Dental Extraction of Tooth 6

Normal Dental Development

• Normal development is defined as average, not ideal. Eruption times vary and are presented in a table.
• Calcification and eruption times are important for assessing dental vs. chronological age and for predicting possible causes of hypocalcification/hypoplasia.
• Transition from primary to mixed dentition is a major milestone for parents, typically occurring around 6 months to 3 years.
• Primary dentition eruption is usually complete around 3 years.
• Deciduous incisors erupt upright and spaced, suggesting permanent successors may be crowded.
• Overbite reduces during primary dentition.
• Mixed dentition phase is heralded by permanent molar or lower central incisor eruption.
• Lower labial segment teeth erupt before their counterparts in the upper arch.
• Lower incisors often erupt slightly lingually or rotated; aligning spontaneously with available space.
• Intercanine width increases 1-2 mm during primary dentition, reaches 3 mm during mixed dentition, and gradually decreases afterwards.
• Arch width increases 2-3 mm between ages 3 and 18.
• Leeway space (difference in width between deciduous and permanent successors) is 1-1.5 mm maxillary and 2.5mm mandibular.

Abnormalities of Eruption and Exfoliation

• Early detection of abnormal tooth development/eruption is crucial for intervention.
• Screening should include observation for deviations from normal eruption patterns.
• Radiographs are indicated if abnormalities are suspected.
• Palpating buccal sulcus for permanent maxillary canines is important around ages 9-10.
• Natal teeth are present at birth or erupt soon after.
• Natal teeth are usually lower primary incisors erupting prematurely.
• Eruption cysts are fluid/blood accumulations in the space over erupting teeth.
• Failure of/delayed eruption can be generalized (hereditary issues, syndromes) or localized (obstruction).
• Early extraction of a primary tooth can cause drifting.
• Mesial drift is more likely in the maxilla.

Mixed Dentition Problems

• Premature loss of deciduous teeth can cause existing crowding to localize.
• The presence of crowding, age, and the extraction site affect the degree of shifting into extraction space.
• Deciduous incisor loss has minimal impact; whereas deciduous canine loss could lead to midline shifts in a crowded mouth.
• Deciduous first molar extraction can cause forward drift of the first permanent molar.
• Deciduous second molar loss frequently results in forward drift of the first permanent molars.
• Retained deciduous teeth are problematic; removal is indicated, particularly if deflecting permanent teeth.
• Infra-occluded primary molars are submerged;
• Resorption of deciduous teeth is intermittent with occasional repair phases; ankylosis/infra-occlusion might, on occasion, stem from these factors.
• Impacting can cause malalignment.
• Space maintenance is ideally using a tooth anchor to avoid jeopardizing dental health and patient cooperation and is indicated only where space is crucial for the permanent successors.
• Retained deciduous teeth should be extracted if the permanent successor present, and affecting the positioning of permanent teeth.
• Impacted first permanent molars are typically in the upper arch, potentially requiring treatment or observation.
• Dilaceration is a distortion or bend in a tooth root.

Supernumerary Teeth

• These are additional teeth.
• Supernumerary teeth often arise in the maxilla.
• Supernumerary teeth can affect eruption.
• These affect appearance or cause malocclusion.
• These can cause malpositioning of other teeth.
• Treatment may include extraction.

Habits

• The effect of habits depend on frequency and intensity.

First Permanent Molars

• Caries or hypoplasia can impact first permanent molars.
• Treatment planning becomes difficult when molars are compromised.
• First permanent molar extraction should only be considered after other solutions have been tested.

Median Diastema

• A gap between central incisors; fairly common in children.
• Causes include physiological factors, familial tendencies, small teeth, missing teeth, or other craniofacial anomalies.

Planned Deciduous Extractions

• Serial Extraction is a sequence of extractions to allow space for incisors to align.
• Indications for canine extraction include crowding in upper arches, palatal deflection in Class I malocclusion, space for additional teeth.
• Lower canine extractions to alleviate crowding and improve alignment.

Referral Considerations

• Referral is often delayed to when the early permanent dentition intervenes.
• Referrals are often needed for cleft palate, craniofacial anomolies or when the best approach is unclear.

This quiz focuses on the key considerations and optimal conditions for the extraction of tooth 6. Test your knowledge on the timing, factors, and circumstances that influence the extraction decision for this particular tooth. Perfect for dental students and practitioners.