Occlusal Problems in the Mixed Dentition

what is dilaceration

abrupt chnage in axial inclination between the crown and root

caused by trauma or idiopathic development - sometimes developmental syndromes

how do we manage dilaceration

fairly common - 3%

half are impacted

depends on factors and inidvidual

if unerupted, have closed exposure and ortho alignment or removal

if erupted removal and pontic based on severity

what is peg lateral

associated with hypodontia - one peg on one side, the other side is likely missing

also has a risk of ectopic canine so always check canines

what types of supernumary teeth are there

supplemental - exact replica of another tooth, suually teeth at the end of the series

odontome - mass of tooth tissue that can cause distrupted eruption

conical - like a peg lateral but extra

tuberculate - kind of looks like premolar but not but extra and can impede central incisors

most common in premaxilla, if in midline call mesiodens

how do we manage supernumaries

depends on whole malocclusion

usually extract but can leave if unerupted

if they sit behind central incisors, if needing orth tx most likely need taken out to avoid damaging the roots

what is hypodontia

abscence of 1 or more teeth noy including the 8s

often hereditary

most commonly affects upper lateral incisors and lower second premolars and also 8s

more common in perm, if they have missing primary it means missing perm

be suspicious of delayed exfoliation or late eruption

what is infraocclusion

Teeth are depressed below the line of occlusion

because it doesnt keep up with growth of alveolar bone

due to ankylosing of the decidoius tooth

what are neonatal teeth

any tooth present at birth

can cause feeding problems

if mobile, consider extraction

what is eruption cyst

appears as blue mucosa

most common over Es and 6s

usually asymptomatic unless traumatising witht he occlusion

as soon as the tooth erupts, it will dissapear

what are impavcted teeth

tooth not erupted

due to lack of space at alveolar ridge, ectopic teeth or obstruction

often first permanent molars and canines

what are retained deciduous teeth

perm tooth maybe missing or ankylosed and dont exfoliate in a normal manner

need extracted if ankylosed as they can displace permanent successor

what causes premature loss of deciduous teeth

caries - see mesial drifting of first perm molars and can see crowding

trauma - can result in centreline shift and delayed eruption due to fibrous mucosa

balancing extractions

compensating extractions

why is trauma bad for deciduous teeth

why is caries bad for deciduous teeth

what are balancing extractions

try to maintain midline by removing teeth

consider when extracting C and Ds not rlly Es

what is a compensating extraction

if a tooth is out on one arch u take it out of the other

mostly for FPMS

theoretical risk of overeruption of the occlusing tooth and can cause issues in future

what are serial extractions

aim to relive incisor crowding in mixed dentition

to try avoid ortho tx

extract all 4 Cs and all Ds and then all premolars when erupt to improve the spacing of the permanent teeth

what happens in early loss of FPMS

not ideal for ortho

often due to caries or MIH

ideally have all perm teeth and check with DPT

optimum age is 9-10 but based on development of unerupted second molars

delay if necessary

what is ankylosis

tooth is fused to the bone and loses PDL so it cannot erupt

this is why it appears to sink

what are cross bites

affect any tooth or teeth

commonly incisors or molars

can result in mandibular displacement tooth wear and gingival recession

can correct in the mixed dentition if causing problems

how do we correct crossbites

if mixed, a removeable applicance is best

RME - rapid maxillary expansion

2 x 4 fixed applance

what are non nutritive sucking habits

dummy or thymb

results in proclined maxillary incisors

retroclined mandibular incisors

anterior open bite

posterior buccal crossbites - pressure pushinf the max teeth in and makes a narrow maxilla

depends on intensity and duration

how do we manage non nutritive sucking habits

positive reinforcement

non invasive methods such as glove, nail varnish, plasters

if unsuccessful try fixed or removeable habit breaker appliance

can get spotnaneous resolving when younger but older needs ortho which is difficult to fix

what is midline diastema

developmental stage of space between central incisors

is normal but sometimes an indication of hypodontia and supernumaries and large frenum

manage with eruption of permanent teeth but might need ortho when older usually a fixed applinace

sometimes need frenulectomy

what do impacted Es impact on

impavct on distal of Ds and difficulty in OH

consider monitoring a seperator or extraction

what do impacted FPMs impact on

not commmon and usually due to crowding

mnitioring extraction or separator

what do impacted second premolars impact on

due to crowding following early loss of deciduous molars

common

what do impacted central incisors impact on

caused by supernumary, dilaceration, trauma, premature loss of deciduous

be suspicious of if eruption sequence id distruptrd by > 6 months since contralateral tooth

remove obstruction if present, create space and dependant on age either await eruption or surgical exposure and gold chain

what do impacted canines impact on

always palpate 8-10 year olds to check and then take xrays

early intervention - extract Cs and review

if it fails to erupt then either leave it and monitor if not resorbing roots, surgical exposure and ortho alignment or extraction

majority are palatal