Protecting All Children’s Teeth
Dental Development
1
www.aap.org/oralhealth/pact
Introduction
2
www.aap.org/oralhealth/pact
Used with permission from Lauren Barone
It is important for child health providers to understand normal dental
development so that:
Learner Objectives
Upon completion of this presentation, participants will be able to:�
3
www.aap.org/oralhealth/pact
Used with permission from Lauren Barone
Normal Development
Oral structures begin to form during the third and fourth weeks of embryonic development. ��The teeth begin to develop around the sixth week of fetal life. ��Development continues throughout fetal life and beyond.
4
www.aap.org/oralhealth/pact
Used with permission from Lauren Barone
Tooth Eruption: Primary Teeth
Primary teeth begin to erupt around �6 months of age (range 5-10 months)
Eruption is completed by 24 to �36 months
Delay of more than 12 months �merits further dental evaluation
5
www.aap.org/oralhealth/pact
Used with permission from Belkis Arroyo
Tooth Eruption: Primary Teeth
Eruption is usually symmetrical �(lower teeth before upper) in the �following pattern for primary teeth:
Exfoliation often follows a similar pattern.
6
www.aap.org/oralhealth/pact
Used with permission from the American Dental Association
Tooth Emergence: Permanent Teeth
Permanent teeth emergence pattern is similar to that of the primary teeth.
Eruption of the permanent teeth begins between 5 and 7 years of age and usually finishes by 13 to 14 years.
7
www.aap.org/oralhealth/pact
Paper Permission on file from Michael Chang
Tooth Emergence: Permanent Teeth
The typical pattern for permanent teeth eruption is:
8
www.aap.org/oralhealth/pact
Used with permission from the American Dental Association
Natal and Neonatal Teeth
Some infants erupt teeth before birth (natal teeth) or shortly thereafter (neonatal teeth).
Generally, no treatment is indicated. Extraction of these incisors may be considered if they are mobile, interfere with breastfeeding, or lead to Riga-Fede ulceration. �
9
www.aap.org/oralhealth/pact
Used with permission from David A. Clark, MD; Chairman and Professor of Pediatrics at Albany Medical Center
Delayed Eruption
10
www.aap.org/oralhealth/pact
Delayed emergence of more than 12 months can be caused by:
It is reasonable to refer a child who has not erupted any teeth by
18 months of age to a dentist if they are not seeing one already.
Early Tooth Loss
Primary tooth exfoliation is a part of the normal process of permanent tooth eruption
Early tooth loss may be the result �of the following causes:
11
www.aap.org/oralhealth/pact
Used with permission from Rocio B. Quinonez, DMD, MS, MPH; Associate Professor Department of Pediatric Dentistry, School of Dentistry University of North Carolina
Dental Caries
Delayed Exfoliation
Delayed tooth loss can be caused by a variety of disorders, including:
12
www.aap.org/oralhealth/pact
Abnormal Teeth
A number of tooth abnormalities can occur in development.
These abnormalities can relate to the shape, color, physical structure, or number of teeth.
13
www.aap.org/oralhealth/pact
Abnormal Teeth, continued
�Hypodontia can be caused by the same problems that delay eruption.
Anodontia is extremely rare and most often associated with hypohydrotic ectodermal dysplasia.��Hyperdontia can be associated with genetic disorders such as cleidocranial dysostosis and Gardner’s syndrome (Familial Adenomatous Polyposis). ��
14
www.aap.org/oralhealth/pact
Tooth Shape
Abnormal tooth shape can result from a variety of medical conditions.
15
www.aap.org/oralhealth/pact
Hutchinson incisors and
Mulberry teeth are caused
by congenital syphilis.
Hutchinson Teeth
Used with permission from AAP Red Book
Tooth Color
Abnormalities in tooth color can result from a number of causes.
Food pigments can stain the teeth, although these changes should be
temporary. Smoking can also discolor the teeth.
Excess fluoride intake can cause a range
of color changes, from a lacy, chalky
white discoloration to severe brown staining of the teeth.
16
www.aap.org/oralhealth/pact
Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital
Tooth Color, continued
Abnormalities in tooth color can also be caused by the following:
mother in the second half of
pregnancy or by a child early in life
17
www.aap.org/oralhealth/pact
Iron Staining
Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital
Teething Care
Teething and symptoms attributed to teething are a common concern
of parents.
It is important to inform parents that none of these symptoms consistently and accurately predict when teething is about to occur:
18
www.aap.org/oralhealth/pact
Teething Care, continued
The recommended intervention for teething is the use of cold items because the cold acts as an anesthetic for the gums.
Suggested items include:
19
www.aap.org/oralhealth/pact
Used with permission from Giusy Romano-Clarke, MD
Teething Care, continued
Topical teething gels sold over-the-counter (OTC) are often used for teething.
These gels can carry serious risks, such as local reactions, seizures with overdose, and methemoglobinemia. Benzocaine containing teething gels should not be used in infants or children under 2 years of age.
If necessary, parents should be instructed on proper dosing of OTC analgesic medications, such as acetaminophen or ibuprofen.
20
www.aap.org/oralhealth/pact
Malocclusion
Malocclusion can be a functional problem, an aesthetic issue, or a hindrance to maintaining good oral hygiene.
Examples of malocclusion include anterior open bite, anterior crossbite, and posterior crossbite.���
21
www.aap.org/oralhealth/pact
Posterior Crossbite
Anterior Crossbite
Anterior Open Bite
Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital
Used with permission from Noel Childers, DDS, MS, PhD; Department of Pediatric Dentistry, University of Alabama at Birmingham
Used with permission from Noel Childers, DDS, MS, PhD; Department of Pediatric Dentistry, University of Alabama at Birmingham
Malocclusion, continued
Signs and symptoms of malocclusion include:
22
www.aap.org/oralhealth/pact
Malocclusion, continued
Malocclusion is usually genetic or congenital in origin.
Examples of genetic causes include congenital absence of teeth, cleft lip or palate, skeletal disorders, and muscular problems.
Malocclusion can also result from environmental
factors, such as prolonged thumb sucking,
pacifier use, or tongue thrusting.
Patients with malocclusions should be referred �to a dental professional.�
23
www.aap.org/oralhealth/pact
Used with permission from ANZ Photography
Question #1
A parent asks you how many "baby teeth" her child will
eventually have. What is the most appropriate response?
A. 18 teeth
B. 20 teeth
C. 28 teeth
D. 32 teeth
E. None of the above
24
www.aap.org/oralhealth/pact
Answer
A parent asks you how many "baby teeth" her child will
eventually have. What is the most appropriate response?
A. 18 teeth
B. 20 teeth
C. 28 teeth
D. 32 teeth
E. None of the above
25
www.aap.org/oralhealth/pact
Question #2
Which of the following is true of malocclusion?
A. It can be an aesthetic problem
B. It can interfere with proper oral hygiene
C. It can make eating difficult
D. Examples include an anterior open bite and a posterior crossbite
E. All of the above �
26
www.aap.org/oralhealth/pact
Answer
Which of the following is true of malocclusion?
A. It can be an aesthetic problem
B. It can interfere with proper oral hygiene
C. It can make eating difficult
D. Examples include an anterior open bite and a posterior crossbite
E. All of the above
27
www.aap.org/oralhealth/pact
Question #3
28
www.aap.org/oralhealth/pact
You are seeing a 15-month-old healthy boy for his 15-month
routine visit. He was not premature. The parents are concerned
because he has not yet erupted any teeth, a finding you confirm on
examination. Which is the most appropriate course of action?
A. Reassure the family. If the child appears normal, you are not concerned
unless no teeth have erupted by 2 years of age
B. Refer to a dentist for evaluation
C. Obtain a panoramic X-ray of the teeth to ensure that they have developed
normally
D. Refer to an endocrinologist for evaluation, as delayed tooth eruption has a
known association with several endocrinopathies
E. Wait 3 months and refer to a dentist if no teeth have erupted by the 18
month routine visit
Answer
You are seeing a 15-month-old healthy boy for his 15-month
routine visit. He was not premature. The parents are concerned
because he has not yet erupted any teeth, a finding you confirm on
examination. Which is the most appropriate course of action?
A. Reassure the family. If the child appears normal, you are not concerned
unless no teeth have erupted by 2 years of age
B. Refer to a dentist for evaluation
C. Obtain a panoramic X-ray of the teeth to ensure that they have developed
normally
D. Refer to an endocrinologist for evaluation, as delayed tooth eruption has a
known association with several endocrinopathies
E. Wait 3 months and refer to a dentist if no teeth have erupted by the 18
month routine visit
29
www.aap.org/oralhealth/pact
Question #4
True or False? Excess fluoride intake can cause irreversible
tooth discoloration.
A. True
B. False �
30
www.aap.org/oralhealth/pact
Answer
True or False? Excess fluoride intake can cause irreversible
tooth discoloration.
A. True
B. False �
31
www.aap.org/oralhealth/pact
Question #5
When do the permanent (adult) teeth begin to erupt?
A. It varies from child to child
B. Around 4 years of age
C. Around 6 years of age
D. Around 8 years of age
E. Starting at 10 years of age
32
www.aap.org/oralhealth/pact
Answer
When do the permanent (adult) teeth begin to erupt?
A. It varies from child to child
B. Around 4 years of age
C. Around 6 years of age
D. Around 8 years of age
E. Starting at 10 years of age
33
www.aap.org/oralhealth/pact
References
��
34
www.aap.org/oralhealth/pact