Eruption & Teething

1. Eruption & Teething
Dr. Sudeep M. Chaudhary
Dept of Paedodontics & Preventive Dentistry

2. Contents
●Introduction
●Physiological tooth movements
●Theories of tooth eruption
●Teething
●Management of teething

3. 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.

4. 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.

5. 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
2)Root Formation
3)Periodontal Ligament
Traction
4)Pulpal constriction theory
4)Pressure from muscular
action
6)Resorption of alveolar crest
3)Vacularity theory
4)Hormonal theory

6. 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.

7. 2)Root Formation Theory
Proliferating root impinges on a fixed
base
Apically directed force
Occlusal movement of tooth

8. 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

9. 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.

10. 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.

11. 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

12. ● 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
Systemic
Signs & Symptoms Associated With Teething

13. Signs & Symptoms Associated With Teething
● 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.
Local

14. 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

15. TEETHING OBJECTS
● Satisfy the natural desire of the infant to
chew on hard objects
● Stimulates the gumpads for the smooth
and painless eruption

16. 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

17. Teething foods
-Hard non sweetened firm rusks
-Toasted bread
-Biscuit preparations
- Hard fruits and vegetables, apple,guava,carrot

18. ● Pacifiers releasing preventive agents- sodium fluoride, xylitol
● Teething necklaces
● Frozen items

19. 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)

20. 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