Dental trauma
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Dental Anatomy

Dental Anatomy

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  • Traumatic dental injuries (TDIs) occur with great frequency in preschool, school age children and young adults comprising 5% of all injuries for which people seek treatment.1,2 A twelve year review of the literature reports that 25% of all school children experience dental trauma and 33% of adults have experienced trauma to the permanent dentition with the majority of injuries occurring before age 19
  • The following guidelines by the International Association of Dental Traumatology (IADT)
  • The crown is the part of the tooth that is visible above the gum (gingiva).The neck is the region of the tooth that is at the gum line, between the root and the crown.The root is the region of the tooth that is below the gum. Some teeth have only one root, for example, incisors and canine (‘eye’) teeth, whereas molars and premolars have 4 roots per tooth.The crownThe crown of each tooth has a coating of enamel, which protects the underlying dentine. Enamel is the hardest substance in the human body, harder even than bone. It gains its hardness from tightly packed rows of calcium and phosphorus crystals within a protein matrix structure. Once the enamel has been formed during tooth development, there is little turnover of its minerals during life. Mature enamel is not considered to be a ‘living’ tissue.DentineThe major component of the inside of the tooth is dentine. This substance is slightly softer than enamel, with a structure more like bone. It is elastic and compressible in contrast to the brittle nature of enamel. Dentine is sensitive. It contains tiny tubules throughout its structure that connect with the central nerve of the tooth within the pulp. Dentine is a ‘live’ tissue.Cementum and the periodontal membraneBelow the gum, the dentine of the root is covered with a thin layer of cementum, rather than enamel. Cementum is a hard bone-like substance onto which theperiodontal membrane attaches. This membrane bonds the root of the tooth to thebone of the jaw. It contains elastic fibres to allow some movement of the tooth within its bony socket.The pulpThe pulp forms the central chamber of the tooth. The pulp is made of soft tissue and contains blood vessels to supply nutrients to the tooth, and nerves to enable the tooth to sense heat and cold. It also contains small lymph vessels which carry white blood cells to the tooth to help fight bacteria.The root canalThe extension of the pulp within the root of the tooth is called the root canal. The root canal connects with the surrounding tissue via the opening at the tip of the root. This is an opening in the cementum through which the tooth’s nerve supply and blood supply enter the pulp from the surrounding tissue.
  • the outer layer of enamel, which is a very hard, crystalline material that acts as a protective helmet or shell. It breaks apart foods during the act of chewing, it can resist grinding and abrasion, and it helps protect the tooth throughout life.The enamel is also resistant to acid and chemical attacks during the process of digestion, but the entire basic tooth structure is not made up of enamel, because enamel is very rigid and brittle. If the entire tooth were made of enamel, it would fracture very easily. The enamel is there as a thin protective shell, protecting the rest of the basic tooth structure from the outside environment.
  • Innervation & Blood Supply of the Teeth 1Maxillary branch of trigeminal nerve (CN V2)2Superior alveolar nerve3Infraorbital artery4Infraorbital nerve5Superior dental nerve plexus6Inferior dental nerve plexus7External carotid artery8Inferior alveloar nerve9Inferior alveolar artery10Lingual nerve11Maxillary artery12Mandibular branch of trigeminal nerve (CN V3)13Trigeminal ganglion14Ophthalmic branch of trigeminal nerve (CN V1)
  • Look at the blood supply to the face
  • t descends with the inferior alveolar nerve to the mandibular foramen on the medial surface of the ramus of the mandible.It runs along the mandibular canal in the substance of the bone, accompanied by the nerve, and opposite the firstpremolar tooth divides into two branches, incisor and mental.

Dental trauma Dental trauma Presentation Transcript

  • Dental Trauma: -Anatomy of Dentition - Primary & Permanent tooth development Peter Andre Soltau DM Emergency Medicine UWI Year 2 Resident
  • Traumatic Dental Injuries (TDIs)  Most common age is 1.5 to 2.5 years  Commonest causes: ◦ Falls / Collisions ◦ Child Abuse (Non-accidental) ◦ Sports or play related injuries ◦ MVA / Bicycle accidents
  • Epidemiology  Boys/girls - 2/1  Maxillary incisors most frequently injured  Primary dentition - luxations  Permanent dentition- uncomplicated crown fractures
  • Traumatic Dental Injuries (TDIs)
  •  The primary goal is to delineate an approach for the immediate or urgent care of TDI
  • Embryology of Teeth
  • Upper Teeth: 55/A, 65/J Second molar 25-33±month eruption 10-12±year exfoliation 54/B, 64/I First molar 13-19±month eruption 9-11±year exfoliation 53/C, 63/H Cuspid (Canine) 16-22±month eruption 10-12±year exfoliation 52/D, 62/G Lateral incisor 8-13±month eruption 7-8±year exfoliation 51/E, 61/F Central incisor 8-12±month eruption 6-7±year exfoliation
  • Lower Teeth: 75/K, 85/T Second molar 23-31±month eruption 10-12±year exfoliation 74/L, 84/S First molar 14-18±month eruption 9-11±year exfoliation 73/M, 83/R Cuspid (Canine) 17-23±month eruption 19-12±year exfoliation 72/N, 82/Q Lateral incisor 10-16±month eruption 7-8±year exfoliation 71/O, 81/P Central incisor 6-10±month eruption 6-7±year exfoliation
  • Embryology of Teeth
  • Upper Teeth: 18/1, 28/16 Third molar 17-21±year eruption 17/2, 27/15 Second molar 12-13±year eruption 16/3, 26/14 First molar 6-7±year eruption 15/4, 25/13 Second bicuspid (premolar) 10-122±year eruption 14/5, 24/12 First bicuspid (premolar) 10-11±year eruption 13/6, 23/11 Cuspid (Canine) 11-12±year eruption 12/7, 22/10 Lateral incisor 8-9±year eruption 11/8, 21/9 Central incisor 7-9± eruption
  • Lower Teeth: 38/17, 48/32 Third molar 17-21±year eruption 37/18, 47/31 Second molar 12-13±year eruption 36/19, 46/30 First molar 6-7±year eruption 35/20, 45/29 Second premolar 10-12±year eruption 34/21, 44/28 First premolar 10-11±year eruption 33/22, 34/27 Cuspid (Canine) 11-12±year eruption 32/23, 42/26 Lateral incisor 8-9±year eruption 31/24, 41/25 Central incisor 7-8±year eruption
  • Embryology of Teeth
  •  When a tooth is first formed, it is nothing more than "germ cells," that forms within the bone. Embryology of Teeth
  • Embryology of Teeth  The first part of the tooth that forms in the bone is the outer shell of the enamel
  • Embryology of Teeth  While developing within the bone, before it comes through the surface, it starts growing the tooth root  The blood flow that goes into the middle of the tooth starts laying down calcium, phosphorous, magnesium and other minerals
  • Embryology of Teeth  Finally, the developing tooth starts erupting into the mouth.
  • Embryology of Teeth  When the tooth first comes into the mouth, it does not have a fully developed root structure.  It is not completely developed until about the age of 15 to 20 years(fully calcify)
  • Anatomy of Dentition  The crown is the part of the tooth that is visible above the gum (gingiva).  The neck is the region of the tooth that is at the gum line, between the root and the crown.  The root is the region of the tooth that is below the gum. (Some teeth have only one root, for example, incisors and canine (‘eye’) teeth, whereas molars and premolars have 4 roots per tooth).
  • Anatomy of Dentition  The crown  The crown of each tooth has a coating of enamel, which protects the underlying dentine. Enamel is the hardest substance in the human body, harder even than bone. It gains its hardness from tightly packed rows of calcium and phosphorus crystals within a protein matrix structure.
  • Anatomy of Dentition  Dentine  The major component of the inside of the tooth  a ‘live’ tissue.  This substance is slightly softer than enamel, with a structure more like bone.  It is elastic and compressible in contrast to the brittle nature of enamel.  Dentine is sensitive. It contains tiny tubules throughout its structure that connect with the central nerve of the tooth within the pulp.
  • Cementum and the periodontal membrane  Below the gum, the dentine of the root is covered with a thin layer of cementum, rather than enamel.  Cementum is a hard bone-like substance onto which the periodontal membrane attaches.  This membrane bonds the root of the tooth to the bone of the jaw.  Contains elastic fibres to allow some movement of the tooth within its bony socket.
  • Anatomy of Dentition  The pulp  Forms the central chamber of the tooth  Made of soft tissue and contains blood vessels to supply nutrients to the tooth, and nerves to enable the tooth to sense heat and cold.  Also contains small lymph vessels which carry white blood cells to the tooth to help fight bacteria.  The root canal  The extension of the pulp within the root of the tooth  Connects with the surrounding tissue via the opening at the tip of the root.
  • The Innervation of Teeth • Maxillary Teeth: • Anterior superior alveolar nerve: upper incisors and canines (CNV2) • Middle superior alveolar nerve: upper premolars and the mesio-buccal root of the maxillary first molar (CNV2) • Posterior superior alveolar nerve: upper molars except the mesio-buccal root of the maxillary first molar (CNV2) • Mandibular Teeth: • Inferior alveolar nerve: mandibular teeth, gingiva and lower lip unilaterally (CNV3)
  • Blood Supply • Maxillary teeth: • Maxillary Artery - Superior alveolar artery : anterior, middle and posterior • Mandibular teeth: • Maxillary Artery - Inferior alveolar artery
  • Questions?
  • References  1. Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Oxford, England, Wiley-Blackwell: 2007.  2. Petersson EE, Andersson L, Sorensen S. Traumatic oral vs non-oral injuries. Swed Dent J 1997; 211-2):55-68.  3. Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. Dent Traumatol 2008:24(6):603- 11.  4. Flores MT. Traumatic injuries in the primary dentition. Dent Traumatol 2002; 18(6):287-98