Problems from Birth to the Transition of the Incisors
In the first year after birth orofacial structures show marked growth and development. The relatively small lower part of the face increases greatly in size. Jaw growth in the first 6 months after birth provides sufficient space for the originally overlapping and rotated deciduous incisors and canines to arrive in good alignment alongside each other.
Development of the dentition and eruption of the deciduous teeth occur in conjunction with a considerable increase in height of the jaws and with increase in size of the alveolar processes. The tongue, which in the infant lies across the maxillary and mandibular alveolar processes, becomes contained within the arches.
The problems described in this chapter are sometimes noticed by the child and his or her parent(s), sometimes by the family doctor or dentist. They are dealt with in the following order: deciduous teeth present at birth, troublesome emergence of deciduous teeth, thumb-sucking and finger-sucking, use of dummies, injuries and loss of deciduous teeth, lateral forced bites, reversed overbites, and serious congenital anomalies.
Children are rarely born with teeth already emerged (natal teeth, approximately 1:1,000). Teeth emerging in the first month seem to occur even less frequently (neonatal teeth). However, this impression is probably incorrect, because deciduous teeth present at birth would usually be recorded, whereas subsequent early emergence is less likely to be noticed. Both situations principally involve the mandibular central and lateral incisors; only very occasionally will a maxillary incisor be involved. It is very rare indeed for deciduous molars and canines to be found in the mouth at birth or soon afterwards.25, 32, 98, 127, 130
Such early teeth usually have little or no root formation. The crowns often are badly formed, small, conical, yellowish in colour, and hypoplastic in their enamel and dentine. The teeth are not firmly fixed, which is understandable because they cannot yet form an attachment between bone and tooth: there is, of course, no root yet.
It is likely that the presence of deciduous teeth in the mouth at birth is due to a genetically determined laying down of the germs of the relevant teeth close to the occlusal aspect of the jaw. They can be associated with gingivitis and tongue damage and can cause distress during breast-feeding, both for the child and the mother (nipple trauma). They often exfoliate as the result of forces applied during feeding or otherwise, with some danger of inhalation. Possibly the danger of inhalation is more imaginary than real; there is in fact no case on record where inhalation has occurred.98, 202 If advice and help are asked for, it depends mainly on the quality of the tooth and its mobility as to whether or not it should be ground down or removed. In this connection the root formation and attachment to the alveolar bone are deciding factors. The later they have emerged the more reasonable it is to retain them. Where teeth are reasonably firm and look clinically acceptable, sharp corners can be rounded, thus largely eliminating the problems. If they are very mobile and there is a likelihood that they will exfoliate or that the discomfort will interfere with feeding, then removal is indicated. Removal is technically simple but for the first 10 days after birth there is a possibility of excessive bleeding. During the first weeks there exists a physiological hypoprothrombinaemia that becomes eliminated when the intestinal flora of the infant begin to produce vitamin K. Excessive bleeding in these circumstances can be dealt with by administering vitamin K.73, 130
Parents should be informed of the implications of extraction. Fortunately the consequences usually are unimportant. After very early loss of deciduous central incisors it appears that at the age of 5 to 5.5 years the space in the involved part of the dental arch is not demonstrably smaller than in normal cases.66 When there is a very early loss of deciduous canines and molars, and also lateral incisors, the development of the dentition can be unfavourably influenced.123
Before teeth emerge a fusion takes place between the dental and oral epithelium, which enables the tooth to perforate the gingiva without ulceration. For some children emergence of their deciduous teeth occurs without difficulty. But for the majority, local symptoms of differing degrees of severity develop. A few days before emergence the tissues overlying the tooth swell and redden. The child shows signs of local irritation, wants to rub the offending gum with fingers or anything handy, and drools frequently. The gingivae over the place where the tooth will appear are blanched. This corresponds with the keratinization of the fused dental and oral epithelium. After emergence, the gingivae retract, the crown comes into view, and the irritation disappears. Many remedies have been tried to counteract local and supposed general symptoms related to emerging deciduous teeth. In general, there are more disadvantages than advantages to such ministrations. For example, a high concentration of aspirin in a salve can even produce burning and ulceration of the gingivae.30 A rubber ring is the bes/>