Chronology of tooth development

The Topic of todays lecture is chronology of tooth development .We will talk about tooth development and eruption: The sequence, the order and the approximate time in which each tooth, whether a deciduous or a permanent, will erupt. What does chronology mean? Chrono means time , logy mean science so here we are talking about the science of time in relation to the development of the dentations , we know the primary (deciduous) and the secondary (permanent) dentition, so chronology deals with the timing of different stages of development .

Why do we need to know the timing of teeth development in dentistry? 1) To know the abnormal problems , for example , if I told you that the lower deciduous central incisors appear at 8 month normally and you have your little brother with an age on 1.5 year and still you havent seen any tooth in his mouth the you know that theres something wrong. So we need to know the normal cases to detect the abnormal ones. 2) In the field of orthodontics , they have to know the order and the sequence of the teeth development in order to adjust, detect and treat the patient orthodentically. 3) In Forensic dentistry sometimes when we have Forensic dentistry or forensic odontology is the proper massive disasters, like aircraft crash, and we handling, examination andevaluati on of dental evidence, which will have body remains, we identify these remains by be then presented in the interest of justice. checking the development of bones such as skull or by looking for the sequence or presence of the Wekipedia teeth, then looking back in the passengers records and identifying the person. 4) In pediatric dentistry as if you extract a deciduous tooth early you have to keep enough space for the permanent tooth to erupt in the
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right place , for example if you as a dentist has a child 6-7 years old with disastrous tooth that cant be treated so the only option is to extract this tooth, in this case we cant extract this tooth without maintain the space for the permanent tooth to erupt correctly ( this is called space maintenance), but u have to estimate the age of that child to know to use the space maintenance or not , for example a child is 11 years old that u need to extract his tooth but u know that in his age after 6 months his permanent teeth will appear so we dont have to maintain the space because the permanent tooth will erupt soon but again if the child too young 6-7 years old we have the maintain the space .
P.S : ( about space maintenance ) After and extraction of a tooth , the neighboring teeth will try to fill up that space by moving toward each other in an abnormal way , not leaving enough space for the permanent tooth to erupt in its normal position replacing the extracted tooth.

** How to estimate the age depending on looking at the teeth? Example: We saw a child with Lateral incisors and we know that lateral incisors erupt at age 8 so we conclude that the age of this child above 8 years. But at the same time we dont see the mandible canine which erupt at the age of 10 so this child is younger than 10 , so finally we conclude that the age of this child between 8-10 years .

** Mixed dentition stage: It is the Case when we have both deciduous and permanent teeth in the mouth at the same time (two sets of dentition deciduous and permanent at the same time.) It is also called "Transition Destination Stage"

Why do we have to have two sets of teeth ? Because when the teeth complete their development they dont grow in size while the other bones grow in size and length, So if you have just one set of teeth by the age of 14 you will end with very big jaw and very small teeth, and you will not function properly using this teeth, thats why you need to have new set of teeth with ** two important characteristics: 1- Bigger in size. 2- More in number.

** Remember:
1. Orthodontic 2. Pediatric dentistry 3. Forensic dentistry - Are very important areas for the application of the chronology of tooth development .

- This skull shows that the whole deciduous teeth have erupted . The last deciduous tooth to erupt is the second molar at the age of 2 and a half. The first permanent tooth to erupt is the first molar at age of 6 which hasnt erupted yet. By this we can say that this child is between the age of 2.5 to 6 years .

- All of the deciduous teeth are formed and all of them have almost complete roots .But regarding to the permanent teeth not all of them are formed yet . - If we look at the mandible we can see that the crown of the first permanent molar is almost full but there is no roots yet .

- We can see that all of the permanent teeth are fully erupted. In addition, we can see the maxillary and mandibular third molar , which erupts at the age let us say 22 , by this we can estimate that these are the teeth of an adult who is more that 22 years in age .

- This model shows : 1) Permanent central and lateral incisors. 2) Deciduous canines and underneath them the permanent ones . 3) Deciduous first and second molars with the first and second permanent premolars underneath. 4) The permanent first molar. 5) The permanent second molar which has not erupted yet.

We can see that the last permanent tooth erupted was the lateral incisor which usually erupts at age of 8 years. The next permanent tooth to erupt is the mandibular canine which erupts at age of 10 is not there yet . so we can estimate the age which is in here from 8 to 10 years old .

- "Prince Ahmed" asked the doctor: when you say erupt did you mean erupt going out or just formation of the tooth? the answer is: No, eruption means when the tooth starts to appear in the mouth, when you start to see the tooth in the mouth this is called eruption.

This table will show you different teeth and the different stages of development related to different teeth.

For example: If I come to a type at the age of 3 years, what teeth should I see? I will see the central incisor , only half of the crown has formed, lateral incisor maybe one third of the crown, canine only the cusp, but notice that I can see that the first molar has completed its crown, and the second molar I can see the very beginning of develop. So thats why they cant develop at the same time, each tooth develops specifically at different states of time.

- Lets start the story from the beginning. Why do we see teeth for a child in the uterus before birth? At the age of five months the baby still not born yet, you can see some deciduous teeth not permanent teeth of course. You can see the incisor edge of the central incisor, part of the incisor edge of the lateral incisor, some development of the third deciduous molar and very small development of the canine.

This is the Gum

At the age of seven months you can see the central incisor, lateral incisor, canine and first deciduous molar. Also you can see the initiation of development of the second deciduous molar.

At Birth when the child is born, You can see most of the crown of the central incisor and the lateral incisor, the tip of canine, and the development of maxillary first deciduous molar. This means that maxillary first deciduous molar precedes the canine, Although its located after it. Plus that you can see some development of the cusp of maxillary and mandibular second deciduous molar. * Notice that NO TEETH ARE ERUPTED AT BIRTH .

We dont see any development of permanent teeth at birth, we only see deciduous teeth, but at six months of age we started to see some development of tooth , which is the permanent first molar. Also you can see the initiation of development of the maxillary central incisor, mandible central incisor and some development of the lateral incisors. Thats why you can see the beginning of appearance of mandibular central incisor then the upper central incisor, after that the lower lateral incisor, finally the upper lateral incisor. * you should memorize the sequence.

At the age of nine months we can see more filtration in oral mucosa , so we can see 3 quarters of the crown of the first permanent premolar are appearing in the mouth, and less appearance for the permanent lateral incisor than the permanent central. At this age we still dont see any eruption of deciduous teeth, only we see eruption of the central and lateral incisors of deciduous teeth. But also at this age the development of almost half of crown of the permanent first molar have formed, and some crowns formation for the central, lateral and lower canine. We have some crown formation for the central and lateral incisors.
* Its Better if you check the slide's pictures to compare between Permanent and deciduous by the color , ( Grey = Deciduous , Brown = Permanent ) . * (+/- ) 2 Months , refers to the (range) , That The Time May Be Less Or More By Two Months .

- At

the age of one year we have new tooth appearing in the mouth , notice that the first tooth after the incisors is not the deciduous canine, you will see central then lateral then deciduous first molar Not the canine . This sequence is very important . also we can see the more development of permanent anterior teeth as well .

At the age of Two years notice that most of the deciduous teeth appear in the mouth as you see in the picture. But notice that although all the teeth appear in the mouth But not all the teeth come into contact , all the anterior teeth are in contact now But the posterior teeth are Not in contact although they appear. This means that this teeth will penetrate into the spaces until they make contact ( this is called the occlusal contact ) .

- At the age of second year as well we can see almost or less than the full development of the crown of the first permanent molars .

- At the age of 3 years All the deciduous teeth are erupted and they are in contact . By this age the child will be able to use the deciduous dentition functionally very well . It is the age of completion of the crown of the permanent first molar.

- At the age of 4 years all the deciduous teeth are erupted and also the crown of the first permanent molar is completed , and also we can see some development of the roots of the first permanent molar . * Before 6 years we dont see any permanent tooth.

- But with the start of 6 years we start to see new permanent teeth , which is the maxillary and mandible first molar .

- At the age of 7 years , There are more development until these 2 teeth become in contact , the child start to lose teeth at the age of 7 years . When the deciduous central incisors are replaced by permanent central incisors . - At the age of 10 years ,More lo st of the deciduous teeth take place , and also more developm ent and apparent of permanent teeth , and this appears in a sequence : 1- The Permanent lower central 2- The Permanent lower lateral 3- The Permanent upper lateral 4- The Permanent lower canine 5- The Permanent lower first premolar 6- The Permanent upper first premolar , 7- Then this three teeth erupt together ( the upper canine and the upper 1st and 2nd premolars the lower 1st and 2nd premolars ). ** Notice that at the age of 10 years we have some development of the second molar , and also the beginning of the development of the last tooth ( third molar )

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- At the age of 12 years , All the deciduous teeth are lost , so this is the end of the ( Mixed deciduous dentition stage ). * Why it is ended ? because all the deciduous has lost , So the mixed deciduous dentition stag starting at the eruption of the first permanent teeth , and ending by losing last deciduous teeth .

If I ask you an exam question and answer true or false y Q1 ) The first permanent tooth that erupt is the mandibular central incisor ? Answer: false , it is the permanent first molar y Q2) The first successor permanent tooth that erupt is the mandibular central incisor ? Answer : True , because molars is non successor permanent , but incisor is successor permanent tooth ( successor mean follows = replaced )

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That's why we can think about different stages of tooth development : 1- The first stage ( from birth until 6 months ) during that stage we dont have any teeth in the mouth * of course you know that all the teeth are represented in the jaw but not appearing in the mouth , we call this stage (edentulous stage ) we will come to this stage later on . an edentulous mean = no teeth . 2- The (primary deciduous stage) , (from 6 months to 3 years ) during this stage we will start to see teeth one by one eruption until 3 years, when all the teeth come in the mouth and they come in contact . * By this stag now the child is able to use his teeth functionally very well . This is why after 3 years we start to name it ( the functional deciduous dentition stage ) . from 6 month to 3 years , until the apparent of the first permanent teeth 3- Before 6 years we dont see any permanent tooth ,That is why we end the functional deciduous dentition stags to begin new dentition stages which is the (mixed dentition stage). 4- The permanent dentition stage . This stage is not fully functionally yet , there are some spaces between the molars ( second molars ) , once this second molars come into complete contact ( as in the picture ) we start to call it. 5- The functional permanent dentition stages , at 15 years old . *** Usually we dont rely on third molar ( wisdom teeth) in naming the different stages , because sometimes they are not present or impacted , thats why at the age of 15 years when these second molars becomes in contact it is the beginning of the functional permanent dentition stage , and it remains until the teeth start to be lost by very old ages .

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** Here is a summary about the teeth development of different stages, and the sequences of those development .

- Here we are giving numbers to the teeth and these numbers are the sequence of eruption not the palmar notation numbers .

(( Recall from the introduction to dentistry that the mandibular teeth arises before the maxillary ones even if their average of eruption is in the same time .))

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Tooth in the left and right side appear in the same. time.

Order of Eruption (Inter-arch)

Deciduous
Jordanian population

Permanent
Jordanian population*
(except 3rd molars)

Maxillary Mandibular

64532 2465618 9 64531 1355617 9

The contra-lateral side has the same order of eruption

*Shaweesh, AI. (2012A). Timing and Sequence of Emergence of Permanent Teeth in the Jordanian Population. Archives of Oral Biology 2012; 57(2):122-130
Shaweesh

AI, Bataineh OB, Alsoreeky E. Timing of Emergence of Deciduous Teeth in the Jordanian Population (unpublished)

The Eruption sequence of permanent teeth are 1- Lower central incisors & lower first molar & upper first molar *these teeth appear in the mouth during the same period of the time 2- Maxillary central incisor 3- Mandible lateral incisor 4- Maxillary lateral incisor 5- Maxillary & mandible first premolar and the mandible canine 6- Upper canine , maxillary second premolar and mandible second premolar (( If u have u dont have enough space ,,, the canine will erupt outside ! )) 7- Mandible second molar 8- Maxillary second molar 9- The mandible and maxillary third molar will erupt

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Order of Eruption (Inter-arch) in Jordanian population : The order for the permanent teeth : 1- Lower central incisor, lower first molar and upper first molar 2- Maxillary central incisor 3- Mandible lateral incisor 4- Maxillary lateral incisor 5- Mandibular canine , mandibular first premolar and maxillary first premolar 6- Second premolars upper and lower ones and upper canine ** If we dont have enough space in the mouth for the teeth to erupt the tooth that will be mostly affected is the upper canine because the premolar which come after it anatomically precedes it in the eruption so there is a chance that this premolar wont let enough space for the canine to come out . 7- Mandibullar second molar 8- Maxillary second molar 9- Third molars upper and lower

Notice thatThis is an : *(Inter- arch sequence) which is according to the time of eruption in both arches : maxillary and mandibular arches together .

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- In the same way we can arrange the time of eruption for each arch separately -within the same arch- that is called ( Intra-Arch Sequence )

Order of eruption for permanent teeth (Intra-arch) : sequence For the maxilla 1 First molar 2 3 4 5 6 7 Central incisor Lateral incisor First premolar Canine + second premolar Second molar Third molar For the mandible Central incisor + first molar Lateral incisor Canine + first premolar Second premolar Sec molar Third molar

Order of eruption for deciduous teeth ( Intra-arch) : sequence For the maxilla 1 Central incisor 2 Lateral incisor 3 4 5 First molar Canine Second molar For the mandible Central incisor Lateral incisor + first molar Canine Second molar

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Timing of emergence of permanent teeth in Jordanians (Shaweesh, 2012A)

Combined gender Males Median age 7.25 8.45 11.56 10.45 11.37 6.35 12.61 6.48 7.51 10.63 10.54 11.73 6.24 12.19 Percentile 5th 5.78 6.51 9.09 7.96 8.87 5.25 10.3 5.38 6.05 8.30 8.11 9.13 5.16 9.87 95th 8.71 10.39 14.04 12.94 13.88 7.45 14.92 7.59 8.97 12.97 12.98 14.32 7.32 14.51 Median age 7.11 8.07 11.09 10.01 11.00 6.20 12.32 6.32 7.34 9.84 10.12 11.20 6.08 11.66 Females Percentile 5th 5.84 6.52 8.74 7.65 8.53 4.81 9.98 5.00 5.94 7.86 7.83 8.65 4.66 9.13 95 th 8.39 9.61 13.43 12.38 13.47 7.59 14.65 7.65 8.74 11.82 12.41 13.74 7.50 14.19

Tooth
1 2 3

Median age 7.18 8.26 11.30 10.23 11.17 6.27 12.44 6.40 7.43 10.23 10.32 11.44 6.16 11.90

Percentile 5th 5.80 6.47 8.91 7.79 8.69 5.01 10.14 5.16 5.99 8.01 7.96 8.87 4.88 9.47 95 th 8.56 10.06 13.70 12.66 13.65 7.52 14.74 7.63 8.87 12.45 12.69 14.00 7.45 14.33

Maxillary

4 5 6 7 1 2 3

This slide represent Data relating to the Timing of emergence of permanent teeth in Jordanian population . This slide

Mandibular

4 5 6 7

- Usually females erupt their teeth before males . - Combined gender data : data that can be used for males and females at the same time . - Percentile: the normal range (time) for a teeth to erupt, it is important in telling if the eruption in a person is normal or not . - Here we can see that data are in years because it is for permanent teeth . We have to memorize the Median age for eruption in the maxilla and the mandible .

Timing of emergence of deciduous teeth in Jordanians (Shaweesh et al*)

Total Sample (M+F) Tooth Median Percentile FDI (Mths) 5th 95th Tooth FDI 51 10.5 5.0 16.0 51 52 13.0 7.3 18.6 52 53 20.3 14.2 26.4 53 54 15.5 10.8 20.2 54 55 27.5 20.5 34.4 55 81 8.6 3.1 13.4 81 82 14.3 7.7 20.8 82 83 20.4 14.5 26.4 83 84 16.0 11.1 20.9 84 85 27.5 20.1 34.8 85
Shawees h AI,

Males Median (Mths) 10.5 12.9 20.6 15.5 27.7 8.3 14.6 20.9 16.1 27.7

Percentile 5th 95th Tooth FDI 5.1 15.8 51 7.2 18.5 52 14.3 26.9 53 11.3 19.7 54 20.5 35.0 55 3.6 13.1 81 7.6 21.5 82 14.8 27.0 83 11.7 20.6 84 20.0 35.5 85

Females Median Percentile (Mths) 5th 95th 10.6 4.9 16.3 13.1 7.5 19.0 19.8 14.3 25.4 15.5 10.2 20.9 27.2 20.5 33.8 8.1 2.6 13.6 13.9 7.9 19.8 19.8 14.4 25.2 15.8 10.3 21.4 27.2 20.3 34.0

This is the Timing of emergence of deciduous teeth in Jordanians, and the data are in months .

Bataineh OB, Alsoreeky E. Timing of Emergence of Deciduous Teeth in the Jordanian Population (unpublis hed)

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Sequence of emergence of permanent teeth in Jordanians (Shaweesh, 2012A)

Rank 1 1 1 2 3 4 5 Inter-arch 5 5 6 6 6 7 8 Tooth mand. 6 max. 6 mand. 1 max. 1 mand. 2 max. 2 max. 4 mand. 3 mand. 4 max. 5 max. 3 mand. 5 mand. 7 max. 7 Median age 6.16 6.27 6.40 7.18 7.43 8.26 10.23 10.23 10.32 11.17 11.30 11.44 11.90 12.44 Mandibular Maxillary Rank 1 2 3 4 5 5 6 1 1 2 3 3 4 5 Tooth max. 6 max. 1 max. 2 max. 4 max. 5 max. 3 max. 7 mand. 6 mand. 1 mand. 2 mand. 3 mand. 4 mand. 5 mand. 7 Median age 6.27 7.18 8.26 10.23 11.17 11.30 12.44 6.16 6.40 7.43 10.23 10.32 11.44 11.90

This represents the Sequence of emergence of permanent teeth in Jordanians: Here we have to memorize arrangment of the eruption in the intra-arch and inter-arch orders , and the Median age at which the tooth erupt .

- Emergence of the tooth mean: surfacing - emerging to the surface and becoming apparent. - Eruption means: the full process of movement of the tooth .

This slide represents the Polymorphisms in sequence of permanent tooth emergence.

Polymorphisms in sequence of permanent tooth emergence (Shaweesh, 2012B)

Shawees h AI. Polymorphis ms in s equence of permanent tooth emergence: a cros s-s ectional study on Jordanian children and adolescents. Acta Odontologica Scandinavica 2012 Jan 3. [Epub ahead of print]

- Polymorphism :is the case where the teeth do not fallow the normal order in eruption (abnormal eruption sequence) . - Here we also have to memorize these data Some examples to help you reading the schedule: - What is the percentage of people who erupt 11 before 16 ? 5%- What is the percentage of people who erupt 13 before 15 Relating to the FDI system ? 41 % And so on.
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The Big 10 points for this Lecture

1- Chronology is the science of time and when we relate it to the teeth development; it tells us the timing and the sequence for tooth development and eruption. 2- Chronology is important in age estimation when the actual DOB is unknown, in Forensic and in pediatric dentistry. 3- There are 3 stages for tooth eruption (in sequence): 1- Primary dentition stage: when all teeth are primary. 2- Mixed dentition stage: when theres some primary and other permanent teeth. 3- Permanent dentition stage: when only permanent teeth are present. 4- Order of eruption for both the deciduous and permanent dentition and timing. (can be memorized easily from the tables that are provided in the Doctors presentation) 5- On 3 years, we have a stage that is also called The functional deciduous teeth stage because the deciduous dentitions are now complete and in full occlusion. 6- Emergence as a word is better used than eruption; because emergence describes the exact moment and stage of a tooth appearance in the mouth while eruption describes the full movement process of a tooth.

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7- Polymorphisms in emergence sequence: variations in the sequence of the permanent teeth emergence in children and adolescents. 8- Some people have a reverse sequence. You need to know the percentage of people who have this from the tables. 9- Times of developmental stages: 1- first evidence of calcification 2- Completion of crown 3- Occlusal contact with opposing tooth 4- Root completion

10- Approximately at age of 12 years ( 6 months) there will be no deciduous teeth and the child will have a full permanent dentition. (Permanent dentition stage, lasts for the rest of life)

Quote of the Day : The hero dont blame anyone but himself , he don't put excuses and thats what make him a Hero . Rmz Rabadi Hadeel Sumrien Hebah Ramadnah A9eel Ghawanmeh Russia ElShboul Salam Ahmed Abeer M. Dirawi Ahmed AlShamary Eman Idkaidek Eman Nazzal Hibah Jarrah Sawsan Z. Jwaied Noha Mohamad Rawda Najjar GaYda'a Kana'an SunDos Abu-zaid

P.S: We will not end this script without showing our appreciation to "Dalya Mohamad" for providing us with her Recorder .

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