Definition

Tooth eruption refers to the process by which teeth move from within the jawbone and through the mucosal layer to reach their final position in the oral cavity. While tooth eruption is typically a normal physiological process, disruptions in this process can lead to delayed eruption. This is considered an abnormality in the tooth eruption process.

The clinical sign of tooth eruption is the appearance of teeth emerging through the gums. Several critical factors during tooth development influence this process, including both local and systemic factors.

Humans experience two phases of tooth development: the eruption of deciduous (milk) teeth and permanent teeth. Some studies suggest differences in eruption timing between these phases, with boys typically experiencing faster milk teeth eruption, while permanent teeth tend to erupt earlier in girls.

Common abnormalities in tooth eruption include:

• Natal teeth: Teeth present at birth.
• Neonatal teeth: Teeth that emerge within the first 30 days after birth.
• Teething: The emergence of baby teeth from the gums.
• Eruption cysts: Benign cysts on the mucosal layer overlying the tooth prior to eruption.
• Impacted teeth: Teeth that are blocked and unable to fully emerge through the gums.
• Delayed eruption of primary or permanent teeth.

Causes

Disruptions in the growth and development of primary or permanent teeth can influence the timing of tooth eruption. Delays in tooth eruption can be caused by a variety of factors, and a delay in the eruption of primary teeth often leads to a corresponding delay in the eruption of permanent teeth.

The following factors can contribute to delayed tooth eruption:

• Disruptions in the tooth growth process.
• Injury.
• Nutritional deficiencies, particularly deficiencies in calcium and vitamin D.
• Systemic diseases, which affect the entire body or multiple organs.
• A family history of delayed tooth eruption.
• Certain genetic conditions, including:
  • Amelogenesis imperfecta: A disorder of tooth development characterized by small, discolored, fragile teeth that are prone to damage.
  • Regional odontodysplasia: A developmental disorder of the hard tissues of the tooth that affects tooth components and is characterized by a distinctive appearance on radiographs.

In some cases, delayed tooth eruption may indicate an underlying health issue. Premature birth or low birth weight can contribute to delayed tooth growth. If permanent teeth have not emerged by the time a child is 12-14 years old, hypodontia—a condition marked by the cessation of tooth growth—should be considered. This condition often stems from genetic disorders.

Risk Factor

Several factors can contribute to delayed eruption of both primary and permanent teeth, including:

• Overlapping tooth position

When teeth are positioned too closely together or overlap, it can hinder the eruption process. Overcrowded teeth occupy the available space, preventing the growth of emerging teeth.

• Gender

Tooth eruption in girls tends to occur more quickly than in boys, as girls generally reach developmental maturity faster.

• Nutritional status

Nutritional status of children can influence the timing of permanent tooth eruption. Children with poor nutrition may experience delayed permanent tooth eruption, while overweight or obese children tend to have accelerated eruption.

• Socioeconomic factors

Socioeconomic status is linked to daily nutritional intake. Individuals in lower socioeconomic groups often have reduced access to nutritious food, leading to delayed tooth eruption.

• Genetic factors

Tooth eruption patterns and timing vary across ethnic and racial groups.

• Birth weight

Newborns with low birth weight or born prematurely are more likely to experience delayed tooth eruption.

Symptoms

Typically, children's milk teeth begin to emerge between the ages of 6 months and 1 year, with full growth completed by age 3. 

By around 6 years old, these milk teeth are gradually replaced by permanent teeth, a process that continues until the child reaches approximately 12 years old.

However, the timing of tooth eruption can vary. While many children follow this typical schedule, others may experience faster or slower tooth growth.

Diagnosis

To diagnose delayed tooth eruption, the dentist will inquire about the child's symptoms and complaints, as well as the observations made by the parents. Additionally, the child's medical history will be reviewed.

A clinical examination of the oral cavity will be conducted to assess the appearance of the child's teeth and compare them with the expected development for their age. The dentist will evaluate whether the eruption of the teeth is on schedule or delayed.

Permanent teeth tend to encounter more issues with the eruption process compared to primary teeth. Growth and developmental disorders in either set of teeth can influence the timing of eruption. The dentist will identify factors contributing to the delay in both primary and permanent teeth.

Management

Parents can support proper tooth development by providing breast milk and complementary foods that are nutritionally balanced and rich in calcium. The texture of the food should be appropriate for the child's age. Teething toys (teethers) may also be provided to help soothe and stimulate tooth growth during primary tooth development.

If a medical condition is causing the delayed tooth eruption, treatment will focus on addressing the underlying condition. Depending on the child’s situation, the doctor may recommend specific procedures to aid tooth growth.

Complications

Although tooth growth varies from child to child, parents should monitor their child’s dental development closely and consult a doctor if there is significant delay. This is because delayed tooth growth can lead to complications, such as:

• Crooked teeth, particularly if the baby teeth emerge very late.
• Difficulty in chewing solid foods, as teeth are necessary for proper chewing.
• A scenario where both permanent and delayed baby teeth emerge simultaneously, resulting in two rows of teeth.

Prevention

To reduce the risk of delayed tooth eruption, children should receive foods that are rich in vitamin D and calcium—nutrients essential for proper tooth development. Additionally, parents should take steps to prevent injury to the face and teeth during early childhood, as trauma can interfere with tooth growth.

When to See a Doctor?

Parents should first inquire about any family history of delayed teething. If the child has exceeded the expected timeframe for tooth growth—more than 1 year for primary teeth or 12 years for permanent teeth—a dental examination is recommended.

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