Untimely orthodontic referrals for unerupted teeth can lead to greater treatment times and greater degrees of case complexity. The need for proper, vigilant dentistry is a necessity within routine appointments when examining the paediatric patient transitioning through the mixed dentition. With the growing demands on the NHS and increasing waiting lists for orthodontic treatment, early referral may lead to decreased pressures and prevent moderate-difficult cases from becoming too complex. This article highlights the need to carry out routine assessments on the chronology and pattern of eruption, paying particular attention to the maxillary canines and central incisors as well as premolars, as these are often the most common source of concern.
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General Dental Council. Standards for the Dental Team, 2013. Available online at https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf (Accessed May 2020).
NHS England. Assessment of Orthodontic Treatment Need and level of service provision for the resident population of Cheshire and Merseyside, 2018. Available online at https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/09/CM-Orthodontic-Needs-Assessment.pdf (Accessed May 2020).
Peedikayil F C. Delayed tooth eruption. e-J Dent 2011; 1: 81−86.
Hussain J, Burden D, McSherry P, Management of palatally ectopic maxillary canine, 2016, Royal College of Surgeons.
American Dental Association. Tooth Eruption The permanent tooth, 2006. Available online at www.ada.org/~/media/ADA/Publications/Files/patient_58.ashx (Accessed May 2020).
Devi A, Padmanabhan S. Role of polymorphisms of MSX1 and PAX9 genes in palatal impaction of maxillary canines. J Orthod 2019; 46: 14-19.
Becker A, Smith P, Beher R. The incidence of anomalous maxillary lateral incisors in relation to palatally displaced cuspids. Angle Orthod 1981; 51: 24-29.
Becker A, Chaushu S, Etiology of Maxillary Canine Impaction: A Review. Am J Orthod Dentofacial Orthop 2015; 148: 557-567.
Kambalimath H V, Jain S, Patil R U, Asokan A and Kambalimath D. Permanent Maxillary Canine Agenesis: A Rare Case Report. Int J Clin Pediatr Dent 2015; 8: 242-246.
McSherry P F. The Ectopic Maxillary Canine: Review. Br J Orthod 1998; 25: 209-216.
Kettle M A. Treatment of the unerupted maxillary canine. Trans Br Soc Orthod 1957; 74−84.
Richards A G. The buccal object rule. Dent Radiogr Photogr 1980; 53: 37-56.
Armstrong C, Johnston C, Burden D and Stevenson M. Localising ectopic maxillary canines--horizontal or vertical parallax? Eur J Orthod 2003; 25: 585-589.
McSherry P. The assessment of and treatment options for the buried maxillary canine. Dent Update 1996; 23: 7-10.
Pitt S, Hamdan A, Rock P. A treatment difficulty index for unerupted maxillary canines. Eur J Orthod 2006; 28: 141-144.
Mitchell L. An Introduction to Orthodontics. 4th ed. Oxford University Press; 2013.
Manne R, Gandikota C, Juvvadi S R, Rama H R M and Anche S, Impacted Canine: Etiology, diagnosis and orthodontic management. J Pharm Bioallied Sci 2012; 4: S234-S238.
Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the deciduous canines. Eur J Orthod 1988; 10: 283−295.
Mac Phee C G. The incidence of erupted supernumery teeth in consecutive series of 4000 school children. Br Dent J 1935; 58: 59-60.
Cozza P, Mucedero M, Ballanti F and De Toffol L. A Case of an unerupted maxillary central incisor for indirect trauma localised horizontally on the anterior nasal spine. J Clin Pediatr Dent 2005; 3: 201-203.
Yaqoob O, Bryant C, O'Neill J, et al. Management of Unerupted Maxillary Incisors. 2016 Available online at: www.rcseng.ac.uk/-/media/files/rcs/fds/publications/incisor-guideline-2016.pdf (Accessed September 2021).
Thilander B. and Myrberg N. The prevalence of malocclusion in Swedish school children. Scan J Dent Res 1973; 81: 12-21.
Winter G B, Gelbier M J, Goodman J R. Severe infraocclusion and failed eruption of deciduous molars associated with eruptive and developmental disturbances in the permanent dentition. Br J Orthod 1997; 24: 149-157.
Public Health England. Delivering Better Oral Health: An Evidence-based Toolkit for Prevention. 3rd Edition. March 2017. Available online at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (Accessed May 2020).
National Institute for Health and Care Excellence. NICE guidance, Dental Checks: Intervals between oral health reviews, 2004. Available online at: www.nice.org.uk/guidance/cg19 (Accessed May 2020).
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Kundi, C., Nandhra, K. Orthodontic warning signs: the GDP's role in detecting, managing and referring common unerupted permanent teeth. BDJ Student (2022). https://doi.org/10.1038/s41406-021-0263-x