Pediatric Dentistry: Eruption & Ankylosis

• Oral manifestations include delay eruption and delay exfoliation; about 95% fall into this category.

Eruption Stages

• Eruption refers to the movement of a tooth germ from its developmental site in the alveolar processes to its functional position in the oral cavity.
• Pre-eruptive movements occur in both deciduous and permanent teeth within the tissues before eruption onset.
• Eruptive movements involve the tooth moving from its intraosseous position to its functional position on the arch, divided into intra-alveolar and supra-alveolar eruption.
• Post-eruptive movements occur when the tooth remains in its functional position, adapting to jaw growth and wear.

Factors Affecting Eruption Time

• Low birth weight can cause retardation of dental growth and development, especially in preterm babies.
• Malnutrition negatively effects tooth eruption, chronic malnutrition can lead to delayed eruption.
• Nutritional deficiencies alter bone mineralization.
• Eruption of permanent teeth is important because it stimulates jaw growth.
• Calcium, Vitamin D, Vitamin B12, Zinc, Fluoride, and collagen deficiencies may impede/ alter proper tooth eruption.
• Height has a positive correlation with teeth emergence.
• Endocrinal disturbances affect the entire body and impact dentition.
• Hormonal imbalances like hypothyroidism, hypopituitarism, and parathyroidism typically lead to delayed permanent teeth eruption.
• Systemic conditions influencing tooth eruption include Down's Syndrome, chondroplastic dwarfism, and Vitamin D resistant rickets.
• Higher socioeconomic status correlates with earlier eruption.
• Breastfeeding supports overall growth and development, including orofacial development and dentition eruption.
• Tooth eruption, both in timing, delay, or failure, can be influenced by genetic disorders.
• Permanent teeth erupt earlier in girls due to an earlier onset of maturation.

Lingual Eruption of Mandibular Permanent Incisors

• A common occurrence, where mandibular permanent incisors erupt lingually.
• Lingual eruption is normal, especially in patients with arch-length inadequacy or adequate spacing.
• Tongue and alveolar growth help permanent incisors move to a more normal position.
• Before 7.5 years, the condition can correct itself, and tongue action is important, if not, extraction necessary
• If radiographs of older child show no root resorption, the primary teeth have achieved self-correction should be removed

Teething and Difficult Eruption

• Increased salivation occurs.
• An infant will have a tendency to put hands and fingers in the mouth, which means the teeth are soon to soon erupt.
• Restlessness and fretfulness are common.
• The symptoms include croup, diarrhea, fever, convulsions, and primary herpetic gingivostomatitis. Yellow stool color is also an indication of discomfort.
• If patient has convulsions, administer IV Valium.
• Fever and systemic disturbances link is not justified when teething.
• These symptoms, if the patient has respiratory tract infection, should be considered coincidental and non related.
• Topical anesthetics which include benzocaine can assist numbing the gums.
• Caution has to be used because rapid systemic absorption of benzocaine with toxic effects is possible.

Eruption Hematoma

• It looks like an eruption cyst and it is bluish-purple.
• An elevated area of tissue on occasion develops weeks prior to a baby tooth or permanent tooth emerging.
• Seen most in primary second molars or permanent first molars.
• Usually a few days after the tooth breaks through the hematoma subsides.
• No intervention is needed for anything lasting 2 weeks, unless it hurts, and then incision is the solution.

Eruption Sequestrum

• It describes a tiny spicule of nonviable bone overlying the crown of an erupting permanent molar.
• Is seen during the eruption of the first permanent molar, described as a tiny bone spicule.
• Composed of dentin, and cementum.
• Usually eruption sequestrum is self limiting/ no intervention is needed

Ectopic Eruption

• Occurs due to arch length inadequacy or tooth mass.
• Ectopic eruption is commonly caused due to a tooth erupting in an abnormal position.
• Sometimes, dental transposition is necessary for sever cases.

Natal and Neonatal Teeth

• Natal teeth: teeth present at birth.

• Neonatal teeth emerge during the neonatal period, within 30 days after birth.

• 85% of natal or neonatal teeth are mandibular primary incisors with a small percentage of supernumerary teeth also manifesting.

• Extraction is considered if ulceration on the tongue, soft tissues, trauma during breastfeeding, or high risk of aspiration due to poor root development.

• Natal and neonatal extraction is a simple process with careful curretage. Anastasia is not required.

• Prematurely erupted teeth are hypermobile due to underdeveloped roots.

• Sharp incisal edges can damage the lingual surface of the tongue.

• Riga-Fede disease affects the lingual surface, therefore it is important to extract those teeth to safeguard the patients health.

Epstein Pearls, Bohn Nodules, and Dental Lamina Cysts

• Lesions incorrectly diagnosed as natal teeth.
• These present as White or grayish small lesions.
• Lesions are usually multiple.
• Lesions spontaneously shed a few weeks after birth, treatment is not indicated.
• Epstein pearls form along the midpalatine raphe.
• Remnants of remnants of epithelial are trapped and form these teeth in the grew. Bohn nodules form along the buccal and lingual regions of dental ridges and palates.
• Remnants of salivary gland tissue become Bohn nodules.
• Dental lamina cysts can form on the crests of the maxillary and mandibular dental ridges.
• The location of dental lamina cysts is derived of remnants of the dental lamina.

Ankylosed Teeth

• Retention of static tissue is a form of ankylosed teeth.
• Mandibular primary molars are the most impacted teeth affected.
• Terms like 'infra occlusion', 'unusual cases', 'all the primary molars may become firmly attached to the. alveolar bone before their normal exfoliation time' are normally used.
• Ankylosis in anterior primary teeth is caused by trauma.
• Normal resorption of primary molars starts on the inner/lingual surfaces, which occurs during inactivity or rest.
• Overtime bones unite with teeth in the reparative process.
• Before exfoliation teeth become firm because of intermittent bone reorption processes. Extensive bony ankylosis in some teeth can slow down shedding, and interrupt a successor tooth.

Diagnosing Ankylosis

• Eruption of primary teeth is not difficult to be realized.
• the alveolar process often doesn't grow around affected the teeth.
• The opposing teeth are often in occlusion.
• Ankylosed teeth are not unstable, even with advanced resorption, but they are known to be impacted to some degree.
• Tapping on the affected tooth with a blunt instrument to make sure the patient’s tooth make a solid sound is important to distinguish.
• Radiography assists detecting an ankylosis, its break in the periodontal tissues will indicate impacted area, and distinguish.

Trisomy 21 Syndrome (Down Syndrome)

• This syndrome stems from a genetic disorder.
• Abnormalities include delayed eruption of teeth.
• Primary teeth may not erupt till after 2 years with all dentition not coming in until age 5.
• Down syndrome traits include orbits size and the nose bridge size being different than the status quo.

Down Syndrome Oral Findings Are Mouth Breathing

• Open bite.
• Appearance of Macroglossia.
• Fissured lips and Tongues.
• Anguler Cheilitis.
• Late Tooth Eruption.
• Missing Teeth.
• Small Teeth.
• Crowd. Low Level Caries.

Cleidocranial Dysplasia (CCD)

• A congenital syndrome is a genetic condition in which the finding is absence of the clavicles.
• Evidenced by the presence of Sternal and acromial ends.
• If the patient has large fontanels, sutures will display on the head.
• Sinuses, particularly the frontal, are small.
• Development of the dentition is impacted in a lot of teeth, and it is common to find retained primary dentition at the age of 15 or older but there is a delayed resorption.

Hypothyroidism

Is normally detected on mental deficits.

• It does not manifest as a life threatening situation/condition.
• This in-general can cause mental and growth impacts.
• Hypothyroidism's main oral manifestation includes : enlarged tongue, delayed teeth and malocclusion.
• Can cause the child to develop and delayed the start of puberty.
• Congenital and Juvenile are two types.

Congenital

• Occurs to the child at their time of birth (normally at their rapid development)
• Untreated this becomes a deficiency of hormones and stortedness.
• This happens when the insufficient levels of thryoid hormones become low at the developemtal
• A child who isn't properly or adequately taken care of that has it will disproportionate the figure.
• Can create a shortend head trunk, which can lead to obesity.
• Juvenile: this occurs between 6 and 12 years of age.
• Patients may have teeth in them and be affected with a delayed permanent teeth.
• It is also caused be malfunction of the thyroid.
• If the dificancy happens through rapid development for a congenital condition then no unusual and or bad characterisic can take a hold on the person.
• A child at the age of 4 when diagnosed may have a similar set to one wh is 9-10

Hypopituitarism

• The child has a decelaration in bone and secretion issues.
• Pituitary dwarfism is is a result of gland. Essentially for hypopititarism the child's teeth will be normal in size. Also, their teeth have slowed.
• If severe then permanent retention will be a factor.
• Do not extract for growth is not detected.

Cautions for Adrenaline Usage

• Adrenaline (epinephrine) may be contraindicated because ask patients with this history first.
• Also make sure cardiovascular diseases, hyperthyroidism, allergies to adrenaline are considered before usage.
• If specific patient comes to clinic, give small quantity of lido/caine and use it in the test area, under the dermis.

If Adrenaline Is An Issue

• Then inject without the assistance of it.
• If there are known allergies use the test under the dermis.
• Also general anaesthetics will give a safe alternative and you should use test for that too.
• If the patient is know to you tell them that their teeth is has been ankylosed there after extraction or teeth implant will be requested for the ages of 1.8. Make be careful to check for their WBC,RBC and platelet.
• Make sure you run viral check like HIV,HBV,HCV.

This lesson covers dental eruption anomalies and ankylosis and emphasizes the importance of diagnosis. Additionally, the significance of radiographs in assessing dental issues and the need for timely intervention in cases of lingual eruption are discussed. Differentiating typical teething from serious underlying issues is also highlighted.