Week 9 Maturational changes in the jaw and teeth

Changes in teeth and supporting structures.

Affects both the hard and soft tissues and the growth continues into adulthood.
Pulp chamber
o
o
o
o

Large pulp chamber at the young age

Pulp chamber gradually becomes smaller with increasing age
Slow deposition of dentine on the inside of the tooth
Additional dentin continues to be produced at a slower rate throughout life.

The pulp chamber in the adult teeth is much smaller than that in children (mixed dentition shown in the x-ray). Sometimes
it's easier to do RCT treatment in a young person than an older person. The older the person gets, the smaller the chamber
becomes.
Gingival attachment
o At the time the permanent teeth erupt the gingival attachment is high on the crown.
o The gingival attachment is well above the cement-enamel junction.
o During the next few years more and more of the crown is exposed.
o With the Vertical growth of the jaws, the teeth compensate by active eruption, so what was thought to be
apical migration of the gingiva is not true. There will be more eruption of the teeth and therefore the gingival
margin changes.
o When we finish the ortho treatment for young person, we have to take into consideration that this person will
have a little more growth and the gingival margin will change. This is why we don't do implants in a young child.
Even for normal implants, the person is still growing vertically. Implants after 10 years will have the same
appearance as 10 years before. We finish vertical growth very late and we don't stop growing until adulthood.

Before the theory was that only the gingiva moved. What the studies found was that the teeth are erupting (there's a little
retraction of the gingiva as well). This explains how a deep bite in a young child tends to fix itself (with vertical growth and
teeth eruption). To fix the deep bite, you need eruption of the posterior teeth to fix the anterior teeth. Effects of posterior
teeth are more influential than anterior teeth. Open bite--posterior teeth overerupting resulting in the front teeth not able to
come into contact.
Teeth wear
Abrasion, erosion and attrition all lead to tooth wear.

Erosion: You see most wear on the buccal aspect of teeth.

Children that have problem in their breathing pattern will grind their teeth at night. Best advice you can give to the parents is
to take the child to the ear nose and throat doctor and check his breathing pattern.

Bigger teeth make you look younger. The natural process of aging--teeth wear off and teeth become smaller.

Splints: takes a few visits (4 or 5). It needs to be very well done and fitted very well to the teeth.
Wearing one or two particular teeth a lot: not biting properly. Can be fixed orthodontically that will put the teeth in the right
alignment and position.

In primitive people eating:

o Teeth wear is due to the coarseness of food
o No crowded teeth at all because of their diet
In modern diet:
o Elimination of coarse particlesWear facets on the teeth comes from bruxism, not what the individual has
been eating. Nowadays the diet is very soft.

Related factors (Tooth wear)

AGE
GENDER males>females
OCCUPATION--people who fix things (put things in their mouth when they're working), athletes (buccal of their
teeth wear off a lot)
How quickly does wear occur?
SLOW - doesn't happen overnight
Tooth wear at any time may be similar for bruxers and non bruxers
Episodic or cyclic- more tooth wear over considerable period

What CONSISTENT changes are observed in primitive man?

Teeth erupt - usually maintain Vertical dimension
Mesial movement of posteriors teeth with inter-proximal
wearLowers > Uppers. This happens when they eat a lot
of coarse food. The contact is flat instead of rounded.
Retroclination uppers > lowers
Occlusal wear, interproximal wear
Modern man teeth- wear
Anterior > Posterior teeth
Lower > Upper teeth
Exposed dentine tubules obliterated

II-Changes in alignment and occlusion

The alveolar bone bends during heavy mastication, allowing the teeth to move relative to each other
On a coarse diet, this movement causes both interproximal and occlusal wear.
Tendency for crowding of the mandibular incisor in the late teens and early twenties.( In modern population)
Know: There is 3 major theories have been proposed:
1. Theory n:1 - Lack of normal attrition in the modern diet
Lack of normal attrition in the modern diet
Raymond Begg: noted in his studies of the Australian aborigines that malocclusion is uncommon, because of the
large amount of interproximal and occlusal attrition
Conclusion: teeth became crowded when attrition did not occur with soft diet
Lack of normal attrition in the modern diet
More recent observation shown, that when Australian aborigines change to a modern diet, as happened in
most of this group by the late 20th century, occlusion and interproximal wear disappears, late crowding rarely
develops.
2. Theory n:2 Pressure from third molars
Late crowding developed at about the time the third molars
should erupt. This is a coincidence. Third molars can cause a lot
of problems but they don't change the anterior teeth.
The pressure from the third molar with no room to erupt is the
cause of late incisor crowding
But:
Often crowding develop even in situation with congenitally
missing 3rd molar.
Crowding occur even when there is no third molars
The same time they are there late crowding occurs.
Crowding of the anterior teeth--called wrinkles of the jaw-a sign of aging.
Our body always has the tendency to go back the way it
was before.
3. Theory n:3 - late mandibular growth
The position of the dentition relative to the maxilla and
mandible, is influenced by the pattern of growth of the
jaws
Even if you fix the Class 3 (which is hard), there is always the chance that it could go back due to late
mandibular growth.
In the picture, you see excessive growth of the mandibular and the lower incisors tipping lingually.
When the mandible grows forward relative to the maxilla, as it usually does in the late teens as well as
earlier, the cephalocaudal gradient of growth
The mandibular incisor teeth tend to be displaced lingually, particularly if any excessive rotation is also
present.

 Tight anterior occlusion + Late mandible growth

In that circumstance ,one of three events must occur:
a. The mandible is displaced distally accompanied by a distortion of temporo-mandibular
joint function and displacement of the articular disc (rare)
b. The upper incisors flare forward, opening space between these teeth(least common)
c. The lower incisors displace distally and become crowded(most likely)
If space available is distally, the teeth could move toward the distal instead of inclining lingually and crowding.
So:
The third molar could be the last straw but not the critical variable ( if the 3rd molar is impacted).

iii. Changes in alignment and occlusion.

Until recently, It was generally assumed that growth of the face ceased in the late teens /early twenties.
1980 studies has reported small amount of growth of the facial skeleton continue into middle age
Transverse finishes just at puberty
AP later
Vertical sometime later and continues (not as great as during puberty)
Women first pregnancy often produces some growth of her jaws (common to see pregnant ladies
complaining that their teeth have changed.)
In general , with aging
- Male: Tendency toward forward Rotation of jaws
- Female: Tendency toward backward Rotation

iv. Changes in facial soft tissues

Changes in the facial soft tissue profile were greater than changes in the facial skeleton. (The older you get,
everything goes down. You'll mostly see the lower teeth of older people when they're talking)
The knowledge of soft tissue changes during aging is important in planning your treatment
A small amount of gingiva at smile --youthful
Exposure of upper teeth at smile appearanceyouthful
Need to be taken into consideration when treating adolescent - patient will change as they age and therefore you
have to take into consideration the potential changes.
2/ lip became progressively thinner with less vermilion exposure and sag downward with aging.
3/ Elongation of the nose
4/ Augmentation of the chin

To summarise
Maturational changes affect both soft and hard tissues of the face and jaws , with greater long-term changes in the
soft tissues
Important effect on the teeth , their supporting structures and the dental occlusion