Definition

The physiologic process resulting in the elimination of the

deciduous dentition is called shedding or exfoliation
PATTERN OF SHEDDING :

 Multinucleated cells similar to osteoclast – the odontoclast,

resorb the roots, pdl and bone

 Generally Pressure developed by the erupting and growing

permanent teeth dictates the pattern of deciduous tooth
resorption.

 Permanent incisors and canines resorb the lingual surface

of root of deciduous teeth as they erupt.
 Resorption of deciduous molars occur in the inner surface
of the roots as bicuspid are found between the roots.

 However due to growth of jaws and occlusal movement of

deciduous molars, developing bicuspids lie apical to the
deciduous molars and continue to grow.

 When bicuspid erupts they once again resorb the roots of

deciduous teeth, this time completely and the tooth is shed
PATTERN OF SHEDDING
HISTOLOGY OF SHEDDING

 Resorbing cells are similar to osteoclast and are highly

specialized to resorb bone and are called odontoclast.

 Their origin is from circulating TRAP positive

monocytes(tartarate resistant acid phosphatase-TRAP).

 Odontoclast fuse with one another and form multinucleated

giant cell only after they get attached to resorbing surface.
Odontoclast –
 large multinucleated cell. adjacent to resorbing surface
shows ruffled border(thrown in to infoldings).

 At the periphery of this border, the plasma membrane is

apposed closely to the bone surface, and the adjacent
cytoplasm, devoid of cell organelles, is enriched in actin,
vinculin, and talin (proteins associated with integrin
mediated cell adhesion).

 This clear or sealing zone not only attaches the cells to the
mineralized surface but also (by sealing the periphery of
the ruffled border) isolates a microenvironment between
them and the bone surface.
 Cytoplasm contains high concentration of mitochondria and
vacuoules showing acid phosphatase activity.

 Odontoclast attaches to hard tissue surface peripherally thro the

clear zone creating a sealed space lined by ruffled border of cell.

 The membrane of ruffled border acts as a proton pump adding

hydrogen ions in to the extracellular environment and acidifying
it so that mineral dissolution occurs.

 Lysosomes secrete enzyme in to the same environment and

degrade organic matrix. odontoclast resorbing enamel
phagocytose enamel crystals and dissolve them intracellularly .
 They resorb all hard tissue including enamel. When dentin
is resorbed they extend their cytoplasmic processes in to
dentinal tubules and resorb easily.

 Location – single rooted teeth shed before root resorption

is complete hence odontoclast are not found in pulp
chamber. In molars root resorption is complete and also
crown is partially resorbed before shedding hence
odontoclast are found within pulp chamber replacing
odontoblastic layer.
 Resorption is not continuous. It is composed of alternate rest and
repair. Resorbed surface is coated with cellular cementum like tissue.

 Acellular cementum like tissue is deposited in shallow and smaller

resorption bays. Cellular cementum like tissue fills larger and deeper
resorption bays. Both contains intrinsic collagen fibres but no extrinsic
fibres. Cementum like tissue aids in retention of the teeth until
shedding.

 After complete tooth resorption dentogingival junction migrates

apically along the inner resorbing surface and attached to residual pulp.
It holds tooth cervically until shedding which involves tearing of
dentogingival junction.
 Shedding of Teeth

Odontoclast

Figure Source: Dr. Sandra Meyers

MECHANISM OF RESORPTION AND SHEDDING

 Pressure from erupting successor and forces of mastication are

responsible for tooth resorption

 The reduced enamel epithelium of erupting permanent teeth

releases some substance to initiate inflammatory process which
in turn damages the cementoblastic layer of deciduous teeth.

 Initially osteoblast resorb organic matrix and expose mineralized

dentin to which odontoclast attach and resorb.

 Predentin resist resorption than any other dental tissue

MECHANISM OF RESORPTION AND SHEDDING

 As resorption of root is initiated by pressure, there is loss of

surface area for attachment of pdl. This coupled with
increasing masticatory force of growing muscles, lead to
tooth resorption. Pdl resorption is by
apoptosis(programmed cell death)
 Pressure From Erupting Tooth

Root Loss

To summarize shedding:
Decreased Tooth Support

Not able to bear increased masticatory load due to growth

Exfoliation
CLINICAL CONSIDERATION

 Remnants of deciduous teeth- Roots of lower second

deciduous molar is strongly curved and divergent.
Mesiodistal diameter of lower II premolar is less than the
distance between the roots of lower II deciduous molar,
hence root remnants may be found deep in the bone,
ankylosed, cased in heavy layers of cementum. They if
present near the surface gets exfoliated and if present
deep, gets resorbed and disappears.
 Retained deciduous-If permanent tooth germ is missing (eg
permanent lateral incisior) or if permanent tooth is ankylosed or
impacted(eg permanent canine)deciduous teeth are retained.

 If permanent lateral incisor is missing, deciduous lateral may be

resorbed by erupting permanent canine and also deciduous
canine is resorbed by the same.

 Sometimes the permanent canine causes resorption of deciduous

lateral incisor only. In that case deciduous canine is retained
distally to permanent canine.

 Supernumerary or odontogenic tumor causes ankylosis of

deciduous tooth.
 Submerged deciduous teeth-Trauma of deciduous follicle
or pdl causes ankylosis of deciduous teeth. Due to
continued eruption of adjacent teeth and increase in height
of alvelolar bone the ankylosed teeth gets submerged . It
prevents eruption of permanent successors hence should
be removed.