DOI: 10.7860/JCDR/2020/43250.

13492
Original Article

A Cross-sectional Study of Eruption Time of

Dentistry Section

Primary Teeth in South Indian Children

Gunashekhar Madiraju1, Harsha Basavaraja2

ABSTRACT differences in the mean age of primary teeth eruption between

Introduction: Eruption chronology of primary teeth can be a males and females for both the maxilla and mandible.
very valuable asset in the diagnosis and treatment planning of Results: The mandibular central incisors were the first teeth to
children in the field of dentistry. erupt with an overall mean eruption time of 10.3±0.6 months.
Aim: The present study aimed to determine the mean eruption Girls displayed significant earlier eruption of first primary molar
time and sequence of eruption of primary teeth in South Indian in both the maxilla and the mandible (p<0.05).
children. Conclusion: South Indian children experienced delayed eruption
Materials and Methods: This cross-sectional study from of primary teeth when compared to their counterparts in other
September 2017 to December 2018 involved a random sample populations. Data from the present study can be used as a
of 954 South Indian children (452 boys and 502 girls) aged six reference. The mean age of eruption was 10.2±0.79 months
to thirty-six months. The mean age of eruption for each tooth in boys and 10.4±0.38 months in girls. All the teeth, except
was calculated using the Karber method, as modified by Hayes canines and first molars emerged earlier in the mandible in both
and Mantel. The student t-test was used to assess possible the genders.

Keywords: Children, Chronology, Deciduous teeth, Eruption sequence, Tooth eruption

INTRODUCTION Inclusion Criteria

Eruption timing and sequence of the primary teeth provides dental Both the parents including the child were of Indian origin, had a
clinicians, a reliable indication of maturation and biological age history of full-term birth, were clinically healthy with a negative history
and aids in the assessment of growth and maturity in orthodontics of early childhood diseases requiring hospitalisation. Children who
including age estimation in forensic sciences. Standard reference age met the inclusion criteria on the respective days of the visit to the
for eruption of primary dentition utilised for academic and research hospital were included in the study.
purposes were derived from studies carried out in western population
groups [1,2]. This data cannot be applied to Indian population owing to Exclusion Criteria
environmental, racial and genetic variations. Although several factors Children with a history of chronic infectious systemic diseases,
have been thought to influence the primary teeth eruption including nutritional or endocrinal disturbances, recognised syndromes and
ethnicity [3,4], socioeconomic status [5], type of feeding [6] and developmental disturbances such as cleft lip and palate were
environmental factors [7,8], the role of these factors were inconsistent excluded from the study.
in the literature. Definitive evidence exists to show that children from Out of the initial sample of 1080 children, 126 children without accurate
different geographic regions have different eruption pattern of primary birth proofs were excluded resulting in a final sample of 954 children.
teeth [9-14]. Indeed, the standards for emergence of primary teeth for Study parameters included age of eruption of primary teeth in
a certain ethnic group should be obtained from that population. months, on both right and left sides of maxilla and mandible in
Indian peninsula constitutes the second largest populated country both the genders. The age of each child was calculated in months
in the world with diverse ethnicity and geographical conditions. from his/her date of birth to the date of examination. The teeth
However, there is little research conducted on the eruption chronology were recorded as either present (when any part of its crown had
of primary dentition in Indian children [13-17]. The purpose of penetrated the mucous membrane and is visible in the oral cavity) or
the present study was to determine the mean eruption time and absent [9,10,13]. Plain mouth mirrors and/or wooden tongue blades
sequence of eruption of primary teeth in South Indian children. were used for oral examination in the presence of good illumination
with the child seated either on parent’s lap or on an ordinary chair
MATERIALS and METHODS (depending on age) along with the parent. The oral examination at
The present cross-sectional study was conducted by CDH Research respective immunisation centers was carried out by a pre-calibrated
Centre, Bangalore and included a sample of 954 South Indian children pedodontist and was recorded by a trained data recorder. One
between the age of six and thirty-six months during the period from of the principal examiners (GM) was calibrated in a pilot study
September 2017 to December 2018. The sample was collected consisting of 30 subjects. All the subjects were checked twice at an
from randomly selected primary health centers from eight different interval of 1 week between the two visits and a kappa score of 0.91
locations of southern India, in order to represent children from different was obtained for intra-examiner reliability. These subjects were not
geographic localities. Children visit these health centers regularly in included in the main study. The mean age of eruption for each tooth
order to receive their mandatory vaccinations. Parents were informed was calculated using the Karber method, as modified by Hayes RL
about the study during the national immunization days and a written and Mantel N (1958) [18].
informed consent was obtained from those who agreed to participate
in the study. The study was reviewed and approved by the institutional Statistical Analysis
review board (CDC/CDHRC/011/2017-B). Participation was voluntary The data were analysed using SPSS version 16.0 software (SPSS,
and a valid birth proof was sought for birth date confirmation. Chicago, IL, USA). Descriptive statistics including means and standard
Journal of Clinical and Diagnostic Research. 2020 Feb, Vol-14(2): ZC07-ZC09 7
 Gunashekhar Madiraju and Harsha Basavaraja, Eruption Times of Primary Teeth in South Indian Children www.jcdr.net

deviations were calculated for all variables. Student’s t-test and paired Kariya P Verma N Singh K Indira MD Present
t-test were used to assess the statistical significance of differences in et al., [13] et al., [17] et al., [15] et al., [16] study
the mean ages of tooth eruption between the gender, and between the Tooth North India South India
upper and lower arches respectively at 5% probability level (p<0.05). Maxilla (months)
Central
RESULTS incisor
9.74 12.8 9.48 11.1 12.21

The present study examined 954 Indian children of which 452 (47.4%) Lateral
11.57 14.3 10.20 13.19 13.72
were boys and 502 (52.6%) were girls. Since there were no significant incisor
differences in the mean age of eruption of the teeth on the right and Canine 18.57 22.8 19.20 19.13 21.67
left sides for both the maxilla and mandible, an average of the mean First
eruption age of each pair of teeth in both the arches was calculated 14.71 18.6 15.7 16.15 17.67
molar
for males and females, as has been done in most previous studies on Second
27.80 30.1 27.7 29.18 28.98
the emergence ages of the teeth [9,10]. The results obtained for mean molar
eruption time of primary teeth including Standard Deviation (SD) and Mandible (months)
Standard Error of Mean (SEM) has been presented in [Table/Fig-1]. Central
The mandibular central incisors were the first teeth to erupt with an 8.30 11.4 8.28 10.21 10.28
incisor
overall mean eruption time of 10.3±0.6 months (Mean±SD). The mean Lateral
14.05 14.8 10.20 15.73 13.14
age of eruption was 10.2±0.79 months and 10.4±0.38 months in incisor
boys and girls respectively. Canine 20.55 23.3 19.32 21.24 22.12
First
Boys Girls 16.21 19.03 15.12 17.10 18.86
molar
Mean SD SEM Mean SD SEM
Second
Tooth (months) (months) (months) (months) (months) (months) 26.78 29.8 27.7 28.51 27.37
molar
51,61 12.07 0.74 0.10 12.34 0.89 0.11 [Table/Fig-2]: Comparison of mean ages (in months) of eruption of primary teeth
52,62 13.42 0.98 0.13 14.02 0.63 0.10 in both the arches combined by gender and sides (Right/Left) in Indian population.

53,63 21.52 1.15 0.18 21.81 0.59 0.08 Genetic, racial and environmental differences may vary considerably
54,64 18.19 0.88 0.13 17.14 1.11 0.17 between Indian and other population groups. Studies conducted on
55,65 29.12 0.89 0.12 28.83 0.73 0.10 populations of other global ethnic groups in Nepal, Saudi Arabia, and
71,81 10.19 0.79 0.098 10.37 0.38 0.05 Egypt were cross-sectional and used comparable criteria for tooth
emergence [Table/Fig-3]. The present study demonstrated delayed
72,82 13.27 0.85 0.13 13.00 0.76 0.12
eruption times of the first primary tooth in south Indian children when
73,83 22.02 1.20 0.19 22.37 0.75 0.11
compared to the data from other studies [9-12]. Although Nepal is
74,84 19.23 0.81 0.13 18.49 0.47 0.07 geographically located adjacent to India, slight differences in the
75,85 27.59 1.43 0.25 27.14 0.79 0.11 eruption times in both the genders were noted when compared
[Table/Fig-1]: Mean, SD and SEM in months, of eruption for primary teeth in boys to those of Indian counterparts [11]. Whilst these findings might
and girls. suggest possible role of genetics and/or ethnicity in the emergence
SD: Standard deviation; SEM: Standard error of mean
of primary teeth, the evidence in the literature regarding the role
Comparison of gender showed a tendency towards earlier eruption of ethnicity is unclear. Numerous studies conducted on different
in boys for all teeth except that the mandibular lateral incisors and population groups have shown a strong influence of genetics on the
first and second primary molars in both the arches erupted earlier in timing and sequence of eruption of teeth [12,19,20]. The sequence
of eruption of primary teeth was consistent with the findings in the
girls. However, statistically significant difference were noted in girls
literature and followed the typical trend in both boys and girls, i.e.,
only for the first primary molar in both maxilla and mandible (p<0.05).
central incisors, lateral incisors, first molar, and canine followed by
Further, earlier eruption of the maxillary lateral incisor in boys was
the second molar [10,13,16,17].
significant compared to that in girls (p<0.05). When the maxillary and
mandibular arches were compared, there was a tendency for central Saudi Arabia India (­Present
[12] Egypt [10] Nepal [11] study)
incisors, lateral incisors, and second molars to be chronologically
advanced in the mandible as compared to the maxillary counterparts, Arch Tooth Boys Girls Boys Girls Boys Girls Boys Girls

while canines and first molars emerged earlier in the maxilla, in both Central
11.19 11.20 9.8 9.9 12.67 10.33 12.1 12.3
incisor
boys and girls. The sequence of eruption of teeth was identical in
both the genders and was in the following order of eruption: central Lateral
13.09 13.31 12.0 13.2 14.00 11.50 13.4 14.0
incisor
incisors, lateral incisors, first molar, canine and second molar.
Maxilla Canine 21.14 21.03 19.4 19.9 19.10 18.80 21.5 21.8

DISCUSSION First
molar
16.88 16.90 17.1 17.0 15.86 14.71 18.2 17.1
Wide variations in the emergence time of primary teeth among
Second
different population groups have been reported in the literature. The molar
28.16 28.25 25.4 28.0 26.67 25.00 29.1 28.8

emergence of primary teeth in south Indian children in the present Central

study commenced approximately at the mean age of 10.3 months 8.44 8.49 8.0 7.8 10.50 9.50 10.2 10.4
incisor
among both the genders. This finding was found to be later than those Lateral
14.44 14.61 13.0 13.1 13.50 12.00 13.3 13.0
reported by other recent studies conducted in Lucknow by Kariya P incisor
et al., and in Mysore by Indira MD et al., [13,16], but earlier when Mandible Canine 21.03 21.10 20.3 19.5 21.43 21.50 22.0 22.4
compared to those reported by Gunashekhar M et al., in Hyderabad First
17.17 17.13 17.0 16.7 14.40 16.25 19.2 18.5
(10.72 months) and Verma N et al., in Bhopal (11.4 months) [14,17]. molar
Disparities in the eruption times of primary teeth in south Indian Second
27.92 27.97 25.6 28.1 25.33 27.00 27.6 27.1
children have been noted when compared to that in the north Indian molar

children [Table/Fig-2]. These differences might be partly due to [Table/Fig-3]: Comparison of mean difference ages (in months) of eruption of
variations in the study design and sampling techniques. primary teeth in both the arches combined by sides (Right/Left) in global population.

8 Journal of Clinical and Diagnostic Research. 2020 Feb, Vol-14(2): ZC07-ZC09

www.jcdr.net Gunashekhar Madiraju and Harsha Basavaraja, Eruption Times of Primary Teeth in South Indian Children

In the present study, boys showed a tendency towards earlier Acknowledgement

eruption for anterior teeth except the mandibular lateral incisors, The authors would like to thank Sheethal, Ganeshan, Suchitra Raju,
whereas first and second primary molars in both the arches Srinivas and Harsha Vardhan for their technical help and support in
including mandibular lateral incisors erupted earlier in girls. Gender the study.
variations in the eruption times and pattern of primary teeth have
not been clearly established [10]. Earlier onset of teeth maturation REFERENCES
has been attributed to advanced eruption times of teeth in girls [21]. [1] Logan WHG, Kronfeld R. Development of the human jaws and surrounding
structures from birth to age fifteen. J Am Dent Assoc. 1933;20(3):379-427.
Meredith HV (1946) had reported that earlier eruption of primary [2] Lunt RC, Law DB. A review of the chronology of eruption of deciduous teeth. J
teeth in boys might be due to accelerated growth in boys during the Am Dent Assoc. 1974;89(4):872-79.
first trimester [22]. However, most studies support the hypothesis [3] Maki K, Morimoto A, Nishioka T, Kimura M, Braham RL. The impact of race on tooth
formation. ASDC J Dent Child. 1999;66(5):353-56, 294-95. PMID: 10631893.
of developmental cross-over pattern suggested by Demirijian A and [4] Warren JJ, Fontana M, Blanchette DR, Dawson DV, Drake DR, Levy SM, et
Levesque GY, which states that anterior teeth erupt earlier in males al. Timing of primary tooth emergence among U.S. racial and ethnic groups. J
and posterior teeth in females [23]. Reports suggest that this pattern Public Health Dent 2016;76(4):259–62. PMID: 26992441.
[5] Poureslami H, Asl Aminabadi N, Sighari Deljavan A, Erfanparast L, Sohrabi A,
appears to follow a spatial gradient of tooth position, corresponding Jamali Z, et al. Does Timing of Eruption in First Primary Tooth Correlate with that
to gender differences arising early in dental development [24]. In of First Permanent Tooth? A 9-years Cohort Study. J Dent Res Dent Clin Dent
the present study, this pattern was evident except for mandibular Prospects. 2015;9(2):79-85. PMID: 26236432.
[6] Gaur R, Kumar P. Effect of undernutrition on deciduous tooth emergence
lateral incisor which erupted earlier in girls but was not statistically among Rajput children of Shimla District of Himachal Pradesh, India. Am J Phys
significant and only the first primary molars emerged significantly Anthropol. 2012;148(1):54-61. PMID: 22411000.
earlier in girls in both the arches. [7] Wu H, Chen T, Ma Q, Xu X, Xie K, Chen Y. Associations of maternal, perinatal
and postnatal factors with the eruption timing of the first primary tooth. Sci Rep.
Many studies on tooth emergence have shown insignificant 2019;9(1):2645. PMID: 30804498.
differences in the eruption times of teeth in the left and right side of [8] Aktoren O, Tuna EB, Guven Y, Gokcay G. A study on neonatal factors and
eruption time of primary teeth. Community Dent Health. 2010;27(1):52-56.
the dental arch [9,15]. Hence, in the present study, this variable was
[9] Folayan M, Owotade F, Adejuyigbe E, Sen S, Lawal B, Ndukwe K. The timing
not evaluated and the combined mean eruption times of both sides of eruption of the primary dentition in Nigerian children. Am J Phys Anthropol.
of each arch was considered for analysis. Contradicting the general 2007;134(4):443-48.
[10] Soliman NL, El-Zainy MA, Hassan RM, Aly RM. Timing of deciduous teeth
agreement that lateral incisors erupt first in the maxilla, this study
emergence in Egyptian children. East Mediterr Health J. 2011;17(11):875-81.
reported earlier eruption of lateral incisors in the mandible in both girls [11] Gupta A, Hiremath SS, Singh SK, Poudyal S, Niraula SR, Baral DD, et al.
(p<0.05) and boys (p>0.05). The earlier eruption of second primary Emergence of primary teeth in children of Sunsari district of Eastern Nepal. Mcgill
J Med. 2007;10(1):11-15.
molars in the mandible and the eruption of canines and first molars
[12] Al-Jasser NM, Bello LL. Time of eruption of primary dentition in Saudi children. J
to be chronologically advanced in the maxilla is in line with other Contemp Dent Pract. 2003;4(3):65-75. PMID: 12937597.
studies [9,13,14,17]. On the contrary, however, earlier emergence of [13] Kariya P, Tandon S, Singh S, Tewari N. Polymorphism in emergence of
first primary molar in the mandible has also been reported [10,16]. deciduous dentition: A cross-sectional study of Indian children. J Investig Clin
Dent 2018;9(1). PMID: 28349669.
Differences in the eruption times of primary teeth have been reported [14] GunaShekhar M, Tenny J. Longitudinal study of age and order of eruption of
to be affected by various significant determinants including low birth primary teeth in Indian children. J Clin Exp Dent. 2010;3:e113-16.
weight, gestational age, and chronic malnutrition [8,17,25,26]. [15] Singh K, Gorea RK, Bharti V. Age estimation from eruption of temporary teeth.
JIAFM 2004;26(3):107-09.
[16] Indira MD, Bhojraj N, Narayanappa D. A cross-sectional study on eruption
Limitation(s) timing of primary teeth in children of Mysore, Karnataka. Indian J Dent Res.
In the present study, only those children with a history of full-term 2018;29(6):726-31.
[17] Verma N, Bansal A, Tyagi P, Jain A, Tiwari U, Gupta R. Eruption chronology in
birth were included and hence the impact of gestational age and children: A cross-sectional study. Int J Clin Pediatr Dent. 2017;10(3):278-82.
birth weight on primary tooth eruption chronology could not be [18] Hayes RL, Mantel N. Procedures for computing the mean age of eruption of
evaluated. Further since this study study focused only on healthy human teeth. J Dent Res. 1958;37(5):938-47.
[19] Hughes TE, Bockmann MR, Seow K, Gotjamanos T, Gully N, Richards LC, et
children attending primary health centers, assessment of the effect al. Strong genetic control of emergence of human primary incisors. J Dent Res.
of nutritional and socioeconomic status on tooth eruption times 2007;86(12):1160-65. PMID: 18037648.
was not  possible. Although the present study determined the [20] Wise GE, Frazier-Bowers S, D’Souza RN. Cellular, molecular, and genetic
determinants of tooth eruption. Crit Rev Oral Biol Med. 2002;13(4):323-34.
eruption times of primary teeth, the possible role of these external [21] Moslemi M. An epidemiological survey of the time and sequence of eruption
environmental factors causing variations in the emergence times of of permanent teeth in 4-15-year-olds in Tehran, Iran. Int J Paediatr Dent.
primary teeth in Indian children should be extensively explored. 2004;14(6):432-38.
[22] Meredith HV. Order and age of eruption for the deciduous dentition. J Dent Res.
1946;25:43-66. PMID: 21015797.
CONCLUSION(s) [23] Demirjian A, Levesque GY. Sexual differences in dental development and
Primary tooth eruption in south Indian children occurred later when prediction of emergence. J Dent Res. 1980;59(7):1110-22.
[24] Holman DJ, Yamaguchi K. Longitudinal analysis of deciduous tooth emergence: IV.
compared to their counterparts in other population groups. The Covariate effects in Japanese children. Am J Phys Anthropol. 2005;126:352-58.
eruption of the first primary molar occurred earlier in boys compared [25] Sajjadian N, Shajari H, Jahadi R, Barakat MG, Sajjadian A. Relationship between
to that in girls. Multiethnic nature of Indian population warrants the birth weight and time of first deciduous tooth eruption in 143 consecutively born
infants. Pediatr Neonatol. 2010;51(4):235-37.
need for further studies on a larger scale to explore the influence of [26] Pavičin IS, Dumanc̆ J, Badel T, Vodanović M. Timing of emergence of the first primary
genetic and external environmental factors. tooth in preterm and full-term infants. Ann Anat. 2016;203:19-23. PMID: 26123712.

PARTICULARS OF CONTRIBUTORS:
1. Faculty of Dentistry, Preventive Dentistry, King Faisal University AlHassa, Saudi Arabia.
2. Faculty of Orthodontics, Department of Orthodontics, KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: PLAGIARISM CHECKING METHODS: [Jain H et al.] Etymology: Author Origin
Gunashekhar Madiraju, •  Plagiarism X-checker: Nov 20, 2019
C/o Chinmayee Dental Care and Orthodontic Centre, Bangalore, Karnataka, India. •  Manual Googling: Jan 02, 2019
E-mail: indshe117@gmail.com •  iThenticate Software: Jan 20, 2020 (19%)

Author declaration:
•  Financial or Other Competing Interests:  None Date of Submission: Nov 19, 2019
•  Was Ethics Committee Approval obtained for this study?  Yes Date of Peer Review: Dec 10, 2019
•  Was informed consent obtained from the subjects involved in the study?  Yes (from parents) Date of Acceptance: Jan 09, 2020
•  For any images presented appropriate consent has been obtained from the subjects.  NA Date of Publishing: Feb 01, 2020

Journal of Clinical and Diagnostic Research. 2020 Feb, Vol-14(2): ZC07-ZC09 9