Disturbances in the Timing of
Tooth Eruption in Children with
General Diseases
Sven Kreiborg, DDS, DrOdont, PhD
Pediatric Dentistry and Clinical Genetics
School of Dentistry, Faculty of Health Sciences
University of Copenhagen, Copenhagen, Denmark
E-mail: skrei@sund.ku.dk
Disturbances in the Timing of
Tooth Eruption
 Natal/neonatal
 Premature
 Delayed
teeth
eruption
eruption
Normal Tooth Eruption
Timing
 In
the primary dentition: no
significant difference between
boys and girls
 In
the permanent dentition: girls
have significantly earlier tooth
eruption than boys (about 6
months)
Normal Tooth Eruption
Timing
 There
is a weak correlation
between tooth eruption and
chronological age
 There
is a weak correlation
between tooth eruption and
skeletal age
Normal Tooth Eruption
Timing
 There
is a strong correlation
between tooth eruption and dental
age
Demijian et al.
A new system of dental age assessment
Hum Biol 1973;45:211-27
Stages of Tooth Eruption
 Pre-eruptive
 Intra-osseous
 Mucosal
penetration
 Pre-occlusal
 Post-occlusal
TOOTH ERUPTION – DURATION
Intra-Osseous Movement
2.5 – 6.5 years
(shortest for M1; longest for C)
No significant sex difference
TOOTH ERUPTION – DISTANCE
Intra-Osseous Movement
5 – 20 mm
(shortest for M1; longest for C)
TOOTH ERUPTION – VELOCITY
Intra-Osseous Movement
1-10m/day
(10m=0.01mm; 100 days=1mm)
No significant sex difference
TOOTH ERUPTION – VELOCITY
Pre-Occlusal Movement
10-75m/day
(100m=0.1mm; 100 days=10mm)
No significant sex difference
TOOTH ERUPTION – VELOCITY
Post-Occlusal Movement
Magnitude and velocity of tooth movement
depend on
magnitude, velocity, and direction of jaw growth
Significant sex difference
Disturbances in the Timing of
Tooth Eruption
 Natal/neonatal
teeth (1:2,000-3,000
births)
 Premature
 Delayed
eruption
eruption
Disturbances of Tooth
Eruption
POSSUM-Database
Natal/Neonatal Teeth
62 Syndromes
(e.g. Ellis-vanCreveld Syndrome and
Hallermann-Streiff Syndrome)
Disturbances of Tooth Eruption
POSSUM-Database
Premature Eruption
51 Syndromes
(e.g. Soto syndrome)
Soto Syndrome
Premature Tooth Eruption
 Tall
stature
 Cerebral gigantism
 Macrocephaly
 Large mandible
Cause of premature tooth eruption:
accelerated general growth
Klippel-Trenaunay-Weber
Syndrome
Premature Tooth Eruption
 Generalized
unilateral hypertrophy
 Cutaneous angiomatosis
 Varicose veins
Cause of premature tooth eruption:
accelerated general growth unilaterally
TOOTH ERUPTION - DELAYED
 Genetic
factors
 Chronic diseases
 Chromosomal aberrations
 Endocrine disorders
- Hypopituitarism
- Hypothyroidism
- Hypoparathyroidism
 Syndromes
TOOTH ERUPTION
DELAYING/HINDERING FACTORS
Intra-Osseous Movement
 Dental
follicle
 Tooth/root formation
 Alveolar bone



Space conditions
Obstacles
Bone metabolism
TOOTH ERUPTION – DELAYED
Physical Factors
 Crowding
 Supernumerary
teeth
 Odontomas/osteomas
 Cysts
 Gingival fibromatosis
 Other
Disturbances of Tooth
Eruption
POSSUM-Database
Delayed Eruption
180 Syndromes
e.g. Apert syndrome, Cherubism, cleidocranial dysplasia,
ectodermal dysplasias, Ellis-vanCreveld syndrome, GAPO
syndrome, Hurler syndrome, Incontinentia Pigmenti
syndrome, McCune Albright syndrome, Pycnodysostosis,
Tricho-Dento-Osseous syndrome, etc. ….
Disturbances of Tooth
Eruption
POSSUM-Database
Delayed eruption in syndromes with:
 General growth disturbances
 Maxillary and mandibular hypoplasia
 Disturbances of tooth formation
 Gingival fibromatosis
 Disturbances of bone metabolism
Delayed Tooth Eruption
 There
is a strong correlation
between tooth eruption and
abnormal tooth development
TOOTH ERUPTION – DELAYED
Syndromes with Dental Anomalies
 Amelogenesis
Imperfecta
 Ectodermal Dysplasia
 Ekman-Westborg-Julin Syndrome
 Morquio syndrome
Ectodermal Dysplasia (X-Linked)
Delayed Tooth Eruption






Sparse scalp hair, eyelashes, eyebrows
Inability to sweat
High forhead, depressed nasal bridge
Decreased anterior face height
Dental abnormalities (oligodontia/anodontia)
Microdontia, tooth shape abnormalities
Cause of delayed tooth eruption:
abnormalities of tooth formation
Ekman-Westborg-Julin
Syndrome
Delayed Tooth Eruption



Macrodontia
Multituberculism
Pulp invaginations
Causes of delayed tooth eruption:
abnormalities of tooth development and crowding
Morquio Syndrome
Delayed Tooth Eruption






Short stature
Coarse facies
Short neck
Joint contractures
Prognathism
Enamel hypoplasia
Cause of delayed tooth eruption:
abnormalities of tooth development
TOOTH ERUPTION – DELAYED
Syndromes with hypoplastic jaws
 Apert
syndrome
 Crouzon syndrome
 Cleft palate
 Treacher-Collins syndrome
 Silver-Russell syndrome
 Pycnodysostosis
APERT SYNDROME
Delayed Tooth Eruption





Premature craniosynostosis
Maxillary hypoplasia
Shallow orbits
Small nose
Syndactyly of hands and feet
Causes of delayed tooth eruption:
maxillary hypoplasia with severe crowding and
gingival hyperplasia
Pycnodysostosis
Delayed Tooth Eruption






Short stature
Increased bone density (osteopetrosis)
Delayed closure of fontanelles and
sutures
Hypoplastic midface
Mandibular retrognathia
Aplasia of teeth
Causes of delayed tooth eruption:
hypoplastic jaws with crowding and abnormal
bone metabolism
TOOTH ERUPTION – DELAYED
Syndromes with Bone Disorders
 Osteopetrosis
 Pycnodysostosis
 McCune
Albright syndrome
 Tricho-dento-osseous syndrome
 Osteopathia striata with cranial sclerosis
McCune-Albright Syndrome
Delayed Tooth Eruption







Endocrine abnormalities (precocious puberty)
Fibrous dysplasia of bone
Scoliosis
Patchy/streak-like skin hyperpigmentation
Facial asymmetry
Sclerotic/dense bone
Dental abnormalities
Cause of delayed tooth eruption:
abnormal bone metabolism
Tricho-Dento-Osseous
Syndrome
Delayed Tooth Eruption





Curly/frizzy hair
Increased bone density
Aplasia of teeth
Amelogenesis imperfecta
Taurodontism
Causes of delayed tooth eruption:
abnormal bone metabolism and abnormalities
of tooth development
Osteopathia Striata with Cranial
Sclerosis
Delayed Tooth Eruption





Increased bone density
Hearing loss
Linear striations in long bones
Aplasia of teeth
Taurodontism
Cause of delayed tooth eruption:
abnormal bone metabolism
TOOTH ERUPTION – DELAYED
Syndromes with Obstacles
 Cleidocranial
dysplasia
 Kreiborg-Pakistan syndrome
 Hurler syndrome
 Cherubism
 Gardner syndrome
Cleidocranial Dysplasia
Delayed Tooth Eruption





Large head with prominent frontal bones
Wide sutures and fontanelles
Small face
Aplasia/hypoplasia of clavicles
Supernumerary teeth
Causes of delayed tooth eruption:
supernumerary teeth and abnormal bone metabolism
Kreiborg-Pakistan Syndrome
Delayed Tooth Eruption


Premature craniosynostosis
Supernumerary teeth
Causes of delayed tooth eruption:
supernumerary teeth and abnormal bone metabolism
Gardner Syndrome
Delayed Tooth Eruption



Familial adenomatous polyposis
(malignancies)
Osteomas of skull/facial bones
Epidermoid/sebaceous skin cysts
Causes of delayed tooth eruption:
osteomas in the jaws
Hurler Syndrome
Delayed Tooth Eruption







Mucopolysaccharidosis 1H
Growth retardation
Progressive neurological deterioration
Coarse face
Corneal clouding
Kyphosis and multiple joint contractures
Dental cysts
Cause of delayed tooth eruption:
dental cysts with accumulation of MPS
Cherubism
Delayed Tooth Eruption




Cystic, fibrous jaw lesions
Bilateral symmetric jaw expansion
Exposure of sclera below the iris
Aplasia of teeth
Cause of delayed tooth eruption:
cystic jaw lesions (giant-cell granulomas)
TOOTH ERUPTION – DELAYED
Syndromes with Anomalies of Oral
Mucosa
 Gingival
fibromatosis
 Neurofibromatosis
 Apert syndrome
TOOTH ERUPTION – DELAYED
Syndromes but with Unknown
Mechanism
 GAPO
syndrome
 Romberg syndrome
GAPO syndrome
Delayed Tooth Eruption






Growth retardation
Alopecia
Pseudoanodontia
Optic atrophy
Premature craniosynostosis
Thick lips, thick and fibrous gingiva
Cause of delayed tooth eruption:
unknown, but ossifications in the gingiva have been seen
Romberg Syndrome
Delayed Tooth Eruption

Hemifacial atrophy (skin, fat, cartilage,
bone, and teeth)
Cause of delayed tooth eruption:
unknown but related to the atrophy of tissues
TOOTH ERUPTION
Delay in Intra-Osseous or
Mucosal Penetration Stages
General Treatment Principle
The tooth should penetrate the
mucosa no later than at
developmental stage G according
to Demirjian et al. (1973)
TOOTH ERUPTION
Delay in Intra-Osseous or
Mucosal Penetration Stages
Treatment Considerations
• Extraction of primary tooth/teeth
• Removal of obstacles
• Denudation
• Removal of alveolar bone occlusally
• Orthodontic traction
• Bone distraction
• Autotransplantation
TOOTH ERUPTION
Delay in Intra-Osseous or
Mucosal Penetration Stages
Be observant and alert
and
ACT!