"Baby teeth" redirects here. For other uses, see Baby teeth (disambiguation).
| Deciduous teeth | |
|---|---|
 Cross-section of upper and lower jaws with permanent teeth located above and below the deciduous teeth prior to their exfoliation. The deciduous mandibular central incisors have already been exfoliated. | |
| Details | |
| Identifiers | |
| Latin | dentes decidui |
| MeSH | D014094 |
| TA98 | A05.1.03.076 |
| TA2 | 912 |
| FMA | 75151 |
| Anatomical terminology | |
Deciduous teeth or primary teeth, also informally known as baby teeth, milk teeth, or temporary teeth,[1] are the first set of teeth in the growth and development of humans and other diphyodonts, which include most mammals but not elephants, kangaroos, or manatees which are polyphyodonts. Deciduous teeth develop during the embryonic stage of development and erupt (break through the gums and become visible in the mouth) during infancy. They are usually lost and replaced by permanent teeth, but in the absence of their permanent replacements, they can remain functional for many years into adulthood.
The erupting permanent teeth cause root resorption, where the permanent teeth push on the roots of the primary teeth, causing the roots to be dissolved by odontoclasts (as well as surrounding alveolar bone by osteoclasts) and become absorbed by the forming permanent teeth. The process of shedding primary teeth and their replacement by permanent teeth is called tooth exfoliation. This may last from six to twelve years of age. By age thirteen, there usually are only permanent teeth remaining. However, it is not extremely rare for one or more primary teeth to be retained beyond this age, sometimes well into adulthood, often because its secondary tooth failed to develop.[2]
Primary teeth are essential in the development of the mouth.[3] The primary teeth maintain the arch length within the jaw, the bone and the permanent teeth replacements develop from the same tooth germs as the primary teeth. The primary teeth provide guidance for the eruption pathway of the permanent teeth. Also the muscles of the jaw and the formation of the jaw bones depend on the primary teeth to maintain proper spacing for permanent teeth. The roots of primary teeth provide a pathway for the permanent teeth to erupt. The primary teeth are important for the development of the child's speech, for the child's smile and play a role in chewing of food, although children who have had their primary teeth removed (usually as a result of dental caries or dental injuries) can still eat and chew to a certain extent.
Tooth decay in primary teeth tends to progress quite quickly and often reaches the pulp of the tooth. In cases of extensive tooth decay, the pulp must be treated to maintain the health of the tooth and its supporting tissues. In pulp therapy, areas of decay and infected pulp tissue are removed, then the pulp is sealed with medicaments.[4] Medicaments are medications placed over the pulp to maintain survival and promote repair. Treatment options include:
- Indirect pulp capping (IPC)
- Direct pulp capping (DPC)
- Pulpotomy
- Pulpectomy
Indirect pulp capping (IPC) is a treatment that leaves the deepest carious tooth material (dentin) next to the pulp undisrupted to avoid exposing the pulp. The caries-affected dentin is covered with a biocompatible medicament to form a seal over the tooth. Medicaments used in IPC include calcium hydroxide and alternates including bonding agents and liners.[5]
Direct pulp capping (DPC) is a treatment performed when a pin-point or small pulp exposure of 1mm or less occurs after removal of carious tooth material (dentin) excavation. The pulp is covered with a medicament. This technique has limited use when pulp is exposed due to injury but is generally not accepted for managing carious pulp exposures in primary teeth, as it has been shown to have limited success. Medicaments used in DPC include calcium hydroxide and alternates such as mineral trioxide aggregate (MTA).[5]
Pulpotomy is a treatment performed on a primary tooth with extensive decay without involving pulp in the root canal (radicular pulp) (Cochrane). The entire coronal pulp is removed and the radicular pulp bleeding is stopped. The remaining radicular pulp is treated with a medicament. Pulpotomy is the most frequently used vital pulp therapy technique for deep dental caries in primary teeth. Medicaments used in pulpotomy include commonly formocresol, MTA and ferric sulfates and less commonly sodium hypochlorite, calcium hydroxide, and tricalcium silicate. [5]
Pulpectomy is a treatment performed on a primary tooth with extensive decay and involving pulp in the root canal (radicular pulp with irreversible pulpitis or necrosis). The radicular pulp is removed, the pulp canals are filled with a medicament, and a filling is put on the tooth. Medicaments used in pulpectomy include resorbable materials so that they will undergo resorption (dissolution) along with the primary tooth root to allow for proper tooth loss (exfoliation) and replacement with permanent successor teeth.[4]
Recommendations for medicaments used in pulp treatment[edit]
After direct pulp capping, it is unclear whether any one medicament is superior.
After pulpotomy, MTA is the most effective medicament and formocresol is also effective. Both are more effective than calcium hydroxide, which is more likely to fail.[4] While there are concerns about the toxicity of formocresol,[4] currently there are no reports of toxicity related to formocresol use for vital pulp therapies in children.[5] An undesirable effect of treatment with MTA is the grey discoloration of treated teeth, but this effect is purely esthetic and does not affect the success of pulp treatment.[5]
For pulpectomy, it is unclear whether any one medicament is superior. Zinc oxide eugenol (ZOE) may be the best choice for filling in the root canals after pulpectomy in primary teeth, but more evidence is needed to confirm the superiority. ZOE is effective, inexpensive, and reasonably safe for use in children. [4]
Treatment recommendations[edit]
It is unclear which pulp therapy (i.e. IPC, DPC, pulpotomy, pulpectomy) is the most effective, as there are no studies directly comparing these treatment options. The success rates are similar amongst the various therapies. The choice of therapy should be made based on the removal of caries-affected dentin, whether there is a pulp exposure, adverse effects, clinical expertise, and patient preference. [5]
https://en.wikipedia.org/wiki/Deciduous_teeth
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