Normal Dental
Development and Oral
Pathology
Rebecca L. Slayton, DDS, PhD
Department of Pediatric Dentistry
Amanda Keerbs, MD
Department of Family Medicine
PRIMARY
DENTITION
Eruption Schedule
Eruption Schedule
Distal surface – towards the back of the mouth
Midline
Mesial surface – towards the front of the mouth
Upper (Maxillary) Arch
Incisal Surface
Labial/Buccal
Surface
Palatal
Surface
Occlusal Surface
Lower (Mandibular) Arch
Occlusal
Surface
Labial/Buccal
Surface
Lingual
Surface
Incisal
Surface
Ectopic Eruption
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Abnormal pattern of tooth eruption
Teeth are delayed in eruption or erupt
in the wrong location
Most common for permanent lower
incisors, permanent upper canines and
permanent first molars
Syndromes with Dental
Manifestations
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Dentinogenesis Imperfecta
Amelogenesis Imperfecta
Cleidocranial Dysostosis
Ectodermal Dysplasia
Common Causes of
Malocclusion

Non-nutritive sucking behaviors
– May cause anterior open bites or crossbites in
children who use pacifiers and digits
– Most children will stop oral behaviors by age 2.
For older children, consider using rewards,
gloves, replacement items
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Caries or trauma with premature loss of
teeth and loss of space
Common Oral Lesions in
the Primary Care Office

Lip lesions
– Angioedema
– Herpes Labialis
– Mucocele
– Angular cheilitis
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Lingual Lesions
– Hairy Tongue
– Geographic Tongue
Common Oral Lesions in
the Primary Care Office
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Oral conditions of infants and children
– Natal teeth
– Epstein’s pearls
– Eruption cysts
– Thrush
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Tooth Conditions
– Tooth Staining
– Erosions
Common Oral Lesions in
the Primary Care Office

White lesions
– Candida
– Oral Leukoplakia
– Morsicatio Buccarum
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Vesiculobullous Lesions
–
–
–
–
Primary herpes gingivostomatitis
Recurrent herpes
Herpangina
Hand-foot-and-Mouth Disease
Common Oral Lesions in
the Primary Care Office
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Ulcers
– Aphthous Ulcers
– Behcet’s Syndrome
Caries
Caries are an infectious, communicable
disease resulting in the destruction of tooth
structure by the acid produced by the
metabolism of sugar by bacteria found in
dental plaque
Plaque is a dense bacterial aggregate
containing about 10% bacteria per milligram
that accumulates on tooth surfaces.
Dental Caries Process
TEETH
MUTAN
STREPTOCOCCI
LACTOBACILLI
Host
Bacteria
DENTAL
CARIES
Substrate
FRUCTOSE
SUCROSE
Dental Caries Stages
The acid created by the caries bacteria’s
metabolism of sugar leads to demineralization.
Demineralization is the loss of calcium,
phosphate and carbonate from the enamel
Dental Caries Stages
Incipient Lesion
(caries not more
than halfway into
enamel)
Lesion has
reached the
dentinoenamel
junction (DEJ)
Lesion is
progressing
laterally and
towards the pulp
Lesion extended
into the pulp
If demineralization is allowed to continue, the
tooth will eventually be eroded enough for a
cavity to form.
Oral Screening
Examination

Tips from a practicing clinician
– Get in the habit of performing a brief oral
examination in all patients presenting to your
office for general wellness exams and use that
time to discuss with patients their dental habits
and risk factors for oral disease
– Perform more detailed evaluations in patients
when indicated by history any review of systems
– In kids always lift the lip
Important Landmarks of
the Oral Cavity
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Lips
Labial and Buccal Mucosa
Floor of mouth
Hard and soft palate
Parotid papilla
Oropharynx and tonsilar pillars