CHARACTERISTICS OF TOOTH ERUPTION AND

FACTORS AFFECTING THE ORDER AND CHRONOLOGY

Authors: Dr. Magela Rodriguez Estevez. First Degree Specialist in Comprehensive

General Dentistry, third-year resident in orthodontics, magelare@infomed.sld.cu

Coauthors: Dr. Leslie Imara de Armas Gallegos, Dr. Maiyelín Rodriguez Llanes, Drac... Brismayda González
García, Drac. Gladia Toledo Mayari

STOMATOLOGY

SUMMARY
Introduction: Normal tooth eruption occurs in a given time, corresponding to a chronological age of the person; however,
it is common to find variations of the standard eruption in the time and order, because their conditions are not stable, by
factors general and local order acting on it. Objective: Update the knowledge about dental eruption and the factors that
influence the normal development of it. Material and Methods: an automated bibliographic review was made in the
databases of the MEDLINE, PubMed, Hinari Ecimed and Google systems, selecting published articles from the last 5
years. Results: The literature reveals an emphasis on the descriptive analysis of the causal relationship, particularly that
related to biological and local determinants, as well as an anthropological interpretation of this phenomenon, which allows
differences to be reported among different population groups.
Conclusions: The dental eruption presents different stages and processes that must arise in an orderly and continuous
manner for the adequate development of the jaws and the establishment of functional occlusion; although it does not
occur exactly in all individuals, due to the influence of both systemic, local, genetic, environmental and alternative
sociocultural factors that modify the chronology and sequence of eruption.

Keywords: tooth eruption, premature eruption, delayed eruption, dentition, permanent dentition, etiological factors.

INTRODUCTION
The tooth eruption is the migratory movement of the teeth from its place of embryological formation, inside the maxillary and
jaw bones, until they reach their final functional position in the occlusal plane, through the bone, soft tissues and oral
mucosa. It is a continuous and dynamic process that covers from the beginning of embryonic life and extends throughout
the life of the tooth, presenting different stages: first, the formation and progressive mineralization of the teeth and second,
its eruption and outbreak in the oral cavity ; that must occur in a certain order, for the development of the jaws and the
establishment of the best possible relationship in the articulation between the dental arches, which will result in a well-
established functional occlusion. The eruption of the teeth can be altered by multiple causes, congenital and / or
environmental, since it is a long process in time and intimately related to the growth and development of the rest of the
craniofacial structures. Therefore it is necessary to know the characteristics of each of its stages, to identify when we are
facing a situation of normality and differentiate from an abnormality. 1, 2 With the aim of updating knowledge to health
professionals about the stages of the eruption dental and the factors that influence the normal development of the same,
and thus can identify and prevent any alteration related to this process, avoiding the appearance of future malocclusions;
We carry out a thorough bibliographic review where the most important aspects related to the subject are synthesized.
International Congress of Stomatology 2015
MATERIAL AND METHOD
A search of current bibliography was carried out using engines such as PubMed, Medline, EBSCO, Inaris and Google. As a
selection criterion, articles published in the last 5 years were taken into account. However, the classic literatures of the
oldest data will be revised, taking into account the importance of the information and the prestige of its authors.

ANALYSIS AND INTEGRATION OF INFORMATION

The dental eruption: it is a physiological process in which different aspects concur: the odontogenesis and simultaneously
to this, the germs move in the arches, emerging in the oral cavity and establishing its functionality. The moment the tooth
bursts into the mouth, it is called an emergency or tooth bud.1, 3
Odontogenesis: is the embryonic process by which the cells of the estomodeo or primitive mouth are differentiated to give
place to the teeth and is produced under a strict genetic control that determines the position, number and shape of the
different teeth, according to molecular studies made in recent years.3,4
Two germ layers are involved in the formation of the teeth: the ectodermal epithelium that forms the enamel and the
ectomesenchyme that forms the dentin-pulp complex, cementum, periodontal ligament and alveolar bone. This life cycle of
the dental organs comprises a series of chemical, morphological and functional changes that begin in the sixth week of
intrauterine life and originate from epithelial buds, but not all begin their development at the same time; that is, the first
dental buds appear in the anterior mandibular region, then appear in the anterior maxillary region. From there, the teeth
appear posteriorly in both jaws.4,5,6
However, in a recent study on odontogenesis in embryos suggests that the odontogenic differentiation in the primary
dentition begins in maxillary incisors (week 15) and mandibular incisors (week 16), followed by canines, first and second
molars with a week interval in the frequency. 7
The process of eruption of the teeth is governed by an endocrine control and begins when the calcification of the crown is
finished and immediately after it begins to calcify two thirds of the root, by the action of the periodontal ligament that
provides the eruptive force through of its fibers and cells, so that fibroblasts with contractile capacity, arranged between the
mesh of collagen fibers inserted in the cement are able to pull the tooth towards occlusal (theory of tooth eruption most
accepted today) .3,5 6.8
The dental eruption is divided into 3 phases: Pre-eruptive phase: It begins with the formation of germs and ends when
approximately one third of its root has been formed.
Pre-functional eruptive phase: begins with the beginning of root formation and ends when the tooth comes in contact with
the opposing tooth. Functional eruptive phase: it begins at the moment in which it contacts the antagonist tooth and begins
to perform the masticatory function. The duration of this phase lasts the entire life of the tooth. Together with the end of the
root formation (which takes to form the entirety of its apex, one year later on the temporary teeth and three years after
budding on the permanent teeth) the alveolus, the periodontal ligament and the root cement, go adopting the definitive
form; as well as the definitive differentiation of the periodontium of protection. 5,6,9,10
The human dentition has two types: temporary dentition and permanent dentition; between the two there is a long period,
known as mixed dentition in which the temporary teeth are replaced by permanent ones and additional teeth appear: the
molars that are located distal to the second temporal molar. So that one goes from a dentition of 20 teeth to another of 32
with which the masticatory capacity of the individual increases.2
It is considered that the 6-7 months is the most frequent age of beginning of the primary eruption. Temporary teeth appear
in homologous pairs generally, in the following order: lower central incisors (6 -7 months), upper central incisors (8-9
months), upper lateral incisors (9-10 months), lower lateral incisors: (10- 11 months), first lower molars and then the upper
molars: (14 months), lower canines and then the upper ones (18 months), second lower molars and then the upper ones:
(24 months). Although it is normal to accept an average of more or less 3 months for temporary dentition; This margin is
useful to keep in mind to determine if there is noticeable delay or delay in the dental outbreak. Approximately between 2
and a half years and 3 years is complete the temporary dentition.6,9,11,12
The permanent dentition begins to appear around 6 years of age and is marked by the appearance of the first permanent
molar in the child's mouth. It is completed with the eruption of third molars or wisdom teeth that usually erupt in the mouth
coinciding with the age of the individual, more less between 18 and 21 years. The permanent teeth appear in pairs usually
International Congress of Stomatology 2015
homologous, in the following order: First molars: 6 years, Central incisors: 6 years the inferior and 7 the superior. Lateral
incisor: 7 years inferior and 8 superior. Canines: 10 inferiors and 11 superiors. First upper and lower premolars: 10½ years.
Upper and lower second premolars: 11 years. Second molars: 12 years. 6
The normal dental bud pattern is variable in both the temporal and permanent dentition, observing greater changes in the
chronology now than in the sequence, which follows a stricter order of appearance in the dental arches.
Several authors claim that a certain order provides the optimal opportunity for the teeth to erupt in the right place. Thus, the
presence of a certain sequence of eruption, considered favorable, is recognized as more important for the achievement of
the correct location of the teeth in the arch, than the chronology in which these appear in the mouth. 6, 9,12
The appearance of the teeth in the oral cavity can be influenced by multiple factors: skeletal development, radicular age,
chronological age, sex, race, genetic disorders (Labioplatin Fissure, Apert Syndrome, Gorlin-Goltz Syndrome, Cleidocranial
Disostosis, Syndrome Down, Osteogenesis and dentinogenesis imperfecta), systemic (endocrine dysfunction, renal failure,
infections, HIV, inheritance, anemia, chemotherapy) and local (ankylosis, malocclusions, trauma, caries, tumor, cyst,
supernumerary teeth) 1,6,10, 13,14 On the other hand, the conditioning factors: sociocultural and environmental factors can
alter the tooth eruption process; Epidemiological studies on the eruption, provide information on the characteristics of these
variations according to the region or place where they occur, a fact that demonstrates the influence of external factors that
force changes in lifestyles, which act as functional agents that stimulate growth and dental development. 10,15,16
Alterations in the chronology of Temporary Teething: It is called: Premature rash, when a tooth emerges before the end of
the third month. It differs: Native teeth: When they have already made an emergency at the time of birth. Neonatal teeth:
Those that emerge in the first three months. Children with neonatal teeth generally have an earlier onset of the rest of the
temporal teeth and begin to change teeth before age 6. 17
Delayed eruption becomes apparent when no tooth has made an emergency at the end of month 13. A general process
that alters growth must be ruled out.
Among the most frequent are nutritional deficiencies, malabsorption syndromes, endocrinological alterations or important
infectious processes. Most often, the delay is due to family patterns or idiopathic causes.10, 12
Studies carried out in different populations suggest that the time and sequence of the eruption is related to the general
development of the child, which affirms that in premature infants the eruption is later, than the overweight children who
have lesser ages of eruption than the normal child And a delay in the outbreak of the temporary dentition is usually
associated with an even greater delay in the eruption of the permanent dentition 6,12,18
There are references that the relationship of the weight on the size of the child shows that the nutritional status influences
the calcification and dental outbreak, as well as the quality of the nutrition of the mothers and / or diseases in the pregnancy
increases five times more the probabilities of delay of the dental bud. 9,12,18,19
Regarding the differences between sexes, many studies coincide in an advanced emergency in females (associated with
hormonal factors) .10 However, others find insignificant differences between sex 9. 20
In reviewing the differences in the eruption of the temporal dentition between the different populations, Morgado10 reflects
results from consulted bibliographies that Korean children present a more advanced rash with respect to other populations,
followed by Spanish children who also have early average ages of emergence15 , being the population of Java and Saudi
Arabia, which presents greater delay in the emergence of the temporary teeth.
Alterations in the chronology of the permanent dentition:
It is called premature eruption of the permanent teeth, when the teeth emerge before their chronological average or when
they do so before half of the root has been formed. It has different effects when the early eruption affects the entire arch in
general; This occurs when there are endocrine alterations that occur with an increase in hormonal secretion, such as
hyperthyroidism, an increase in growth hormone.6,10 On the other hand, when the early rash affects a localized tooth or few
teeth, the causes are varied, being between they: premature loss of the temporal tooth by caries or trauma (it is the most
frequent cause and the tooth that erupts can rotate or poorly positioned) and local increase in vascularity. For example:
angiomas. Idiopathic: It is common not to find a specific cause and that is called idiopathic.21,22 Different investigations in
Cuba have shown an advance: in permanent dental eruption and more in females than in males, a result that coincides with
previous studies in Germany, Mexico, Brazil, Argentina and Spain1, which may be related to hormonal causes, since girls
usually have an earlier maturation than children.10,13,18,23 As for the breed, there are few researches on all in America that
demonstrate ethnic differences; A study carried out in Curaçao indicated that permanent teeth erupted earlier in black

International Congress of Stomatology 2015

children than in whites.13 In a study carried out by Morgado10 in Ciego de Ávila, the mestizo population presented a slight
advance in the budding of the dentition.
Delayed eruption occurs when the average chronological age has been widely exceeded or the root development is
sufficient but not emergent; it manifests itself in a general way, affecting all or most of the teeth and is caused by
chromosomal alterations and syndromes, due to its frequency it can be mentioned: cleft palate, Down syndrome or trisomy
21, cleidocranial dysostosis, Achondroplasia, ectodermal dysplasia, Syndrome de Gardner, Hypovitaminosis D, Family
patterns, Idiopathic. It can also be affected locally when one or some teeth deviate from the average emergency pattern.
Frequently the delayed eruption of a tooth gives rise to a malocclusion. The most frequent causes are: - Space alterations
(the negative bone-tooth discrepancy complicates the eruption process), - Very premature loss of the temporal tooth (bone
and mucosa) they heal after the loss of the temporal tooth and the definitive one can erupt later), -Alkylosis-dental
ankylosing of the temporal tooth (fusion of the dental cement with the alveolar bone and can alter the replacement process
of that molar), - Supernumerary teeth (cause important that produces an alteration of the sequence, more frequent in the
upper incisal area). Ectopic interruptions, malpositions and transpositions of the dental germ in the maxillary bone (cause a
displacement of the permanent germ and / or an alteration of the morphology thereof resulting in an alteration of the dental
eruption), -Tumors (more frequent are odontomas). 25,26 The teeth with frequent alterations of the eruption are the canines,
which present all the problems of space that may exist in the arch and the eruption is frequent in a high area. The retention
of canines has a complex etiology, favored by evolutionary, anatomical and mechanical factors. 18
The events of the dental eruption are influenced by factors of a genetic, environmental and sociocultural nature,
consequently differences for them are found between different populations; in the population of Nigeria the dental eruption
is advanced with respect to Arabia and America and delayed with respect to Ireland10. The dental eruption is coordinated
with the general development of the child The establishment of the dentitions as a phenomenon registered in this process
and subjected to the same influences will be equally variable in regard to the calcification of the dental follicles, the
chronology and the sequence of eruption.21

CONCLUSIONS
The dental eruption presents different stages and processes that must arise in an orderly and continuous manner for the
proper development of the jaws and the establishment of functional occlusion; although it does not occur exactly in all
individuals, due to the influence of both systemic, local, genetic, environmental factors and socio-cultural variants that
modify the chronology and sequence of eruption.

BIBLIOGRAPHIC REFERENCES
1. Bruna del Cojo M., Gallardo López NE, Mourelle Martínez MR., De Nova García MJ. Study of the eruption of permanent
dentition in children and adolescents of the community of Madrid (Spain). Scientist Dent. 2012; 9, 3: 159-164.
2. Plasencia E, García-Izquierdo F, Puente-Rodríguez M. Emergency age and sequences polymorphs of the permanent
dentition in a population sample of Asturias. RCOE [magazine on the Internet]. 2005 Feb [cited 2013 May 28]; 10 (1): 31-
42. Available in: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1138.123X2005000100003&lng=es.http:
//dx.doi.org/10.4321/S1138-123X2005000100003
3. Revuelta R. The oral cavity from birth to childhood: Development, pathologies and care. Perinatol Reprod Hum [Internet].
2009 [cited 2013 Jan 07]; 23 (2): [Approx. 9 p.]. Available in: http://www.medigraphic.com/pdfs/inper/ip-2009/ip092f.pdf

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4. Valdés Valdés, Armando et al. Human embryology. Havana: Editorial Medical Sciences. 2010. p.160-90 [cited 26 Jan
2015] Available in: http://gsdl.bvs.sld.cu/greenstone/PDFs/Coleccion_ciencias%20basicas/embriologia_humana/em
briologia_humana_completo.pdf.
5. Cavazos L Band, González Quintero JS, Nava Calvillo JF, Ponce Palomares M, Nava Zarate N, Onofre Quilantán MG, et
al. "Comparison of panoramic radiography and study models as instruments for mixed dentition analysis". 2010 [cited 4 July
2013]; Available at: www.veranos.ugto.mx/Memorias/.../documentos/178.pdf.
6. Proffit W Contemporary orthodontics. 4th Edition Mosby Madrid. [Internet] 2008 [quoted 5 Jun 2013]; 9 (2): [Approx. 37
p.]. Available at: http://www.odontologiauaplim.com
7. Xuefeng H, Shan X, Chensheng L, Lishan Z, YipingC. Precise chronology of differentiation of developing human primary
dentition. Histochemistry and Cell Biology [Internet] 2014 [cited 10 Dec 2014] 141 (2): 221-7 [Approx. 6 p.]. Available in:
http://link.springer.com/article/10.1007/s00418-013-1149-y
8. Frazier-Bowers SA, Hendricks HM Failure of Tooth Eruption: Diagnosis and Management. Craniofacial and Dental
Developmental Defects [Internet] 2015: [cited 12 Feb 2015] 11-26. [approx. 15 p.] Available at:
http://link.springer.com/chapter/10.1007/978-3-319-13057-6_2
9. Morgado Serafín Danay, and García Herrera Anerley. "Risk factors of alterations chronology of the dental eruption in the
population of Baraguá municipality. "MEASUREMENT 2013; 19. (suppl.1)
10. Morgado Serafín D, García Herrera A. Timeline and variability of tooth eruption. Teaching Polyclinic "Dr. Mario Páez
Inchausti", Baraguá Rev. MEASUREMENT. [Internet]. 2011 [cited June 5, 2013]; 17 (Suppl 2): [Approx. 13 p.]. Available in:
http://www.bvs.sld.cu/revistas/mciego/vol17_supl2_%202011/pdf/T16.pdf
11. Aquino M, Bojorge J, Granados M, Ramírez V. Determination of the chronological age in Mexican patients by analyzing
the apical closure of the mandibular second molar legal medical purposes. ODOUS CIENTIFICA [Internet]. 2011 [cited
2013 June 07]; 12 (2): [Approx. 16 p.]. Available at: http://servicio.bc.uc.edu.ve/odontologia/revista/vol12-n2/art1.pdf
12. Mayoral J, Mayoral G. Orthodontics, fundamental and practical principles. 4th ed. City of La Havana: Scientific-
Technical Editorial; 1986
13. Mora Pérez C, López Fernández R. Dental outbreak and nutritional status in children from 5 to 13 years old. MediSur
[Internet]. 2009 [cited 2013 June 07]; 7 (1): [Approx. 8p.]. Available in:
http://www.medisur.sld.cu/index.php/medisur/article/view/529
14. Vaillar Jiménez E. Correlation of weight and height with dental eruption. Rev. Cubana Stomatology [Internet]. 2008
[cited 8 Jun 2013]; 45 (1): [approx. 8 p.]. Available in: http://bvs.sld.cu/revistas/est/vol45-1-08/est01118.htm
15. Burgueño L., Gallardo, N. E., Mourelle, M. R. Chronology and sequence of tooth eruption events in a children's sample
of the Community of Madrid. Rev. Cient. Dent. 2011. [cited 2013 June 07]; (2): 111-118. Available in:
www.coem.org.es/sites/default/files/publicaciones/.../31-38.pdf
16. Pentón ASM, Veliz Concepcion OL, Escudero Alemán RZ, Calcines Ferrer ME, Ortega Romero L. Emergency
chronology of permanent dentition in children of the municipality of Santa Clara: Part I. Rev. Cubana Estomatol [Internet].
2011 Jul-Sep; [cited 2013 Mar 8]; 48 (3). Available at: http://bvs.sld.cu/revistas/est/vol48_03_11/est03311.htm
17. De la Teja Ángeles E, Durán Gutiérrez LA, Zurita Bautista YE. Native and neonatal teeth. Acta Pediatr Mex [Internet].
2011 [cited 12 Oct 2012]; 32 (6): [approx. 8p.]. Available in: http://www.medigraphic.com/pdfs/actpedmex/apm-
2011/apm116g.pdf
18. Morgado Serafín Danay. "The science-technology-society view of the behavior of the dental eruption according to
chronology and risk factors. "MEASUREMENT 2013 19.2: (2) 19. Toro, Adelaida, and Ana Lucia Vélez. "INFLUENCE OF
NUTRITION ON THE DENTAL ERUPTION. "CES Dentistry 1.3 (2011): 113-118.A Toro, AL Vélez – CES Dentistry, 2011 -
revistas.ces.edu.co
20. San Miguel Pentón AI, Veliz Concepcion OL, Escudero Alemán RZ, Calcines Ferrer ME, Ortega Romero L. Emergency
chronology of permanent dentition in children of the municipality of Santa Clara: Part II. Rev Cubana Estomatol. [Internet].
2011 [cited June 5, 2013]; 48 (3): [Approx. 8 p.]. Available at: http://www.bvs.sld.cu/revistas/est/vol48_03_11/est03311.htm
21. Barreda P. The exit of the teeth or tooth eruption. [monograph on the Internet]. Santiago de Chile. Pediatr a day. Julio
Meneghelo Foundation, 2005. [cited: 8 Jun 2013]. Available in: http://www.pediatraldia.cl/erupcion_dentaria.htm.
22. Pérez M. A., Pérez P., Fierro C. Alterations in the Eruption of Permanent Canines. Int. J. Morphol., 2009 27 (1): 139-
143.Available in: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022009000100025

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23. Morgado Serafín D., Rocha Castillo E. Chronology of permanent tooth eruption in the population of the North Health
Area of the Morón municipality. MEASUREMENT 2013; 19 (No.2)
24. Velásquez ME. Comparison of the estimate of dental age by the Demirjian method employed in children attending the
Faculty of Dentistry of the University of Carabobo, with its biological age, in order to determine the effectiveness of this
method, for purposes forensic [Internet]. Bolivarian Republic of Venezuela: University of Carabobo; 2010 [quoted 24 Nov
2012] [approx. 90 screens]. Available in:
http://www.riuc.bc.uc.edu.ve/bitstream/123456789/146/1/11008.pdf
25. Kapner M. Delay or absence in the formation of the teeth. New York: Veri Med Healthcare Network [Monograph on the
Internet]. 2007. Available in: http://www.walgreens.com/library/spanish_contents.jsp?docid=003061&doctype=5
26. German R. M., Martínez M. G., Leonardo M. R. Congenital eruption cyst: a case report .Braz. Dent. 2010, 21 (3).
Available at: http://dx.doi.org/10.1590/S0103-64402010000300015

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