PEDODONTICS

2. ERUPTION AND SHEDDING
OF TEETH

3. REFERENCES
1) Mc Donald and Avery’s Dentistry for the child and adolescent
( 9th edition )
2) Pediatric Dentistry- Infancy through adolescence – Jimmy
Pinkham ( 4th edition )
3) Fundamentals of Pediatric Dentistry- Mathewson ( 3rd edition )
4) Forrester
5) Stephen wei
6) Text book of Oral histology –Orbans (12th edition )
7) Ten Cates Oral histology development , structure and function
(7th edition )

4. CONTENTS
-Introduction
-Definition
Eruption
Shedding
ERUPTION:
-Pattern of tooth movement
Pre eruptive
Eruptive
Post eruptive
-Histology of tooth movement
-Mechanism of tooth
movement(THEORIES OF ERUPTION)

5. -Cellular and molecular events in eruption
 -Clinical considerations
 -Factors associated with eruption
SHEDDING:
 -Shedding of teeth
 -Pattern of shedding
 -Histology of shedding
 -Mechanism of resorption and shedding
 -Clinical considerations

6. INTRODUCTION
-The word “ERUPTION” properly refers to “ the cutting of
the tooth through the gum”.
-Derived from: Latin word-ERUMPERE meaning “ To break
out”.
-Eruption is the axial or occlusal movement of the tooth
from its developmental position within the jaw to its
functional position in the occlusal plane.

7. -The emergence of the tooth through the gingiva is the first
clinical sign of eruption.
-Human dentition consists of two generations or sets of
teeth ,
first : the deciduous,and ,second : permanent.
-Shedding is loss of tooth by physiologic resorption of roots
and supporting tissues

8. DEFINITION
ERUPTION :
The act of breaking out , appearing or becoming
visible. For a tooth, it is the process of moving
through alveolar bone into the oral cavity.
(PINKHAM)
The axial or occlusal movement of the tooth from its
developmental position within the jaw to its functional
position in the occlusal plane.
(ORBAN’S)
SHEDDING:
The physiologic process resulting in the elimination
of the deciduous dentition is called SHEDDING or
EXFOLIATION.
(ORBAN’S)

9. TYPES OF TOOTH ERUPTION
1.Continuosly growing:
Tooth formation and eruption occurs throughout life.
The dental tissues are formed from a proliferative base.
The anatomic crown & root are very similar morphologically.
Ex: incisors of RODENTS like; rats, mice, squirrels etc.

10. 2.Continuosly extruding:
Tooth formation stops once root formation is complete.
No alveolar bone remodelling present in response to
eruption.
Well defined anatomic crown & root.
 Associated with moderate occlusal wear.
Ex; lower incisor of SHEEP & CATTLE

11. 3.Continuosly invested:
Tooth formation stops after root formationis complete.
Alveolar bone remodelling present in response to eruption.
Distinct anatomic crown and root.
Ex: HUMANS

12. PATTERN OF TOOTH MOVEMENT
The physiologic tooth movement is divided as :
1) Pre eruptive tooth movement
2) Eruptive tooth movement
3) Post eruptive tooth movement

13. PRE ERUPTIVE TOOTH MOVEMENT
Made by the deciduous and permanent tooth germs
within tissues of the jaw before they begin to erupt.
It’s a combination of 2 factors:
1) Total bodily movement of tooth
2) Eccentric growth:Growth in which one part of tooth
germ remains fixed while the rest continue to grow,
leading to a change in centre of tooth germ.

14. Movements of primary and permanent tooth crowns from
the time of early initiation and formation to the time of
crown completion

15. Crowns of permanent teeth move within the jaws
adjusting their position within jaws,to the resorbing
primary roots and remodelling alveolar bone.
•Permanent anterior teeth and pre molars:

16. *Maxillary molars:
Slanting distally and
Then change the
direction to vertically.
*Mandibular molars:
are slanting mesially which then
change their direction with the
growth of jaws.
•All movements occur within the
bony crypts

17. Root formation: begins with proliferation of Hertwig’s
epithelial root sheath
Initiation of root dentin and formation of pulp tissue of
forming root takes place with time.
Movement:
Due to enlarging root there is movement of teeth
occlusally/incisally through bony crypt of jaws.
Rate of eruption during intraosseous phase1-10µm/day which
increases to 75µm/day once tooth escapes from bony cell.

18. •Reduced enamel epithelium comes in contact with oral
epithelium
R.E.E proliferates and forms a thin attachment with oral
epithelium.
Fused double layer over erupting crown is
formed.
Penetration:crown enters oral cavity by breaking
through the centre of double-layered epithelial cells.

19. ERUPTIVE TOOTH MOVEMENTS
During this phase , the tooth moves from its position within the
bone of the jaw to its functional position in occlusion, and the
principle direction of movement is occlusal or axial.
Starts with initiation of root formation and ends when teeth
reach occlusal contact
•Events :
•Root formation
•Movement
•Penetration
•Intra-oral/incisal movement

20. Lateral borders of oral mucosa
become dento-gingival junction
and R.E.E as attachment
epithelium.
Intra-oral occlusal/incisal
movement:
Erupting tooth moves occlusally
and there is gradual exposure of
clinical crown
Gradual exposure of clinical
crown by separation of the
attachment epithelium from the
crown and resulting apical shift
of gingiva

22. POST ERUPTIVE TOOTH MOVEMENT
Are those made by the tooth
after it has reached its functional
position in the occlusal plane.
Movements made by the tooth
after it has reached its functional
position
Active eruption: to compensate
incisal and occlusal wear
Passive eruption:the apparent
lengthening of the crown due to the
loss of attachment, or recession of
the gingiva.

23. Both active and passive eruption leads to
lengthening of clinical crown
It is divided into 3 categories :
1)Movements to accommodate the growing jaws
2)Those to compensate for continued occlusal wear
3)Those to accomodate interproximal wear

24. •Movements to accommodate
growing jaws:
• growth of jaws:
completed towards the end of 2nd decade
of life
Maximum at 14-18yrs of age
•Histologically –readjustment of position of tooth socket
achieved by formation of new bone at alveolar crest and
socket floor.
•Earlier in girls than boys
•Apices of the teeth move 2-3mm away from the inferior
dental canal(considered fixed reference point)

25. •Compensation for occlusal
wear:
•Achieved by continued deposition of cementum
at the apices of the root,
this occurs only after tooth has moved.

26. Accomodation for interproximal
wear:
Interproximal wear is compensated by
mesial/approximal shift
•The forces causing this are:
•1.anterior component of occlusal force:
When the teeth are clenched an anterior
component of force is created
Molars: mesial inclination and summation of
inter-cuspal force

27. When teeth are brought in contact ,ex:when
jaws are clenched , a forwardly force is
generated . This force is a result of
Mesial inclination of most teeth.
Summation of intercuspal plane producing a
forwardly directed force.
In case of incisor which are inclined labially ,
it is expected that they move in same
direction BUT infact they move MESIALLY
explained by “BILLIARD BALL ANALOGY”

28. •if 2 balls are in line with the pocket ,no matter how the first is
struck, the 2nd will enter the pocket because, it travels at right
angles to common tangent between the balls.
•Following this
example the CANINES
and INCISORS move
in direction at right
angles to the common
tangent drawn
through contact
points. This leads to
IMBRICATION often
found in older
dentition

29. 2.Contraction of transeptal fibres:
•These fibres maintain the contact between the teeth by
drawing them together.

30. HISTOLOGY OF TOOTH MOVEMENT
Tissue changes occuring in this stage:
Changes overlying teeth:
dental follicle forms pathway
for erupting teeth
•zone of degenerating
connective tissue fibres and
cells overlying teeth appear first
•Altered tissue area become
visible as an inverted triangular
area - Eruption
pathway

31. At the periphery of eruption pathway fibrocellular
follicle directed towards the mucosa regarded as
gubernacular dentis/cord are directed towards mucosa
:small canal located between the permanent tooth germ
and the apex of the deciduous tooth,
containing remnants of dental lamina and connective tissue.

32. •The canals which carry these fibers is called
gubernacular canal .
•It is also said to be the connection between oral
epithelium and dental follicle.
•Changes in the alveolar bone:
•Osteoclasts are present on the bone above the
erupting tooth
•Circulating monocytes fuse with each other to
form multinucleated osteoclasts
•Resorption occurs by osteoclasts cell
membrane coming in contact with bone .

33. •Bone becomes modified
by an enfolding process
called ruffled border.
• The ruffled border
increases surface area for
osteoclasts and allows cell
to function maximally in
bone resorption.

34. •Hard tissue resorption is
similar to root resorption
• occurs in 2 phases:
extracellular
intracellular
•Extracellular :minerals are
separated from collagen
•Intracellular: ingestion and
dissolution of mineral
fragment

35. Changes surrounding
the teeth:
•Tissue around the teeth
change from delicate fine fibres
lying parallel to the surface to
bundles of fibres attached
between tooth surface
extending towards the
periodontium.

36. •The first noticeable periodontal fibre bundles appear at
the cervical area of the root and extend coronally to the
alveolar process.
•With root formation bundles of fibres appear on root
surface
•height of alveolar bone increases
•Collagen fibre formation and fibre turnover is rapid
occurs within 24hrs
•Fibres increase in number and density and Blood vessels
become more dominant in developing ligament exert
additional pressure on erupting tooth

37. •Underlying the
teeth:
•As the crown moves
occlusally ,it provides
space for the tooth root to
lengthen.
•Fibroblasts are in great
number in fundic area
•Formation of collagen
fibres around root apex

38. •Some of the fibres mature into calcified trabaculae
•Delicate bony ladder is formed at the root apex
• bony ladder remains till the tooth
reaches the functional occlusion
•Dense bone formation after tooth
reaches
functional occlusion
•Attachment of fibre bundles from
cementum to alveolar bone

39. THEORIES OF TOOTH MOVEMENT
BONE REMODELING THEORY :
• Selective bone resorption and deposition brings about
eruption.
Major proof : when a mandibular PM is removed without
disturbing its follicle or you wire down the tooth germ, an
eruptive pathway still forms within bone as
osteoclasts widen the gubernacular canal.
If the dental follicle is also removed no eruption path develops.
So not sure if bone remodeling plays a significant role but is
involved.
One point to remember: Bone formation also occurs apical to
the developing tooth

40. ROOT FORMATION THEORY
Root formation follows crown formation, and involves cellular
proliferation and formation of new tissue.
If the root formation is to result in an eruptive force , the
growth of the root needs to be translated in to occlusal
movement , and requires the presence of a fixed base.
•Root formation should be an obvious cause of tooth eruption
Supporting feature:
•The tissue beneath the growing root resists the apical
movement of the developing root. Resistance results in the
occlusal movement of tooth crown as the root lengthens.

41. Shortcomings of the theory:
•If a tooth is continuously erupting is prevented,the root still
forms by causing bone resorption
•Rootless teeth still erupt
•Some teeth erupt more than their root length
•Teeth still erupt after completion of root formation.
•Therefore root formation is accommodated during eruption
and may not be the cause for tooth eruption
•Root formation produces a force which causes bone
resorption by osteoclasts.

42. VASCULAR PRESSURE THEORY:
The teeth move in synchrony with the arterial
pulse, so local volume changes can produce limited
tooth movement.

43. PERIODONTAL LIGAMENT TRACTION THEORY
 There is a good deal of evidence that the eruptive forces
resides in the dental follicle-periodontal ligament complex.
> Formation and renewal of PDL has been considered a factor
in tooth eruption because of the traction power that fibroblasts
have.
> Force for eruptive tooth movement resides in periodontal
ligament which pulls the tooth out

44. > Mechanism: Forces necessary for
generating tooth eruption may be
by:
-Randomly oriented fibres become
ordered
-Contraction of collagen due to
crosslinking
-Remodeling of periodontal ligament
collagen by fibroblasts

45. Evidences:
Experiment by interfering with collagen synthesis by
denying Vit C or by injecting latharytic agent slowsdown
or stops tooth movement.
shortcoming: in case of osteopetrotic mutations a
periodontal ligament is present but teeth do not erupt

46. DENTAL FOLLICLE THEORY
It is believed that there is signalling between the REE and dental
follicle.
# BIOLOGIC CLOCK: Stellate reticulum releases factors and by
so doing provides a biologic clock that regulates the timing of
tooth eruption.
# Studies have shown that the reduced dental epithelium
initiates a cascade of intercellular signals that recruit osteoclasts
to the follicle.

47.  # By providing a signal and chemoattractant for osteoclasts, it
is possible that the dental follicle can initiate bone remodeling
which goes with tooth eruption.
 # Teeth eruption is delayed or absent in animal models and
human diseases that cause a defect in osteoclast differentiation.

48. CELLULAR & MOLECULAR EVENTS IN
ERUPTION
Eruption is a localised genetically programmed event
Dental follicle contains genes concerned with eruption
Paracrine signalling from the stellate reticulum affects
gene expression of molecules from dental follicle
Many molecules regulate eruption, there are more than
one having similar and overlapping function(redundancy
in function)

49. Dental follicle acts as a target tissue for mononuclear
cells that come from blood stream.
Dental follicle cells secrete CSF-1 and MCP-1
CSF-1 and MCP-1 increases the rate of eruption by
increasing the recruitment of monocytes and
formation of osteoclast.

50. IL-1 increases the
eruption rate
IL-1 increases MCP-1
secretion and CSF-1
formation
MCP-1 formation is
increased by IL-1, TGF-
b1, EGF and CSF-1
MCP-1 increases
maximally just before
influx of mononuclear
cells then their number
decreases.
PTHrp, IL-1 from stellate
reticulum play similar
role as that of the dental
follicle.

51. Parathyroid
hormone
related protein
+CSF-1
decrease
expression of
OPG
osteoprotegerin
Interferes with
binding of RANKL
to RANK (receptor
activated nuclear
factorK)receptor in
alveolar bone

52. ARTICLE:
GE Wise. Cellular and molecular basis of tooth eruption. NIH
Public Access Orthod Craniofac Res . 2009 May ; 12(2): 67–
73
AIM: objectives of our investigations have been to determine
how the DF regulates both the osteoclastogenesis and
osteogenesis needed for eruption.
CONCLUSION:
The osteoclastogenesis and osteogenesis needed for
eruption are regulated by differential gene expression in the
DF both chronologically and spatially.

53. CLINICAL CONSIDERATIONS
LINGUAL ERUPTION OF MANDIBULAR PERMANENT
INCISORS
It is common and this pattern should be considered
essentially normal.
The tongue and the alveolar growth seems to play an
important role in influencing the permanent incisors to a
more normal position with time..

54. TEETHING AND DIFFICULT ERUPTION
Teething is a process by which teeth erupt after
penetrating the overlying gums.
In most children eruption of primary teeth is preceded
by increased salivation and the child wants to put the
hand and fingers into mouth

55. Child puts whatever it finds into the mouth
If relief not given the child becomes
wakeful,fretful,restless,refusing nourishment
•The signs of teething may be manifested both locally And
systemically
Local: redness or swelling of the gingiva over the erupting
tooth.
Systemic:
general irritability.
Loss of appetite
Sleeplessness
Increased salivation
Reduced appetite
Increased thirst
Circumoral rash

56. •Treatment:
•local:
•chewing on clean,hard,cool objects gives relief from
soreness
•Chilled teething rings and rattles,cold wet flannels,chilled
vegetables can be given to bite on.
•Teething toys have a softening agent disononyl pthalate
which causes cancer in children so not to be used

57. •Topical medicaments:
•Can be given if pain is unbearable
Systemic:
Considered if localtreatment
is ineffective
types of drugs used:
1.analgesic
•1.Analgesic:
•Several sugar –free Paracetamol preparation are
available
•5ml contains 120mg of Paracetamol
•Dosage: 5ml at bedtime

58. Guidance of treatment:
Complaint: treatment:
Irritation at the site of - topical application
tooth eruption
Day time irritability - topical application and
and fretfullness systemic analgesic
Disturbed sleep - topical application,
systemic analgesic &
hypnotic

59. ARTICLE:
Mahtab Memarpour, Elham Soltanimehr and Taherh
Eskandarian. Signs and symptoms associated with
primary tooth eruption: a clinical trial of
nonpharmacological remedies. Memarpour et al. BMC
Oral Health (2015)
AIM: To evaluate disturbances in primary tooth eruption
and their management with nonpharmacological
remedies.
CONCLUSION: There was no association between
teething and symptoms such as fever or diarrhea. Low
birth weight children may have more teething
symptoms. Teething rings, cuddle therapy and rubbing
the gums were the most effective methods to reduce
symptoms.

60. ERUPTION HEMATOMA ( ERUPTION CYST )
•Bluish purple ,elevated area of tissue
developed few weeks before
eruption of primary or permanent
teeth
•Seen in :2nd primary molar
• 1st permanent molar
•Believed that the condition develops
as a result of soft tissue trauma
during function.
•Hematome subsides within few
days the tooth breaks through the
soft tissue
•Treatment : not necessary
•Surgically uncovering of crown
might be occassionally necessary

61. ERUPTION SEQUESTRUM
Hard tissue fragment is seen ocassionally at the time of eruption of first
permanent molars.
•Present at the central fossa of the associated tooth underlying soft tissues
•As the tooth erupts,cusps emerge,fragment sequestrates
•Treatment if it remains after eruption:
•Remove the sequestra either with topical anaesthesia or by infiltration of L.A

62. ECTOPIC ERUPTION Tooth erupts or tries to erupt in an
abnormal position.
May be because of :
>Arch length inadequacy
>Tooth mass redundancy
>Or a variety of local factors.
*ARTICLE:
Rie kojima,Yo taguchi,Hiroki kobayashi,Tadashi noda. External
root resorption of the maxillary permament incisors caused by
ectopically erupting canines.
J C P D2002;26/2:193-7
AIM OF THE STUDY:
To investigate cases of incisor root resorption caused by
ectopically erupting canines and to clarify the relationship
between the prognosis of the resorbed incisor and the
condition of the ectopic canine.

63. NATAL AND NEONATAL TEETH
CONCLUSION: Resorptive areas were detected in the apical third of
affected root of , middle third as well as in the cervical third.and
ectopically erupting canine showed mesial inclination between 0 to
37 degrees.
Ectopic eruption of maxillary permanent canines occur in
approximately 1.5% to 2% of the population.and among them ,about
12% resorb the incisor root.

64. •Natal teeth-present in mouth at birth
•Neo-natal teeth-present within 30days of birth
•Prevalance 1 in 2000-3000 live births
•Tooth involved:lower central incisor
• rarely maxillary incisors and molars
•Cause:
•ectopic positioning of tooth germ during fetal life
•Endocrinal disturbances, congenital syphilis ,dietary
deficiencies
•Shows heriditary /familial pattern

65. •C/F :
•Natal/neo-natal teeth are very mobile.
• lack root development
• crowns occasionally dilacerated
• enamel hypo plastic /hypomineralised
• surrounding gingival tissue inflamed
• ventral surface of tongue ulcerated
• teeth left in-situ will continue root development
and attain normal mobility
Complications:
- Feeding problems
-Aspiration of tooth
- riga fede disease

66. Sublingual ulceration(Riga fede)
described by Antonio Riga1881 and published by
F.Fede1890
Traumatic ulceration occurring on the ventral surface of
the tongue.
Occurs in infants with natal and neo-natal teeth
Also in infants with repetitive tongue thrusting habits
and familial dysautomia

67. Enlarged fibrous mass on the ventral surface of tongue with appearance
of an ulcerative granuloma.
Leads to dehydration and inadequate nutrient intake for infants
Treatment:
Teeth modified by smoothening the edges of lower incisors with finishing bur or
sandpaper disk
Small increments of composite may be bonded to the incisal edges of teeth
Treatment with ointment Kenalog in orabase relieves symptoms
Child should be assessed daily for dehydration
If conservative treatment options do not lead to rapid resolution of this lesion –
extract the lower incisor
Not necessary to remove the lesion
If persists after tooth extraction –excisional biopsy should be done.
Sippy cups with modified lid –holes are increased to increase flow of liquids

68. EPSTEIN PEARLS, BOHN NODULES , & DENTAL LAMINA
CYSTS
•Epstein pearls: formed along mid-palatine raphae.
•Considered as epithelial tissue trappped along the
raphae as fetus grows.

69. Bohn’s nodules: formed
along buccal and lingual
aspect of dental ridges
and on palate away from
the raphae
•Remnants of mucous
glands
•Dental lamina cyst:
•Found on crest of maxillary
and mandibular dental
ridges
•Remnants of dental lamina

70. ANKYLOSIS:

71. The problem of ankylosed primary molars
deserves much attension by dentists.
Henderson pointed out that ankyloses should
be considered as an interruption in the rhythm
of eruption .
Mandibular primary molars are the teeth most
often observed to be ankylosed.
Ankylosis of the anterior primary teeth does
not occur unless there has been a trauma.

72. LOCAL AND SYSTEMIC FACTORS THAT
INFLUENCE ERUTION
SYSTEMIC FACTORS LOCAL FACTORS
Nutritional Severe trauma
Genetic Ankylosis
Endocrine deficiencies
like,
Decreased GH, TH
Increased density of fibrous
tissue over the erupting tooth
Bone diseases like,
Osteopetrosis
Cyst such as eruption cyst.

73. factors which alters the timing of eruption:
Genetic factors
genetic control of deciduous tooth eruption has been estimated to be 78%
Sex:
Teeth of girls erupt earlier than the boys
i.e 3% ahead of boys
Birth weight:
Low birth weight has been associated with delayed emergence of
teeth and vice versa
Systemic factors
which delay eruption
•Hyporvitaminosis(A&D)
•Amelogenesis imperfecta
•Osteopetrosis
•Cleidocranial dysplasia

74. •Local factors:
•Abberent tooth position
•Lack of space in the arch
•Early loss of predecessors
•Ectopic eruption
•Ankylosis
•Tooth ankylosis:
•Ankylosis between tooth and bone is a common
phenomenon in primary dentition rare in permanent
dentition.

75. FACTORS WHICH ACCELERATES
TOOTH ERUPTION
• HYPERPITUITARISM
• TURNER’S SYNDROME
FACTORS WHICH DELAY
TOOTH ERUPTION
 ANKYLOSIS
 DOWN’S SYNDROME
 CLEIDOCRANIAL DYSPLASIA
 HYPOTHYROIDISM
 HYPOPITUITARISM
 ACHONDROPLASTIC DWARFISM
 CHONDROECTODERMAL
DYSPLASIA
 GARDNER SYNDROME
 GOLTZ SYNDROME
 PROGERIA SYNDROME

76. SEQUENCE OF TOOTH ERUPTION
PRIMARY TEETH
PERMANENT
A B D C E
A B D C E

78. •Physiologic process results in the elimination of
deciduous dentition is called
shedding/exfoliated.
•Due to progressive resorption of roots of
deciduous teeth and their supporting tissue,the
periodontal ligament.

79. •1st sign of root resorption is seen in deciduous
incisors and 1st molars i.e by age4-5
•Resorption begins on the lingual side in incisors
•Molars resorption starts from the inner surfaces
by the developing permanent tooth germ

80. •Resorption of deciduous incisor takes place more
rapidly (lasting1.5-2yrs)than canines and
molars(2.5-5.7yrs)
•The permanent successors are visible
immediately after exfoliation of deciduous /after a
latent period 1-5 months.

81. The resorption process is not continuous,but is
interrupted by resorption and repair

82. MECHANISM OF SHEDDING
•Resorption of dental hard tissue done by
odontoclasts
•Odontoclasts fuse to the resorption site and form a
ruffled border and a clear zone of attachment
•During active root resorption coronal pulp appears
normal and odontoblasts still line the surface of
predentin
•When the root resorption is almost complete,
odontoblasts degenerate

83. Ruffled border Odontoclasts

84. •Mononuclear cells emerge from pulpal vessels
•migrate to predentin surface
•fuse with other mononuclear cells –form
odontoclasts
• removal of predentin and dentin
•Tooth exfoliates with some pulpal tissue intact
•Just before exfoliation resorption ceases, a
remaining pulp cells deposit cement like tissue on the
remaining dentin

85. •PRESSURE
•Pressure from successional tooth plays a role in
shedding of deciduous dentition
• growth of face and jaws
• corresponding enlargement in size and strength of
masticatory muscles
• increase the force applied on supporting apparatus of
tooth

86. •Pressure by permanent tooth causes resorption
of supporting tissues
•Support of the tooth diminishes
•Tooth wont be able to withstand masticatory
forces
•Exfoliation accelerated

87. Shed element following “shedding of primary incisor
Complete resorption
of roots
Resorption lacunae
seen (arrow)
Most of coronal pulp
is intact

88. PATTERN OF SHEDDING
•Symmetrical for right and left sides
•Exception 2nd molar, is simultaneous i.e
mandibular primary teeth are shed
before maxillary counterparts
•Exfoliation occurs in girls before boys

89. SEQUENCE OF SHEDDING
•Maxilla : A B C D E
•Mandible: A B C D E

90. CLINICAL CONSIDERATIONS OF
SHEDDING
Remnants of deciduous teeth
Retained deciduous teeth

91. Remnants of deciduous teeth:
most frequently found in association with permanent
pre-molars
Reason : root of deciduous second molar are strongly
divergent
mesio-distal diameter of second molar is greater than
the 2nd pre-molar

93. Retained deciduous teeth:
Most commonly retained teeth are : upper lateral
incisors
Lower deciduous molar less frequently
Lower central incisors and upper canines have
shown incidence
Causes:
Permanent tooth impacted or ankylosed

94. CONCLUSION
Since eruption and shedding of teeth forms
the base of dentistry, a thorough
understanding and a sound knowledge is
required by a dentist regarding the eruption
process and anomalies related to it, so as to
identify and treat them in a proper fashion.