Disturbances in the Timing of Tooth Eruption in

Disturbances in the Timing of Tooth Eruption in Children with General Diseases Sven Kreiborg, DDS, Dr. Odont, Ph. D Pediatric Dentistry and Clinical Genetics School of Dentistry, Faculty of Health Sciences University of Copenhagen, Denmark E-mail: skrei@sund. ku. dk

Disturbances in the Timing of Tooth Eruption Ø Natal/neonatal teeth Ø Premature eruption Ø Delayed eruption

Normal Tooth Eruption Timing Ø In the primary dentition: no significant difference between boys and girls Ø In the permanent dentition: girls have significantly earlier tooth eruption than boys (about 6 months)

Normal Tooth Eruption Timing Ø There is a weak correlation between tooth eruption and chronological age Ø There is a weak correlation between tooth eruption and skeletal age

Normal Tooth Eruption Timing Ø There is a strong correlation between tooth eruption and dental age

Demijian et al. A new system of dental age assessment Hum Biol 1973; 45: 211 -27

Stages of Tooth Eruption Ø Pre-eruptive Ø Intra-osseous Ø Mucosal penetration Ø Pre-occlusal Ø Post-occlusal

TOOTH ERUPTION – DURATION Intra-Osseous Movement 2. 5 – 6. 5 years (shortest for M 1; longest for C) No significant sex difference

TOOTH ERUPTION – DISTANCE Intra-Osseous Movement 5 – 20 mm (shortest for M 1; longest for C)

TOOTH ERUPTION – VELOCITY Intra-Osseous Movement 1 -10 m/day (10 m=0. 01 mm; 100 days=1 mm) No significant sex difference

TOOTH ERUPTION – VELOCITY Pre-Occlusal Movement 10 -75 m/day (100 m=0. 1 mm; 100 days=10 mm) No significant sex difference

TOOTH ERUPTION – VELOCITY Post-Occlusal Movement Magnitude and velocity of tooth movement depend on magnitude, velocity, and direction of jaw growth Significant sex difference

Disturbances in the Timing of Tooth Eruption Ø Natal/neonatal teeth (1: 2, 000 -3, 000 births) Ø Premature eruption Ø Delayed eruption

Disturbances of Tooth Eruption POSSUM-Database Natal/Neonatal Teeth 62 Syndromes (e. g. Ellis-van. Creveld Syndrome and Hallermann-Streiff Syndrome)

Disturbances of Tooth Eruption POSSUM-Database Premature Eruption 51 Syndromes (e. g. Soto syndrome)

Soto Syndrome Premature Tooth Eruption Ø Tall stature Ø Cerebral gigantism Ø Macrocephaly Ø Large mandible Cause of premature tooth eruption: accelerated general growth

Klippel-Trenaunay-Weber Syndrome Premature Tooth Eruption Ø Generalized unilateral hypertrophy Ø Cutaneous angiomatosis Ø Varicose veins Cause of premature tooth eruption: accelerated general growth unilaterally

TOOTH ERUPTION - DELAYED Ø Genetic factors Ø Chronic diseases Ø Chromosomal aberrations Ø Endocrine disorders - Hypopituitarism - Hypothyroidism - Hypoparathyroidism Ø Syndromes

TOOTH ERUPTION DELAYING/HINDERING FACTORS Intra-Osseous Movement Ø Dental follicle Ø Tooth/root formation Ø Alveolar bone l Space conditions l Obstacles l Bone metabolism

TOOTH ERUPTION – DELAYED Physical Factors Ø Crowding Ø Supernumerary teeth Ø Odontomas/osteomas Ø Cysts Ø Gingival fibromatosis Ø Other

Disturbances of Tooth Eruption POSSUM-Database Delayed Eruption 180 Syndromes e. g. Apert syndrome, Cherubism, cleidocranial dysplasia, ectodermal dysplasias, Ellis-van. Creveld syndrome, GAPO syndrome, Hurler syndrome, Incontinentia Pigmenti syndrome, Mc. Cune Albright syndrome, Pycnodysostosis, Tricho-Dento-Osseous syndrome, etc. ….

Disturbances of Tooth Eruption POSSUM-Database Delayed eruption in syndromes with: Ø General growth disturbances Ø Maxillary and mandibular hypoplasia Ø Disturbances of tooth formation Ø Gingival fibromatosis Ø Disturbances of bone metabolism

Delayed Tooth Eruption Ø There is a strong correlation between tooth eruption and abnormal tooth development

TOOTH ERUPTION – DELAYED Syndromes with Dental Anomalies Ø Amelogenesis Imperfecta Ø Ectodermal Dysplasia Ø Ekman-Westborg-Julin Syndrome Ø Morquio syndrome

Ectodermal Dysplasia (X-Linked) Delayed Tooth Eruption Ø Ø Ø Sparse scalp hair, eyelashes, eyebrows Inability to sweat High forhead, depressed nasal bridge Decreased anterior face height Dental abnormalities (oligodontia/anodontia) Microdontia, tooth shape abnormalities Cause of delayed tooth eruption: abnormalities of tooth formation

Ekman-Westborg-Julin Syndrome Delayed Tooth Eruption Ø Ø Ø Macrodontia Multituberculism Pulp invaginations Causes of delayed tooth eruption: abnormalities of tooth development and crowding

Morquio Syndrome Delayed Tooth Eruption Ø Ø Ø Short stature Coarse facies Short neck Joint contractures Prognathism Enamel hypoplasia Cause of delayed tooth eruption: abnormalities of tooth development

TOOTH ERUPTION – DELAYED Syndromes with hypoplastic jaws Ø Apert syndrome Ø Crouzon syndrome Ø Cleft palate Ø Treacher-Collins syndrome Ø Silver-Russell syndrome Ø Pycnodysostosis

APERT SYNDROME Delayed Tooth Eruption Ø Ø Ø Premature craniosynostosis Maxillary hypoplasia Shallow orbits Small nose Syndactyly of hands and feet Causes of delayed tooth eruption: maxillary hypoplasia with severe crowding and gingival hyperplasia

Pycnodysostosis Delayed Tooth Eruption Ø Ø Ø Short stature Increased bone density (osteopetrosis) Delayed closure of fontanelles and sutures Hypoplastic midface Mandibular retrognathia Aplasia of teeth Ø Causes of delayed tooth eruption: hypoplastic jaws with crowding and abnormal bone metabolism

TOOTH ERUPTION – DELAYED Syndromes with Bone Disorders Ø Osteopetrosis Ø Pycnodysostosis Ø Mc. Cune Albright syndrome Ø Tricho-dento-osseous syndrome Ø Osteopathia striata with cranial sclerosis

Mc. Cune-Albright Syndrome Delayed Tooth Eruption Ø Ø Ø Ø Endocrine abnormalities (precocious puberty) Fibrous dysplasia of bone Scoliosis Patchy/streak-like skin hyperpigmentation Facial asymmetry Sclerotic/dense bone Dental abnormalities Cause of delayed tooth eruption: abnormal bone metabolism

Tricho-Dento-Osseous Syndrome Delayed Tooth Eruption Ø Ø Ø Curly/frizzy hair Increased bone density Aplasia of teeth Amelogenesis imperfecta Taurodontism Causes of delayed tooth eruption: abnormal bone metabolism and abnormalities of tooth development

Osteopathia Striata with Cranial Sclerosis Delayed Tooth Eruption Ø Ø Ø Increased bone density Hearing loss Linear striations in long bones Aplasia of teeth Taurodontism Cause of delayed tooth eruption: abnormal bone metabolism

TOOTH ERUPTION – DELAYED Syndromes with Obstacles Ø Cleidocranial dysplasia Ø Kreiborg-Pakistan syndrome Ø Hurler syndrome Ø Cherubism Ø Gardner syndrome

Cleidocranial Dysplasia Delayed Tooth Eruption Ø Ø Ø Large head with prominent frontal bones Wide sutures and fontanelles Small face Aplasia/hypoplasia of clavicles Supernumerary teeth Causes of delayed tooth eruption: supernumerary teeth and abnormal bone metabolism

Kreiborg-Pakistan Syndrome Delayed Tooth Eruption Ø Ø Premature craniosynostosis Supernumerary teeth Causes of delayed tooth eruption: supernumerary teeth and abnormal bone metabolism

Gardner Syndrome Delayed Tooth Eruption Ø Ø Ø Familial adenomatous polyposis (malignancies) Osteomas of skull/facial bones Epidermoid/sebaceous skin cysts Causes of delayed tooth eruption: osteomas in the jaws

Hurler Syndrome Delayed Tooth Eruption Ø Ø Ø Ø Mucopolysaccharidosis 1 H Growth retardation Progressive neurological deterioration Coarse face Corneal clouding Kyphosis and multiple joint contractures Dental cysts Cause of delayed tooth eruption: dental cysts with accumulation of MPS

Cherubism Delayed Tooth Eruption Ø Ø Cystic, fibrous jaw lesions Bilateral symmetric jaw expansion Exposure of sclera below the iris Aplasia of teeth Cause of delayed tooth eruption: cystic jaw lesions (giant-cell granulomas)

TOOTH ERUPTION – DELAYED Syndromes with Anomalies of Oral Mucosa Ø Gingival fibromatosis Ø Neurofibromatosis Ø Apert syndrome

TOOTH ERUPTION – DELAYED Syndromes but with Unknown Mechanism Ø GAPO syndrome Ø Romberg syndrome

GAPO syndrome Delayed Tooth Eruption Ø Ø Ø Growth retardation Alopecia Pseudoanodontia Optic atrophy Premature craniosynostosis Thick lips, thick and fibrous gingiva Cause of delayed tooth eruption: unknown, but ossifications in the gingiva have been seen

Romberg Syndrome Delayed Tooth Eruption Ø Hemifacial atrophy (skin, fat, cartilage, bone, and teeth) Cause of delayed tooth eruption: unknown but related to the atrophy of tissues

TOOTH ERUPTION Delay in Intra-Osseous or Mucosal Penetration Stages General Treatment Principle The tooth should penetrate the mucosa no later than at developmental stage G according to Demirjian et al. (1973)

TOOTH ERUPTION Delay in Intra-Osseous or Mucosal Penetration Stages Treatment Considerations • Extraction of primary tooth/teeth • Removal of obstacles • Denudation • Removal of alveolar bone occlusally • Orthodontic traction • Bone distraction • Autotransplantation

TOOTH ERUPTION Delay in Intra-Osseous or Mucosal Penetration Stages Be observant and alert and ACT!