 or 4 times a day.

25. problems during eruption teeth
- The child can be given vegetables such as carrot that are hard and chewable to bite onto it. This may give some relief to the child.
- Commercially available sterile and clean teethers can also be used.
- Reassuring the parents is helpful.
- Fever, if present, should be treated with paracetamol
If the fever is persistent, the child should be referred to a pediatrician.

26. problems during eruption teeth
Hematoma cyst :It appears as bluish purple, elevated area of tissue, which develops a few weeks before the eruption of a primary or permanent tooth.
This blood filled cyst is most frequently seen in primary second molar or permanent first molar region.

27. problems during eruption teeth
- Since it is self- correcting, treatment is usually unnecessary.

28. problems during eruption teeth

29. problems during eruption teeth
Eruption sequestrum
Sequestrum is a tiny spicule of nonviable bone overlying the crown of an erupting permanent molar. They have little or no clinical significance, as they usually sequestrate spontaneously.

30. problems during eruption teeth
Natal and Neonatal teeth :

31. problems during eruption teeth
Natal and Neonatal teeth :
Natal teeth are those that are present at birth.
neonatal are those that erupt within the first 30 days of birth.
Natal teeth may resemble normal primary teeth. In about 85% of the cases they are prematurely erupted deciduous incisors

32. problems during eruption teeth
They may appear poorly developed, small, conical shaped, yellowish brown opaque, and have hypoplastic enamel and dentin, poor texture, and small root.
The mandibular incisor region is the most prevalent location
The condition is probably attributed to superficial positioning during the formation of the involved tooth germ

33. problems during eruption teeth
Lack root structure, will usually exfoliate prematurely during infancy
presenting a potential hazard for aspiration
They teeth seem to have familial predilection (in about 15%).
Natal teeth appear more frequently than neonatal teeth in a ratio of 3:1.

34. problems during eruption teeth
A sharp incisal edge of the natal or neonatal teeth may lacerate the tongue and cause difficulty while breastfeeding
In such cases it may be extracted or otherwise left without extraction. Where possible, extraction should be avoided until after the tenth postnatal day to avoid hemorrhage, due to possibility of vitamin K deficiency present.

35. problems during eruption teeth
Riga-Fede disease: It is characterized by the formation of an ulcer on the ventral surface of the tongue caused by the natal or neonatal teeth rubbing against the teeth. It is also called a Fede’s disease

36. problems during eruption teeth
They may be sometimes associated with three syndromes:
1- Chondroectodermal dysplasia or Ellis Van Creveld syndrome
2- Hallermann-Streiff syndrome
3- Pachyonychia congenita syndrome

37. problems during eruption teeth

38. problems during eruption teeth
Ankylosis ( submerged tooth ):
It is the aberration of tooth eruption in which the continuity of the periodontal ligament has been compromised and the tooth is fused to the underlying bone.
- The tooth appears submerged and does not occlude with the opposing tooth,

39. problems during eruption teeth
ankylosed tooth is in the state of static retention whereas in the adjacent areas eruption and alveolar growth continues
There are high chances for the occurrence of many ankylosed teeth when a patient is diagnosed to have one or two ankylosed tooth in oral cavity

40. problems during eruption teeth
Mandibular primary molars are the teeth most often observed to be ankylosed.
Ankylosis of anterior primary tooth usually follows any kind of trauma.
Familial occurrences (non-sex linked) have been noted

41. problems during eruption teeth
Diagnosis of an ankylosed tooth can be made based on the following points:
No contact with opposing molar
Not mobile inspite of advanced root resorption
Comparing the sound by taping the involved and adjacent tooth.

42. problems during eruption teeth
Ankylosed tooth exhibits solid sound, but a normal tooth has a cushioned sound
Break in the continuity of periodontal membrane

43. problems during eruption teeth

44. problems during eruption teeth

45. problems during eruption teeth
Treatment :
Surgical removal, if the permanent successor is present.
If permanent teeth are missing, functional occlusion is established with stainless steel crowns on the affected tooth

46. problems during eruption teeth
Understanding tooth development and eruption will guide a practitioner to diagnose or differentiate normal from an abnormal. Constant evaluation or observation of the development of teeth and occlusion can be included under preventive dentistry program thus intervening any developing malocclusion at its early stage.

47. problems during eruption teeth
Delayed eruption :
Down Syndrome,
cleidocranial dysplasia,
hypothyroidism,
hypopituitarism or achondroplastic dwarfism.

48. thank you