In this lecture we are going to talk about dental age and how to use the tables related to the

timing of different stages of tooth development. We have Jordanian data and non Jordanian data, Jordanian data is related to tooth emergence of primary (deciduous) teeth and (secondary) permanent teeth. But all other stages are related to non Jordanian data. There are three published studies on teeth: 1- for American 2-for Australian 3-for Jordanian (the doctor project) We have learnt how to use table in the lab to determine the age.

Polymorphism There is a common sequence of tooth emergence. For example we know that maxillary first molar emerges in the mouth before maxillary central incisor. But now one student may ask I have a brother (male or female) and I noticed that the central incisor appeared before the first molar, is that possible? The doctor answered: it is possible because common sequence is built on average. Polymorphism: it's the percentage of reverse sequence We know that the common sequence is built on the average this mean that the most children have this sequence and it's possible that some children have reverse sequence of teeth emergence. Lets look to this table, this table is in FDI notation and the teeth are ordered according to their average sequence of emergence. It will start in tooth #6 (first molar) First molar > central incisor > lateral incisor> first premolar> second premolar > canine > second molar

NOW: what is the percentage of central incisor to appear before fist molar? Answer: 5%, this means that 5% of Jordanian children have their central incisor appeared before their first molar but other than 5% of children have normal sequence. E.g.: what is the percentage of Jordanian children (male) having tooth 15 appearing in the mouth before tooth 14??? Answer: 8% <<this question is the type of question in exam so be careful>>

E.g.: what is the percentage of Jordanian female having the mandibular first premolar appearing in the mouth before the mandibular canine??? Answer: 43% which is a very high percentage
<<So this table is very important >>

The highest polymorphism is 50% which is the percentage of Jordanian male having their mandibular first premolar appearing before mandibular canine (because this percentage is above 50% we can't call it reverse sequence it's called actual sequence (normal average)) Sometimes it's impossible for Jordanian children (male or female) tooth 47 to appear before tooth 46 so this 0%. The percentage of reverse sequence in second stage (mixed dentition phase) which is (canine, premolar, second molar) is higher than the percentage of incisor and first molar (first mixed dentition) The percentage for central incisor to appear before the first molar in a mandible is higher than maxilla. In males this percent is equal to 5% in maxilla and 29% in mandible In females this percent is equal to 3% in maxilla and 23% in mandible

very important note: we don't need to remember these tables for practical question but for theoretical question we need to remember some information from this table (because we are a dentist :) ) so we have to remember the table which is about the timing of emergence of permanent and deciduous teeth just for combined gender and approximate number into one decimal point. And you have to remember the sequence for intra and inter arch.

QUISTION: is this case normal or abnormal??? A Jordanian boy having maxillary canine appearing in the mouth at the age of 7 is that normal??? ANSWER: abnormal because the normal age of appearance is from 8.9 - 13.7

The timing of emergence of teeth in Jordanian people is insignificant different between right and left side because we don't have bilateral asymmetry, Asymmetry mean right side differ from left side, because of that we can use data for just one side either right or left side

We know that the teeth in the lower jaw appear in the mouth before the teeth in upper jaw. Why??!!! Because the difference in the mandibular precedence ( .) But this difference is not significant in premolars and first molar (4,5,6) but this difference is large significant in canine between mandibular and maxillary.

*** Permanent teeth emerge earlier in females than males among Jordanian people, The big difference between females and males starts after the emergence of first molar and central incisor and it become significant. So in first molar and central incisor there's no significant difference between male and female. What do we mean by eruption? In text book they use the term eruption instead of term emergence (we must be careful because the two terms different and the best term is emergence) What is the effect of body mass index in the time of emergence?? Body mass index =weight (kg)/ (height (m))^2 ANSWER: the tooth emergence is accelerated in high body mass index and is delayed in lower body mass index. And tooth in second phase dentition is very affected by this factor, so when we see a very heavy child his teeth will emerge earlier than a very thin child. *** The time difference between tooth emergence and functional eruption First we know the difference between anatomical crown and clinical crown Anatomical crown: is the actual crown of the tooth from cusp tip until the surgical part of enamel, it's not necessary that the full anatomical crown appear in the mouth because in normal situation about 2 mm is covered by the gingiva. Clinical crown: it is the part of the tooth appears in the mouth. In normal situation it is shorter than anatomical crown, but the clinical crown becomes longer than anatomical crown in old people who have periodontities (inflammation in periodontal tissue surrounding the tooth) Time of functional eruption is the time needed from emergence until functional eruption; this time is clinically detectable from emergence of tooth until occlusion with the opposing tooth in other jaw. The tooth that emerges earlier, like first molar and central incisor, have short period of time to reach functional eruption First molar =0.17 year ~two months

Second molar =0.81 year SO as we go toward the teeth that emerge later this time interval become greater. Each tooth is represented by one vertical line First evidence of calcification > crown completion > emergence > root completion

Can teeth tell the age? Dental age estimation depending on the first evidence of calcification, crown completion and root completion NOTE: sometime we can produce models; this means that we take an impression for the tooth. Models are similar to clinical examination so anything detectable clinically can be detect by impression

WHY DO WE NEED DENTAL ESTIMATION???!! 1) It is important in forensic investigation ( 2) It is important in police investigation

3) It is important for determining teeth abnormalities We need to know the dental age and the time for emergence of different teeth, depending on that we can judge that this tooth normal or abnormal. 4) Planning for orthodontic treatment 5) In pediatric dentistry sometimes children develop decay or caries in their deciduous molars, just we need to remove this molar because after a short time the permanent molar will appear, this is when a child in age of eleven because we know that after a short period of time the permanent molar will emerge. But when the child in age of six or seven there's a long period of time between deciduous and permanent molar, so if we remove this deciduous molar very early the space for permanent molar will disappear because one function of deciduous teeth are to

maintain the space for permanent teeth, so the knowledge of the age is very important.

<< DENTAL AGE ESTIMATION >> *First: identify all permanent and deciduous teeth that present in the mouth *Second: identify any abnormalities If we have any abnormality we have to exclude it. (Like one of x-ray in lab, second premolar is missing so be careful :) So don't depend on abnormality to estimate the age and if you depend on abnormalities you will have incorrect result How we can identify abnormality? 1) We can determine abnormality by comparing right with left side because sometime the abnormalities just in one side. 2) If abnormality is bilateral (symmetrical) we refer to tables to know if there's abnormality or not * Third: identify 1. The last tooth that has emerged according to the known sequence 2. The age of this event is the minimum of the range 3. The next tooth to emerge according to the sequence 4. The age of this event is the maximum of the range Give the range *Fourth: pick up teeth at crown completion, teeth at root completion and teeth in first evidence of calcification. And refer to table to estimate the age. NOTE: sometimes you find a tooth in half root completion in this case you have rough estimation and the result will be not accurate. Always when you find tooth in crown or root completion you will be happy

because it is very easy :)

NOW WE BEGIN NEW SHORT LECTURE

Dental terminology
***dental arch: can be maxillary or mandibular (which the arrangement of tooth in the arch is We have upper and lower arch ***tooth class: can be incisor or canine or premolar or molar We have three classes for deciduous teeth and four for permanent teeth. Identification Traits: When we have to identify any tooth in the mouth we should know a) The set traits: where the tooth belongs either primary set dentition or secondary set dentition. Any difference that lead to distinguish between primary (deciduous) and permanent teeth called set traits b) Arch traits : the difference between any corresponding tooth but belonging to different arch, example if you want to distinguish between lower first molar and upper first molar Example lower molars have two roots but upper molars have three root, so the number of root one of the arch traits because we used it to distinguish between upper and lower molar. c) Class Traits: traits that enable you to distinguish between different classes of teeth example we see that premolars have two cusp but canine has one cusp. d) Type traits: sometimes we have more than one tooth in the same class. Incisors: two teeth. Premolars: two teeth. Molars: three teeth. SO the characteristic that allow you to distinguish between the teeth in the same class is called type traits Example the difference between central incisor and lateral incisor

e) Side traits: we don't have this term because all time the right side is symmetrical to left side Buccal and labial: The surface of teeth opposing the lip called labial. The surface of the teeth opposing cheek called buccal. Both of them are called facial. So facial used for both labial and buccal Labial is the outer surface of anterior teeth including incisors and canine but the outer surface of posterior teeth include premolar and molar called buccal surface. We have two terms anterior and posterior in anatomy, the line distinguished between anterior and posterior is canine, so anterior to canine including canine is called anterior and anything posterior to canine called posterior. Also we use medial and lateral terms in anatomy, Medial: toward Medline Lateral: away from midline But in dentistry we use mesial and distal instead of medial and lateral Mesial surface is the surface toward midline. Distal surface is the surface away from midline. We use buccal and labial instead of anterior and posterior Buccal is toward the cheek Labial is toward the lip Also we use facial and lingual. For maxillary teeth we use facial for outside surface and we use palatal for the inside surface or we use lingual because the palate surface toward the tongue. But the term lingual mostly use for lower teeth (the inside surface of mandible). in summary the inner surface is either called lingual or palatal, but we prefer palatal for the maxillary teeth, and lingual for the mandibular teeth.

NOTE: Inside surface of maxillary teeth - palatal and lingual Inside surface of mandibular teeth lingual but not palatal. Question: what are the two teeth in the arch that meet mesial surface to mesial surface? Answer : central incisor In all teeth the mesial surface of one tooth meets with the distal surface of adjacent tooth except central incisor and third molar, because distal surface doesnt meet with any tooth so distal surface is free. Proximal: is the term which is used for both mesial and distal (the surface of teeth that meets together.) Facial and lingual surface always free in contact but proximal surface all the time in contact except distal surface of third molar. Caries that develops in proximal surface grow very fast, why? Because it is an area of food accumulation in comparison with caries which are growing in facial, lingual and occlusal surfaces that grow very slowly, because there's no food accumulation in these areas and subject to tooth brushing. VERY IMPORTANT NOTE Use of brush is not enough also we should use dental floss Each tooth has five surfaces Top surface, facial surface, lingual surface, mesial surface, distal surface Line angle: the line between two joining surfaces Example: labial and mesial this angle is a line angle not a point angle and we call it mesio-labial line angle Point angle: the point between three joining surfaces Example: occlusal, buccal and mesial surface. We can call it mesio-bucco-occlusal point angle.
Point angle Line angle

Question: how many point angles in molar??? Answer: there are four point angles in molar we call it : 1)occluso-bucco-mesial 2)occluso-bucco-distal 3)occluso-lingual-mesial 4)occluso-lingual-buccal Question: how many line angle we have in molar? Answer: 6 line angle Incisor edge: the tip of incisor cusp: it is evidence not in anterior teeth, it is evidence in posterior teeth and canine, it means the round ends on the top of the tooth, they are important for mastication. When we go older the cusps become flat, that why the old people not as good as we (young people) in mastication. Cingulum: feature we find in anterior teeth (incisor and canine),It is an elevation which is found in cervical part on the lingual surface. Fossa : any depression in the tooth called fossa

Done by: Eman mousa khashashneh <<Forgive me for any mistake >>

Corrected by: Sawsan Jwaied