Eruption of Teeth Lecture PDF

Eruption of the Teeth Note : regarding thisnLEC , you can say 95% of oral manifestations include ( delay eruption , delay exfoliation …etc ) ,,, if you don’t remember anything then just write delay…( ‫🙂 😁 ) فالن‬  eruption stages Eruption is defined as the movement of the tooth germ...

Eruption of the Teeth Note : regarding thisnLEC , you can say 95% of oral manifestations include ( delay eruption , delay exfoliation …etc ) ,,, if you don’t remember anything then just write delay…( ‫🙂 😁 ) فالن‬  eruption stages Eruption is defined as the movement of the tooth germ from its site of development in the alveolar processes to its functional position in the oral cavity. ‫ نكريه‬eruption ‫هيشتا دستبيك‬ Pre-eruptive movements: undergone by deciduous and permanent teeth within the tissues before the onset of eruption. ‫ بكت‬eruption ‫حركه كي بسيط دكت بري دستبيك‬ ‫حركات بزوغ االسنان‬ Eruptive movements: when the tooth moves from its intraosseous position to its functional position on the arch. This phase can be divided into intra-alveolar and supra-alveolar eruption; ( ‫ بي ) خالص‬erupt ‫بشتي ددان‬ Post eruptive movements: the tooth remains in its functional position and adapts to the growth of the jaw and proximal and occlusal wear. Factors affecting the eruption time 1. Weight of children: Low birthweight: retardation of dental growth and development in preterm babies ‫ئو زاروكني بري وختى خو بني‬ Malnutrition: The extremes of nutritive deficiency that the effects on tooth eruption. chronic malnutrition can lead to delayed eruption. Lack of nutritional supply alters bone mineralization leading to disturbances in bone formation. Eruption of permanent teeth is important as it also stimulates the jaw growth. Most commonly Ca & Vit D What are de ciencies that may lead to this condition ? Ca , Vit D , Vit B12 , Zn , F , collagen  The thyroid gland in 1st year in child , act as growth hormone [ GH ] for. that reasons it very imp { thyroid} 2. Height: a positive correlation between the height and weight of the body with teeth emergence, with the taller and heavier children showing an early dental growth. Endocrinal disturbances, which affects the entire body also affects the dentition. The hormonal conditions such as hypothyroidism, hypopituitarism and parathyroidism usually exhibit delayed permanent teeth eruption. The other systemic conditions influencing tooth eruption includes: Down’s Syndrome, a chondroplastic dwarfism, Vitamin D resistant rickets. ‫الكساح‬ Socioeconomic: higher socioeconomic status show earlier eruption. Bcuz of levels of Ca , Vit D….etc And tooth brushing  rickets ‫الكساح‬ chondroplastic dwar sm The Down syndrome can’t be con rmed ‫قزم‬ unless you make genetic test to con rm it Primary teeth ‫تاخير دركفن وتأخير دكفن‬ ‫ تاخير دين حتى دردكفن‬permanent teeth ‫فيجا‬ All this 3 conditions induce delay eruption of teeth 🫤  ‫ فيجا بو هندي كلك مهمة بشتي شيري بدي زاروك‬، ‫ جارا بترا ژي صناعي‬5 ‫شكر لنيف شيري دايكي دا‬ ‫ نيفيا ويف كافا داني وي يي اولي دركفت‬٦ ‫ ژعمري‬، night ‫دواني وي بشوي خاصة لدمي‬ 3. Breast feeding: breastfeeding has an overall effect on growth and development of children. the effect of breastfeeding habits on orofacial development, including eruption of primary and permanent dentitions ( physiological orofacial stimulation) Genetic factors: Certain genetic disorders affect tooth eruption either by delaying or by a complete failure of tooth eruption.( + ) correlation with teeth eruption ‫ كا دداني ديك وبابي وي ژي تاخير بون ؟‬، ‫ برسيار كه‬، ‫هكه دداني زاروك تاخير بي‬ Gender: also plays an essential role with the permanent teeth erupting earlier in girls which is mainly due to the earlier onset of maturation.  lingual eruption of mandibular permanent incisors It is common for mandibular permanent incisors to Cause : erupt lingually, and this pattern should be considered Small arch size , space essentially normal. It is seen both in patients with an obvious arch length inadequacy and in those with a desirable amount of spacing of the primary incisors. ✅ In either case the tongue and continued alveolar growth seem to play important roles in influencing the permanent incisors into a more normal position with time. Before 7.5 years leave it > will be corrected by itself in few months , By action of tounge older child than 7.5 and X-ray show no root resorption >> Exo ✅ when parents discover a double row of teeth. He suggested that if the condition is identified before 7½ years of age, it is unnecessary to subject the child to the trauma of removing the primary teeth, because the problem always self-corrects within a few months. when lingually erupted permanent mandibular incisors are seen in an older child and the radiograph shows no root resorption of the primary teeth, self-correction has not been achieved and the corresponding primary teeth should be removed teething and difficult eruption In most children the eruption of primary teeth is preceded by increased salivation, and the child will want to put the hand and fingers into the mouth, these observations may be the only indication that the teeth will soon erupt. Some young children become restless and fretful during the time of eruption of the primary Infec teeth. Infec Many Infec conditions, including croup, diarrhea, fever, convulsions, primary herpetic ( viral inf ) Due to sever fever gingivostomatitis. If patient develop convulsions , what is the management ? Sign and symptoms of teething ? Yellow color Give Valium IV ( intravenous ) by cannula , or rectally Because the eruption of teeth is a normal physiologic process, the association with fever and systemic disturbances is not justified. A fever or respiratory tract infection during this time should be considered coincidental to the eruption process rather ‫متزامن‬ than related to it. By the mean , it’s not necessary always child deveop fever in each tooth eruption ( bcuz the eruption is physiological process )  ‫ بس بحذر‬، ‫ استخدام كي‬topical anesthetic ‫شي‬ As gel …etc The parent can apply the anesthetic to the affected tissue over the erupting tooth three or four times a day. Caution must be exercised, however, when one is prescribing topical anesthetics, especially for infants, because systemic absorption of the anesthetic agent is rapid, and toxic doses can occur if the product is misused.  Few days - 2 weeks leave it More than > 2 weeks eruption hematoma (eruption cyst) and painful , do incison A bluish-purple elevated area of tissue, commonly called an eruption hematoma, occasionally develops a few weeks before the eruption of a primary or permanent tooth. The blood-filled cyst is most frequently seen in the primary second molar or the first permanent molar region. Usually, the tooth breaks through the tissue within a Eruption cyst few days, and the hematoma subsides.  ‫قطعكي هستي مري‬ eruption sequestrum The eruption sequestrum is occasionally seen in children at the time of the eruption of the first permanent molar. described the sequestrum as a tiny spicule of nonviable bone overlying the crown of an erupting permanent molar just before or ‫ ئو بخوه‬، ‫ دركفت‬cusp ‫هما وختى‬ immediately after the emergence of the tips of the ‫دي جيبت‬ cusps through the oral mucosa, eruption sequestrum Self limiting are composed of dentin and cementum as well as a No need curretage cementum-like material formed within the follicle.  Main cause : Early extraction of primary ectopic eruption Arch length inadequacy, tooth mass ‫ زائد‬redundancy, or a variety of local factors may influence a tooth to erupt or try to >> ortho erupt in an abnormal position. Occasionally this condition may be so severe that actual transposition of teeth takes place.  At birth First ( 1 - 30 days ) post birth natal and neonatal teeth The prevalence of natal teeth (teeth present at birth) and neonatal teeth (teeth that erupt during the first 30 days), They found that about 85% of natal or neonatal teeth are mandibular primary incisors, and only small percentages are supernumerary teeth. Case Management ? Do extraction in these cases ? Imp case ulceration on tongue and soft tissues ( sharp edges ) Trauma to mother during breast feeding Risk of aspiration bcuz failure of root development ( mobile tooth ) No need Anastasia , just extract and do curretage for that area ( socket ) Most prematurely erupted teeth (immature type) are hypermobile because of limited root development. Some teeth may be mobile to the extent that there is danger of displacement of the tooth and possible aspiration, in which case the removal of the tooth is indicated. In some cases the sharp incisal edge of the tooth may cause laceration of the lingual surface of the tongue (Riga-Fede disease), and the tooth may have to be removed. Extraction of such a tooth, if necessary, is a simple procedure but is emotionally difficult for the parents. After the tooth is removed, careful curettage of the socket is indicated in an attempt to remove any odontogenic cellular remnants that may otherwise be left in the extraction site. ‫ ليوري جينه بت‬cyst ‫دا باشترا جئ‬ You should distinguish between this neonatal tooth and three below conditions ? 🫳 NEXT SLIDE epstein pearls, bohn nodules, and dental lamina cysts On rare occasions, small, white or grayish-white lesions on the alveolar mucosa of the newborn may be incorrectly diagnosed as natal teeth The lesions are usually multiple but do not increase in size. No treatment is indicated because the lesions are spontaneously shed a few weeks after birth. Origin and position are imp for each one ( 3 conditions )  Position 1. Epstein pearls are formed along the midpalatine raphe. They are considered remnants of epithelial tissue trapped along the raphe as the fetus grew. Origin  Position 2. Bohn nodules are formed along the buccal and lingual aspects of the dental ridges and on the palate away from the raphe. The nodules are considered remnants of salivary gland tissue and are histologically Origin different from Epstein pearls.  Position 3. Dental lamina cysts are found on the crests of the maxillary and mandibular dental ridges. The cysts apparently originated from Origin remnants of the dental lamina. ankylosed teeth ( imp ‘ ) ankylosed tooth is in a state of static retention, whereas in the adjacent areas eruption and alveolar growth continue. The term infra occlusion, although Infra-occlusion commonly used today. The mandibular primary molars are the teeth most often observed to be ankylosed. In unusual cases all the primary molars ‫ بس تني ئف‬، ‫ هاتينه‬permenent ‫همي دداني‬ may become firmly attached to the alveolar bone ‫ جيبيه لفيري‬ankylosis ‫ و‬primary ‫يي ماي‬ before their normal exfoliation time. Ankylosis of the anterior primary teeth does not occur unless there has been a trauma. Normal resorption of the primary molar begins on the inner or lingual surfaces of the roots. How? The resorption process is not continuous but is interrupted by periods of inactivity or rest. A reparative process follows periods of resorption. In the course of this reparative process, a solid union often develops between the bone and the primary tooth. This intermittent resorption and repair may explain the various degrees of firmness of the primary teeth before their exfoliation. Extensive bony ankylosis of the primary tooth may prevent normal exfoliation and the eruption of the permanent successor.  diagnosis Why ? The diagnosis of an ankylosed tooth is not difficult to make. Because eruption has not occurred and the alveolar process has not developed in normal occlusion, the opposing molars in the area seem to be out of occlusion. The ankylosed tooth is not mobile, even in cases of advanced root resorption. 1 Ankylosis can be partially confirmed by tapping the suspected tooth and an adjacent normal tooth with a blunt instrument and comparing the sounds. The ankylosed tooth will have a solid sound, whereas the normal tooth will have a cushioned sound because it has an intact periodontal membrane that absorbs some of the shock of the blow. 2 The radiograph is often a valuable diagnostic aid. A break in the continuity of the periodontal membrane, indicating an area of ankylosis, is often evident radiographically. trisomy 21 syndrome (down syndrome) Trisomy 21 syndrome (Down syndrome [DS])—that is, the presence of three number 21 chromosomes rather than the normal two (diploid)—is one of the congenital anomalies in which delayed eruption of the teeth frequently occurs. The first primary teeth may not appear until 2 years of age, Lower‫بنب‬central ‫ سالي تمام‬٣ ‫ هيفي دستبيبكت و لعمري‬٦ ‫بشكل طبيعي مفروض ژ‬ and the dentition may not be complete until 5 years Last one erupt ( primary 2nd molar ) of age. Primary teeth eruption The eruption often follows an abnormal sequence, Normally ( 6 month - 3 year ) Down.S ( 2 year - till 5 year ) and some of the primary teeth may be retained until 15 years of age.In down.S primary have been decayed ‫ ساال و‬15 ‫ هات وعمري وي‬pt ‫هكه‬ ‫ ناهيت‬permanent ‫ هر يى‬، ‫ كر‬exo ‫هكه ته‬ Features of Down syndrome ? The diagnosis of DS in a child is not difficult to make because of the characteristic facial pattern. The orbits are small, the eyes slope upward, and the bridge of the nose is more depressed than normal. Mental retardation is another characteristic finding, with most children in the mild to moderate range of disability Retardation in the growth of the maxillae and mandible was evident in those with DS. Both the maxillae and mandible were positioned anteriorly under the cranial base. The upper facial height was found to be significantly smaller. The midface was also found to be small in the vertical and horizontal dimensions. Oral findings include mouth breathing, open bite, appearance of macroglossia,👅 fissured lips and tongue, angular cheilitis, delayed eruption times, missing and malformed teeth, microdontia, crowding, and a low level of caries cleidocranial dysplasia A rare congenital syndrome that has dental significance is cleidocranial dysplasia (CCD), which has also been referred to as cleidocranial dysostosis, The diagnosis is based on the finding of an absence of clavicles, although there may be remnants of the clavicles, as evidenced by the presence of the sternal and acromial ends. The fontanels are large, and radiographs of the head show open sutures, even late in the child’s life. The sinuses, particularly the frontal sinus, are usually small the patients exhibited mandibular prognathism caused by increased mandibular lengths and short cranial bases. The maxillae tended to be short vertically but not antero posteriorly. The development of the dentition is delayed. Complete primary dentition at 15 years of age, resulting from delayed resorption of the deciduous teeth and delayed eruption of the permanent teeth, is not uncommon Hypothyroidism : Usually those patients mentally retardedretarded Hypothyroidism does not manifest as a severe life threating condition. Congenital hypothyroidism may lead to growth retardation in general including mental development. Oral manifestation : ⬇ thyrodism Delay eruption of teeth. Enlarged tongue Malocclusion. Oral manifestation: the child with congenital hypothyroidism is delayed in all stages, including eruption of the primary teeth, exfoliation of the primary teeth, and eruption of the permanent teeth. The teeth are normal in size but are crowded in jaws that are smaller than normal. The tongue is large and may protrude from the mouth. The abnormal size of the tongue and its position often cause an anterior open bite and flaring of the anterior teeth. Tooth crowding, malocclusion, and mouth breathing cause a chronic hyperplastic type of gingivitis. hypopituitarism A pronounced deceleration of the growth of the bones and soft tissues of the body will result from a deficiency in secretion of the growth hormone. Pituitary dwarfism is the result of an early hypofunction of the pituitary gland. The dentition is essentially normal in size. Delayed eruption of the dentition is characteristic. In severe cases the primary teeth do not undergo resorption but instead may be retained throughout the life of the person. The underlying permanent teeth continue to develop but do not erupt. Don’t extract primary in this stage , bcuz there is no growth > no permanent Extraction of the deciduous teeth is not indicated because eruption of the permanent teeth cannot be ensured. Extra information out of LEC , that dr.delan mention them and they are signi cant ✔ 🫴 the patients exhibited mandibular prognathism caused by Takeincreased care that adrenaline mandibular may be contraindicated lengths and short in such cases :bases. cranial Always ask pt about them The hypertension , cardiovascular diseases , hyperthyroidism , allergies to adrenaline Etc maxillae tended to be short vertically but not antero posteriorly. Thec patient If speci development of , the come to clinic dentition and suffering from ismost delayed. Complete of anasethtic primary agents , what to do ? — bring syringe of short needle ( insulin syringe ) and withdraw only 1 ‫ شخطة‬of lidocaine drug , dentition at 15 years of age, resulting from delayed resorption of then inject it intradermally ( ‫ ) تحت الجلد‬and wait for 15-20 minutes for detect any sensitivity the (deciduous reaction if not sign andteeth symptomsand) delayed eruption then u can inject patientof the with thatpermanent drug teeth, is not uncommon ( 1/10 ) For sensitivity test  If patient come and where adrenaline absolutely contraindicated for that pt , what to do ? the patients exhibited mandibular prognathism caused by Useincreased mandibular anaesthesia free of adrenaline ✅lengths and short cranial bases. The maxillae tended to be short vertically but not antero posteriorly. ‫بو عملي تو محتاج بي كلكي‬ The development of the dentition is delayed. Complete primary How to prepare dental syringe - carbuel free of adrenaline ???! Procedure? Imp dentition at 15 years of age, resulting from delayed resorption of the deciduous teeth and delayed eruption of the permanent teeth, Bring a dental carpule , Empty it from the current solution , and now withdraw amount is not uncommon of lidocaine from vial that is free of adrenaline by traditional-normal syringe and inject it to that carpule that you empty it before , and now your dental syringe with carpule is ready that contain lidocaine ( or any anaesthestic agent ) free of adrenaline In case of patients allergic to almost types of anaesthesia , even lidocaine ? What is the mangement ?? If situations need intervention with pulp and others painful procedures , you need insert patient into G.A ( general anaesthesia ) , while if no need for pulp intervention and other painful and stress procedures you can treat the patient under nitros oxide gas If patient present with primary ankylosed tooth , what is practical management ? the patients Depend exhibited on age , but at general 🫳 mandibular prognathism caused by increased mandibular lengths and short cranial bases. The 1 maxillae - exo >tended then toplacement of space be short vertically but notmaintainer antero posteriorly. Or The development of the dentition is delayed. Complete primary 2-dentition at 15age leave it until years of for of 18 age,doing resulting from either exodelayed resorption and implant of , or prepare the deciduous crown ( ‫ ) تلبيس‬eruption of the permanent teeth, teeth and delayed do tooth crowning is not uncommon Be carful , any patient need to G.A ( ‫ ) تخدير عام‬he will need two more important tests ? — CBC ( HB , WBC , RBC , platelets ) — Viral screen ( HIV , HBV , HCV ,,,etc ) the patients exhibited mandibular prognathism caused by increased mandibular lengths and short cranial bases. The maxillae tended to be short vertically but not antero posteriorly. The development of the dentition is delayed. Complete primary dentition at 15 years of age, resulting from delayed resorption of the deciduous teeth and delayed eruption of the permanent teeth, is not uncommon