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Department Of Paediatric dentistry PREDENTATE PERIOD
PREDENTATE PERIODDefinition: Refers to the period from birth to the eruption of thefirst deciduous teeth in the oral cavity.GUM PADS :- The alveolar arches of an infant are called gum pads. Gum pads are firm & pink in color Gum pads develop in 2 parts. - Labial portion - Lingual portion These portions are separated from each other by adental groove which is the site of origin of the dental lamina
UPPER GUM PAD• Horseshoe Shaped• Upper Gum pad is divided into 10 Segments by transverse groove.• Gingival groove separates the gum pad from palate.• Dental groove originates in the incisive papilla region & extends backwards to touch gingival groove in the camine region.• Lateral Sulcus:- Present between deciduous canine & first molar segment.
LOWER GUM PAD• U-Shaped with its anterior portion averted labially• Lower gum pad is divided into 10 segments by Transverse groove.• Gingival groove separates the gum pad from floor of the mouth.• Dental groove – Running backwards and join the gingival groove in the canine region.• Lateral sulcus – Present between deciduous canine & first molar segment.
RELATIONSHIP OF THE GUM PADS• At rest gum pads are separated by the tongue.• The lateral sulcus of lower gum pad lies distal to that of the upper.• Variable overjet with contact only In the first molar segment.• During function – Mandible moves vertically & in anteroposterior direction. Lateral movements are absent.
Growth of gum Pads:• At birth the width of gum pads are inadequate to accommodate all the incisors.• Growth of gum pad is rapid in first year after birth.• More in transverse & labio-lingual direction. CLEANING OF GUM PADS• Started within the first week of birth• The parent can be instructed to:- Lay the baby down with his/her head in your lap & feet pointing away.• Take a small gauze ( 2” x2”) between thumb and forefinger & wipe vigorously over the gum pad
• Now a days specially designed:- – infant tooth brush – Finger coats – Wipes are used• Use adequate pressure just to remove the film that covers the gum pad.• Clean at least every day twice after morning & last feed in the night.• Duration of cleaning :- 2 to 3 minutes.
PRECOCIOUSLY ERUPTED TEETH.2. Natal Teeth :- Present since birth2. Neonatal teeth: Erupt during neonatal period. ( upto 28 days after birth)3. Predeciduous dentition:- Erupted after 28 days and before six months after birth.
Soft Tissue lesions which are seen during predentate period.• CONGENITAL EPULIS :- Soft tissue tumer that occurs on the gum pads Clinical features :- Pink to red in color Smooth surfaced Polypoid mass. size – 2 cm. – 7.5 cm. Maxillary > mandibular Lateral to midline ( in lateral insisor and canine region) Female > Male Treatment :- Can be seen in utero by ultrasound After birth :- It diminishes in size. Otherwise :- Surgical excision
Epstein pearls or Bohn’s noduleSmall superficial, Keratin filled cysts that are foundon the alveolar mucosa of infant. Clinical Feature:-– Small, usually multiple, whitish papules on the mucosa overlying the alveolar process of neonate.– Size of individual :- 2 to 3 mm.– Maxilla > mandible Treatment:- Spontaneous involute at a result ofrupture of cyst.Rarely seen after 3 months of age.
Rega fede disease• Ulceration on the ventral surface of tongue caused by sharp edges of natal & neonatal teeth.Clinical Feature:- – Mild to severe ulcerations on ventral surface of tongue. – Interfere with infants feeding & suckling
Treatment:- – If the tooth is mature & root is sufficient to retain the tooth than • Smoothening of the incisal edge • Placement of a smooth & rounded composite – In case of larger lesion • Extraction of offending tooth with vitamin K supplementation ERUPTION CYST • Associated with natal and neonatal teeth.
• Clinical Feature:- – Usually symptomless – Sometimes : Interfere with feeding Bleed intermittently – Appear as clear or blood tinged, fluid filled masses on the crest of the alveolar ridge.• Treatment:- – Usually disappear when the underlying tooth erupt. – If it is painful or infected or if the lesion bleeds than it should be drained and natal or neonatal teeth are removed.
Transient Malocclusion During Predentate Period1. RETROGNATHIC MANDIBLE• Mandible is severely retruded during predentate period.• It is retruded 14 degree at birth• Corrected by forward growth of mandible
2. OPEN BITE OF GUM PAD:-• Corrected when incisor teeth fully erupts.
References:• Textbook of pedodontics- Shobha Tandon• Oral & maxillofacial pathology- 2nd edi.- Neville, Damm , Allen, Bouquot• A textbook of oral pathology- 4th edi.- Shafer