1. GOOD MORNING

2. Eruption & factors affecting it
Deepti Awasthi
PG Student
Dept. of Pedodontics

3. Contents Introduction Definitions Factors influencing the eruption
Eruption pattern
- pre eruptive
- eruptive
- post eruptive
Theories of tooth eruption
Teething
Chronology of human dentition
Eruption rhythm
Conclusion
References

4. Comprehensive pediatric dentistry :Nikhil Marwah
Introduction
Eruption – cutting of the tooth through the gum.
Erumpere – ‘to break out’
Comprehensive pediatric dentistry :Nikhil Marwah

5. Teething : Myths & facts
Definitions
Axial or occlusal movement of the tooth from its developmental position within the jaw to its functional position in the occlusal plane.
Developmental process responsible for moving a tooth from its crypt position through the alveolar process into the oral cavity to its final position of occlusion with its antagonist.
Teething : Myths & facts

6. Active eruption is defined as the bodily movement of a tooth from its site of development to its functional position in the oral cavity.

7. passive eruption is the apparent lengthening of the crown due to the loss of attachment, or recession of the gingiva.

8. Factors influencing the eruption
Genetic factor
deciduous – 78%
Sex
girls > boys
tooth development for girls is about 3%
ahead of boys.
Principles & practice of pedodontics :Arathi Rao

9. Birth weight
low- delayed eruption
increased – early eruption
Socioeconomic status
low - accelerated eruption of posteriors
& retarded eruption of anteriors has
has been linked.

10. Hormones & vitamins-
Systemic disorders –
delay in permanent tooth eruption :
Down’s syndrome
Cleidocranial dysostosis
Hypothyroidism
Hemifacial atrophy

11. Precocious eruption :
precocious puberty
Hyperthyroidism
Hyperpituitarism
Hemifacial hypertrophy
Sturge weber syndrome
Premature loss of deciduous teeth :
Acrodynia
Papillon lefevre syndrome
Hypophosphatasia

12. Local factors
Ankylosis
Impaction
Dental caries & periapical infection
Early loss of primary teeth
Root formation

13. Eruption pattern
PRE-ERUPTIVE
ERUPTIVE
POST-ERUPTIVE

14. Pre-eruptive movement
Movement positioning the tooth & its crypt within the growing jaws preparatory to tooth eruption.

15. Eruptive movement
As the eruptive movements begin the enamel of the crown is still covered by reduced enamel epithelium.
The bone covering the erupting teeth is soon resorbed & crown passes through the connective tissue of the mucosa.
Tencate’s

17. For permanent :
The follicle retain its connection with oral mucous membrane by gubernacular cord.

19. Post- eruptive movement
They may be needed to –
Accommodate the growing jaws
Compensate for continued occlusal wear
Accommodate the proximal wear
The mesial drift is achieved by contraction of transseptal fibres and enhanced by occlusal forces.
Tencate’s

20. Theories Of Tooth Eruption

21. Principles & practice of pedodontics :Arathi Rao
THEORIES OF ERUPTION
Root elongation theory
Periodontal ligament traction theory
Bone remodeling theory
Pulpal constriction theory
Growth of periodontal tissue theory
Pressure from muscular action
Principles & practice of pedodontics :Arathi Rao

22. Resorption of the alveolar crest theory Hormonal theory.
THEORIES
Resorption of the alveolar crest theory
Hormonal theory.
Foreign body theory.
Cellular proliferation theory.
Vascular theory.
Blood vessel thrust theory.
Dental follicle theory

23. Root elongation :
-crown of the teeth are pushed into the oral
cavity
-rootless teeth erupt
Pulpal constriction
Bony remodelling :
-the connective tissue of dental follicle &
PDL proliferate & the tooth & crypt are
pushed away. The space is filled by growing
root & bone apposition.

24. Oral Anatomy, Histology& Embryology : Berkovitz
Cushion Hammock theory:
PDL traction theory :
-Dental follicle-PDL complex.
-ligament fibroblasts are able to contract a collagen gel which brings about movement of a disk of root tissue attached to the gel.
-fibroblast possess contractile filaments, exhibit fibronexus & such forces can be transmitted to the collagen fibre bundles.
-these not onl remodel but are also inclined at the correct angle to bring about eruptive movement.
-analogy
Oral Anatomy, Histology& Embryology : Berkovitz

25. Rate of eruption Within the bony crypt – 1µ/ day
When tooth comes out of – 7.5 µ/ day
the bony socket
After its appearance in the – 1mm /day
oral cavity
Final position is determined by the pressure exerted by the tongue ,cheeks, lips& by the teeth.
Orban’s

26. Eruption rhythm Circadian rhythm- significant in clinical practice
The teeth intrude transiently in conjunction with masticatory activity & then erupt significantly overnight.
Modification of treatment – more effective at night than during day.
S.Tandon

27. Difference between early eruption & premature eruption :
Early : occurs because of changes occuring in endocrine systems.
Premature : a pathologic phenomenon, with
the formation of incomplete root
less teeth.
Damle

29. Chronology Of Permanent Dentition

30. TEETHING

31. TEETHING Clinical features:-
Physiological process of eruption of primary dentition through the gingiva
Clinical features:-
A) Local signs-
1.Hyperemia or swelling of the mucosa overlying the erupting teeth
2. Patches of erythema on the cheeks
3. Flushing in the skin of adjacent cheek
S.Tandon

32. Systemic signs:- 1. General irritability & crying 2. Loss of appetite
3. Sleeplessness,
4. restlessness
5. Increase salivation & drooling
6. Increase thirst
7. Circumoral rash
8. Tendency to place objects in mouth
S.Tandon

33. TEETHING PROBLEMS SYSTEMIC PROBLEMS:-
Discomfort resulting from teething due to pressure exerted on periodontal membrane.
SYSTEMIC PROBLEMS:-
1.Fever
2. Diarrhea
3. Vomiting
4. Convulsions
5.Bronchitis
6. Cholera
7. Infantile paralysis
S.Tandon

34. LOCAL PROBLEMS:- 1.Eruption hematoma 2. Eruption sequestrum
3. Ectopic eruption
S.Tandon

35. Teething : Myths and Facts
Does teething cause systemic upset ?
The timing of eruption of the primary incisors coincides with the diminution of the circulating maternal humoral immunity conferred via the placenta & establishment of the child’s own humoral immunity.
The dental follicle is a source of eicosanoids , cytokines & growth factors ,thus contributing to pain , tenderness & inflammation by sensitizing afferent pain impulses.
Teething : Myths and Facts

36. Teething : Myths and Facts
Management :
Teething rings (chilled)
Cucumber, carrot
Frozen items
Pacifier
Rub gums with clean finger, cool spoon, wet gauze
Analgesics /Antipyretics
Topical anesthetic agents
Reassurance
Teething : Myths and Facts

37. Comprehensive pediatric dentistry :Nikhil Marwah
Eruption hematoma
A bluish purple, elevated area of tissue
Develops few weeks before the eruption
Primary second molar or first permanent molar
Result of trauma to the soft tissues
Self limiting condition.
Comprehensive pediatric dentistry :Nikhil Marwah

38. Eruption sequestrum Tiny spicule of non-viable bone
Cementum like material formed within the follicle.
Overlying the central fossa of the associated tooth embedded & contoured within the soft tissue.
Sequestrates.
McDonald & Avery

39. Ectopic Eruption Arch length inadequacy, Tooth mass redundancy,
local factors may influence a tooth to erupt in an abnormal position.
McDonald & Avery

40. Comprehensive pediatric dentistry :Nikhil Marwah
Natal & Neonatal teeth
Natal – present at birth
Neonatal – erupt within
1 month after birth.
Prevalance – 1:4000
Acc. to Bodenhoff’s study :
85% - mandibular incisors
11% - maxillary incisors
3% - mandibular canines
1% - maxillary canines & molars
Comprehensive pediatric dentistry :Nikhil Marwah

41. - superficial positioning of the developing tooth germ - infection
Etiology :
- superficial positioning of the developing tooth germ
- infection
- malnutrition
- hereditary
- trauma
- maternal exposure to environmental toxins
Natal Teeth :A Review

42. might resemble normal primary teeth in size & shape
Clinical features ;
might resemble normal primary teeth in size & shape
Often smaller, conical, yellowish
Hypoplastic enamel & dentin with poor or total failure of the development of root.
Natal Teeth :A Review

43. Dysplastic or hypomineralized enamel Irregular dentin
Histologically,
Dysplastic or hypomineralized enamel
Irregular dentin
Osteodentin in the cervical portion
Interglobular dentin in the coronal regions
Natal Teeth :A Review

44. discomfort during suckling Laceration of the mother’s breast
Complications :
discomfort during suckling
Laceration of the mother’s breast
Sublingual ulceration (Riga-Fede disease)
Feeding refusal
Aspiration of the teeth
Natal Teeth :A Review

45. Hypermobile , danger of aspiration – removal
Management
A radiograph
No interference with breast feeding & is asymptomatic – no intervention
Hypermobile , danger of aspiration – removal
Riga-fede –smoothing of rough incisal edge
After extraction –curettage of the socket is indicated to remove any odontogenic cellular remnants.
Natal Teeth :A Review

46. Precautions for extraction
Avoiding extraction upto 10th day to wait for the commensal flora of intestine to produce Vit.K
If planned immediately after birth ,Vit K supplements can be given to prevent hemorrhagic disease.
Damle

47. Epstein pearls, Bohn Nodules & Dental Lamina cysts
Small, white or grayish white lesions on the alveolar mucosa of the newborn
Incorrectly diagnosed as Natal teeth
Spontaneously shed few weeks after birth.
McDonald and Avery

48. Conclusion

49. References
Dentistry for the children & adolescent : McDonald & Avery, 9th ed.
R.Ten Cate. Oral Histology, development,
structure, and function. 5th ed.
Oral Anatomy,Histology & embryology : Berkovitz 3rd ed.
Principles & Practice of Pedodontics : Arathi Rao
Orban’s oral histology & embryology,12th ed.
Comprehensive pediatric dentistry : Nikhil Marwah
Tandon S. Textbook of Pedodontics
Damle S G. Textbook of Pediatric Dentistry. 3rd ed
Natal teeth :A Review ; Alexander K.C.Leung, J of National Medical association 2006,98(2)
Teething :Myths & facts , sankalp sood. JCPD vol.35(1)