Exfoliation Of Teeth Research Articles

A rare case of unilateral facial infiltrating lipomatosis: summary of medical and dental implications

Introduction Facial infiltrating lipomatosis (FIL) is a rare congenital and benign condition, resulting from mature nonencapsulated adipocytes penetrating into neighbouring structures. Individuals with FIL present with unilateral facial and craniofacial hemihypertrophy, alongside various medical and dental complications of the affected side. Case report At birth, the infant had an evident right sided facial swelling which remained asymptomatic but continued to increase in size. Magnetic resonance imaging confirmed right-sided lipomatous hyperplasia and genetic testing confirmed a somatic mutation to PIK3CA; the cause of cell hyperproliferation, often identified in FIL cases. On the right side, the child has developed epidermal naevus and mild hearing and visual impairment. A multidisciplinary team (paediatric medicine and dentistry, dermatology, ENT and plastics at Great Ormond Street Hospital) has contributed to managing the complex condition. At 12 months old, paediatric dentistry observed premature eruption of teeth 53, 54 and 84 and hyperplasia of the upper right alveolar arch. At 5 years-old, the child presented with premature exfoliation of primary teeth and premature eruption of permanent teeth 14, 16, 41, 42 and 46 with bilateral crossbites. Management A dental prevention regime has been implemented and the child remains caries free. The developing dentition will continue to be monitored with consideration of orthodontic management. Presently, as the child remains stable, a conservative approach without surgical or medical intervention has been adopted. His vision is corrected with glasses. Conclusion FIL is associated with dental developmental anomalies and medical complications of the affected side, requiring multidisciplinary care.

Rationalization Progress of Novel Drug Delivery System for Intra-Periodontal Pockets Against Periodontitis

Periodontitis (PD) is a pathological condition that results in chronic swelling in the tissue around a tooth, which results in advanced periodontal structural injury to the encircling soft and hard tissues with eventual exfoliation and movement of teeth. It affects around 60% of the world's population, indicating a relatively high prevalence. Therefore, the discovery of efficient therapeutic interventions for dental disorders is a primary goal of the health sciences, and periodontitis is a significant public health problem. Currently, perioceutics plays a revolutionary role in periodontal therapy with the introduction of both systemic and local route administration of therapeutic drugs as supportive therapy to SRP (Scaling and Root Planning). The key to effective periodontal treatment is the selection of the proper antibacterial agent and the local route of medication delivery. The items mentioned, including irrigation systems, gels, fibers, films, thin strips, microvesicles, zero-dimensional nanomaterial, and moderate-dose biocide agents, reflect the innovative site-specific drug delivery available in the sector, resulting in the fulfillment of antimicrobial substances to sites of periodontal disease with low to non-existent negative impacts on other bodily systems. The current report seeks to present the most recent technologies in local biomaterial-based delivery with different properties that play a significant role in gum disease so that the practitioners are able to select appropriate bioactive agents for LDDS that are custom-tailored for a given clinical condition, identify present obstacles, and determine the future research opportunities.

Orthodontic Space Management in Pediatric Dentistry: A Clinical Review.

The mixed dentition stage is a vital period characterized by significant physiological changes, including jaw growth, the development and eruption of permanent teeth, the exfoliation of primary teeth, and the maturation of surrounding soft tissues. These processes collectively ensure functional, esthetic, and stable occlusion. Disruptions during this stage, such as the premature loss of deciduous teeth, can lead to spacing or crowding issues and affect the dental arch length and the position of permanent teeth. To prevent or mitigate malocclusion, space maintainersand regainers are commonly used as part of space management strategies during the mixed dentition phase. This clinical review examines traditional and modern approaches to space management, highlighting the types of appliances used and their effectiveness. It emphasizes the importance of preserving primary teeth until their natural exfoliation, as they serve as the best natural space maintainers. In cases of premature tooth loss, removable or fixed space maintainers and regainers are effective tools to minimize malocclusion and ensure optimal dental outcomes.

Root resorption-an overview

Root resorption is a naturally occurring phenomenon in primary dentition for the exfoliation of teeth. Root resorption in permanent teeth is a pathologic process that is not only specific to trauma or infections of pulp but also likely to occur due to untoward sequelae of any orthodontic procedures. There are internal and external types of root resorption, each having its variety. External apical root resorption is primarily asymptomatic, thereby mostly accidentally revealed by radiographic examination. Early diagnosis is essential to prevent, and manage the consequences, and to provide an optimal treatment option for the patient.

Management and Outcomes of Severe Submergence in Second Premolar

General Background: The early loss of primary molars is a prevalent dental issue that can lead to significant occlusal disturbances, including space reduction and misalignment of permanent teeth. Specific Background: Submergence of the second permanent molar following premature exfoliation of primary molars exacerbates these issues, complicating the eruption pattern and dental arch integrity. Knowledge Gap: Despite existing treatment modalities, there is limited evidence on the effectiveness of specific appliances in managing severe submergence cases in pediatric patients. Aims: This study aims to evaluate the efficacy of the Gerber Space Regainer in restoring lost space and correcting the alignment of submerged second premolars in a pediatric patient. Results: A 10-year-old patient experiencing significant space loss due to premature exfoliation of tooth 85 was treated with a Gerber Space Regainer. Over a 7-week period, the appliance successfully regained 8 mm of space, with notable uprighting of the affected premolar, achieving complete recovery of the dental arch. Novelty: This case report highlights the practical application and success of the Gerber Space Regainer, emphasizing its efficiency in a short time frame, which has not been extensively documented in similar clinical scenarios. Implications: The findings suggest that the Gerber Space Regainer is an effective and reliable option for managing complex orthodontic cases involving submergence and space loss, contributing to the enhancement of treatment protocols in pediatric dentistry. Highlights: Effective space recovery: The Gerber Space Regainer successfully restored 8 mm of lost dental arch space in 7 weeks. Improved alignment: The treatment led to the uprighting of the submerged second premolar, ensuring proper occlusion. Pediatric applicability: The appliance demonstrated high efficiency and compliance in a young patient, showcasing its potential in pediatric cases. Keywords: Premature Loss, Space Regainer, Submergence, Second Premolar, Eruption Disturbance

Rare presentation of maxillary osteonecrosis and tooth exfoliation induced by herpes zoster infection in a 29-year-old Chinese male: a case report and literature review

BackgroundWe present a case of a 29-year-old male patient without immunodeficiency who suffered from rapid osteonecrosis and tooth exfoliation resulting from herpes zoster (HZ) infection in the left maxillary branch of the trigeminal nerve. Various complications associated with shingles infections have been reported, cases of osteonecrosis and tooth exfoliation due to HZ infection among young people without immunodeficiency are rare. In this case, we focus on the particular manifestation of HZ infection.Case presentationThe patient presented with clusters of erythema and papules, along with non-hemorrhagic blisters on the left face and the loss of the left upper incisor. All lesions were localized to the left side of the face without exceeding the midline. After receiving antibacterial and antiviral treatment, successful control over the infection was achieved; however, he experienced the loss of all upper teeth on the left side except for the first and second upper left molars.ConclusionThis case highlights that rapid osteonecrosis and tooth exfoliation may occur among young individuals without immunodeficiency after HZ infection. HZ infection of the face should be taken very seriously to obtain prompt treatment to prevent the rare complications of bone necrosis and tooth loss as much as possible.

How well do parents identify their child's baby teeth? Engagement and accuracy of parent-reported information on a tooth checklist survey.

Naturally exfoliated primary teeth are being increasingly collected in child development studies. Most of these odontological collections and tooth biobanks use parent-reported information from questionnaires or tooth checklists to collect data on offspring teeth. To the best of the authors' knowledge, no studies have assessed parental engagement in tooth checklists, nor parental accuracy in identifying their child's baby tooth. This study aimed to evaluate these dimensions by analysing data from the about this tooth checklist returned with donated primary teeth in a natural experimental study called STRONG (the Stories Teeth Record of Newborn Growth). Parental self-reported information were analysed on checklists returned with 825 primary teeth belonging to 199 children. The percentage of blank answers was calculated for each question. The accuracy of parents-reported tooth identification was evaluated by comparing parental ratings to researchers' ratings. Reliability of researchers' tooth identification was first evaluated by calculating intra-observer and inter-observer agreements, as well as Cohen's Kappa values. The percentage of accuracy of parents' tooth identification (relative to researcher's) was then calculated, and logistic regressions were used to evaluate if time elapsed between when exfoliation occurred and the checklist was completed associated with parental accuracy in tooth identification. Parents returned 98.4% of the checklists and completed 74.9% to 97.7% of the questions. Excellent reliability was demonstrated for researchers' intra- and inter-rater tooth identification (agreement percentages >90%; Cohen's Kappa values >.83). Moderate accuracy of parents-reported tooth identifications was found, with parents correctly identifying 49.5% of the donated tooth. Better parental accuracies were highlighted for partial identifications (87.1% of correct jaw, 75.6% of correct tooth type, and 65.8% of correct lateralization). Logistic regressions showed the odds of correct parental identifications decreased on average by 1.8% every 30 days of distance between tooth exfoliation and checklist completion. While parental engagement is high, parents-reported tooth identifications have moderate accuracy, which decreases over time. High accuracy is however found for partial identifications. Parent-reported information on the accompanying questionnaire of naturally exfoliated primary teeth collection or tooth biobanks, even when filled in a long time after exfoliation took place, should be encouraged. However, expert identifications of teeth should remain best practice.

Reinclusion of the Primary Molar: Case Report

Dental reinclusion, also referred to as ankylosis, retention, or infra occlusion, is a clinical condition in which a fully erupted tooth gradually moves away from the occlusal plane. The prevalence of primary molar reinclusion ranges from 1.3% to 38.5% in the population, with an unclear etiology. Reinclusion can lead to various complications, including delayed exfoliation of the primary tooth, disruption of occlusion, and improper eruption of the succeeding permanent tooth. Early diagnosis and intervention are essential to prevent these complications. In this report, we present an unusual case of severe infraocclusion of the primary maxillary right first molar in a 10-year-old child.

Imaging diagnosis of compound - complex odontoma and impacted dental elements: a case report

Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient’s diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam. Keywords: Odontoma. radiography. tomography. Impacte.

Cultural diversity of traditions for the disposal of exfoliated teeth: Implications for researchers.

For decades, researchers in anthropology and archaeology have used teeth, including exfoliated primary teeth, as fossil records of people's physical life experiences. Recently, researchers in psychiatry, epidemiology, environmental health and other fields have recognized the potential for teeth to serve as biomarkers of other early-life experiences, including trauma exposure and other types of psychosocial stress, which are potent determinants of later mental and physical health problems. Despite the emerging appreciation and value of teeth as biospecimens, little is understood about cultural beliefs and practices surrounding exfoliated teeth. If known, such insights could inform culturally appropriate practices for paediatric dental care and improve protocols for the ethical acquisition of teeth as biospecimens in research studies. To address this gap, a qualitative systematic review was performed to summarize the variety of traditions performed worldwide for disposing of primary exfoliated teeth. PubMed, Google Scholar, AnthroSource, Anthropological Literature, EHRAF World Cultures and Anthropology Plus were searched with a systematic search strategy to identify articles published from inception through December 2, 2021. Citations of relevant papers were also forward and backward searched. There were 3289 articles that met the initial inclusion criteria, of which 37 were included after individual screening and applying exclusion criteria. Thematic analysis was used to identify 74 distinct traditions related to the disposal of exfoliated teeth, which were organized into seven general themes: (1) giving teeth to a tooth fairy, (2) giving teeth to mouse figures, (3) throwing teeth, (4) hiding/keeping teeth, (5) burying teeth, (6) giving teeth to animals and (7) eating the tooth. The results of this study elucidate the diversity within-yet universality of-exfoliated tooth disposal traditions and underscore the importance of tooth exfoliation as a major milestone during child development. Special attention must be paid to these traditions and related ethical concerns when designing research protocols related to their collection. With a greater understanding of beliefs and practices related to exfoliated teeth, researchers will be better equipped to engage children and families in studies that include analyses of exfoliated teeth, collect teeth as biospecimens, and broaden the use of teeth in research.

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study.

This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

Phases and chronology of tooth eruption: its impact on oral health

IntroductionThe study analyzed the phases of eruption and dental chronology, highlighting the importance of primary teeth in dental development and the consequences of their premature loss. The order of eruption and exfoliation of primary teeth was described, emphasizing that the loss of space due to the absence of these teeth generates malocclusions and affects the development of the permanent dentition.DevelopmentThe phases of dental eruption (pre-eruptive, pre-functional eruptive and functional eruptive) and the factors that influence their chronology, such as genetics, climate, nutrition and systemic diseases were discussed. The clinical manifestations related to dental eruption, such as irritability and excessive salivation, were also discussed. In addition, the main causes of premature loss of primary teeth, including caries, trauma and congenital anomalies, and how these affect the correct eruption of permanent teeth, were highlighted.ConclusionPremature loss of primary teeth has a significant impact on the masticatory function, phonetics and psychological well-being of the child, in addition to generating malocclusions and alterations in the chronology of the dentition. Prevention through proper oral hygiene, healthy diet and early dental care is crucial to avoid complications and promote comprehensive oral health.

Case report on CBCT guided management of compound odontoma with 2 denticles in a 9-year-old patient

Odontomas are benign developmental tumors formed by the improper growth of completely differentiated epithelial and mesenchymal cells of odontogenic origin. The etiology of odontoma is unknown and it is detected during routine radiographic examination. The ideal management is early detection and surgical enucleation. The commonly associated clinical problems of odontomas are delayed exfoliation of primary teeth, delayed eruption or impaction of permanent teeth, displacement of teeth, root resorption, congenital missing, and widening of follicular space. Here, we describe a unique case of compound odontoma with two denticles managed in the right anterior maxillary region underwent surgical management of a case of compound odontoma in a 9-year-old girl patient who presented with a complaint of swelling in the maxillary right anterior region.

Retrospective analysis of ferric sulfate and sodium hypochlorite pulpotomy procedures in primary molars.

Pulpotomy is a vital pulp treatment procedure frequently used in primary molars to preserve pulp vitality and function until tooth exfoliation. There is currently no pulp medicament with all the features of the ideal pulpotomy material. The present study compared the radiographic success of sodium hypochlorite with ferric sulfate (FS) when used for pulpotomy in primary molars. A retrospective analysis was performed to evaluate the success rates of primary molars pulpotomized using sodium hypochlorite or FS according to radiographic findings. Healthy 4‒10-year-old children who had pulpotomy procedures on primary molars between 2018 and 2021 at the pediatric dental clinic and had a control radiograph at least 12 months later were enrolled in the study. The chi-squared test was used to determine the differences in success between these two materials. A total of 142 teeth, including 85 (59.9%) first primary molars and 57 (40.1%) second primary molars, in 98 healthy children were evaluated. The mean follow-up period of the teeth included in the study was 585.1±249.4 days. Radiographic success rates for NaOCl and FS groups were 73.8% and 71.0%, respectively, with no statistically significant difference (P>0.05). Internal root resorption (IRR) was the most common cause of radiographic failure in both groups. Radiographic success rates of both materials were similar, and using these materials in primary molar pulpotomy procedures can be recommended in clinical practice.

Knowledge, Attitudes, and Practices Towards ECC Prevention in Thai Medical Personnel

This study aimed to identify the knowledge, attitudes, and practices related to the prevention of early childhood caries (ECC) amongst medical personnel in well-baby clinics (WBC). Participants were 152 health care professionals, including public health officers, nurses, and physicians, working in WBC in Chonburi Province, Thailand. Participants completed a 6-part online questionnaire asking about demographic data, knowledge and attitudes related to ECC, ECC prevention practices, collaboration, referral systems, and suggestions for improving collaboration between dental and medical personnel in WBC. Whilst most participants had high levels of knowledge about oral care instructions, tooth brushing frequency, and cariogenic foods and beverages, they knew less about recommendations for timing of the first dental visit, fluoride concentration in toothpaste, and the time for exfoliation of primary teeth. There were significant differences in the proportions of correct answers to questions related to the first dental visit and bottle feeding and in total knowledge scores between physicians and other health care professionals. Most participants demonstrated a positive attitude towards ECC prevention. More than 70% of participants always advise parents on oral hygiene and nutrition related to ECC prevention, but only 29% always refer patients to see dental personnel. Attitudes, collaboration, and referral systems were significantly associated with ECC prevention practices, but not knowledge. This study demonstrates that attitudes, collaboration, and referral systems are key contributors to ECC prevention amongst Thai medical personnel. In addition to training programmes, consistent interprofessional policy and referral systems should be formulated, especially in primary care settings.

Development of Yorkshire Terrier Dentition.

The development of dentition in dogs has been associated with several problems including tooth over-crowding, missing permanent dentition, and persistent deciduous teeth (PDT). Information on dentition development in different breeds is lacking. This study of 61 Yorkshire terriers aimed to determine the (i) average age at deciduous tooth exfoliation, (ii) average age at permanent tooth eruption, (iii) PDT incidence, and influencing factors such as body weight. The ages of exfoliation of deciduous teeth and eruption of permanent dentition were influenced by body weight and tooth type. These dentition changes tended to occur later in dogs ≤ 3 kg versus dogs > 5 kg. Generally, incisors were exfoliated first, followed by premolars and then canines. At a body weight of 4.5 kg, the middle of the data range, the estimated age at loss of deciduous teeth (with 95% confidence intervals) was 21.9 (21.1, 22.9) weeks for incisors, 26.1 (24.9, 27.4) weeks for canines, and 23.9 (22.9, 24.9) weeks for premolar. The estimated age at eruption of permanent dentition was 22.3 (21.6, 23.0) weeks for incisors, 23.8 (23.0, 24.6) weeks for canines, 24.7 (24.0, 25.5) weeks for premolars, and 26.4 (25.5, 27.3) for molar teeth. However, this sequence was disrupted in dogs ≤ 3 kg. Yorkshire terriers had a high incidence of PDT. At a body weight of 4.5 kg, the estimated proportion of PDT was: incisors 0.86% (0.32, 2.31), canines 15.62% (7.62, 29.37) and premolars 3.57% (1.62, 7.66). Canines constituted the most frequently retained tooth type, with 89.1% retained in dogs ≤ 3 kg compared to 12.0% in dogs > 5 kg. This information will enable veterinarians to provide personalised advice regarding the oral care requirements for Yorkshire terriers and highlights the need to regularly monitor this breed between the ages of two and seven months, during the active phases of tooth development.

A Retrospective Study on the Effect of Pulp Treatment on the Exfoliation of Primary Teeth

The aim of this study was to retrospectively analyze the effects of pulp treatment on exfoliation of primary teeth and its related factors. In this study, 167 teeth of 97 patients aged 6 months to 12 years who were treated with pulp treatment at Dankook Dental Hospital were selected, and information related to pulp treatment and tooth loss was collected. The included subjects were 72 primary anterior teeth (43.1%) and 95 primary posterior teeth (56.9%), of which 56 were males (57.7%) and 41 females (42.3%). The mean follow-up period was 106.1 ± 38.7 months, and the mean age at pulp treatment was 34.8 ± 15.4 months for primary anterior teeth and 69.1 ± 25.1 months for primary posterior teeth. Unilaterally pulpectomized teeth were significantly exfoliated earlier than the same tooth on the opposite side (<i>p</i> < 0.05). Also, in the case of teeth with periapical lesions, despite pulp treatment, the probability of extraction due to infection has been increased on primary anterior teeth (<i>p</i> < 0.05), but not on posterior teeth (<i>p</i> > 0.05). Pulpectomized teeth were lost earlier, an average of 7.8 months for primary anterior teeth and 8.5 months for primary posterior teeth. Early loss of the primary tooth can lead to space loss and premature eruption of the successor, so this can be considered when planning or performing treatment of the primary tooth.

SURGICAL EXPOSURE OF TEETH IN CLEIDOCRANICAL DYSPLASIA UNDER PROCEDURAL SEDATION:- CASE REPORT

Cleidocranial Dysplasia (CCD) is a rare autosomal dominant condition which is mainly characterised by skeletal abnormalties like hypoplastic or aplastic clavicles, increase in transverse diameter of the cranium, delayed closure of fontanelles with presence of open sutures and skeletal changes in maxilla and mandible. 2,4 These patients usually presents with delayed exfoliation of deciduous teeth, delayed or failed eruption of the permanent dentition with multiple supernumerary teeth, protruding mandible and mid- face retrusion.2 We present a case report of a 16 year old girl undergoing multiple surgical exposure of impacted permanent teeth under conscious sedation so as to move them in normal occlusion with orthodontic traction

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

Time and sequence of the replacement of the deciduous by the permanent dentition in dogs and its applicability for age estimation.

This study investigated the influence of several covariates on the time and sequence of permanent dentition emergence following exfoliation of the deciduous teeth in puppies. The aim was to determine whether the emergence of permanent dentition can be used to assess whether a puppy that is traded across borders in the EU has reached the legally required minimum age of 15 weeks. The events were evaluated in a longitudinal study, with some cross-sectional observations, of 440 puppies belonging to 82 breeds. No significant differences were found between the left and right sides of a puppy's dentition nor between male and female puppies. Breed size and skull type had a significant impact: both the appearance and the completion of tooth eruption occurred considerably later in small or toy breeds and brachycephalic skull type breeds. The sequence of emergence differed little between maxillary or mandibular quadrants or between breeds. The first emerging elements were the maxillary first premolars or first incisors or the mandibular first incisors. The emergence of a permanent tooth usually occurred within 3 days before or after exfoliation of its precursor, except for the canines, which demonstrated a wider tooth replacement interval. This study presents standards for age assessment based on the emergence of permanent dentition for breeds of different sizes, using median ages or cumulative emergence percentages. However, the legal age determination of puppies with an assumed age of 15 weeks cannot be performed based on permanent dentition emergence, as this occurred at a later age in a large proportion of dogs (at least 95%) in our studied population. The probability of being at least 15 weeks old when at least one maxillary tooth has emerged was at least 72.25%, depending on breed size.