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Dr Mistry > Yr 3 Week 10- Eruption and Exfoliation > Flashcards

Yr 3 Week 10- Eruption and Exfoliation Flashcards

1
Q

What is the primary eruption sequence?

A 
RULE OF 4's
Central Incisors: 7 months
Lateral Incisor: 11 months
First Molar: 15 months
Canine: 19 months
Second molar: 23 months
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2
Q

What are the 3 factors of eruption to look for?

A

Sequence
Age
Symmetry

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3
Q

What happens to the primary tooth when it exfoliates?

A

Primary teeth roots resorb and the crown exfoliates

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4
Q

When should delayed eruption be investigated?

A

After 12 months.

Any medical syndrome? Are they missing the permanent successor?

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5
Q

Is there a difference in genders for eruption timing?

A
  • Primary dentition: no difference

* Permanent dentition: Girls have earlier tooth eruption than boys (around 6 months)

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6
Q

What are symptoms of teething?

A
  • No excessive symptoms –only drooling
  • Might get irritability, rise in temperature, loss of apetite, runny nose
  • Only get symptoms day or 2 before tooth erupts.
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7
Q

How can teething discomfort be alleviated?

A
  • Rubbing or cooling the gums (teething rings, fruits & veggies)
  • Topical anaesthetic
  • Analgesic –for babies (paracetamol)
  • Alternative therapies (amber beads, clove oil/ointment)
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8
Q

What are natal teeth?

A

A primary tooth that is present at birth

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9
Q

What are neonatal teeth?

A

A primary tooth that erupts within the first month

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10
Q

What is the most common natal/neonatal tooth?

A

Lower central incisor

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11
Q

What is the presentation of natal/neonatal teeth and what can they cause?

A
  • Normal crown shape
  • Undeveloped, loosely attached root
  • Gingival inflammation
  • May cause trauma to tongue (Riga-Fede) and/or to mother’s breast with feeding,
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12
Q

What is the treatment for natal/neonatal teeth?

A
  • Removal- if mobility poses a threat of aspiration or if traumatic
  • Leave- if not impacting
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13
Q

What are factors (races, dentition type, syndromes, conditions) associated with accelerated eruption?

A
  • Permanent dentition
  • Permanent premolars if loss of primary molars btwn 8-10yrs.
  • Female
  • African, Aboriginal, Polynesian
  • Ellis van Creveld syndrome
  • Cerebral Gigantism, Sturge Weber, Adrenal hyperplasia
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14
Q

What systemic diseases and syndromes are associated with delayed eruption?

A 
Endocrinopathies (hypopituitarism, hypothyroidism)
Downs Syndrome
Rickets
Cleidocranial Dysplasia
Gingival hyperplasia
Mx & md hypoplasia (Treacher collins, Apert, Crouzon)
AI, ED
Disturbance of bone metabolism
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15
Q

What local factors are associated with delayed eruption?

A
  • Fibromatosis of the gingiva
  • Supernumerary
  • Tooth/ root formation anomaly
  • Crowding
  • Cyst
  • Ankylosed primary tooth may delay eruption of successor
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16
Q

What are tx considerations for delayed eruption?

A
  • Exo of primary tooth/teeth
  • Removal of obstacles
  • Removal of alveolar bone occlusally
  • Orthodontic traction
  • Bone distraction
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17
Q

Why can you have eruption of teeth in abnormal position?

A
  • Arch length discrepancy
  • Tooth size discrepancy
  • Teeth number discrepancy –Supernumerary
  • Ankylosis
  • Idiopathic ectopic positioning
  • Trauma
  • Pathology
18
Q

What is the chance of a canine coming into position (after extracting the primary canine) if its cusp tip overlaps the distal aspect of the lateral incisor root?

A

91%

19
Q

What is the chance of a canine coming into position (after extracting the primary canine) if its cusp tip overlaps the midline of the lateral incisor root?

A

64%

20
Q

How can you diagnose impacted maxillary canines?

A
  • At 9yrs, palpate canine bulge
  • Obtain OPG if absence of canine bulge or anomalous upper lat incisor)
  • If cusp tip of canine lies over distal half of lat incisor root.
21
Q

What dental anomalies are common along with impacted maxillary canines?

A

Peg upper laterals

Missing upper laterals

22
Q

What is the management of impacted maxillary canines?

A
  • Early intervention
  • Extraction of primary mx canines to provide room (9-10yrs age)
  • Surgical exposure of canine (can have ortho bracket) if diagnosed at later stage
23
Q

What is the management of ectopic first permanent molars?

A
  • Self correction possible between 6-7yrs
  • Placement of separating elastics between the teeth
  • If mild, distal grinding of second primary molar to free permanent molar.
  • Distalisation of permanent molar
24
Q

How can a crown with internal resorption appear clinically?

A

Pink coloured

25
Q

How are ectopic first permanent molars diagnosed?

A

Clinically: only distal part of molar is visible in mouth due to mesial tipping
Radiographic: mesial tipping and impaction against distal root of 2nd primary molar. May also see resorption in this area.

26
Q

What is an eruption cyst?

A

Soft translucent swelling in gingival mucosa overlying the crown of an erupting deciduous or permanent tooth. Can have bluish-purple colour.

27
Q

What is an eruption sequestrum?

A

Tiny irregular spicule of usually nonviable bone overlying the crown of an erupting permanent molar.

28
Q

What case should an eruption sequestrum be removed?

A

If not resolved and irritating mucosa.

29
Q

How long can be allowed for normal variation in exfoliation time of primary teeth?

A

18 months

30
Q

Is it a concern if there has been exfoliation of teeth in children <5 years in the absence of trauma?

A

Yes

31
Q

What conditions are linked to premature exfoliation of primary teeth?

A 
Hypophosphatasia 
Prepubertal periodontitis
Cherubism
Acrodynia
Rickets
Cyclic neutropenia
Downs sydrome
Ehlor Danlos syndrome
Juvenile diabetes
Papillon Lefevre syndrome
Leukaemias
32
Q

What are oral impacts of hypophosphatasia?

A 
Spontaneous exfoliation 
Deficient cementum
Root not completely resorbed (roots can be intact as attachment of PDL to bone and tooth is impaired)
Lack of severe gingival inflammation
May have decreased alveolar height
33
Q

What are causes of delayed exfoliation/over retained teeth?

A 
Genetics
Missing successor
Impacted successor
Trauma
Ankylosis
34
Q

How is delayed exfoliation managed?

A

Monitor

Extract- if impacting the successor or uncomfortable

35
Q

What is ankylosis?

A

Fusion between cementum or dentine and alveolar bone.

36
Q

How can ankylosis affect adjacent and opposing teeth?

A
  • Tilting of adjacent teeth
  • Infraocclusion of tooth in growing child
  • Over-eruption of opposing teeth
  • Deficient vertical height of alveolar bone in area of ankylosed tooth.
37
Q

How is ankylosis diagnosed clinically?

A

Progressive infraocclusion
Solid sound when tooth tapped
For primary- there is lack of physiological mobility and failure to exfoliate.

38
Q

How is ankylosis diagnosed radiographically?

A
  • Loss of lamina dura
  • Union between tooth and bone
  • Lack of or delayed root resorption in primary teeth.

Sometimes not evident as a small area may only be affected.

39
Q

What happens when ankylosis occurs in primary tooth with and without a successor?

A

With successor: monitor and asses. Tooth may exfoliate naturally.
Without successor: may not exfoliate. Root resorption occurs at slow rate.

40
Q

What is the management of ankylosis of primary teeth?

A

Monitor
May be built up/crown if to be kept and if infraoccluded.
May need exo if severe infraocclusion, tipping, missing successor and if ortho plan involves exo.

41
Q

What are the most common teeth to fail to erupt?

A

Posterior permanent teeth that are fully formed. Rare in primary teeth.

42
Q

If a tooth fails to erupt, how can this be diagnosed and managed?

A

Can be difficult to diagnose as the teeth are neither impacted nor ankylosed. Tx in permanent teeth can also be challenging as ortho tx may result in ankylosis. Exo may be required.

Dr Mistry (8 decks)

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