25: Disorders of eruption and exfoliation

25 Disorders of eruption and exfoliation

Case 1

Summary

Beth was only 20 days old when it was noticed she had two teeth at the front of the lower jaw (Fig. 25.1).

image

Fig. 25.1 Natal teeth.

image What is the correct terminology for these early erupting teeth?

If the teeth are present at birth, ‘natal’ is the correct term. If they are not present at birth but erupt within the first month of life, ‘neonatal’ is correct.

The prevalence rates for both natal and neonatal teeth are reported as 1 in 2000–3000 live births. The most commonly presenting tooth is the lower central incisor. More rarely, maxillary incisors or first molars have been reported. The early eruption is thought to be caused by the ectopic position of the tooth germ during fetal life. Natal and neonatal teeth may follow a sporadic pattern or they may be familial. However, they can be associated with specific syndromes:

Pachyonychia congenita.
Ellis–van Creveld.
Hallermann–Streiff.

image What are the main problems associated with natal and neonatal teeth?

Mobility.
Ulceration of ventral surface of tongue.
Nipple soreness (breastfeeding mothers).
The teeth are mobile because the development of the tooth is consistent with age. Only about five-sixths of the crown is formed and usually no root. Additionally, the crown is occasionally dilacerated and the enamel hypoplastic or hypomineralized.
Excessive mobility is a danger to the airway from aspiration and the tooth should be removed. Care should be taken to ensure that the entire tooth including the pulpal tissue is removed, otherwise dentine and a root will form, which will require eventual removal. If teeth can be left then continued root development will occur.
Nipple soreness may occasionally necessitate tooth removal.
Ulceration on the ventral surface of the tongue may respond to carmellose sodium oral paste. Smoothing of the incisal edges with sandpaper discs may also help.

image What factors can cause generalized premature eruption but still be considered as ‘normal’?

Familial – a family history is a common finding.
Children with high birth weights.
Race – generally Negroids tend to erupt their permanent teeth earlier than Mongoloids, who are in turn in advance of Caucasians. Racial group does not seem to affect eruption times of primary teeth but eruption patterns can vary in the primary dentition.
Sex – females tend to erupt permanent teeth several months ahead of males.
The opposite of premature eruption is delayed eruption.

image When is generalized delay in eruption of primary teeth expected?

Preterm infants.
Very low birth weight infants.

image What conditions may lead to a generalized retarded eruption of teeth in both primary and permanent dentitions?

Chromosomal abnormalities – Down’s and Turner/>

Related posts:

  1. 27: Facial swelling and dental abscess
  2. 33: Tooth discoloration, hypomineralization and hypoplasia
  3. 22: Nursing and early childhood caries
  4. 12: Increased overbite
  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 25: Disorders of eruption and exfoliation

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