A Paper Presentation On IDENTIFICATION OF TEETH

by
K. SOWMYA SREE III B.D.S.,

Guidelines for Identification of Teeth

If a student finds it difficult to identify a particular tooth, he is asked to assess and thoroughly evaluate the following factors one by one to come to a conclusion: Size and shape of the teeth Color of the teeth Presence of Mamelons (lobed incisal edge/developmental grooves) Eruption status of the teeth Eruption sequence of the teeth Chronological age of the patient Mobility of teeth Eruption status of teeth in the opposing quadrant/ arch Previous history of extraction Presence of wear facets.

Size and shape of Teeth (Fig. 4.1)

Size of the primary teeth is smaller (Fig. 4.1 A, B) compared to their succedaneous teeth except for the primary molars where they are larger than premolars. Hence a smaller size tooths usually indicates a primary tooth. Occasionally one may encounter a which looks smaller and this may confuse a student to identify it as a primary tooth. Under such circumstances, the assessments of the other factors like chronological age, mobility and eruption status of the tooth will help them to identify the tooth correctly. Fusion and gemination of primary tooth in a sixyear-old child can create an illusion of a permanent tooth because of its larger size. The mandibular second primary molar resembles the mandibular first permanent molar, (Fig. 4.2), not the succedaneous second premolar. Maxillary primary second molar resembles maxillary first permanent molar. Mandibular first primary molar and maxillary first primary molar do not resemble any permanent tooth. Knowledge about the cuspal anatomy of primary molars and premolars is essential and it helps a student to identify the teeth correctly.

Color of Teeth

Generally, primary teeth are whiter in color in comparison to the permanent teeth. This may also sometimes aid in identification of teeth correctly.

Presence of Mamelons (Developmental Grooves) (Fig. 4.3)

Mamelons are developmental grooves present on the incisal edges of a newly erupted incisor. These are seen in permanent teeth because the enamel formation in permanent teeth occurs in lobes. (Fig. 4.3 A, B) These lobes fuse together to form the labial and lingual surfaces of teeth. The lines of fusion are seen as grooves on the incisal edge of newly erupted incisor which are called mamelons. These grooves wear off as the age advances unless the teeth are in crossbite or out of occlusion. Hence presence of mamelons indicates that they are young permanent incisors. The mamelons are not seen in primary incisors as the enamel formation takes place from a single lobe.

Eruption Status of Teeth

All the primary teeth are present in a childs mouth by the age of 3 years. Hence any newly erputing tooth found in a child more than 5 years of age has to be a permanent tooth. Observing the extent of crown that has come out of the gingival (Whether it is partially erupted or completely erupted) and correlating it chronology of eruption gives a clue for identification (Fig 4.4).

Eruption sequence of Teeth

The sequence of eruption teeth can vary with individuals. The favorable sequence observed for permanent teeth in the maxilla is as follows: 6, 1, 2, 4, 5, 3, 7, 8 (first molar, central incisor, lateral incisor, first premolar, second premolar, canine, second molar and third molar). The favorable sequence observed for permanent t mandible is as follows: 6, 1, 2, 3, 4, 5, 7, 8 (first molar, central incisor, lateral incisor, canine, first premolar, second premolar, second molar and third molar). In primary teeth, the normal eruptions sequence both maxilla and mandible is: A, B, D. C, E (central incisor, lateral incisor, first molar, canine, second primary molar). Knowing the sequence correctly can further help the identify the teeth properly.

Chronological Age of Patient

Generally, the undergraduate students tend to eruption of teeth to the chronological age of the child as they are familiar with the eruption schedule from the year of the dental school. However, there is always variation in the chronological age and the eruption of teeth, e.g not every premolar erupts between 10-12 years. If an infected primary second molar is extracted by the age of 8 years it can lead to accelerated eruption of second premolar by 8.5 years of age.

Mobility of Teeth

Mobility of a tooth indicates that it is a primary tooth. Hence checking any tooth in doubt for its mobility can give a clue to the undergraduate student in identification.

Eruption Status of Teeth in Opposing Quadrant/Arch

Generally, the eruption of teeth is bilaterally symmetrical. Hence, observing the eruption status of the opposing quadrant or comparing, the eruption status of teeth in both the quadrants can give a hint about the tooth in question.

Previous History of Extraction

Previous history of extraction can lead to either accelerated or delayed eruption of the succedaneous permanent teeth. Occasionally, when a chronically infected primary molar with destruction of bone covering the unerupted permanent tooth (premolar) is extracted, it accelerates the eruption of a premolar at an age as early as 7 years (Fig. 4.5). However, a delay in eruption of premolar can be observed, if the extraction of primary molar (without sepsis) has taken place at an early age like 6 years. A brief history of previous extraction could indicate that the tooth which was removed was a primary tooth and the tooth which is present is a prematurely erupted permanent tooth.

Presence of Wear Facets (Fig. 4.6)

This particular factor can be a good clue for identification of canine. The primary erupt into the mouth by the age of 2 years. In a patient aged 6 years or more, the canines may have wear facets on the incisal edge because of the occlusal wear (Fig. 4.6). However, a newly erupting permanent canine may not have any wear facets even by the age of 13 or 14 years. Observation of wear facets can eliminate the risk of identifying the canine incorrectly.

Conclusion

The teeth identification exercise followed in a systematic way has resulted in lesser number of mistakes committed by our students over the years. When the above mentioned factors are carefully evaluated by students the chances for incorrect identification becomes negligible. Having a minimum requirement on the number of identification exercises to be performed during the undergraduate training program can help students mastering this exercise.