Pedodontics III Al Azhar University Palestine Gaza Upload By: Lama El Banna lama1997bana@gmail.com Faculty of oral and dental medicine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. College of Dentistry
Pedodontic II
Introduction & Eruption of primary teeth
Dr. Hazem El Ajrami

3. • Pedodontics is that branch of dental science,
which deals with the guidance of the primary and
young permanent dentition in growth and
development as well as the prevention and
treatment of pathologic oral conditions, which
may occur during childhood. It is the most
needed of all the services performed by the
dentist.

4. • Inadequate or unsatisfactory dental treatment
during childhood may damage permanently the
entire masticatory apparatus, leaving the
individual with many of the dental problems so
common in adult population.

5. • When treating children, the dentist is dealing with
patients that are in their formative years,
accordingly, he is in a position to alter the growth
pattern and resistance to disease of the oral
tissues in these growing organisms, to produce a
more ideal oral structure from a metabolic,
functional and esthetic viewpoint.

6. • In pedodontics, one is dealing mainly with
prevention. There is actually no important phase
of this field that is not preventive in its broad
contest. In this respect, working on children is a
truly dedicated service, for prevention is the
ultimate goal of all medical science.

7. Aims and Benefits of Pedodontics
I. For the child patient:
1) The child will have a better masticatory
apparatus that provides good masticatory
function, which is essential for the child's
optimal growth, better health and better look.
Any defect in the masticatory apparatus as pain
due to dental caries, loss of teeth, malocclusion
and/or diseases of the soft tissues will result in
impaired masticatory function.

9. • In an attempt to compensate for this, the child
will adapt, by acquiring, bad eating habits such
as improper food selection, moistening of food
and washing it down with liquids, increasing
the chewing tissues; and hyperactivity of the
tongue. These bad habits will lead to gastro-
intestinal disturbances, malnutrition and
subnormal general growth.

10. 2) The child will have less dental diseases in his
adulthood as prevention is the most important
aim of pedodontics.
3) He will have less psychological trauma from
dentistry as he is properly approached,
managed and treated.
4) From the economical point of view,
pedodontics is far less expensive to the
individual because it reduces very much
operative, orthodontic, periodontic, oral
surgery, crown and bridge and prothodontics
work later in his adulthood.

13. II. For the dentist:
He will learn more skills and abilities
in the different fields of dentistry as well as
learning many techniques, which are unique
to children alone.
III. For the nation:
As pedodontics permit the child
optimal state of growth and development
through maintaining good and healthy
masticatory apparatus, pedodontics carry its
responsibility towards the nation that we
will have better healthy citizens.

15. • Importance of primary teeth:
All of the primary teeth are in use from age
2 to 7 years, some of the primary teeth are in
use from age 2 till 12 years of age. So they are
in use contributing to the health and well being
of the individual during his first years of
greatest development, physically and mentally:

16. 1. Preparation of the child's food for digestion
and assimilation during some of his most
active periods of growth and development.
2. Maintenance of space in the dental arches for
the permanent teeth with the premature loss of
the primary teeth, severe dental irregularities
may develop. Unless the primary dentition
remains intact, the permanent teeth may not be
guided into their normal position.

18. 3. Development of speech: The primary teeth have
all important part in the development of speech.
Ability to use the teeth for pronunciation is
acquired entirely with the aid of the primary
dentition. Early and accidental loss of the
primary anterior teeth may lead to difficulty in
pronouncing the sounds f, v, s, z and th.
4. Cosmetic function: Improving the appearance of
the child. If a child accidentally loses his primary
anterior teeth, his appearance will be affected, he
will find himself different from the other
children in his same age and accordingly this
affects him from the psychological point of view.

19. Eruption of Primary Teeth

20. • Definition:
Tooth eruption is usually defined as the
movement of a tooth from its site of
development (bony crypt) within the alveolar
bone to its functional position in the oral
cavity. t

21. • Normal eruption process:
There are many theories that have explained
the emption process as:
 Forces exerted by vascular tissues around and
beneath the root.
 Growth of alveolar bone.
 Growth of dentine.
 Growth and pull of periodontal ligament.
 Hormonal influences.
 Presence of dental follicle.
 Pressure from muscular action and resorption of
alveolar crest.

22. • However, many studies concluded that there is
no simple explanation for this biological
phenomenon, which is not surprising since
most of teeth erupt during periods of active
craniofacial growth and therefore eruption
should be considered as a part of multi-
factorial event.

23. • Teething in children:
Eruption of the primary dentition usually
begins in the fifth or sixth month of a child's life.
The first appearance of normal teeth is eagerly
awaited by the parents since it represents an
important early milestone in development. In
most cases, eruption of teeth causes no distress to
the child, but sometimes causes local irritation,
which is usually minor, but which may be severe
to interfere with the child's sleep.

25. • The primary teeth begin to form at 7 w.i.u.
Calcification of the central incisor starts at 4
w.i.u. The sequence of calcification of the
primary teeth is central incisors, first molars,
lateral incisors, canines and second molars.
• At the time of birth, there are no functioning
teeth in the mouth, but radiographs of the
infant's jaws however, show many teeth in
various stages of the process of formation and
calcification.

27. • These radiographs show calcification of
approximately five-sixths of the crown of the
central incisors, approximately two-thirds of
the crown of the lateral incisors, at least the
incisal tip of the canine, the cusps of the first
and second primary molars may be evident,
although the cusp tips may still be isolated.
Occasionally evidence of calcification of the
first permanent molar and the incisal edge of
the permanent central incisor can be seen.

28. • The signs of teething may be manifested
locally and/ or systemically:
I. Local:
 Redness or swelling of gingiva over erupting
tooth.
 Patches of erythema on the cheeks.
 Child wants to put the hands or fingers into
the mouth.
 Increased salivation and drooling.

29. II. Systemic:
• High fever.
• General irritability and crying.
• Loss of appetite.
• Diarrhea.
• Increased thirst.
• Circumoral rash.
Most studies refer these symptoms to the
reason that teething is either normal
physiologic process, immune process or due to
bacteremia.

30. • Treatment:
I. Local:
 Teething toys: a baby uses hands and mouth to
explore unfamiliar objects. A variety of teething
rings, rattles and keys are available. They are
designed to satisfy the natural tendency of the
child to bite and suck. The baby may obtain
relief from soreness by the pressure of biting.
Parents should be advised to purchase only
well-made and smooth toys.

32. Teething foods: hard rusk or biscuit
preparations are used in the same way as
teething toys. It is important that they should
contain no sugar.
Topical medications: various types of ointment
and gel are available for topical application to
gingiva. Common ingredients include:
Salicylates, which have anti-inflammatory
properties in addition to systemic analgesic
and anti-pyretic effects. e.g. : Dentinox.

33. II. Systemic:
 Treatment by systemic administration of drugs
should be considered only if local treatment has
been ineffective.
 Analgesics: several sugar-free paracetamol
preparation are available.
 Dosage: up to 1 year: 5ml at bedtime. 1-5
years: 10ml at bedtime.
 It is not justified to give any injection such as
Vitamin D and calcium to enhance teething in
children with delayed eruption since these
prescription if are not needed may cause severe
damage to the kidneys.

34. • N.B:
Natal and neonatal teeth:
• The prevalence of natal teeth (present at birth)
and neonatal teeth (erupt during the first 30 days)
is low. Most of them are mandibular primary
incisors, it is common to occur in pairs, and
molars are rare.
• Most prematurely erupted teeth seem to occur in
normal infants, with or without family history, in
some infants, the presence of such teeth may be a
localized manifestation of an environmental
etiology or underlying syndrome.

36. • Radiographs should be made to determine
amount of root development and its relation to
adjacent teeth. Most of them are immature and
mobile due to limited root development, mobile
tooth is danger to the extent of displacement and
aspiration so its removal is indicated.
• The preferable approach if the tooth is not
mobile is to leave it and explain to the parents
the desirability of maintaining this tooth because
of its importance in growth. It may cause
difficulty to mother during breast feeding,
however the infant may be conditioned not to
bite during suckling.

37. • Systemic conditions influencing eruption of
teeth:
There are some conditions that cause delay
in development and eruption of teeth as:
 Down's syndrome.
 Cleido-cranial dysplasia.
 Hypothyroidism.
 Hypopituitarism.

38. Chronology of Primary and
Permanent Dentition
• Chronology of primary dentition:
EDCBAPrimary Teeth
24M14M18M8-9M7-8MMaxillary
20M12M16M7-8M6-7MMandibular

39. • N.B. variation 6 months in eruption date is
considered normal. Teeth of girls erupt earlier
than teeth of boys. Parents should not be
worried about delayed eruption if there
children are healthy.

40. • Chronology of permanent dentition can be
determined from the following formula:
• Tooth eruption + ( ) → Root completion of
primary teeth + ( ) → Starting of root resorption
of primary teeth (Coincide with complete crown
calcification of the permanent successor) + ( ) →
Shedding of the primary tooth (Eruption of the
permanent successor) + ( ) → Root completion of
the permanent successor.

41. • Tooth eruption (primary tooth) + 1 (incisor) 1.5
years (canine & molars) → Root completion of
primary teeth + (1 to 1.5 years) → Starting of root
resorption of primary teeth (Coincide with
complete crown calcification of the permanent
successor) + (3-5 years) → Shedding of the
primary tooth (Eruption of the permanent
successor) + 3 years → Root completion of the
permanent successor.

42. • Coincide with complete crown calcification of
the permanent successor i.e. beginning of root
formation of the permanent successor.
• Eruption of the permanent successor (at this
stage about 1/2 - 2/3 of the root is formed).

43. • E.g.: Mandibular A:
• Eruption date (6 m.) + 1 y. → Root completion of
A 1.5 y. + (1.5 y.) → Starting of root resorption
of A (Coincide with complete crown calcification
of 1) (3 y.)+ (3 y.) → Shedding of A (Eruption of
1) (6 y.) + 3 y. → Root completion of 1 (9 y.).

44. Thank You