Chapter 10: Pathologies Associated With Tooth Eruption, Eruption Disorders, Anomalies Of Timing, And Eruption Sequence Flashcards
Eruption is:
A physiological process normally asymptomatic
Local symptoms of eruption:
- nonspecific marginal gingivitis (reddening of the gingiva)
- whitish line (compressed keratinised epithelium)
- subsequently spontaneous resolution—> dental emergence
Some children might experience symptoms such as?
- low grade fever (38 degrees)
- irritability
- increased salivation
Convulsive or severe gastrointestinal disorders are
Discarded
Idk
In exceptional cases, what can occur?
Necrotising gingivitis due to the lack of hygiene and severe malnutrition or the risk of osteomyelitis if the immune status of the patient is compromised
The eruptive disorders are:
5:
1. Eruption hematoma
2. Follicular cysts
3. Eruption sequestrum
4. Gingival operculum
5. Foliculitis
Eruption hematoma:
- definition
- is it pathological?
- how does it occur
- how does it resolve
- more frequent in which teeth?
- blue stain in the oral mucosa in the area where the tooth will erupt
- not pathological—> occurs because the tooth while advancing breaks a capillary
- resolves spontaneously when the tooth appears
- more frequent in incisors and 1st primary molars
Follicular cysts:
- definition
- how does it resolve
- what happens if eruption is delayed and what do we have to do?
- increase in size of the mucosa, accumulation of fluid beneath the mucosa because of the germ tissue activity during eruption
- it’s usually resolved spontaneously as the tooth erupts
- if the eruption is delayed or the path of the tooth is altered, we will have to drain the cyst to remove it
Eruption sequestrum:
- definition
- what is it caused by?
- how does it resolve
- how does it look like in an x-ray?
- finding is?
- piece of bone without vascularisation isolated forward or above a molar that is going to erupt
- caused by the lack of blood supply to the part of the bone as the walls reabsorb (produces aseptic necrosis)
- in radiography—> bone refraction over the crown (Radiolucency)
- spontaneous resolution
- incidental finding
Gingival operculum:
- definition
- in which teeth?
- more frequent in which area?
- it often becomes?
- how is it resolved?
- if inflammation occurs, how do we treat it?
- gingival tissue partially overlying the distal occlusal surface of a molar
- usually in the retromolar space during the eruption of the 1st, 2nd, 3rd permanent molars
- it often becomes inflamed
- it’s usually resolved when the molar erupts, and no treatment is required
- if inflammation occurs, a. Brush the area with chlorhexidine gels, and b. Antibiotics if there is an infection
Folliculitis:
- definition
- in which teeth does it occur?
- how does it occur?
- symptoms?
- treatment
- what does it favor
- inflammation of the follicle (area surrounding the germ) due to an infection
- it happens in un erupted permanent teeth
- caused by the peri radicular infection in a temporary tooth (due to caries or trauma) that extends to the follicle of the successor permanent tooth
- symptomatology: primary teeth, osteitis like symptoms and similar radiographic image of rare fraction (bone loss) and increased tooth cyst
- treatment: extraction of the affected temporary tooth and the elimination of the cystic lesion (+ space maintainer if necessary)
- it favors the premature eruption of the permanent tooth
The anomalies in eruption chronology are:
- early eruption
- delayed eruption
Early eruption in primary dentition is when teeth appear
Before 3 months
Early eruption in primary dentition can be generalised or localised
- generalised: all teeth are affected, it’s a rare, genetic influence (1:20,000)
- localised: some teeth are affected, it’s more common especially in lower incisors (family tendency, more common in first born of young women)
ITS NOT A SUPERNUMERARY
Classification of early eruption in primary dentition:
- natal teeth: teeth preset at birth (already erupted)
- neonatal teeth: those that erupt during the neonatal period (first 30 days of life)
Which teeth are more immature, neonatal or natal?
Natal
We try to maintain natal and neonatal teeth, but they are extracted if?
- they’re poorly developed
- there is mobility (risk of swallowing or sucking)
- they cause interferences with feeding
What do we do it the natal and neonatal teeth injured the tongue or lip?
We’ll smoothen the incisal edges
- if the ulceration is large and denuded, such treatment may not suffice
Ulcerations caused by natal teeth?
Riga Fede disease
If we extract natal or neonatal teeth, we will monitor the patient to control space and because of the risk of eruption of ?
An aberrant root (remnant of the not viable root)
Early eruption in permanent dentition can be generalised or localised:
- Generalised: all permanent teeth appear early, it’s a rare condition and a family tendency, it can be due to hyperthyroidism, or increased secretion of the growth hormone
- localised: it affects a single tooth, it’s more common, it’s due to the early loss of temporary teeth, usually by caries or trauma, also in cases of angioma or idiopathic causes
If there is enough of the root (2/3) then it’s considered a ___ eruption?
Early
If root formation has not reached 2/3 then its a ___ eruption?
Delayed
Delayed eruption in primary dentition, is when there are no temporary teeth in the mouth at ___ months?
13
Delayed eruption in permanent dentition, is when there are no permanent teeth in the mouth at ___ years?
7
The diseases and syndromes that are associated with the delayed eruption of both dentitions can be ___ or ____?
Endogenous (affecting all teeth) or local (affecting a single tooth)
What are the endogenous disorders that are associated with the delayed eruption of both dentitions?
- Malnutrition
- Down syndrome
- Cleido cranial syndrome
- Anti hydrotic ectodermal dysplasia
- Gardner syndrome
- Hypopituitarisim
- Congenital hypothyroidism or cretinism
- Vitamin D deficiency
- Premature infants
- Amelogenesis imperfecta
Relation between eruption and Down syndrome?
- what is Down syndrome
- symptoms
- trisomy of chromosome 21, the most common chromosomal alteration
- cognitive and growth delay, muscular hypotonia, Brachycephal, microdontia, narrow (high arched) palate and macroglossia
Relation between eruption and cleido cranial syndrome?
- definition?
- dental problems
- rare genetic syndrome
- abnormal development of bone in the skull and clavicle (absence of clavicles) (like the guy in stranger things)
- large fontanelles, suture close later than normal
- dental problems: eruptive delay and multiple supernumerary teeth
Relation between eruption and anti hydrotic ectodermal dysplasia?
- definition
- dental problems
- rare genetic syndrome
- abnormalities in ectodermal formation (hair, nails, teeth, sweat glands)
- absence of sweat glands
- thin and sparse hair, bulging forehead, low nasal bridge, prominent lips
- clear and glowing skin
- abnormal nails, absence or decrease of tears, hyperacusis, poor temperature regulation, poor vision
- hypodontia (missing teeth)—> anodontia oligodontia
Relation between eruption and Gardner syndrome
- dentition
- dental symptoms
- hereditary intestinal polyposis autogol dominant
- delayed eruption, osteomas, odontomas, supernumerary teeth, and multiple fibromas
Relation between eruption and hypopituitarism:
- definition
- what happens in severe cases?
- decreased secretion of 1 or more of the 8 hormones that are normally produced by the pituitary gland
- delayed eruption
- in severe cases, the root resorption of the primary teeth doesnt occur which prevents the eruption of the formed permanent teeth
- primary teeth may be maintained for life
Relation between eruption and congenital hypothyroidism or cretinism:
- due to?
- symptoms
- due to the lack of development of the thyroid gland
- delayed physical and mental growth
- small jaws and crowding
- big tongue—> anterior open bite
- youth cretinism: due to abnormal thyroid gland function between 6-12 years old, it may produce a delayed eruption of permanent teeth
Relation between eruption and vitamin D deficiency:
- responsible for calcium absorption in the intestine
- causes rickets in children (lack of mineralisation of bone and cartilage ) and osteomalacia in adults (causes fractures)
Relation between eruption and premature infants:
- primary vs permanent teeth
- eruptive delay in primary teeth
- permanent teeth erupt normally
Relation between eruption and amelogenesis imperfecta:
- what does it affect and what does it cause
- genetic
- affects the enamel or primary and permanent teeth
- anterior open bite: analgesic (by introducing the tongue between the teeth to avoid having sensitivity due to the lack of enamel, using the tongue to protect the teeth)
Local causes of delayed eruption include?
- Lack of space
- Malposition of the dental germ
- Supernumerary teeth
- Abnormal resorption
- Ankylosis
6.ectopic eruption - Sequelae of trauma
- Premature loss
- Fibrotic mucosa
- Disorders of tooth development
- Persistent radicular remains
- Radiated areas
- Tumour pathology
- Eruptive path alterations
Other eruptive disorders:
- Transposition
- Transmigration
Treatment of transposition and transmigration?
Orthodontic or aesthetic surgery
Transposition is ?
Exchange of 2 teeth positions
Transmigration is?
The migration of the tooth through the middle in to the opposite side
Relation between eruption and lack of space?
- most frequent cause
- by shortening the arch length or because the permanent teeth are too large (volumetric anomalies)
Relation between eruption and supernumerary teeth?
- what do they cause
- most frequent type
- what do we suspect if there is a great symmetry in the chronology of eruption of the 2 central incisors?
- treatment
- they usually cause eruptive delay
- most frequent type: mesiodens
- mesiodens
- extraction, right movement —> spontaneous eruption in 75% of the cases
Relation between eruption and abnormal resorption?
One of the roots of primary teeth is reabsorbed because of the unerupted permanent
Relation between eruption and ankylosis?
Eruptive abnormality where an anatomical fusion between the cementum and alveolar bone occurs with total or partial disappearance of the periodontal space
Ankylosis of primary teeth:
- what happens of the eruption and occlusion of the affected tooth?
- what type of occlusion is the affected tooth in?
- what happens to the antagonist tooth?
- what happens with the adjacent teeth?
- mobility?
- percussion?
- xray?
- The eruption of the affected tooth is blocked, and occlusion is lost
- Clinically, the ankylosed tooth is in infraocclusion (immersed), it loses contact
with the antagonist teeth - the antagonist will extrude
- It may lose contact with adjacent teeth and sometimes disappears buried in the mucosa (the adjacent teeth will move towards the ankylosed tooth)
- Total lack of mobility
- Dull percussion unlike the tympanic sound of a normal tooth
- X-ray: difference in height of the ankylosed tooth to the neighbours is clear, but the ankylosed area is difficult to see (we must verify if there is agenesis of the permanent successor)
Etiology of ankylosed teeth and predisposing factors?
- unknown, defect or failure in the periodontal membrane
- localised metabolic anomaly, excessive biting pressure, and family inheritance as a predisposing factor
Which tooth is the most affected by ankylosis ?
2nd mandibular temporary molar
Clinical significance: occlusal alteration of ankylosis?
- antagonist is extruded
- adjacent are inclined
- loss of arch length
- premolar cannot erupt
Treatment of ankylosis?
- depends on?
- if contact points are maintained?
- if contact points are lost?
- if space is lost
- depends on the degree of infra-occlusion
- if contact points are maintained —? Reconstruction
- if contact points are lost—? Extraction and space maintainer
- if space is lost—? Space recovery (Space regainer)
Primary retention (when it affects the ankylosed tooth)?
- what happens ?
- treatment ?
- cessation of tooth eruption of a temporary or permanent tooth before its emergence in the mouth without a local or systemic known cause
- exodontia
Secondary retention (when it affects an unerupted tooth that consequently gets buried under the mucosa)
- what happens?
- treatment ?
- temporary or permanent tooth that has inexplicably stopped its eruption process, after having penetrated buccal mucosa
- exodontia
Relation between eruption and ectopic eruption:
- what happens
- what toot is more frequently affected?
- tooth is developed out of its normal position
- upper canine and 1st permanent molar
Ectopic eruption of 1st permanent molar:
- Atypical resorption of the distal surface of the 2nd temporary molar —> 2nd temporary molar exfoliation—> 1st permanent molar migration—> arch length decreases—> eruptive delay of the 2nd premolar
- The 1st upper permanent molar erupts more mesial, causes resorption of the distal root of the 2nd primary molar, and erupts later, the 2nd premolar will lack space to erupt
Treatment of ectopic eruption of the permanent 1st molar:
- If the ectopic tooth is at the height of the temporary crown?
- If the ectopic tooth is at the height of the temporary root ?
- If the ectopic tooth is at the height of the temporary crown, —> we try to move it to its position
- If the ectopic tooth is at the height of the temporary root—> there is already a lack of space, we use a space regainer (when the permanent tooth erupts)
Relation between eruption and sequelae of trauma?
- what 2 types of trauma produce an eruptive delay?
- in which teeth usually?
- intrusion and avulsion
- temporary incisors
Temporary tooth intrusion:
- the tooth is reinserted into the alveolar socket.
- The apex strikes the permanent germ and can produce its movement towards apical (more distance to erupt) or produce laceration (change in the eruptive direction)
Temporary tooth avulsion (1-4 years):
- The tooth is lost and as the permanent tooth is poorly developed, the bone is
formed, and a delayed eruption occurs
Temporary tooth avulsion (developed permanent tooth):
Early eruption of the permanent tooth
Relation between eruption and premature loss?
Can cause an eruptive delay if the permanent tooth does not have 2/3 of the root formed
Relation between eruption and fibrotic mucosa?
- in which teeth is it frequent?
In central incisors
Mucosa is too hard
Relation between eruption and disorders of tooth development?
Local odonto dysplasia
Relation between eruption and persistent radicular remains?
The permanent molar will erupt buccally with the persistence of the temporary molar
Relation between eruption and tumour pathology?
Cysts
Odontomas
