9. Eruption of teeth.pdf

Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Eruption of teeth Definition The process by which the tooth moves from its site of...

Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Eruption of teeth Definition The process by which the tooth moves from its site of development within the jaws to its final functional position in the oral cavity. Tooth eruption phases The movements teeth make are complex and may be described in general terms as follows: Note: These phases apply to both permanent and primary teeth.  Pre-eruptive phase: o Made by tooth germs within the tissues of the jaws before they erupt. o Includes all movements from the time of early initiation and formation to the time of crown completion. o The phase is finished with early initiation of root formation. ".roots‫ وبتنتهي لما يبلّش تكوين ال‬,‫بتبلش من بداية تكوين السن‬ ّ ,‫ لسا ما طلع السن‬,‫يتكون في العظم‬ ّ ‫"هاي الفترة اللي بيكون فيها السن عم‬ o For anterior teeth:  Early in this stage, the permanent anterior teeth begin developing lingual to incisal edge of their predecessors.  Later, as the primary teeth erupt, the secondary teeth are positioned lingual to the apical third of their roots. ".‫ لألسنان اللبنية‬lingual ‫ األسنان األمامية الدائمة بتتكون‬,‫"خلوها ببالكم‬ o For premolars:  They are usually enclosed within the roots of the primary molars. ".‫ بيتكونوا بين الجذور تبعت األسنان‬premolars‫ ال‬,‫"بالمقابل‬ o For molars:  Permanent maxillary molars develop within the tuberosity.  Permanent mandibular molars develop in the ramus. ".‫ ما بيكون فوقهم سن‬molars‫"طب ًعا ال‬ 1 Dr. Hisham Darwish Pediatric Dentistry 00962796664867  Pre-functional eruptive phase: Gingival emergence. o A transition from intra-bony position to intra-oral position. o Made by a tooth to move from its position within the bone of the jaw to its functional position in occlusion. o Starts with the initiation of root formation and ends when the teeth reach occlusal contact. ".)occlusal contact ‫ وبتنتهي لما السن يبزغ ويخبط بالسن المقابل (يوصل‬,roots‫ بتبلش من بداية تكوين ال‬,‫"هاي الفترة اللي بيبلش فيها السن يبزغ‬ o Four major events: 1. The initiation of root formation. 2. Movement incisally/occlusally within the bony crypt to reach the oral mucosa. 3. Penetration into the oral cavity (The actual emergence): As the tooth is erupting, fusion between the reduced enamel epithelium and the oral epithelium occurs to allow tooth emergence. ,)‫ (موجود فوق السن‬reduced enamel epithelium ‫ بين شي بنسميه‬fusion ‫ بيصير‬eruption‫ كنا نحكي انه بفترة ال‬,oral histology‫"هذا الحكي أخذناه أيام ال‬ ".‫ وهالشي بيخلي السن يطلع بدون نزيف‬,oral epithelium‫وال‬ 4. Intraoral movement until clinical contact with the opposing crown. ".opposing‫ لما يخبط السن بال‬phase‫ بتنتهي هاي ال‬,‫"مثل ما حكينا‬  Functional eruptive phase: o Maintains the position of the erupted tooth in occlusion while the jaw continues to grow and to compensate for occlusal and proximal wear of the tooth and accommodate for growth. o Continues as long as the teeth are present in the mouth. ً ‫ بالسن المقابل‬attrition ‫ بيصير السن يطلع لو صار شوية‬,‫"هاي المرحلة بتضل مستمرة طول حياة السن‬ ".‫مثًل‬ Shedding of primary teeth  Shedding is the loss of the primary dentition caused by the physiologic resorption of the roots, the loss of the bony supporting structure and therefore the inability of these teeth to withstand the masticatory forces.  For anterior teeth: Resorption occurs on the lingual surface and these teeth are shed with their pulp chamber intact. ".‫ للسن اللبني‬lingual side‫تذوب بال‬ ّ ‫ حتبلش‬,‫؟ فلما تبلش تطلع‬lingual ‫"مش حكينا فوق انه األسنان األمامية موجودة‬  For primary molars: Resorption occurs in inter-radicular dentine with some resorption of the pulp chamber, coronal dentine and sometimes enamel. ".interradicular area‫ فحيبشوا يذوبوا بال‬,‫ موجودين تحت السن‬premolars‫ ال‬,‫"بالمقابل‬  Note: Shedding of primary teeth occurs during the pre-functional eruptive phase of permanent teeth. 2 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Eruptive tooth movement  The rate of tooth eruption depends on the type of movement: - Intraoseous phase (Bony phase): 1 to 10 μm/ day (Slower). - Extraoseous phase (Soft tissue phase): 75 μm/day. ".‫"جوا العظم بتكون حركة السن أبطأ‬  Note, this movement is affected by circadian rhythm "‫"الساعة البيولوجية‬ Most changes occur between 8 pm and midnight reflecting possible hormonal involvement. This explains why kids experience most of their teething pain during night time. Theories of Tooth Eruption  Mechanism of tooth eruption is not fully understood yet. However, it’s a multifactorial process.  Theories of tooth eruption include: 1. Role of root formation. 2. Role of bone remodeling. 3. Role of periodontal ligament. 4. Role of hydrostatic pressure. 5. Role of dental follicle (The most valid theory). We will talk about them in details. (Note: Don’t focus a lot on details, just try to understand them briefly). 1. Role of root formation: - Initially believed to be the reason behind teeth eruption. - Tooth is pushed upward by the growth of its root. - Animal and experimental studies found that this is not actually correct, and the evidences: A. Rootless teeth erupt. B. Teeth still erupt following root completion. - However, this role may account for eruption acceleration. ".‫ بتطلع عادي‬roots ‫ إلنه األسنان بدون‬,‫ لكن باآلخر رفضوها‬,)‫ نفسه بيدفع السن لفوق (مثل اللي عم بيحاول يرفع حاله‬root‫"هاي فكرتها انه تكوين ال‬ 2. Bone remodeling (Bone deposition and resorption): - Movement of teeth by the inherent growth of the maxilla and mandible and selective resorption and deposition of bone. - However: Tooth germs enucleated  eruption pathway is still formed. - So, bone remodeling per se is not sufficient. ‫ بس بعدين القوا انه حتى لو شلنا‬,‫ وهالشي بيحفّز طلوعه‬,‫ في الجزء السفلي من السن‬deposition ‫ وبيصير‬,‫ في الجزء العلوي‬resorption ‫"هاي فكرتها انه بيصير‬ ".path‫ حيضل يتكون هذا ال‬,tooth germ‫ال‬ 3. Role of periodontal ligaments: - Formation and renewal of PDL  eruption of teeth by the traction power of fibroblast (shrinking and crosslinking of collagen fibers). - However: Teeth still erupt even in the absence of PDL or even in rootless teeth. ".pdl ‫ إلنه األسنان بتطلع حتى لو ما فيها‬,‫ بس برضو نفوها‬,)‫ عم تسحبها لفوق (عن طريق انها تتقلّص‬pdl fibers‫"هاي فكرتها انه األسنان بتطلع إلنه ال‬ 4. Role of hydrostatic pressure: - The hydrostatic pressure difference between the tissue around the erupting crown and the apical extend (Tissue pressure was found to be greater apically than occlusally generating an eruptive force). - They found that it is a factor in eruption, but not the only cause. ".‫ بس مش العامل الوحيد‬,‫ كانت منطقية‬,hydrostatic pressure ‫ اللي بنسميه‬,‫"وهاي فكرتها انه فيه سوائل تحت السن بتدفعه لفوق بسبب ضغط الماء‬ 3 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 5. Role of the dental follicle: - The most acceptable theory. - Based on the cellular activity (The release of proteases and other mediators) within the reduced enamel epithelium and the follicle. - It is likely to have a central role in eruption. ".eruption‫ بيساعدوا في ال‬REE‫ عم يطلعوا من األسنان وال‬mediators ‫ انه فيه‬,‫"هاي أكثر نظرية مقتنعين فيها حاليًا‬ Chronology of primary teeth - AKA deciduous, baby, and milk teeth. - 20 primary teeth. - A, B, C, D, E - Incisors, canines, and molars (No premolars). - Primary molars are replaced with permanent premolars. ".‫ بينهم‬premolars‫ عشان يقدر يندحش ال‬,divergent ‫ بيكونوا‬primary molars‫ في ال‬roots‫"عشان هيك ال‬ - By 6 months of age, primary teeth start to erupt. - By 2.5 years – All primary teeth erupted. - Sequence of eruption: A, B, D, C, E. ".C‫ بيطلع قبل ال‬D‫"الحظوا كيف ال‬ - Sequence of calcification: A=B, D=C, E. - Note: Root formation in primary teeth needs 18 months after eruption. ".‫ سنين‬3 ‫ بيقعد‬permanent‫ تحت حنشوف انه بال‬,primary‫ هذا الحكي بال‬,‫ بس ديروا بالكم‬.root‫ بيكتمل ال‬,‫"يعني بعد ما يطلع السن بسنة ونص‬ Try to memorize them like this: Central incisors: Erupt at 6-8 months. "‫"نص سنة‬ Lateral incisors: Erupt at 8-12 months. "‫"سنة‬ First molars: Erupt at 12-18 months. "‫" سنة ونص‬ Canines: Erupt at 18-20 months. "‫"سنتين‬ Second molars: Erupt at 24-30 months. "‫"سنتين ونص‬ Sequence: Lower A  upper A  lower B  upper B  lower D  upper D  lower C  Upper C  Lower E  Upper E. Chronology of Permanent Teeth :‫إذًا‬ - 28-32 in number..‫ بزوغ األسنان اللبنية‬:‫ سنين‬3-‫ شهور‬6 - Appear between 6-12 years..‫ فترة استقرار‬:‫ سنين‬6-3 ‫من‬.‫ بزوغ األسنان الدائمة‬:‫ سنة‬12-‫ سنين‬6 - Will start to erupt at 6 years of age. The first tooth to erupt is FPM. - The last permanent tooth will erupt at 12 years of age (with the exception of third molars). - Sequence of eruption: Maxilla: 6, 1, 2, 4, 5, 3, 7, 8. Mandible: 6, 1, 2, 3, 4, 5, 7, 8. ".‫ سنة‬12 ‫ تقريبًا بيطلع على عمر‬,‫ بيتأخر ليطلع كثير‬maxillary canine‫"الحظوا كيف ال‬ - Sequence of calcification: Maxilla: 6, 1, 3, 2, 4, 5, 7. Mandible: 6, 1=2, 3, 4, 5, 7. - Root formation: 3 years post-eruption. ".‫ سنين بالدائم‬3 ‫ و‬,‫ سنة ونص باللبني‬,‫"مثل ما حكينا‬ 4 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Try to memorize them like this: Lower 6  5.5 years. Upper 6  6 years. Lower 1  6 – 6.5 years. Upper 1  7 years. Lower 2  7 – 7.5 years. Upper 2  8 years. Lower 3  9 years. Upper 4  9.5 years. Lower 4  9.5 – 10 years. Upper 5  11 years. Lower 5  11 years. Upper 3  12 years. Upper and lower 7  12+ years. The most important thing to focus on is the calcification of first molars: it starts exactly at birth. Sequence: Lower FPM  upper FPM  lower central  upper central  lower lateral  upper lateral  lower canine  premolars  upper canine  lower second molar  upper second molar. Primary Dentition 5 months in utero: Development of all primary teeth has started. At 6 months of age: First eruption. At 3 years: All primary teeth have erupted. At 4 years: All primary teeth roots are fully formed, and you will start to see signs of physiologic root resorption. At 5 years: FPM is closer to eruption. At 6 years: FPM have erupted. Mixed Dentition At 7-8 years: FPMs, centrals, and laterals have erupted. At 10 years: Lower canine and upper premolar have erupted. 5 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Permanent Dentition 11 years: Second molars have not yet erupted. 12 years: Second molars have erupted but not in inter-digitation. 15 years: Second molars are in inter-digitation. Timing of eruption The time of eruption for primary and permanent teeth varies greatly; a variation of 6 months on either side of the usual eruption date may be considered normal. ".‫ ومش الزم نقلق منه‬,‫ شهور محسوب طبيعي‬6 ‫ بالغالب تأخير‬,variations ‫ بس كثير موجود‬,‫"صحيح احنا أخذنا أرقام وحفظناهم‬ Sequence of eruption Sequence of eruption is more important than timing. That’s why we need to know the sequence of eruption for teeth. Clinically, any disturbance in the sequence of eruption might be an alarming sign for abnormalities ً ‫ شهور أو سنة‬6 ‫ ما بخاف لو كل األسنان تأخروا‬,‫ يعني‬,timing‫ أهم بكثير من ال‬sequence‫"ال‬ ".upper premolar‫ قبل ال‬upper canine‫ بس بخاف لو مريض طلعله ال‬,‫مثًل‬ 6 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Teething "‫"التسنين‬  Teething period: The 8-day period beginning 4 days before eruption and extending 3 days after the event.  Symptoms "‫"مهمات‬ - Finger chewing. - Gum rubbing. - Lip/object biting. - Red, swollen gums. - Drooling. - Circumoral rash/inflammation. - Flushed cheeks. - Irritability/restlessness. - Night crying. "‫"متذكرين ليش البكاء بيكون بالليل أكثر من بالصبح؟‬ - Mild temperature elevation. - Appetite loss. - Discomfort at the area of tooth eruption. Note: Parents claim that teething cause high grade fever, but that’s actually not the case. The case is that maternal immunity around the time of the first tooth eruption tend to be low, so the patient will be more susceptible to infections. So, if there’s a high grade fever, then it’s more likely to be a coincident, as a result of another infection happening at the same time. ".‫ فبالغالب ارتفاع درجة الحرارة بيكون محض صدفة‬,‫ هذا خطأ شائع‬,‫"الفكرة انه بزوغ األسنان ال يسبب ارتفاع شديد في درجة الحرارة‬  Many conditions, including croup (respiratory infection), diarrhea, fever, convulsions, primary herpetic gingivostomatitis, and even death have been incorrectly attributed to eruption. ".‫ لكن هالكًلم غير صحيح‬,eruption‫"كل هاي الحاالت كانوا يفكروا زمان انها بتصير بسبب ال‬  Studies found that teething: - Does not increase the incidence of infection, does not cause any rise in temperature, erythrocyte sedimentation rate, or white blood cell count, and does not cause diarrhea, cough, sleep disturbance, or rubbing of the ear or cheek. ".eruption‫"هاي كلها شغًلت ما بتصير بسبب ال‬ - Does cause daytime restlessness, an increase in the amount of finger sucking or rubbing of the gum, an increase in drooling, and possibly some loss of appetite. ".‫ بيعمل هالشغًلت‬eruption‫ ال‬,‫"بالمقابل‬  Serious mistakes have been made in the health care of infants and toddlers when their symptoms were ascribed to teething without a thorough diagnostic evaluation, which resulted in the overlooking of significant systemic disturbances. ".‫ بيحكوا انه هذا من التسنين‬,‫ بيروح على المستشفى‬,40 ‫ بتًلقي الطفل حرارته واصلة‬,‫"كثير أخطاء كانت تصير بخصوص هالمواضيع‬  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 than related to it. "‫"مثل ما كنا نحكي فوق‬ 7 Dr. Hisham Darwish Pediatric Dentistry 00962796664867  Management of Teething: - Reassurance. - Pain killers. - Topical medications/anesthetics. - The eruption process may be hastened "‫بيتسرع‬ ّ " if the child is allowed to chew on a piece of toast or a clean teething object. Eruption disturbances  Natal and neonatal teeth  Definition: Teeth present at birth (Natal) or during the first 30 days of life (Neonatal).  Etiology: A. Superficial position of tooth germ. B. Febrile conditions. C. Hormonal stimulation. D. Hereditary factors. E. Syndromes (such as Hellerman-streiff, Ellis-van creveled…etc).  Management: Leave/smoothen edges, or extract. ".‫ اذا كانوا مأثرين بنشيلهم‬,‫ أو بيأثروا على الرضاعة‬,sharp ‫ أو‬mobile ‫ إال اذا كانوا‬,‫"ما بنخاف منهم‬  Clinical decision depending on: - Degree of mobility. - Interference with breast feeding. - Riga-Fede  it means the ulceration of ventral surface of the tongue due to presence of natal or neonatal teeth. ‫ في البداية بتكون‬mucosa‫ أثرها واضح النه ال‬,‫ اللي بتكون على هذول األسنان‬sharp edges‫ باللسان بسبب ال‬ulceration ‫ عبارة عن‬Riga-Fede disease‫"هذا ال‬ ".‫ فسهل تتأثر بأي شي‬,‫ضعيفة‬ Riga-Fede disease.  Eruption hematoma/cyst  Definition: A bluish purple elevated area of tissue occasionally develops few weeks before the eruption of a primary or permanent tooth.  Etiology: Might be due to trauma.  Management: A. The tooth erupts through the lesion (Self-limiting), no treatment is necessary. B. Only if it gets sustained or infected you might consider to create a window in it and allow tooth to erupt (Surgical uncovering). 8 Dr. Hisham Darwish Pediatric Dentistry 00962796664867  Eruption sequestrum  Definition: A small fragment of calcified tissue overlying the crowns (generally the central fossa) of erupting molar teeth.  Management: - Nothing  it is of little clinical significance. - Resolve spontaneously; as teeth erupt through bone, the small piece is lost. - However, if local irritation happened, you may remove it.  Lingual eruption of mandibular permanent incisors - The lower permanent mandibular incisors erupt lingual to lower primary incisors. - Seen both in patients with an obvious arch length inadequacy (crowding) and in those with a desirable amount of spacing ".‫"يعني ما بيفرق اذا فيه ازدحام باألسنان أو أل‬ - 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. “In all cases, labial migration occurred naturally and extraction of the corresponding primary incisor was unnecessary.” (Gellin and Haley, 1982) - So: Before 7.5 years of age, it is unnecessary to subject the child to the trauma of removing the primary teeth, it almost always self-corrects within a few months. - Removal is recommended only if the primary incisors remained firm and the roots failed to resorb. ‫ طب ًعا‬,‫ لساتهم موجودين‬primary‫ بلشوا يطلعوا وال‬permanent‫ بيكونوا األسنان ال‬,double row of teeth ‫ بيسموها بعض الكتب‬,‫"هاي حالة مشهورة حبايبي‬ ,‫ بنخلعه‬,‫ لو ضلت المشكلة أكثر من هيك وما كان فيه خلخلة بالسن اللبني‬,7.5‫ انه بنستنى لل‬management‫ ال‬,‫ لكنها حالة طبيعية‬,‫ بييجوك خافف عقلهم‬parents‫ال‬ ".‫ بسبب خلع مش ضروري‬trauma‫نعرض الطفل ل‬ ّ ‫الفكرة انه ما فيه داعي‬  Ectopic first molars  Definition: Abnormal eruption at an angle mesial to the normal path causing abnormal resorption of the neighboring primary second molar.  Types:  Jump (reversible) type, about 65% of cases.  Hold (irreversible) type, about 35% of cases.  Etiology: Genetics or crowding.  Management: A. Self correction (If the jump type). B. Interproximal wedging. C. Extraction of the affected primary molar and space management. We only intervene with the hold type. 9 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Primary failure of eruption  Definition: - Cessation of tooth’s movement in the pre-eruptive phase  tooth fails to achieve emergence. - Roots are usually fully formed and un-resorbed.  Etiology: - Genetics. - Hormonal disturbances. - Syndromes e.g., Cleidocranial dysplasia.  Management: - If the tooth is not amenable for orthodontic traction, surgical removal is indicated. Failure of eruption of tooth 46. The roots are forming, but the tooth is not erupting for some reason. Infraocclusion (Submerged teeth).  Definition: Tooth that has failed to maintain its position relative to adjacent teeth in the developing dentition and is therefore inferior to the occlusal level.  Clinically: Tooth below the occlusal level, immobile, dull (high-pitch) percussion tone.  Radiographically: Absence of PDL space +/- vertical bone defect.  Etiology: Genetics, metabolic disturbances, trauma, or space deficiency.  Complications: - Malocclusion: Tipping of adjacent teeth, or overeruption of opposing teeth. - Retained primary molar, and delayed eruption of the successor. - Periodontal complications.  Management: A. Close monitoring. B. Restoration/buildup (With SSC preferably). C. Extraction and space management.  Clinical decision depends on: - Severity. - Rate of progression  this depends on patient’s age. If the patient is going through the growth spurt, you would expect a rapid rate of progression. - Presence of successor. If the successor is present, there is a high chance that the tooth will exfoliate on its own. If the successor is absent (Which is common with infraocclusion), we might need to intervene. 10 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 Systemic conditions affecting teeth eruption  Hereditary gingival fibromatosis: - Very thick gingiva, causing failure of eruption of teeth. - We might need to intervene (by gingivectomy) to accelerate eruption.  Down syndrome  cause delayed eruption of teeth.  Cleidocranial dysplasia  cause delayed eruption of teeth, due to the presence of multiple impacted supernumerary teeth.  Hypopituitarism  cause delayed eruption of teeth.  Hypothyroidism  cause delayed eruption of teeth. Hereditary gingival fibromatosis You can see how thick the gingiva is. Cleidocranial dysplasia Abnormalities in the clavicle and in the cranium. Clinical features of the condition: 1. Absence of clavicles. 2. Multiple supernumeraries. 3. Delayed eruption of teeth. 11 ‫‪Dr. Hisham Darwish‬‬ ‫‪Pediatric Dentistry‬‬ ‫‪00962796664867‬‬ ‫"خلصت المحاضرة هون حبايبي‪ ,‬بس بدي أفرجيكم شوية صور أسنان عشان تتعودوا تحددوا ال‪".ages‬‬ ‫بكل بساطة القاعدة كالتالي‪ :‬بتدوروا على آخر سن طلع عند الطفل‪ ,‬وعلى أساسه بتحكموا على العمر‬ ‫مثًل مريض طالع عنده ال‪ permanent 6s‬وال‪ lower centrals‬وال‪ ,upper centrals‬آخر سن بيطلع هو ال‪ ,upper central‬فبالتالي المريض عمره ‪ 7‬سنين‬ ‫يعني ً‬ ‫تقريبًا‪ ,‬وهكذا‪".‬‬ ‫هذا مريض عمره بين ‪ 6-3‬سنين‪ ,‬كل األسنان ال‪ primary‬طالعة‪ ,‬وبنفس الوقت ما فيه اشي‬ ‫‪ permanent‬طالع‪.‬‬ ‫هذا مريض عمره تقريبًا ‪ 6‬سنين‪ ,‬واضح انه ال‪ 6s‬عم يطلعوا‪ ,‬وال‪ lower centrals‬طالعين‪.‬‬ ‫هذا الحلو عمره تقريبًا ‪ 7.5 – 8‬سنين‪ ,‬آخر سن طلع عنده هو ال‪.lower lateral‬‬ ‫مين الشاطر اللي الحظ كمان مشكلة عند المريض هذا؟ ‪‬‬ ‫وهذا الحلو عمره تقريبًا ‪ 8‬سنين‪ ,‬آخر سن طالع عنده هو ال‪ ,lower lateral‬وال ‪upper‬‬ ‫‪ laterals‬عوشك يطلعوا‪.‬‬ ‫هذا البطل عمره تقريبًا ‪ 8‬سنين ونص‪ ,‬عنده طالع كل ال‪ incisors‬وكل ال‪6s‬‬ ‫‪ 12‬سن لبني‪ ,‬و‪ 12‬سن دائم‪ 8 :‬سنين ونص‪.‬‬ ‫انسوا ال‪ ,lower left 5‬هذا انخلع من الدكتور‬ ‫وهذا البطل عمره تقريبًا ‪ 10-9‬سنين‪ ,‬آخر سن طلع عنده هو ال‪.mandibular canine‬‬ ‫هذا األخير ختيار‪ ,‬عمره تقريبًا ‪ 11-10‬سنة‪ ,‬بلشوا يطلعوا عنده ال‪premolars‬‬ ‫وال‪mandibular canine‬‬ ‫آخر سن طلع عنده هو ال‪".first premolar‬‬ ‫‪12‬‬ Dr. Hisham Darwish Pediatric Dentistry 00962796664867  ‫شوية سنوات‬ 1. What is the best management for such a case a. It is common for mandibular permanent and should be considered essentially normal. b. Extraction of other primary teeth in the area is not recommended; contribute to the development of arch length inadequacy. c. Before 7 ½ years of age, it is unnecessary to subject the child to the trauma of removing the primary teeth, it almost always self-corrects within a few months. d. In an older child and the radiograph shows no root resorption of the primary teeth, self-correction has not been achieved, the corresponding primary teeth should be removed. A. a, b, d. B. a, b, c. C. a, c, d. D. a, d. E. All are correct. 2. Arrange these teeth according to their eruption sequence (16, 11, 54). A. 16, 11, 54. B. 54, 16, 11. C. 54, 11, 16. D. 11, 54, 16. 3. Because the eruption of teeth is a normal physiologic process, the association with fever and systematic disturbances is not justified. A fever or respiratory tract infection during the same time should be considered coincidental to the eruption process rather than related to it. A. Both statements are true. B. First statement is true, second statement is false. C. First statement is false, second statement is true. D. Both statements are false. 4. What is the estimated age for this patient? A. 5-6 years. B. 6-7 years. C. 7-8 years. D. 8-9 years. 5. Omar came to the dental clinics at J.U.S.T. Examination revealed the following teeth in his mouth (FDI # 51, 52, 61, 62, 71, 72, 81, 82). How old is Omar likely to be? A. 6 months. B. 12 months. C. 18 months. D. 2 years. 13 Dr. Hisham Darwish Pediatric Dentistry 00962796664867 6. The correct sequence of eruption for the following teeth ( , 11 (FDI), ) is: A. 11 (FDI), ,. B. , , 11 (FDI). C. , 11(FDI),. D. , 11(FDI),. 7. Which of the following is not a symptom of teething in children? A. Rubbing ears and cheeks. B. Drooling. C. low grade fever. D. Restlessness. 8. A patient came over with 12 primary teeth and 12 permanent teeth, what is the estimated age of this patient? A. 5.5 years. B. 6.5 years. C. 7.5 years. D. 8.5 years. E. 9.5 years. 1 2 3 4 5 6 7 8 E B A C B B A D 14