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Key Points
 
Teeth begin to develop around the sixth week of fetal life, with development continuing throughout fetal life and beyond.
 
Germ cells from the ectoderm, mesoderm, and endoderm all contribute to tooth formation.
 
Tooth development is divided into 4 stages: the bud, the cap, the bell, and crown.
 
A variety of potential insults can interfere with normal tooth development.
 
The primary teeth begin to erupt around 6 months of age, with eruption completed by 24 to 36 months.
 
The timing of typical primary eruption can be easily recalled using the 7+4 rule.
 
Eruption is usually symmetrical, with the lower teeth erupting before the upper teeth.
 
The primary teeth typically erupt in the following pattern: central incisors, lateral incisors, first molars, canines, second molars.
 
Permanent teeth erupt in a pattern similar to that of the primary teeth.
 
The permanent teeth typically begin erupting between 5 and 7 years and finish by 13 to 14 years.
 
Although some infants develop natal or neonatal teeth, this type of eruption is uncommon.
 
Delayed tooth eruption of more than 12 months may be the result of a medical condition and should be evaluated. Referral is warranted if a child has no teeth by 18 months of age.
 
Tooth loss is also known as exfoliation.
 
Both early and delayed tooth loss should be evaluated to determine the underlying cause.
 
Caries, trauma, and a variety of medical disorders can result in early tooth loss.
 
Global delay in tooth loss most commonly results from an endocrine or genetic disorder.
 
Hypodontia occurs in approximately 3% of the US population.
 
Anodontia, the complete lack of tooth development, is extremely rare.
 
The wisdom teeth do not develop in approximately 20% of people.
 
It is important to recognize medical conditions that affect the number or shape of an individual's teeth.
 
Excess fluoride intake can result in a chalky white or severe brown discoloration of the teeth.
 
Root death from trauma or severe caries causes a grayish discoloration of the teeth.
 
Food pigments, smoking, oral iron supplements, and poor oral hygiene can all discolor the teeth.
 
Tooth discoloration should be evaluated by a dentist to determine the likely cause and if treatment or prevention exists.
 
There are no symptoms that consistently and accurately predict teething.
 
Fever, vomiting, diarrhea, and cough or congestion should not be attributed to teething and may require evaluation.
 
Teething rings should be refrigerated only to prevent infants from developing fat necrosis.
 
Parents should be made aware of the potential dangers of over-the-counter topical teething gels.
 
Malocclusion can be genetic in nature or result from prolonged oral habits.
 
Malocclusion may affect appearance or hinder eating and proper oral hygiene.
 
Referral to a dental professional is appropriate if a malocclusion is noted on examination.
 
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