Shedding of deciduous teeth

Definition of shedding

Pattern and histology of shedding

Knowledge:
At the end of the session the students must be able to:
 Define shedding
 Describe the various patterns and histology of shedding of deciduous anterior
and posterior teeth
Skills:
 Apply the detailed knowledge in clinical dental practice for making diagnosis
and treatment plan
 Shedding or exfoliation is the
loss of deciduous or primary
teeth caused by physiologic
Definition resorption of roots, the loss of
the bony supporting structures
& therefore the inability of these
teeth to withstand masticatory
forces
 Patterns of shedding

 The shedding of deciduous teeth is the result of resorption of the

roots of teeth & their supporting tissue , the PDL.

 The removal of hard tissues is accomplished by multinuclear cells

similar to osteoclasts.
 The growing & erupting permanent teeth exerts pressure on the
roots of deciduous teeth which results in their resorption.
 Patterns of shedding contd…
Resorption of deciduous anterior teeth:

Deciduous
Incisor
 The pressure exerted by the
permanent anterior teeth is initially
directed towards the roots of
deciduous incisors & canines and
resorption occurs on the lingual
surface . Permanent
Incisor
 Later these developing tooth
germs occupy a position Deciduous
canine
directly apical to the
deciduous teeth which permits
them to erupt in the position
formerly occupied by the
deciduous teeth.
Permanent
canine
 In case of permanent mandibular incisors , this apical positioning
does not occur & the permanent tooth erupts lingual to the still
functioning deciduous teeth.
 Patterns of shedding contd…
Resorption of deciduous molars:

 Resorption of the roots of

deciduous molars first begin
on their inner surfaces
because the early developing
bicuspids are found between
Developing Developing
them. premolar premolar
 Resorbing
deciduous molar

 With continued growth of the

jaws & occlusal movement of Erupting
premolar
deciduous molars, the
successional tooth germs lie
apical to the deciduous
molars.
 When the bicuspids begin to erupt, the resorption of the
deciduous molars is again initiated & continues until the roots are
completely resorbed & the molars are shed.
 Histology of shedding

A. Odontoclasts ( Tooth resorbing cells):

 Identical to osteoclasts.

 Large , multinucleated giant cells.

 Occupy resorption bays on the surface of dental hard
tissue.

 Vacuolated cytoplasm.

 Ruffled border.(finger-like processes that increase surface

area of cell
 Histology contd…

 Clear zone → peripheral to ruffled border

 Cytoplasm contains actin & myosin filaments & no organelles.

 Cytoplasm of odontoclasts → high content of mitochondria, many

vacuoles ( acid phosphatase activity).
 Derived from monocyte-macrophage system (tartarate
resistant acid phosphatase (TRAP) positive circulating
monocytes).
 Histology contd…

B. Role of RANKL:

 Receptor activator of Nuclear factor Kappa B Ligand ( RANKL) is a

molecule of Tumor necrosis factor (TNF) family which is expressed
by PDL cells in teeth undergoing shedding.

 It causes activation of shedding process.

 In odontoclasts RANKL increases resorbing activity.

( TNF is a cell signaling protein involved in inflammation ,

produced by activated macrophages)
Osteoprotegrin (OPG) which is found in the PDL of non resorbing
cells inhibits odontoclast differentiation
 Histology contd…

C. Resorption:

 Resorption occurs on the surface of

cementum & dentin.

 It involves the loss of organic as well as

mineral content of the matrix.
 Anterior teeth are shed with their pulp chamber intact.

 Resorption of primary molars occurs in inter radicular dentin

with some resorption of pulp chamber, coronal dentin &
sometimes enamel.
For anterior teeth: The teeth are exfoliated before complete
resorption of their roots

For posterior teeth: The teeth are exfoliated after almost complete
resorption of their roots and the crown is also partially resorbed
 Histology contd…

D. Repair:

 Resorption is not a continuous process but have periods of repair.

 But resorption predominates repair.

 Repair is achieved by cells resembling cementoblasts.

 Final repair tissue resembles cellular cementum but is less

mineralized.

 Formation of cementum like tissue may play a role in retention of

deciduous teeth until shedding occurs.
Mechanism of Shedding and resorption : Physiological resorption and
pathological resorption

Clinical considerations
Knowledge:
At the end of the session the students must be able to:
 Describe the mechanism of physiological and pathological resorption
 Have a thorough knowledge of the clinical aspects like remnants of deciduous teeth,
retained deciduous teeth and submerged deciduous teeth
Skills:
 Apply the detailed knowledge in clinical dental practice for making diagnosis and
treatment plan
 Mechanism of
shedding & resorption

Physiological resorption

Pathological resorption
 Mechanism of shedding contd…

Physiological resorption:
 Pressure from the erupting successional tooth plays a key role in
physiological resorption.

 The cementoblastic layer has to be damaged prior to resorption by

inflammatory process.

 Reduced enamel epithelium is involved in this process because it

releases certain substances which cause this damage.
 Mechanism of shedding contd…

 Membrane of ruffled border acts as proton pump → adding

hydrogen ions to extracellular environment → acidification →
mineral dissolution.
 Lysosomes secrete their enzymatic contents to degrade the
organic matrix.

 Increased masticatory forces → trauma to PDL → initiation of

resorption.
 Mechanism of shedding contd…

Pathological resorption:

Caused by pressure exerted by:

 Tumors

 Cysts
 Clinical considerations

Remnants of deciduous teeth

 Clinical considerations contd…

Retained deciduous teeth

Submerged deciduous teeth
Thank You