Eruption & Teething

Dept of Paedodontics & Preventive Dentistry

Contents

● Introduction
● Physiological tooth movements
● Theories of tooth eruption
● Teething
● Management of teething
Introduction

The word “eruption” refers to cutting of teeth through gums (from the
●

Latin erumpere, meaning “to break out”).

It is the process by which tooth moves within the jaw bone comes into the
●

oral cavity and comes up to the occlusal contact and maintains its clinical

position.

Teeth undergo complex movements related to maintaining their position

●

in the growing jaws and compensating for masticatory wear.

 Physiological tooth movements

Physiological tooth movements consists of the following:

➔ Pre-eruptive tooth movement – made by the deciduous and permanent
tooth germs within tissues of the jaw before they begin to erupt.
➔ Eruptive tooth movement – 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. Has an intraosseous and extraosseous
compartments.
➔ Post eruptive tooth movement – 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.
Theories Of Tooth Eruption

The mechanism that brings about tooth movement is still debatable and is
➔

likely to be combination of number of factors.

Various factors were proposed

➔

1)Bone Remodeling 4)Pressure from muscular

action
2)Root Formation
5)Resorption of alveolar crest
3)Periodontal Ligament
Traction 6)Vacularity theory

4)Pulpal constriction theory 7)Hormonal theory

1)Bone Remodeling Theory

Selective bone resorption & deposition causes tooth

●

movement.
●The follicle that provide the source for new bone-forming cells
and conduit for osteoclasts derived from monocytes through
its vascular supply.
2)Root Formation Theory

Proliferating root impinges on a fixed

base

Apically directed force

Occlusal movement of tooth

3)Periodontal Ligament Traction Theory

Cells & fibers of periodontal ligament possess contractile force

●

Tooth movement brought about by:

●

➔ Fibroblast contractile properties

➔ Connection with collagen fibers ectracellular ‘fibronexus’
➔ Oblique alignment of PDL collagen fibers
Teething

● Teething is the process by which an infant's teeth erupt or break

through, the gums. Teething is also referred to as "cutting" of the teeth.
● Teething is medically termed Odontiasis.
● In most cases, eruption of primary
teeth causes no distress to the child
or parents, but sometimes process
causes local irritation which may
interfere with child’s sleep.
● The small primary incisor usually
erupts without difficulty, but difficult
teething is commonly associated
with larger teeth.
WHEN DO BABIES START TEETHING?

The onset of teething symptoms typically precedes the eruption of a tooth

by several days. While a baby's first tooth can present between 4 and 10
months of age, the first tooth usually erupts at approximately 6 months of
age. Some dentists have noted a family pattern of "early," "average," or
"late" teethers.
ORDER OF ERUPTION
Upper Teeth
Central incisor 8-12 months
Lateral incisor 9-13 months
Canine (cuspid) 16-22 months
First molar 13-19 months
Second molar 25-33 months
Lower Teeth
Central incisor 6-10 months
Lateral incisor 10-16 months
Canine (cuspid) 17-23 months
First molar 14-18 months
Second molar 23-31 months
Signs & Symptoms Associated With Teething
Systemic
● General irritability and crying
● Fever (especially over 101 F)
● Diarrhea, runny nose and cough
● Prolonged fussiness
● Rash over the body
● Increased thirst
● Loss of appetite
Signs & Symptoms Associated With Teething
Local
● Increased drooling
● Restless or decreased
sleeping due to gum
discomfort
● Refusal of food due to
soreness of the gum region
● Bringing hands to the mouth
● Mild rash around the mouth
due to skin irritation secondary
to excessive drooling
● Rubbing the cheek or ear
region as a consequence of
referred pain during the
eruption of the molars.
Management

PREVENTIVE MEASURES
● Mention teething in prenatal counselling- the first postnatal oral issue
confronted
● Educate members of the family
● Advice maintain good oral and body hygiene
● Wipe gums after each meal with cotton soaked in weak antiseptic- 1:100
KMnO4 (Potassium permanganate)
● Provide adequate vitamins, minerals, proteins
TEETHING OBJECTS
● Satisfy the natural desire of the infant to
chew on hard objects
● Stimulates the gumpads for the smooth
and painless eruption
Teething toys
● Specifically manufactured teething rings,
keys, blowers, rattles
● Relief from soreness by the pressure
● Liquid containing ones – avoided
● Caution against cheap toys with lead
Teething foods
-Hard non sweetened firm rusks
-Toasted bread
-Biscuit preparations
- Hard fruits and vegetables, apple,guava,carrot
● Pacifiers releasing preventive agents- sodium fluoride, xylitol
● Teething necklaces
● Frozen items
Topical Medicaments
- glycerin
-lignocaine hydrchloride(tds/qid)
Caution : Rapid systemic absorption- toxic doses if misused
-benzyl alcohol
-mild purgatives (phenolphthalein, castor oil, calomel, milk of magnesia)
Only if local treatment has been ineffective
ANALGESICS
Sugar free Paracetamol preparations(5ml=120mg)
Dosage: upto 1year- 5ml at bedtime
1-5 years - 10ml at bedtime