Ortho module 2 part B

Question 1

What symptoms are associated with eruption of primary teeth?

Answer 1

A common problem related to the primary teeth is the complex of symptoms often summarized as “teething”. Eruption of primary teeth in infants is associated with drooling, increased salivation, restlessness and irritability.

Question 2

What complications can arise from teething?

Answer 2

Eruption haematoma or cyst

Natal and neonatal teeth

Question 3

What is an eruption haematoma/cyst?

Answer 3

During eruption of a tooth, as the tooth nears the epithelial surface, blood or fluid can fill the tooth follicle to form an eruption haematoma. This appears as a raised bluish lesion usually in the region of a soon to erupt second primary molar.

Question 4

What are neonatal and natal teeth?

Answer 4

Natal teeth are teeth present at birth in approximately 1/3000 babies.

Neonatal teeth are teeth that erupt in the first 30 days after birth seen in approximately 1/2000 babies.

Question 5

What are the problems that can arise from natal and neonatal teeth and how should they be dealt with?

Answer 5

Often these teeth can be very mobile due to incomplete root development. If there is risk of aspiration due to displacement, extraction is indicated.

Sharp incisal edges can also cause ulceration and irritation of sublingual tissues in affected infants. In these cases extractions may be indicated as well.

Sharp incisal edges can also cause ulceration and irritation of sublingual tissues in affected infants.

Question 6

What does it mean if there are no primary teeth by 18 months?

Answer 6

One should suspect an underlying cause and order a thorough dental and medical evaluation.

Question 7

What conditions can be suspected if eruption of primary teeth is non-existant at 18 months?

Answer 7

Trisomy 21

Cleidocranial dysplasia

Hypothyroidism

Hypopituitarism

Acondroplastic dwarfism

Osteoporosis

Ectodermal dysplasia

Question 8

What is cleidocranial dysplasia?

Answer 8

In this condition the clavicles are absent or rudimentary.

the primary teeth erupt without problems on the normal schedule.

Permanent molars erupt on normal schedule.

The rest of permanent teeth develop normally at first but can’t erupt due to lack of resorption of primary teeth, multiple supernumerary teeth, and heavy fibrotic gingiva.

As a result over-retained primary teeth are possible.

Question 9

What systemic conditions can result in early eruption of primary teeth?

Answer 9

Hyperpituitarism

Hyperthyroidism

Question 10

What is ankylosis?

Answer 10

When tooth fuses with adjacent bone structure.

Question 11

What causes ankylosis of primary teeth? (pathophysiology)

Answer 11

Osseus bridging can occur between tooth and alveolar bone in areas of recent osteoclastic resorption.

Question 12

How can ankylosis be diagnosed?

Answer 12

Best diagnostic criterion is tooth position (relative to the occlusal plane) If the primary tooth is below the occlusal plane and sufficient mesio-distal space exists for it to be positioned more superiorly, the tooth is diagnosed as ankylosed.

Tapping the affected tooth can allow diagnosis (production of higher pitched sound)

Radiographs may reveal reduced periodontal ligament space if the area of fusion is perpendicular to the central x-ray beam.

Question 13

What are the sequelae of ankylosis?

Answer 13

Ankylosed primary teeth can disrupt vertical development of alveolar processes.

As the vertical discrepancy increases, normal interproximal contacts are lost between adjacent teeth and adjacent teeth can tip mesially or distally over the top of the ankylosed primary tooth. (no tooth in the way of tipping mesially/distally)

Majority of ankylosed primary teeth eventually exfoliate without intervention.

Question 14

What is exfoliation?

Answer 14

Exfoliation is when the remaining root structure of the primary tooth is no longer sufficient to hold the tooth in place causing it to fall out.

Question 15

What leads to exfoliation?

Answer 15

2 processes:

Resorption of overlying alveolar bone and primary tooth roots

Eruption of permanent teeth.

The degree to which the primary teeth roots are resorbed is valuable in estimating the dental age of the children.

Question 16

What causes resorption of primary roots and alveolar bone?

Answer 16

The action of osteoclastic cells

Question 17

What does early exfoliation or loss of primary teeth indicate?

Answer 17

Can be associated with a number of systemic conditions some of which can be very serious in nature.

This is especially a concern if there is early loss of multiple primary teeth in an atypical sequence.

Question 18

What should be done for patients with abnormalities in loss of primary or permanent tooth eruption?

Answer 18

A review of permanent teeth, a review of family history and genetic testing may be appropriate.

Question 19

What conditions are examples of systemic conditions that can be detected by abnormalities in exfoliation?

Answer 19

Cherubism

Acrodynia

Hypophosphatasia

Familial hypophosphatemic vitamin D-resistant rickets

Cyclic neutropaenia

Progeria

Leukaemia

Langerhan’s cell histiocytosis

Congenital agranulocytosis

Question 20

What should be done to lingual eruption of permanent incisors?

Answer 20

Nothing, as the permanent teeth erupt further the tongue will position them correctly. The primary teeth will eventually fall out.

Question 21

What is ectopic eruption?

Answer 21

The eruption of permanent teeth along a deviated path is called ectopic eruption.

This is relatively common with the eruption of mandibular lateral incisors, occurs sometimes with maxillary first molars, and can occur in the eruption of any permanent tooth.

Question 22

What are the teeth that most commonly undergo ectopic eruption?

Answer 22

Most common: Mandibular lateral incisors

Second most common: Maxillary molars

Question 23

How is ectopic eruption treated?

Answer 23

In ~2/3rds of children with an ectopic maxillary first molar, the affected permanent molar is able to jump the area of resorption which allows eruption to occur soi theproblem self corrects.

Techniques such as a brass-separating wire, orthodontic separator, or an active appliance may be indicated.

Question 24

What is the difference between normal and pathological root resorption?

Answer 24

Pathological can occur either externally or internally on a primary tooth.

Internal or external resorption occurs due to inflammatory changes in pulpal or periapical tissue. The inflammation is usually a sequel to carious involvement of the pulp or trauma to the tooth.