Delayed Tooth Emergence

Abstract

1. Jeffrey M. Karp, DMD, MS* 1. *Assistant Professor, Division of Pediatric Dentistry, Departments of Dentistry and Pediatrics, University of Rochester Medical Center, Rochester, NY. After completing this article, readers should be able to: 1. Recognize abnormalities in tooth emergence timing and order based on oral inspection. 2. Discuss local and systemic causes of delayed tooth emergence. 3. List treatment modalities available for management of delayed tooth emergence. 4. Determine when timely referral to a dentist is necessary. Delayed tooth emergence (DTE) is a clinical term used when exposure of a tooth or multiple teeth through the oral mucosa is overdue, according to population norms based on chronologic age. DTE is common in childhood and adolescence, yet it is often overlooked or dismissed in pediatric primary care. Timely screening and recognition of DTE by clinicians can minimize medical, developmental, functional, and esthetic problems resulting from untreated underlying local and systemic causes. This article provides clinicians with an overview of conditions responsible for DTE in children. Multidisciplinary care for patients who experience DTE in medical, dental, and surgical settings also is discussed. Human teeth develop through a series of complex, reciprocal interactions between the oral epithelium and migrating cranial neural crest ectomesenchymal cells of the first branchial arch. This process is tightly regulated by more than 300 genes expressed temporospatially within the jaws. Dental patterning of the primary and permanent dentition is expressed in three dimensions, exerting morphogenetic controls over tooth number, position, size, and shape. In the end, the normal primary dentition consists of three tooth classes (four incisors, two canines, four molars) in each jaw, for a total of 20 teeth. Thirty-two teeth distributed among four tooth classes (8 incisors, 4 canines, 8 premolars, 12 molars) comprise the permanent dentition. Tooth emergence, the clinical exposure of any part of a …