Delayed Tooth Eruption

Introduction

Teething or eruption of the first milk teeth is a child’s development milestone. Eruption disturbances include delayed eruptions, incomplete eruptions, eruptions that do not occur at all, or the average direction of an eruption is influenced. To recognize the eruption disturbances on time, a thorough knowledge of the normal development of dentition is essential. Problems related to eruption disturbances are common in permanent dentition but rare in deciduous dentition. An early diagnosis can prevent many undesirable dental conditions, or the seriousness can be limited.

When Do Teeth Usually Appear?

Human dentition consists of 20 deciduous or primary teeth and 32 permanent teeth. Primary or milk teeth are the first to erupt in the oral cavity. Tooth development begins in the fetus at about 28 days in utero. All the primary and some parts of the permanent dentition develop in the fetus. Mineralization of the primary dentition starts at about 14 weeks in utero. All the primary teeth are mineralized at birth.

The permanent incisors and first molars begin to mineralize at or close to birth, whereas the other permanent teeth mineralize later. Tooth eruption occurs after the formation and mineralization of the crown but before the roots are fully formed.

Teething is when the baby's first teeth erupt in the oral cavity. It may be preceded by a transient bluish gingival swelling that may rupture spontaneously. It is mainly associated with irritability, disturbed sleep, drooling, fever, or a circumoral rash.

The average ages of tooth eruption are:

What Is the Etiology of Delayed Tooth Eruption?

A delay in tooth eruption up to 12 months may be unimportant in a healthy child. Delay is mainly due to local factors such as the path of eruption, insufficient space in the dental arch, or infection in the tooth. Impaction (failure to erupt through the gums) is commonly seen in third molars, second premolars, and canines because they are the last tooth to erupt in the oral cavity. Generalized failure of tooth eruption is rare, but it may be associated with various systemic causes.

Causes of delayed tooth eruption in primary teeth include:

• Impacted teeth.

• Excessively thick gums.

• Supernumerary or extra teeth.

• Injury or trauma where the tooth needs to erupt.

• Odontogenic tumors (tumors or cancer arising from the tooth buds).

• Oral clefts (congenital disability affecting the oral cavity or mouth).

• Ectopic eruption (eruption of the teeth other than the usual site).

• Ankylosis (fusion of the alveolar bone and cementum of the teeth).

• Iatrogenic causes.

• Cytotoxic therapy (cancer treatment).

• Radiotherapy (use of high doses of radiation to kill cancer cells).

• Down syndrome (a genetic disorder in which there is an abnormal cell division resulting in an extra gene).

• Cleidocranial dysplasia (a genetic disorder affecting teeth and bones). Dental anomalies are found in more than 90% of such individuals.

• Apert syndrome (a genetic disorder characterized by skeletal abnormalities).

• Congenital hypopituitarism (deficiency of one or more hormones produced by the anterior pituitary).

• Congenital hypothyroidism (thyroid glands fail to develop or function properly).

• Gaucher disease (buildup of fatty substances in specific organs).

• Osteopetrosis (a bone turnover defect that causes easy bone breaking).

• Family history and other genetic disturbances.

• Low birth weight or premature birth.

• Vitamin D or nutritional deficiency.

• Conditions like HIV, anemia, kidney diseases, cancer, and heavy metal poisoning affect the child's immune system and cause a delay in tooth eruption.

• Long-term medications like Phenytoin can affect normal tooth development.

Delayed eruption in the permanent tooth is due to early loss of milk teeth, retained milk teeth, or harmful habits that obstruct the path of the erupting teeth, like constantly touching the teeth with their hands.

What Are the Clinical Implications of Delayed Tooth Eruption?

Delayed tooth eruption can have several clinical implications for a child’s oral and overall health:

• Jaw and Alignment Problems: Teeth eruption may be delayed, resulting in improper jaw growth and misaligned teeth. This may lead to crowded or spaced teeth, which may need orthodontic correction at some point in the future.

• Speech and Chewing Difficulties: Teeth are vital in speaking and chewing food. If the eruption is delayed, speech may be affected because certain sounds may be difficult to pronounce, and the child may have problems chewing solid foods.

• Underlying Health Conditions: By this, it could be concluded that delayed tooth eruption could be a sign of systemic health problems, including:

  • Other medical conditions such as hypothyroidism (lack of thyroid hormone), growth hormone deficiency, or another hormonal imbalance.

  • Abnormalities in organ development, such as Down syndrome or ectodermal dysplasia, may interfere with tooth formation.

  • Lack of sufficient calcium, vitamin D, or poor nutrition likewise affects dental and bone development.

• Increased Risk of Cavities and Gum Disease: Even if a child has delayed tooth eruption, he or she may still be prone to dental problems, including red and swollen gums or tooth decay once the teeth grow in. It is important to keep the mouth clean if teeth are delayed in coming through.

When to Be Worried That Baby Teeth Are Not Growing?

Primary or baby teeth start to emerge at the age of 6 to 12 months. While a child is still three, most or all baby teeth are supposed to have already been developed. However, there are situations when the eruption of the baby's teeth is delayed, which can worry parents.

You may need to consider consulting a dentist if:

• No Teeth by 12 to 15 Months: If your baby has not developed any teeth by the time he or she is 12 to 15 months old, then it is advisable that you seek the opinion of a pediatrician to find out the cause of delayed eruption of teeth, and this could be as a result of genetic factors, nutritional problems, or health complications.

• Teeth Erupt Out of Order: Despite this, if the eruption sequences are slightly different or baby teeth are out of order, there could be a dental or jaw development problem.

• Associated Developmental Delays: If delayed tooth eruption is accompanied by other developmental problems, such as walking or talking difficulties or delayed growth, it can be attributed to underlying medical conditions like hypothyroidism and genetic disorders, among others.

When Is the Right Time for the Baby to Visit a Dentist?

According to the American Academy of Pediatric Dentistry, the first dental visit should be made by the child’s first birthday or when the child has the first birthday tooth. It also helps the dentist notice any irregularity in the development of the baby’s teeth and correct them early. During the visit, the dentist examines the signs of tooth decay, teaches the correct oral hygiene, and evaluates the progress of jaws and teeth. If delayed tooth eruption is noted, the dentist may:

• An X-ray is performed to determine whether any irregularities or blockages are present.

• Assess the child’s diet for bone and tooth development and ensure adequate nutrition, especially calcium and vitamin D.

What Are the Complications of Delayed Tooth Eruption?

The complications of delayed tooth eruption include:

• Need for orthodontic treatment due to tooth discrepancies like crowding or poorly aligned teeth. Tooth eruption is related to the growth of the jaws and face. A delayed discharge may cause abnormal development of them.

• A delayed eruption can alter the position of the neighboring teeth.

• Undiagnosed genetic disorders.

• Undiagnosed nutritional deficiencies can further delay growth and development.

• Possible delayed development in other areas of the body.

What Are the Treatment Options Available?

Treatment is not required if the delay in tooth eruption is due to the family pattern. However, treatment is done if other underlying medical conditions and local factors cause the delay. Extraction is done to remove the milk tooth, which is not exfoliated. Surgery is done to remove thick gums and help the tooth erupt or unite oral clefts. Orthodontic treatment to pull the tooth out over some time is done. Underlying systemic medical conditions must be treated accordingly.

Conclusion

If you suspect a delayed eruption, a proper evaluation by a dentist is necessary to determine the underlying cause and provide treatment if necessary. The primary or permanent teeth play an important role in the child's chewing function and phonetics. Dental anomalies can be seen as individual findings or craniofacial abnormalities; in both cases, they affect the individual's quality of life.