Delayed eruption from supernumerary tooth — ORE Part 1 MCQ

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HardOrthodonticsDelayed eruption from supernumerary toothORE Part 1

A 9-year-old child has failure of eruption of the maxillary right permanent central incisor, six months after eruption of the contralateral incisor. The primary right central incisor exfoliated one year ago. There is a firm swelling on the anterior palate and no history of trauma. What is the most appropriate investigation?

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Correct answer: B — Take upper anterior occlusal and periapical radiographs

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

D is correct. SDCEP advises investigation when a tooth has not erupted more than six months after its contralateral counterpart, and indicates that radiographs are useful to diagnose delayed eruption and identify an underlying problem. Here, the prior loss of the primary incisor excludes simple retention, while the firm palatal swelling makes a palatally placed supernumerary tooth or odontome likely. Upper anterior occlusal and periapical views provide targeted assessment of the unerupted incisor and a possible obstruction. A is inappropriate because investigation should not be deferred. B does not assess an eruption obstruction. C is unrelated to the presentation. E assesses salivary function and has no role in investigating delayed eruption.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Assessment and Review: Full Guidance, Version 1.0, 2012, sections 4.4.6 and 4.4.7 (failure of eruption >6 months after the contralateral tooth should be investigated; radiographs assist diagnosis of delayed eruption). https://www.sdcep.org.uk/media/sy2ldxp2/sdcep-ohar-version-1-0.pdf