Tooth eruption

Overview


Tooth eruption after humans is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligaments play an important role in tooth eruption. Primary (baby) teeth erupt into the mouth from around 6 months until 2 years of age. These teeth are the only ones in the mouth until a person is about 6 years old. At that time, the first permanent tooth erupts and begins a time in which there is a combination of primary and permanent teeth. This stage, known as the mixed stage, lasts until the last primary tooth is lost. Then, the remaining permanent teeth erupt into the mouth.

Theories
Although researchers agree that tooth eruption is a complex process, there is little agreement on the identity of the mechanism that controls eruption. There have been many theories over time that have been eventually disproven. One of the theories is that the tooth is pushed upward into the mouth by the growth of the tooth's root. Others advocated that a tooth is pushed upward by the growth of the bone around the tooth. In addition, some believed teeth were pushed upward by vascular pressure or by an anatomical feature called the cushioned hammock. The cushioned hammock theory, first proposed by Harry Sicher, was taught widely from the 1930s to the 1950s. This theory postulated that a ligament below a tooth, which Sicher observed under a microscope on a histologic slide, was responsible for eruption. Later, the "ligament" Sicher observed was determined to be merely an artifact created in the process of preparing the slide.

The most widely held current theory is that while several forces might be involved in eruption, the periodontal ligaments provide the main impetus for the process. Theorists hypothesize that the periodontal ligaments promote eruption through the shrinking and cross-linking of their collagen fibers and the contraction of their fibroblasts.

Timeline
Although tooth eruption occurs at different times for different people, a general eruption timeline exists. Typically, humans have 20 primary teeth and 32 permanent teeth. Tooth eruption has three stages. The first, known as primary dentition stage, occurs when only primary teeth are visible. Once the first permanent tooth erupts into the mouth, the teeth are in the mixed (or transitional) dentition. After the last primary tooth falls out of the mouth, the teeth are in the permanent dentition.

Primary teeth
Primary dentition starts on the arrival of the mandibular central incisors, usually at eight months, and lasts until the first permanent molars appear in the mouth, usually at six years. The primary teeth typically erupt in the following order: (1) central incisor, (2) lateral incisor, (3) first molar, (4) canine, and (5) second molar. As a general rule, four teeth erupt for every six months of life, mandibular teeth erupt before maxillary teeth, and teeth erupt sooner in females than males. During primary dentition, the tooth buds of permanent teeth develop below the primary teeth, close to the palate or tongue.

Mixed stage
Mixed dentition starts when the first permanent molar appears in the mouth, usually at six years, and lasts until the last primary tooth is lost, usually at eleven or twelve years. Permanent teeth in the maxilla erupt in a different order from permanent teeth on the mandible. Maxillary teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) first premolar, (5) second premolar, (6) canine, (7) second molar, and (8) third molar. Mandibular teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) canine, (5) first premolar, (6) second premolar, (7) second molar, and (8) third molar. Since there are no premolars in the primary dentition, the primary molars are replaced by permanent premolars. If any primary teeth are lost before permanent teeth are ready to replace them, some posterior teeth may drift forward and cause space to be lost in the mouth. This may cause crowding and/or misplacement once the permanent teeth erupt, which is usually referred to as malocclusion. Orthodontics may be required in such circumstances for an individual to achieve a straight set of teeth.

Permanent teeth
The permanent dentition begins when the last primary tooth is lost, usually at 11 to 12 years, and lasts for the rest of a person's life or until all of the teeth are lost (edentulism). During this stage, third molars (also called "wisdom teeth") are frequently extracted because of decay, pain or impactions. The main reasons for tooth loss are decay or periodontal disease.