PEDIATRIC DENTISTRY

Part 1: Developmental Disturbances of Teeth

Development of the Tooth
1) Bud stage (Initiation)
-formation of dental lamina
-begins in 6th week of embryonic life
-all primary teeth and permt molars arise from dental lamina
-permt incisors, canines, and premolars arise from primary predecessor
-failures during initiation result in congenitally missing teeth
-excessive budding results in supernumerary teeth
2) Cap stage (Proliferation)
-formation of shape of tooth
-peripheral cells of cap form inner and outer enamel epithelium
-failure in proliferation results in congenitally missing teeth
-excessive proliferation results in cysts, odontomas, or supernumerary teeth depending on amt of cell
differentiation
3) Bell stage (Histo/Morphodifferentiation)
-differentiation into specific tooth types
-cells of dental papilla differentiate into odontoblasts
-cells of inner enamel epithelium differentiate into ameloblasts
-failure in histodifferentiation results in structural abnormalities of enamel and dentin
(amelogenesis/dentinogenesis imperfecta)
-failure in morphodifferentiation results in size and shape abnormalities (peg incisors, macrodontia)
4) Apposition
-ameloblasts and odontoblasts deposit a layer-like matrix (enamel, dentin, etc.)
-disturbances in apposition results in incomplete tissue formation (enamel hypoplasia)
5) Calcification/Maturation
-enamel is 96% inorganic matter and 4% organic matter/water
-calcification begins at cusp tips and incisal edges and proceeds cervically
-localized infxn, trauma, and excessive systemic fluoride ingestion may cause hypocalcification
Lobes
-lobes are primary centers of ossification in tooth development
-lobes separated by developmental grooves in post. teeth and by developmental depression in ant. teeth
-all anterior teeth have 4 lobes (3 facial and 1 cingulum)
-premolars have 4 lobes (3 buccal and one lingual); mand. 2PM has 5 lobes (3 buccal, 2 lingual)
-1st molars have 5 lobes (1 for each cusp)
-2nd molars have 4 lobes (one for each cusp)
-3rd molars have at least 4 lobes
Formation Sequence (Histogenesis) of Tooth Substances
1) Elongation of inner enamel epithelial cells of enamel organ
2) Differentiation of odontoblasts
3) Deposition of first layer of dentin
-Korffs fibers in pulp periphery help in formation of dentin matrix
4) Deposition of first layer of enamel
5) Deposition of root dentin and cementum
-formation of root dentin induced by Hertwigs epithelial root sheath
Hertwigs Epithelial Root Sheath
-forms when outer enamel epithelium and inner enamel epithelium combine
-determines number, size, and shape of roots
-when clinically erupted in mouth, roots are usually -2/3 formed