FacultyNAHDA UNIVERSITY of Dentistry, Minia University, Egypt

INTRODUCTION TO PAEDIATRIC DENTISTRYODONTOGENESIS AND TOOTH ERUPTION

Dr. AHMAD ABDEL HAMID ELHEENY

2018 INTENDED LEARNING OUTCOMES (ILOS)

I. Knowledge and Understanding By the end of the program, the student should be able to: 1. Identify the basis of pedodontics practice management. 2. Recognize the social and psychological issues relevant to dental care with emphasis on behavioural management. 3. Identify pathogenic mechanism and manifestation of child diseases which are of dental significance. 4. Identify the basis of endodontic practice management for children. 5. Identify the basis of orthodontic practice management for children. 6. Identify the basis of oral surgery practice management for children. 7. Identify the basis of operative dentistry practice management for children. 8. Identify the basis of prosthodontic practice management for children. 9. Identify the basis of oral radiology practice management for children. 10. Identify the basis of periodontology practice management. 11. Describe the biomaterials, types, uses, biological responses, and their limitations.

II. Professional & Practical By the end of the program, the student should be able to: 1. Establish a comprehensive patient's history and perform clinical examination. 2. Request and evaluate appropriate investigations and consult with other health care professionals, when required. 3. Detect abnormal and pathological conditions, etiology and detect risk factors that may contribute to disease process. 4. Perform a range of clinical procedures. 5. Apply different local anesthetic techniques. 6. Perform extraction of teeth and removal of roots when necessary. 7. Perform restorations of carious and non-carious tooth defects. 8. Perform basic pulp therapy procedures. 9. Control different levels of patient's anxiety and apprehension in different age group. 10. Prescribe and monitor the effects of appropriate pharmaceutical agents taking into consideration drug and patient factors.

III. Intellectual skills By the end of the program, the student should be able to: 1. Differentiate between normal and abnormal features that are particularly relevant to child oral health. 2. Generate and prioritize a list of potential patient clinical problems. 3. Analyze collected diagnostic data and design appropriate diagnostic and treatment plans for different dental problems.

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4. Solve clinical problems related to dental practice by intellectual rigor and analytical thinking.

IV. General and transferable skills 1. By the end of the program, the student should be able to: 2. Work effectively within a team in a limited time frame. 3. Practice self-evaluation and criticism. 4. Implement critical thinking and problem solving skills. 5. Practice self-learning for continuous improvement of professional knowledge.

PAEDIATRIC DENTISTRY DEFINITIONS . A branch of dental science which deals with the guidance of primary and permanent dentition during growth and development as well as prevention and treatment of any pathological condition occurs during childhood.

. AAPD: It is a specialty that provides primary and comprehensive oral health care for infants and children through adolescence including those with special health care needs.

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LIFE CYCLE OF THE TOOTH

1. Initiation (bud stage) Cells in the basal layer of the oral epithelium proliferate at a more rapid rate than do the adjacent cells. The result is an epithelial thickening in the region of the future dental arch that extends along the entire free margin of the jaws. This thickening is called the primordium of the ectodermal portion of the teeth and what results is called the dental lamina. At the same time, 10 round or ovoid swellings occur in each jaw in the position to be occupied by the primary teeth. The permanent molars, like the primary teeth, arise from the dental lamina. The permanent incisors, canines, and premolars develop from the buds of their primary predecessors. 2. Proliferation (cap stage) Proliferation of the cells continues during the cap stage. As a result of unequal growth in the different parts of the bud, a cap is formed. A shallow invagination appears on the deep surface of the bud. The peripheral cells of the cap later form the outer and inner enamel epithelium. 3. Histodifferentiation and Morphodifferentiation (bell stage) The epithelium continues to invaginate and deepen until the enamel organ takes on the shape of a bell. It is during this stage that there is a differentiation of the cells of the dental papilla into odontoblasts and of the cells of the inner enamel epithelium into ameloblasts. In the morphodifferentiation stage the formative cells are arranged to outline the form and size of the tooth. This process occurs before matrix deposition. The morphologic pattern of the tooth becomes established when the inner enamel epithelium is arranged so that the boundary between it and the odontoblasts outlines the future DEJ. 4. Apposition Appositional growth is the result of a layer like deposition of a nonvital extracellular secretion in the form of a tissue matrix. 5. Calcification Calcification (mineralization) takes place following matrix deposition and involves the precipitation of inorganic calcium salts within the deposited matrix.

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PROBLEMS MAY ASSOCIATED WITH TOOTH DEVELOPMENT

TEETH ERUPTION

I. Eruption Phases 1. Pre-eruptive phase: All movements of primary and permanent tooth germs (crowns) from time of their early initiation and formation to the time of crown completion (ends with early initiation of root formation). 2. Eruptive phase: Starts with initiation of root formation and made by teeth to move from its position within bone of the jaw to its functional position in occlusion. Have intraosseous and extraosseous compartments. 4 stages: root formation, movement, penetration and occlusal contact. 3. Post-eruptive phase: Takes place after the teeth are functioning to maintain the position of the erupted tooth in occlusion while the jaws are continuing to grow and compensate for occlusal and proximal tooth wear.

II. Problems Associated with Teeth Eruption

1. Teething Clinical features . In most children the eruption of primary teeth is preceded by increased salivation, and the child will want to put the hand and fingers into the mouth. These observations may be the only indication that the teeth will soon erupt. . Some young children become restless sleeplessness and fretful during the time of eruption of the primary teeth. . Redness and swelling of gingiva over erupting tooth . Crying

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Management . Non-pharmacological strategies:

. Pharmacological strategies: Topical and/or systemic medications

2. Natal and Neonatal Teeth . Teeth most often affected are mandibular primary incisors. . In most cases, anterior natal and neonatal teeth are part of the normal complement of the dentition. . If the tooth is not excessively mobile or causing feeding problems, it should be preserved and maintained in a healthy condition if possible. . Close monitoring is indicated to ensure that the tooth remains stable.

3. Ankylosis Prevalence . Lower primary molars (7-14%) and 50% of cases have more than one ankylosed tooth . Ankylosis is a condition in which the cementum of a tooth’s root fuses directly to the surrounding bone. . The periodontal ligament is replaced with osseous tissue, rendering the tooth immobile to eruptive change Etiology . Unknown but may be due to: . Familial pattern and genetic background. . 2ry to trauma, infection, crowding & agenesis of perm. Successor. . Associated with syndromes as ED, CCD & Down’s syndrome. . There is an increased frequency of other dental anomalies in children who have infraoccluded teeth such as ectopic eruption of first permanent molars, peg laterals, enamel hypoplasia and palatal displacement of maxillary canine Diagnosis 1. Out of occlusion 2. Not mobile even with advanced root- - 3. Solid sound 4. Fusion between centum and bone in radiograph

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Classification According to the surrounding hard and soft tissues 1. Mild 2. Moderate 3. Sever Treatment Factors affecting the treatment 1. Presence or absence of permanent successor 2. Severity of 3. Age of onset 4. Rate of progression 5. Tipping of adjacent teeth

5. ECTOPIC ERUPTION (EE) Of Upper First Permanent Molar . It occurs due to the molar’s abnormal mesioangular eruption path, resulting in an impaction at the distal prominence of the primary second molar’s crown EE of permanent molars is classified into two types; those that self-correct and others that remain impacted. . 66% of EE permanent molars self-corrected by age seven . A permanent molar that presents with part of its occlusal surface clinically visible and part under the distal of the primary second molar usually does not self-correct and is the impacted type . After the age of seven, definitive treatment is indicated to manage and/or avoid early loss of the second primary molar and space loss.

6. Lingual Eruption of Mandibular Permanent Incisors . It is common for mandibular permanent incisors to erupt lingually, and this pattern should be considered essentially normal. . Spontaneous correction of lingually erupted permanent incisors is likely to occur given enough time, particularly in cases in which there is not severe crowding. . The parents' feelings should not be ignored in the decision; even a 95% chance that correction will occur may not satisfy all parents.

7. Eruption Hematoma (Eruption Cyst) . A bluish purple, elevated area of tissue, commonly called an eruption hematoma, occasionally develops a few weeks before the eruption of a primary or permanent tooth. The blood-filled cyst is most frequently seen in the primary second molar or the first permanent molar regions. . This fact substantiates the belief that the condition develops as a result of trauma to the soft tissue during function. Usually within a few days the tooth breaks through the tissue, and the hematoma subsides.

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. The condition is almost always self-limited, treatment of an eruption hematoma is rarely necessary. However, surgically uncovering the crown may occasionally be justified.

Causes of Delayed Eruption

Local Systemic Genetic

•Mucosal barriers-scar •Nutrition •AI tissue: trauma/surgery •Endocrine disorders: •OI •Ankylosis Hypothyroidism •Down syndrome •Ectopic eruption (cretinism), •Ectodermal dysplasia Hypoparathyroidism •Regional •Mucopolysaccharidosis Hypopitutitarism odontodysplasia •Neurofibromatoses •Arch length deficiency •Drugs: Phenytoin •Gingival fibromatosis/ •Cerebral palsy gingival hyperplasia •Prematurity/low birth •Odontogenic tumors weight •Supernumerary teeth

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