Relationship between enamel formation and eruption rate in rat mandibular incisors

Summary The relationship between the formation of dental enamel and tooth eruption was investigated. Rat mandibular incisor eruption rate was accelerated by maintaining incisors out of occlusion. Rate of eruption, enamel thickness, secretory zone length and matrix breakdown were measured. Eruption rate increased by 120% in experimental teeth but enamel secretion increased by only 90%. There were no obvious differences between control and experimental teeth in final enamel thickness or in the molecular weight distribution of the enamel matrix proteins.     

Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: a case report

Background

Rampant caries is an advanced and severe dental disease that affects multiple teeth. This case describes the management of rampant caries in a young teenager suffering from chronic oral graft versus host disease after allogeneic bone marrow transplantation.

Case presentation

A 14-year-old Chinese boy suffering from β–thalassemia major was referred to the dental clinic for the management of rampant dental caries. An oral examination revealed pale conjunctiva, bruising of lips, and depapillation of tongue indicating an underlying condition of anemia. The poor oral condition due to topical and systemic immunosuppressants was seriously aggravated, and rampant caries developed rapidly, affecting all newly erupted, permanent teeth. The teeth were hypersensitive and halitosis was apparent. Strategies for oral health education and diet modification were given to the patient. Xylitol chewing gum was used to stimulate saliva flow to promote remineralization of teeth. Silver diamine fluoride was topically applied to arrest rampant caries and to relieve pain from hypersensitivity. Carious teeth with pulpal involvement were endodontically treated. Stainless steel crowns were provided on molars to restore chewing function, and polycarbonate crowns were placed on premolars, upper canines and incisors.

Conclusion

This case report demonstrates success in treating a young teenager with severe rampant dental decay by contemporary caries control and preventive strategy.     

Schultz's unruly rule: dental developmental sequences and schedules in small-bodied, folivorous lemurs

Schultz's rule (as reconstructed by Smith) states that there is a relationship between the pattern (or relative order) of eruption of molar versus secondary (replacement) teeth and the overall pace (or absolute timing) of growth and maturation. Species with 'fast' life histories (rapid dental development, rapid growth, early sexual maturation, short life spans) are said to exhibit relatively early eruption of the molars and late eruption of the secondary replacement teeth (premolars, canines, incisors), whereas species with 'slow' life histories are said to exhibit relatively late eruption of the molars and early eruption of the secondary dentition. In a recent review, B.H. Smith noted that primates with tooth combs might violate this rule because tooth combs tend to erupt early, regardless of the pace of life history. We show that exceptions to Schultz's rule among lemurs are not limited to the relative timing of eruption of the tooth comb. Rather, among lemurs, some species with extremely accelerated dental development exhibit a pattern of eruption of molars and of secondary teeth in direct opposition to the expectations of Schultz's rule. We focus particularly on the pattern (order) and pace (absolute timing) of dental development and eruption in Avahi and Lepilemur - two relatively small, nocturnal folivores with rapid dental development. These taxa differ markedly in their eruption sequences (the premolars erupt after M2 and M3 in Lepilemur but not Avahi ). We offer an explanation for the failure of Schultz's rule to predict these differences. Schultz's rule presumes that eruption timing is dependent on the size of the jaw and that, therefore, molar crown formation and eruption will be delayed in species with slow-growing jaws. We show that a variety of processes (including developmental imbrication) allows the crowns of permanent teeth to form and to erupt into jaws that might appear to be too small to accommodate them.     

The reasons for tooth loss in geriatric patients attending two surgical clinics in Jerusalem,Israel.

Abstract Objectives Numerous studies around the world have been conducted in order to understand the reasons for tooth extractions in various age groups. Most studies have dealt with the general adult population but little attention has been paid to the elderly population. In Israel, as in most of the western countries, the elderly population is growing rapidly and thus demands for its dental needs are also increasing. In order to meet the dental requirements of the geriatric population, data on the main reasons of tooth mortality have been collected. Design Retrospective analysis of reasons for extraction divided into three categories: caries, periodontal disease and “other’’. Subjects The files of 302 consecutive elderly patients aged 65-95 years attending for extraction. The cause for tooth extraction was gathered from the written diagnosis described by the operator as well as from radiographs. Setting Two surgical clinics in Jerusalem serving low income residents. Results Results indicated that 30% of the extractions were due to caries, 65% were due to periodontal disease and only 6.4% related to “other’’ reasons. In both, males and females, periodontal disease was the major cause for tooth loss yet, females exhibited more extractions due to caries than males (35%vs 23% respectively). A relatively high incidence of tooth loss was documented for the 85+ age group. Of the teeth that were extracted, incisors and molars were equally the most frequent (29%) followed by premolars (26%) and canines (17%). Premolars were the teeth most frequently extracted out of the teeth removed due to caries (32%) whereas incisors were the most frequently removed within the group of teeth extracted due to periodontal disease (31%). Conclusions The results of this study point to the importance of prevention and treatment of dental diseases, particularly periodontal disease, in adults aged 0 years and above in order to prevent tooth loss in their later years.     

Screening of fixed prosthodontic dentures after five years of use in relation to material and construction

The aim of this study was to screen patients with fixed prosthodontic appliances that were in oral cavity for a period of 5 years or more and to assess clinically and radiologically root caries, gingival recession, pocket formation, alveolar ridge resorption, as well as gingival (GI) and plaque index (PI). The aim also was to find out the differences between materials and constructions, between abutment and non-abutment teeth, and to find out the need for replacement. A total of 260 patients and their orthopantomograms were examined, with a total of 2,265 teeth, 610 being bridge abutments and 246 being crowns. The most frequent were metal+ acrylic veneer crowns or bridges. Root caries was found under the abutments in 10-20%; however abutments with ceramic crowns had the lowest percentage of caries (p < 0.01). Alveolar ridge resorption, pocket formation deeper than 3 mm and gingival recession of various degree was found in 50% of the cases, again with the lowest percentage of ceramic-fused-to-metal appliances (p < 0.01). Pocket depth was registered in significantly higher percentage in metal-acrylic veneer appliances compared to natural teeth (p < 0.01), while there was no significant difference between metal-ceramic appliances and natural teeth (p > 0.05). Although the worst findings were recorded for metal- + acrylic veneer crowns for PI, no significant difference existed between crowns of different material or non-abutment teeth (p > 0.05). There was statistically significant difference between abutments with metal + acrylic veneer crowns, full metal crowns, metal ceramic crowns and non-abutments for GI scores. Higher percentage of scores 0 and 1 was recorded for metal ceramic crowns and non-abutments and significantly higher percentage of scores 2 and 3 was recorded for metal + acrylic veneer crowns and full metallic crowns. Almost 50% of metal-ceramic abutments had no pathologic findings. Almost 30% of the patients needed replacement, or even some abutments to be extracted and therefore a new prosthodontic appliance.     

New insight into dental epithelial stem cells: Identification,regulation, and function in tooth homeostasis and repair

Tooth enamel, a highly mineralized tissue covering the outermost area of teeth, is always damaged by dental caries or trauma. Tooth enamel rarely repairs or renews itself, due to the loss of ameloblasts and dental epithelial stem cells (DESCs) once the tooth erupts. Unlike human teeth, mouse incisors grow continuously due to the presence of DESCs that generate enamel-producing ameloblasts and other supporting dental epithelial lineages. The ready accessibility of mouse DESCs and wide availability of related transgenic mouse lines make mouse incisors an excellent model to examine the identity and heterogeneity of dental epithelial stem/progenitor cells; explore the regulatory mechanisms underlying enamel formation; and help answer the open question regarding the therapeutic development of enamel engineering. In the present review, we update the current understanding about the identification of DESCs in mouse incisors and summarize the regulatory mechanisms of enamel formation driven by DESCs. The roles of DESCs during homeostasis and repair are also discussed, which should improve our knowledge regarding enamel tissue engineering.     

Dental formulae and dental eruption patterns in Parapithecidae (Primates, Anthropoidea)

The eruption sequence for the lower teeth of Apidium phiomense based on 18 juvenile specimens is dP3, dP4, M1, M2, P2, P4, (P3, M3), C. Only five specimens of Parapithecus grangeri show developing lower teeth. P2, M1, and M2 all erupted before P3 and P4; C and M3 were the last cheek teeth to erupt. Late eruption of the lower canines in parapithecids is a possible shared derived resemblance linking these species with Anthropoidea and Adapidae and distinguishing both from Omomyidae, Tarsiidae, and tooth-combed lemurs. Late eruption of M3 in parapithecids is a shared derived resemblance with Anthropoidea alone. The lower dental formula of Apidium phiomense is confirmed as 2 X 1 X 3 X 3 by additional specimens which show the incisors. Based in part on tooth socket counts, the deciduous lower dental formula was 2 X 1 X 3. New specimens of Parapithecus grangeri now demonstrate an adult mandibular dental formula of 0 X 1 X 3 X 3 (not 2 X 1 X 3 X 3 as previously thought) and a juvenile formula of 1 X 1 X 3. The number of incisors possessed by Parapithecus fraasi is again open to debate. Material is insufficient to judge whether this species had a pair of incisors in each lower jaw quadrant, by analogy with Apidium, or had undergone reduction to just one incisor. In any event, the presence of two incisors in another parapithecid Apidium shows anterior tooth reduction of Parapithecus grangeri occurred independent of, and should not be considered a shared derived similarity with, Tarsiidae, as was once thought.     

Histological study on the chronology of the developing dentition in gorilla and orangutan

The single previous study on tooth development in great apes (Dean and Wood: Folia Primatol. (Basel) 36:111–127, 1981) is of limited value because it is based on cross-sectional radiographic data. This study considers problems in defining stages of tooth development in radiographs of developing ape dentitions and provides data on tooth chronology in Pongo pygmaeus and Gorilla gorilla by using histological methods of analysis. Crown formation times were estimated in individual teeth, and an overall chronology of dental development was found by registering teeth forming at the same time by using incremental growth lines. The earlier radiographic study correctly identified the molar and second premolar chronology and sequence in great apes, but significantly underestimated crown formation times in incisors, first premolars, and canine teeth in particular. Ape anterior tooth crowns take longer to form than the equivalent human teeth, but the overall dental developmental period in great apes is substantially shorter than in humans. Gorilla root extension rates appear to be fast, up to approximately 13 μm/day. This rapid root growth, associated with early tooth eruption, appears to be the developmental basis for the observed differences in timing between developing dentitions in great apes and humans.     

Aluminum concentrations in human deciduous enamel and dentin related to dental caries

The aluminum (Al) concentrations in the enamel and dentin of 314 human deciduous teeth were determined in order to examine the relationship between Al and dental caries. The sample teeth were divided into three groups: the sound tooth group, carious tooth group and filled tooth group. The teeth of the carious tooth group were further classified into three groups depending on the stage of caries. The Al content was determined using graphite furnace atomic absorption spectrometry. In both the enamel and dentin, the Al concentrations were unaffected by sex, but did depend on tooth type. In enamel, the Al concentration was significantly higher in the sound tooth group (42.8 +/- 37.3 microg/g) than in the three carious groups (20.7 +/- 17.1-24.9 +/- 22.0 microg/g) and the filled tooth group (27.3 +/- 25.5 microg/g). As for dentin, the Al concentration was also significantly higher in the sound tooth group (36.2 +/- 35.1 microg/g) than in the three carious groups (15.1 +/- 13.3-24.5 +/- 23.4 microg/g) and the filled tooth group (17.2 +/- 20.6 microg/g). Even when analyzing incisors alone, the Al concentrations were significantly higher in the sound tooth group than in the other groups, for both enamel and dentin. Furthermore, the Al levels in carious enamel and dentin did not decrease with the advance of caries. These findings indicated that the deciduous teeth containing higher Al concentrations on average had less caries than the teeth with lower Al concentrations, and suggest that Al acts as a possible cariostatic agent by itself.     

Innervation of the human upper primary dentition: Implications for understanding tooth initiation and rethinking growth and eruption patterns

Recent comparisons of humans with apes and early fossil hominids have prompted renewed interest in the study of sequences of dental growth and development. Such comparisons, however, rely on certain assumptions about tooth development and dental homology and the biological reality of distinguishing “deciduous” from “permanent” teeth. In light of earlier suggestions by Schwartz that there might be a correlation between nerves and the stem progenitors of tooth classes, and thus between nerve branch number and number of tooth classes, we studied a large sample of ～ 3 month fetuses to elucidate the nature of nerve branching patterns and the development of the primary dentition (i.e., the “deciduous” incisors, canine, and molars, and the first “permanent” molar). Contrary to expectation, variation in nerve branch patterning was the rule. If nerve fibers do have a role in tooth development, it can only be at the time of initiation, with definitive innervation occurring late in tooth development. In taking into consideration the entire span of tooth development—from initiation to innervation to eruption—and the process by which successional teeth arise (each from the external dental epithelium of a predecessor tooth), we suggest that dividing tooth growth and eruption into patterns of the “deciduous” teeth vs. those of the “permanent” is artificial and that a more meaningful approach would be the study of the entire dentition.     

From Embryo to Adult: The Complete Development and Unusual Replacement of the Dentition of the Tammar Wallaby (Macropus eugenii)

Unlike their reptile-like ancestors with continuous tooth replacement, mammals have evolved to replace each tooth either only once, or not at all. In previous large-scale comparative studies, it has been suggested that this tooth replacement only occurs from a successional dental lamina produced lingually to the primary tooth. This study aims to document the complete tooth development and replacement pattern of the tammar wallaby (Macropus eugenii). The tammar wallaby is a diprotodont marsupial, a group defined by their two procumbent lower incisors. To provide a comprehensive documentation of the spatio-temporal pattern of tooth development, we used Lugol’s Iodine staining and microCT scanning (diceCT) of embryos and pouch young into adulthood, resulting in high resolution 3D models for both soft and mineralised stages of development for all tooth positions. Our results reveal that the eponymous lower incisors are the successional generation at the third incisor locus, where the primary dentition initiates but never erupts. Furthermore, we track the development of the only replacement tooth, the permanent third premolar (P3), from initiation to eruption, and found it develops from the primary dental lamina, mesial to the dP3. This is contrary to the conventional view of lingual replacement from successional lamina in mammals. Our findings indicate that no functional tooth replacement occurs in the tammar wallaby, and expands the diversity of tooth replacement patterns found in mammals. We also conclude that since almost all marsupial and placental mammals produce replacement teeth from the distalmost deciduous premolar, this tooth should be considered homologous in these two groups.

     

Masculinization of the eruption pattern of permanent mandibular canines in opposite sex twin girls

The aim of this study is to explore the effect of prenatal androgenization on the clinical eruption of permanent teeth expressing dimorphism and bimaturism. The eruption curves of permanent teeth (except third molars), including those that make up the canine complex (permanent canines, lower first premolars), are compared among opposite sex twins (OS twins) relative to single‐born boys and girls. The comparisons are made with regard to three phases of eruption (pierced mucosa, half‐ erupted, and completely erupted) from a cross‐sectional sample of dental casts, using Kaplan–Meier survival and Cox regression analyzes. The casts were collected from 2159 school children from the US Collaborative Perinatal Project, including 39 pairs of OS‐twins, of which 12 pairs (30.8%) were Euro‐Americans and 27 pairs (69.2%) were of African‐American ancestry. The eruption patterns of the incisors, upper first molars, and lower canines were found to be significantly masculinized (delayed) among OS twin girls. The differences in most other teeth were either not significant, or the number of observations of active eruption phases were too few, such as in the upper first molars and incisors, to yield strong evidence and meaningful results. The masculinization of the tooth eruption pattern in OS twin girls is intriguing because of the lower canine responses during puberty, as well as canine primordial formation during early fetal androgenization of their co‐twin during the 8th to 14th gestational weeks. The present results offer a challenge for future research exploring tooth eruption mechanisms, and may also highlight some cases of delayed or ectopic canines, which are biased toward females. Am J Phys Anthropol 151:566–572, 2013. © 2013 Wiley Periodicals, Inc.     

Tooth Eruption Results from Bone Remodelling Driven by Bite Forces Sensed by Soft Tissue Dental Follicles: A Finite Element Analysis

Intermittent tongue, lip and cheek forces influence precise tooth position, so we here examine the possibility that tissue remodelling driven by functional bite-force-induced jaw-strain accounts for tooth eruption. Notably, although a separate true ‘eruptive force’ is widely assumed, there is little direct evidence for such a force. We constructed a three dimensional finite element model from axial computerized tomography of an 8 year old child mandible containing 12 erupted and 8 unerupted teeth. Tissues modelled included: cortical bone, cancellous bone, soft tissue dental follicle, periodontal ligament, enamel, dentine, pulp and articular cartilage. Strain and hydrostatic stress during incisive and unilateral molar bite force were modelled, with force applied via medial and lateral pterygoid, temporalis, masseter and digastric muscles. Strain was maximal in the soft tissue follicle as opposed to surrounding bone, consistent with follicle as an effective mechanosensor. Initial numerical analysis of dental follicle soft tissue overlying crowns and beneath the roots of unerupted teeth was of volume and hydrostatic stress. To numerically evaluate biological significance of differing hydrostatic stress levels normalized for variable finite element volume, ‘biological response units’ in Nmm were defined and calculated by multiplication of hydrostatic stress and volume for each finite element. Graphical representations revealed similar overall responses for individual teeth regardless if incisive or right molar bite force was studied. There was general compression in the soft tissues over crowns of most unerupted teeth, and general tension in the soft tissues beneath roots. Not conforming to this pattern were the unerupted second molars, which do not erupt at this developmental stage. Data support a new hypothesis for tooth eruption, in which the follicular soft tissues detect bite-force-induced bone-strain, and direct bone remodelling at the inner surface of the surrounding bony crypt, with the effect of enabling tooth eruption into the mouth.     

The oral manifestations of Apert syndrome.

As part of an ongoing study of 119 patients with the Apert syndrome, extensive data were available for the analysis of oral manifestations, including mouth shape, lip posture, palatal morphology, dental anomalies, and malocclusion. Findings included a characteristic trapezoidal-shaped mouth. Cleft soft palate or bifid uvula was found in approximately 75%. A Byzantine-arch shaped palate was recorded in almost all patients. Dental anomalies included severely delayed eruption, ectopic eruption, and shovel-shaped incisors. Malocclusion tended to be severe with mesial molar occlusion, mandibular overjet, anterior and posterior crossbites, and severe crowding of teeth. The oral manifestations of Apert syndrome are compared and contrasted with those of Crouzon syndrome.     

Ontogeny and homology of the dentition in dasyurid marsupials: Development inSminthopsis virginiae

Histological analysis of an ontogenetic series of the dasyurid marsupial,Sminthopsis virginiae, from birt to 60 days old, was undertaken to assess the developmental homologies of the deciduous and successional teeth. This period covers the time from the initiation of all teeth as epithelial buds up until the time of early eruption of some teeth. In addition, two older specimens, aged 81 and 97 days, were examined to provide additional information on the state of differentiation of the unerupted third premolar. In the postcanine dentition, only a single tooth position, dP3, was characterized by the later development of a replacing successional tooth (P3), following developmental pathways identical to those in eutherian mammals. In contrast, the anterior dentition is characterized by the formation of rudimentary, nonerupting deciduous incisors and canines, and by the accelerated development of normal, erupting successional incisors and canines in both jaws. Comparison of relative developmental stages for each tooth position throughout its preeruptive ontogeny suggests thatheterochrony (both developmental acceleration and retardation) has played an important role in the evolutionary history of the dasyurid dentition. Differing aspects of this phenomenon are identified and discussed for the anterior dentition, the anterior two premolars, P3, and the lower molars. Further evidence is presented to corroborate the identification of the anterior two premolars in the adult as dP1 and dP2, based on the relative retardation of their initiation and their lack of successor tooth germs. This developmental heterochrony has probably occurred in all three-premolared marsupials.     

Study of dental caries and periapical lesions in a mediaeval population of the southwest France: Differences in visual and radiographic inspections

Dental caries and periapical lesions have often been studied in archaeological samples. The majority of these studies concern lesions detected clinically and, in some cases, radiography is used to improve the scoring results. The purpose of the present study was to compare and combine the two methods for recording caries and cysts. The studied dental material derived from a mediaeval sample from the south of France. The study included sixty mandibles (788 teeth). Each tooth was observed clinically and radiographically. Absence of teeth was noted and unerupted teeth, which could be viewed on radiographs were also noted. The location and degree of development of each lesion were recorded. Occlusal lesions of degree 1 were mostly detected clinically (5.1% vs.1.4% detected radiographically). Radiographic detection increased the score of approximal lesions of degree 2 (1.4% vs. 0.7%) and the detection of intraosseous lesions. This research has shown that the combination of radiographic and clinical examinations improves the caries detection and thus, increases the caries score in a studied dental sample.     

Quantitative assessment of interproximal wear facet outlines for the association of isolated molars

The determination of the minimum number of individuals can be very challenging, especially in an assemblage of fragmentary bones and isolated teeth. Similarities in tooth morphology, degree of wear, and interproximal wear facets (IPWF) are generally used to associate isolated teeth qualitatively. However, no quantitative method has yet been established for an objective identification and matching of isolated tooth crowns. In this study, we analyze the IPWF morphology of adjacent mandibular molars (17 M(1)/M(2) pairs), applying both qualitative and quantitative methods to test a reproducible approach for crown association. The surfaces of distal (for M(1)) and mesial (for M(2)) IPWF were surface-scanned and digitally selected. Three-dimensional (3D) and two-dimensional (2D) outlines of IPWF were analyzed using elliptic Fourier analysis (EFA) and geometric morphometrics methods (GMM). Additionally, teeth were qualitatively associated by visual evaluation of the IPWF outline and by physical matching. Unsatisfactory results with less than 50% of tooth pairs correctly associated were obtained by using both methods, shape analysis (digital approach) and the visual evaluation (qualitative assessment) of the IPWF outline. The physical matching of the crowns showed highly variable accuracy ranging between 53% and 77%. The quantitative form-space analysis of 2D IPWF outlines provided the best results (82% of correctly associated teeth), but no statistically significant differences were recorded when compared with the manual matching. Since three tooth pairs out of 17 could not be quantitatively associated, we suggest that the quantitative analysis of IPWF should be used only in addition with other approaches.     

Dentition in Pacific walrus (Odobenus rosmarus divergens) calves of the year

The oral cavity and teeth were examined in Pacific walrus calves of the year that died or were harvested on Cape Vancarem and Koluchin Island, the Chukchi Sea, in September to October 2010. The order of gingival eruption of teeth, the resultant dental formula in calves of the year and 1.5-year-old animals, and the dental formula after alveolar eruption of teeth were determined. The number of teeth after gingival eruption in calves of the year did not depend on their body length and sex. The loss of some teeth, mainly incisors, was recorded in individuals aged 5?C6 months. Already at early developmental stages, functional teeth were found to differ significantly from other (rudimentary) teeth in their weight, total size, and the size of apical foramen. Some individuals had milk teeth, which were either gingivally erupted or partly remained within soft tissues. Cases of aberration in dentition that require additional studies were recorded.     

An effect of zinc deficiency on dental caries.

Rat pups suckled by dams fed a zinc-deficient diet developed higher levels of dental caries following a caries-test challenge than pups suckled by dams fed a zinc-adequate diet. The zinc deficient treatment was administered during the mineralization stage of tooth development before the molars erupted. The data shows that suboptimal zinc nutriture was associated with an increase in dental caries.Fluoride, a trace element, is recognized as a factor in preventing dental caries and its use has had a significant impact on dental health in this country. However, the possible roles of other trace elements have not been closely examined. Zinc is a trace element important to bone mineralization as well as in general nutrition.The effects on dental caries produced by the addition of zinc to rat diets have been reported (1, 2, 3). In those investigations, however, zinc supplements were added to diets that were adequate in zinc. Moreover, zinc supplements were fed after the teeth had appeared in the oral cavity. Because the critical period of tooth maturation occurs before eruption (4), post-eruptive zinc supplements probably should not markedly influence the development and, specifically, the mineralization of the tooth. Therefore, we investigated the influence of pre-eruptive zinc deficiency on caries development in rats.     

The eruption times of permanent teeth in boys and girls in the Stormarn District, Schleswig-Holstein (Germany)

In a longitudinal study in two small towns in southern Schleswig-Holstein (Ammersbek and Ahrensburg, District Stormarn; 9155 inhabitants) we investigated 2832 oral findings of 1396 patients (711 males, 685 females). The minimum age was 1.51 years, and the maximum age was 25.50 years. The dental findings were collected over a period of about 20 years (1982-2002). The oral findings per child were assessed between one and eight times. The eruption times of teeth in females are earlier than those for the same teeth in males. Further, the permanent dentition in females is completed earlier than in males. In both sexes the tooth eruption occurs symmetrically in both jaws. The comparison of both jaws revealed a slightly advanced eruption of the lower jaw teeth in both sexes. There is a noteworthy change in the eruption sequence of the teeth. In contrast to other reports we observed that the eruption of the canine proceeds the eruption of the second molar. We found no acceleration of the dentition when compared with other reports and could confirm the rules of tooth eruption in man. Conclusion: Oral examination of teeth is a simple tool to calculate tooth eruption intervals. This first investigation on a population of Schleswig-Holstein revealed a change in the eruption sequence of permanent teeth. These findings are relevant for dental treatment planning and should be reconfirmed at certain intervals.