Dental anatomy educational teaching resource

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  • There are two general categorizations for teeth:
    Primary (deciduous) teeth
    Secondary (permanent) teeth
  • There are two general categorizations for teeth:
    Primary (deciduous) teeth
    Secondary (permanent) teeth
  • Primary (deciduous)
    Consist of 20 teeth
    Begin to form during the first trimester of pregnancy
    Typically begin erupting around 6 months
    Most children have a complete primary dentition by 3 years of age
  • Secondary (permanent)
    Consist of 32 teeth in most cases
    Begin to erupt around 6 years of age
    Most permanent teeth have erupted by age 12
    Third molars (wisdom teeth) are the exception; often do not appear until late teens or early 20s
  • Teeth may be classified based on structure/function:
    Incisors (central and lateral)
    Canines (cuspids)
    Premolars (bicuspids)
    Molars
  • Incisors (central and lateral)
    The incisors are located near the entrance of the oral cavity and function as cutting or shearing instruments for food. From a proximal view, the crowns of these teeth have a triangular shape with a narrow incisal surface, including the incisal edge, and a broad cervical base. The incisors contribute significantly in cutting actions and other functions; esthetics; and phonetics.
     
    Canines
    The canines possess the longest roots of all teeth and are located at the corners of the dental arch. They function in the seizing, piercing, and tearing of food, as well as in cutting. From a proximal view the crown also has a triangular shape with a thick incisal ridge. The stocky anatomic form of the crown and length of the root are reasons why these teeth are strong, stable abutment teeth for a fixed or removable prosthesis. The canines serve as imortant guides in occlusion because of their anchorage and position in the dental arches.
     
    Premolars
    The premolars serve a dual role in function: they act like the canines in the tearing of food and are similar to molars in the grinding of food.
    Whereas the first premolars are angular, with their facial cusps resembling the canines, the lingual cusps of the maxillary premolars and molars have a more rounded anatomic form. The occlusal surfaces present in a series of curves in the form of concavities and convexities that should be maintained throughout life for correct occlusal contacts and function.
     
    Molars
    The molars are large, multicusped, strongly anchored teeth located nearest the temporomandibular joint (TMJ), which serves as the fulcrum during function. These teeth have a major role in the crushing, grinding, and chewing of food to the smallest dimensions suitable for deglutition. The occlusal surfaces of both premolars and molars act as a myriad of shears that function in the final mastication of food. The premolars and molars are also important in maintaining the vertical dimension of the face.
     
    All definitions from: Sturdevant JR, Lundeen TF, Sluder TB Jr. Clinical significance of dental anatomy, histology, physiology, and occlusion. In:
    Roberson TM, Heymann HO, Swift EJ Jr, eds. Sturdevant's Art and Science of Operative Dentistry. 4th ed. St. Louis, MO: Mosby; 2002:15-16.
     
     
  • Tooth surfaces include:
    Apical: Pertaining to the apex or root of the tooth
    Labial: Pertaining to the lip; describes the front surface of anterior teeth
    Lingual: Pertaining to the tongue; describes the back (interior) surface of all teeth
    Distal: The surface of the tooth that is away from the median line
    Mesial: The surface of the tooth that is towards the median line
  • Tooth surfaces include:
    Apical: Pertaining to the apex or root of the tooth
    Labial: Pertaining to the lip; describes the front surface of anterior teeth
    Lingual: Pertaining to the tongue; describes the back (interior) surface of all teeth
    Distal: The surface of the tooth that is away from the median line
    Mesial: The surface of the tooth that is towards the median line
  • The anatomic tooth crown is the portion of the tooth covered by enamel.
    The anatomic root is the lower two thirds of a tooth. The roots are normally subgingival, buried in bone, and serve to anchor the tooth in position.
    The pulp cavity houses the dental pulp, an organ of myelinated and unmyelinated nerves, arteries, veins, lymph channels, connective tissue cells, and various other cells involved in formative or developmental, nutritive, sensory, protective, and defensive or reparative processes.
  • The anatomic tooth crown is the portion of the tooth covered by enamel.
    The anatomic root is the lower two thirds of a tooth. The roots are normally subgingival, buried in bone, and serve to anchor the tooth in position.
    The pulp cavity houses the dental pulp, an organ of myelinated and unmyelinated nerves, arteries, veins, lymph channels, connective tissue cells, and various other cells involved in formative or developmental, nutritive, sensory, protective, and defensive or reparative processes.
  • The anatomic tooth crown is the portion of the tooth covered by enamel.
    The anatomic root is the lower two thirds of a tooth. The roots are normally subgingival, buried in bone, and serve to anchor the tooth in position.
    The pulp cavity houses the dental pulp, an organ of myelinated and unmyelinated nerves, arteries, veins, lymph channels, connective tissue cells, and various other cells involved in formative or developmental, nutritive, sensory, protective, and defensive or reparative processes.
  • The 4 main dental tissues are:
    Enamel
    Dentin
    Cementum
    Dental pulp
  • Structure
    Highly calcified and hardest tissue in the body
    Crystalline in nature
    Enamel rods
    Insensitive—no nerves
    Acid-soluble—will demineralize at a pH of 5.5 and lower
    Cannot be renewed
    Darkens with age as enamel is lost
    Fluoride and saliva can help with remineralization
  • Softer than enamel
    Susceptible to tooth wear (physical or chemical)
    Does not have a nerve supply but can be sensitive
    Is produced throughout life
    Three classifications
    Primary
    Secondary
    Tertiary
    Will demineralize at a pH of 6.5 and lower
    Primary dentin forms the initial shape of the tooth. It is usually completed 3 years after tooth eruption (for permanent teeth).
    Secondary dentin is deposited after the formation of the primary dentin. Secondary dentin forms on all internal aspects of the pulp cavity, but in the pulp chamber of multirooted teeth it tends to be thicker on the roof and floor than on the side walls.
    Tertiary dentin, or “reparative dentin” is formed by replacement odontoblasts in response to moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries, and some operative procedures. It usually appears as a localized dentin deposit on the wall of the pulp cavity immediately subadjacent to the area of the tooth that has received the injury.
  • Softer than enamel
    Susceptible to tooth wear (physical or chemical)
    Does not have a nerve supply but can be sensitive
    Is produced throughout life
    Three classifications
    Primary
    Secondary
    Tertiary
    Will demineralize at a pH of 6.5 and lower
    Primary dentin forms the initial shape of the tooth. It is usually completed 3 years after tooth eruption (for permanent teeth).
    Secondary dentin is deposited after the formation of the primary dentin. Secondary dentin forms on all internal aspects of the pulp cavity, but in the pulp chamber of multirooted teeth it tends to be thicker on the roof and floor than on the side walls.
    Tertiary dentin, or “reparative dentin” is formed by replacement odontoblasts in response to moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries, and some operative procedures. It usually appears as a localized dentin deposit on the wall of the pulp cavity immediately subadjacent to the area of the tooth that has received the injury.
  • Softer than enamel
    Susceptible to tooth wear (physical or chemical)
    Does not have a nerve supply but can be sensitive
    Is produced throughout life
    Three classifications
    Primary
    Secondary
    Tertiary
    Will demineralize at a pH of 6.5 and lower
    Primary dentin forms the initial shape of the tooth. It is usually completed 3 years after tooth eruption (for permanent teeth).
    Secondary dentin is deposited after the formation of the primary dentin. Secondary dentin forms on all internal aspects of the pulp cavity, but in the pulp chamber of multirooted teeth it tends to be thicker on the roof and floor than on the side walls.
    Tertiary dentin, or “reparative dentin” is formed by replacement odontoblasts in response to moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries, and some operative procedures. It usually appears as a localized dentin deposit on the wall of the pulp cavity immediately subadjacent to the area of the tooth that has received the injury.
  • The tubules run parallel to each other in an S-shape course. The tubules are filled with a fluid. External stimuli cause movement of the dentinal fluid, a hydrodynamic movement, which can result in short, sharp pain episodes. These details are important in understanding dentin hypersensitivity.
  • The tubules run parallel to each other in an S-shape course. The tubules are filled with a fluid. External stimuli cause movement of the dentinal fluid, a hydrodynamic movement, which can result in short, sharp pain episodes. These details are important in understanding dentin hypersensitivity.
  • Associations between erosion and hypersensitivity involve:
    Open/patent tubules
    Greater in number
    Larger in diameter
    Removal of smear layer
    Erosion/tooth wear
    Undercalcified
  • Cementum is:
    Thin layer of mineralized tissue covering the dentin
    Softer than enamel and dentin
    Anchors the tooth to the alveolar bone along with the periodontal ligament
    Not sensitive
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • The gingival is commonly divided into free (the unattached portion, forming the wall of the gingival crevice) and attached (the part that is firm and resilient and bound to the underlying cementum and the alveolar bone, thus being immovable).
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • Dental pulp is:
    Innermost part of the tooth
    A soft tissue rich with blood vessels and nerves
    Responsible for nourishing the tooth
    The pulp in the crown of the tooth is known as the pulp chamber
    Pulp canals traverse the root of the tooth
    Typically sensitive
  • The oral environment consists of:
    Plaque
    Saliva
    pH Values
    Demineralization
    Remineralization
  • Plaque:7,8
    is a biofilm
    contains more than 400 different identified species of bacteria
    there is harmless and harmful plaque
    salivary pellicle allows the bacteria to adhere to the tooth surface, which begins the formation of plaque
  • Saliva:7,8
    complex mixture of fluids
    performs protective functions:
    lubrication—aids swallowing
    mastication
    key role in remineralization of enamel and dentin buffering
  • pH values:7,8
    measure of acidity or alkalinity of a solution
    measured on a scale of 1-14
    pH of 7 indicates that the solution is neutral
    pH of the mouth is close to neutral until other factors are introduced
    pH is a factor in demineralization and remineralization
  • Demineralization:7,8
    mineral salts dissolve into the surrounding salivary fluid:
    enamel at approximate pH of 5.5 or lower
    dentin at approximate pH of 6.5 or lower
    erosion or caries can occur
  • Remineralization:
    pH comes back to neutral (7)
    saliva-rich calcium and phosphates
    minerals penetrate the damaged enamel surface and repair it:
    enamel pH is above 5.5
    dentin pH is above 6.5

Transcript

  • 1. DENTAL ANATOMY & PHYSIOLOGY Physiology, Etiology, Epidemiology, Diagnosis, and Treatment Reviewed by:
  • 2. Dental Anatomy and Physiology After viewing this lecture, attendees should be able to: • Identify the major structures of the dental anatomy • Discuss the primary characteristics of enamel, dentin, cementum, and dental pulp • Describe the biologic functions that take place within the oral cavity
  • 3. Dental Anatomy and Physiology •Primary (deciduous) •Secondary (permanent) Definition (teeth): There are two definitions
  • 4. Dental Anatomy and Physiology A tooth is made up of three elements: •Water •Organic materials •Inorganic materials Elements
  • 5. Primary (deciduous) • Consist of 20 teeth • Begin to form during the first trimester of pregnancy • Typically begin erupting around 6 months • Most children have a complete primary dentition by 3 years of age Dental Anatomy and Physiology Dentition (teeth): There are two dentitions 1. Oral Health for Children: Patient Education Insert. Compend Cont Educ Dent.
  • 6. Dental Anatomy and Physiology Secondary (permanent) • Consist of 32 teeth in most cases • Begin to erupt around 6 years of age • Most permanent teeth have erupted by age 12 • Third molars (wisdom teeth) are the exception; often do not appear until late teens or early 20s Dentition (teeth): There are two dentitions Mandible Maxilla Incisors Canine (Cuspid) Premolars Molars
  • 7. Classification of Teeth: • Incisors (central and lateral) • Canines (cuspids) • Premolars (bicuspids) • Molars Dental Anatomy and Physiology Identifying Teeth Incisor Canine Premolar Molar
  • 8. Dental Anatomy and Physiology Identifying Teeth2 Incisor Canine Premolar Molar • Incisors function as cutting or shearing instruments for food. • Canines possess the longest roots of all teeth and are located at the corners of the dental arch. • Premolars act like the canines in the tearing of food and are similar to molars in the grinding of food. • Molars are located nearest the temporomandibular joint (TMJ), which serves as the fulcrum during function.
  • 9. Dental Anatomy and Physiology • Apical • Labial • Lingual • Distal • Mesial • Incisal Teeth: Identification Tooth Surfaces Labial Apical Lingual Distal Apical Mesial Incisal Incisal
  • 10. Dental Anatomy and Physiology • Apical: Pertaining to the apex or root of the tooth • Labial: Pertaining to the lip; describes the front surface of anterior teeth • Lingual: Pertaining to the tongue; describes the back (interior) surface of all teeth • Distal: The surface of the tooth that is away from the median line • Mesial: The surface of the tooth that is toward the median line Labial Apical Lingual Distal Apical Mesial
  • 11. Enamel Alveolar Bone Pulp Chamber Dental Anatomy and Physiology • Enamel (hard tissue) • Dentin (hard tissue) • Odontoblast Layer • Pulp Chamber (soft tissue) • Gingiva (soft tissue) • Periodontal Ligament (soft tissue) • Cementum (hard tissue) • Alveolar Bone (hard tissue) • Pulp Canals • Apical Foramen The Dental Tissues: Dentin Odontoblast Layer Gingiva Periodontal Ligament Cementum Pulp Canals Apical Foramen
  • 12. • Anatomic Crown • Anatomic Root • Pulp Chamber The 3 parts of a tooth: Anatomic Crown Anatomic Root Pulp Chamber Dental Anatomy and Physiology
  • 13. Anatomic Crown Anatomic Root Pulp Chamber Dental Anatomy and Physiology • The anatomic crown is the portion of the tooth covered by enamel. • The anatomic root is the lower two thirds of a tooth. • The pulp chamber houses the dental pulp, an organ of myelinated and unmyelinated nerves, arteries, veins, lymph channels, connective tissue cells, and various other cells.
  • 14. • Enamel • Dentin • Cementum • Dental Pulp The 4 main dental tissues: Dental Anatomy and Physiology Enamel Dentin Cementum Dental Pulp
  • 15. • Structure • Highly calcified and hardest tissue in the body • Crystalline in nature • Enamel rods • Insensitive—no nerves • Acid-soluble—will demineralize at a pH of 5.5 and lower • Cannot be renewed • Darkens with age as enamel is lost • Fluoride and saliva can help with remineralization Dental Anatomy and Physiology Dental Tissues—Enamel2
  • 16. Dental Tissues—Enamel2 Dental Anatomy and Physiology • Enamel can be lost by:3,4 – Physical mechanism • Abrasion (mechanical wear) • Attrition (tooth-to-tooth contact) • Abfraction (lesions) – Chemical dissolution • Erosion by extrinsic acids (from diet) • Erosion by intrinsic acids (from the oral cavity/digestive tract) • Multifactorial etiology –Combination of physical and chemical factors
  • 17. • Softer than enamel • Susceptible to tooth wear (physical or chemical) • Does not have a nerve supply but can be sensitive • Is produced throughout life • Three classifications • Primary • Secondary • Tertiary • Will demineralize at a pH of 6.5 and lower Dental Tissues—Dentin2 Dental Anatomy and Physiology
  • 18. Three classifications: • Primary dentin forms the initial shape of the tooth. • Secondary dentin is deposited after the formation of the primary dentin on all internal aspects of the pulp cavity. • Tertiary dentin, or “reparative dentin” is formed by replacement odontoblasts in response to moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries, and some operative procedures. Dental Tissues—Dentin2 Dental Anatomy and Physiology
  • 19. Dentin Pulp Tubule Fluid Nerve Fibers Odontoblast Cell Dental Anatomy and Physiology Dental Tissues—Dentin (Tubules)2 • Dentinal tubules connect the dentin and the pulp (innermost part of the tooth, circumscribed by the dentin and lined with a layer of odontoblast cells) • The tubules run parallel to each other in an S- shape course • Tubules contain fluid and nerve fibers • External stimuli cause movement of the dentinal fluid, a hydrodynamic movement, which can result in short, sharp pain episodes
  • 20. Dental Anatomy and Physiology • Presence of tubules renders dentin permeable to fluoride • Number of tubules per unit area varies depending on the location because of the decreasing area of the dentin surfaces in the pulpal direction Dental Tissues—Dentin (Tubules)2
  • 21. Association between erosion and dentin hypersensitivity3 • Open/patent tubules – Greater in number – Larger in diameter • Removal of smear layer • Erosion/tooth wear Enamel Exposed Dentin Receding Gingiva Tubules Odontoblast Dental Anatomy and Physiology Dental Tissues—Dentin (Tubules)2
  • 22. Dental Anatomy and Physiology • Thin layer of mineralized tissue covering the dentin • Softer than enamel and dentin • Anchors the tooth to the alveolar bone along with the periodontal ligament • Not sensitive Dental Tissue—Cementum2
  • 23. • Innermost part of the tooth • A soft tissue rich with blood vessels and nerves • Responsible for nourishing the tooth • The pulp in the crown of the tooth is known as the coronal pulp • Pulp canals traverse the root of the tooth • Typically sensitive to extreme thermal stimulation (hot or cold) Dental Tissue—Dental Pulp2 Dental Anatomy and Physiology
  • 24. • Pulpitis is inflammation or infection of the dental pulp, causing extreme sensitivity and/or pain. • Pain is derived as a result of the hydrodynamic stimuli activating mechanoreceptors in the nerve fibers of the superficial pulp (A-beta, A-delta, C-fibers). • Hydrodynamic stimuli include: thermal (hot and cold); tactile; evaporative; and osmotic • These stimuli generate inward or outward movement of the fluid in the tubules and activate the nerve fibers. • A-beta and A-delta fibers are responsible for sharp pain of short duration • C-fibers are responsible for dull, throbbing pain of long duration • Pulpitis may be reversible (treated with restorative procedures) or irreversible (necessitating root canal). • Untreated pulpitis can lead to pulpal necrosis necessitating root canal or extraction. Dental Tissue—Dental Pulp2,5 Dental Anatomy and Physiology
  • 25. • Gingiva • Alveolar Bone • Periodontal Ligament • Cementum Periodontal Tissues6 Dental Anatomy and Physiology Gingiva Alveolar bone Cementum Periodontal Ligament
  • 26. • Gingiva: The part of the oral mucosa overlying the crowns of unerupted teeth and encircling the necks of erupted teeth, serving as support structure for subadjacent tissues. Dental Tissue—Dental Tissue6 Dental Anatomy and Physiology Gingiva
  • 27. • Alveolar Bone: Also called the “alveolar process”; the thickened ridge of bone containing the tooth sockets in the mandible and maxilla. Dental Tissue—Dental Tissue6 Dental Anatomy and Physiology Alveolar bone
  • 28. • Periodontal Ligament: Connects the cementum of the tooth root to the alveolar bone of the socket. Dental Tissue—Dental Tissue6 Dental Anatomy and Physiology Periodontal Ligament
  • 29. • Cementum: Bonelike, rigid connective tissue covering the root of a tooth from the cementoenamel junction to the apex and lining the apex of the root canal. It also serves as an attachment structure for the periodontal ligament, thus assisting in tooth support. Dental Tissue—Dental Tissue6 Dental Anatomy and Physiology Cementum
  • 30. • Plaque • Saliva • pH Values • Demineralization • Remineralization Oral Cavity/Environment7,8 Dental Anatomy and Physiology
  • 31. Dental Anatomy and Physiology Plaque:7,8 • is a biofilm • contains more than 600 different identified species of bacteria • there is harmless and harmful plaque • salivary pellicle allows the bacteria to adhere to the tooth surface, which begins the formation of plaque Oral Cavity
  • 32. Dental Anatomy and Physiology Saliva:7,8 • complex mixture of fluids • performs protective functions: – lubrication—aids swallowing – mastication – key role in remineralization of enamel and dentin – buffering Oral Cavity
  • 33. Dental Anatomy and Physiology pH values:7,8 • measure of acidity or alkalinity of a solution • measured on a scale of 1-14 • pH of 7 indicated that the solution is neutral • pH of the mouth is close to neutral until other factors are introduced • pH is a factor in demineralization and remineralization Oral Cavity 3. Strassler HE, Drisko CL, Alexander DC.
  • 34. Dental Anatomy and Physiology Demineralization:7,8 • mineral salts dissolve into the surrounding salivary fluid: – enamel at approximate pH of 5.5 or lower – dentin at approximate pH of 6.5 or lower • erosion or caries can occur Oral Cavity
  • 35. Dental Anatomy and Physiology Remineralization:7,8 • pH comes back to neutral (7) • saliva-rich calcium and phosphates • minerals penetrate the damaged enamel surface and repair it: – enamel pH is above 5.5 – dentin pH is above 6.5 Oral Cavity
  • 36. Dental Anatomy & Physiology—References References   1. Oral Health for Children: Patient Education Insert. Compend Contin Educ Dent. 2005;26(5 Suppl 1):Insert. 2. Sturdevant JR, Lundeen TF, Sluder TB Jr. Clinical significance of dental anatomy, histology, physiology, and occlusion. In: Robertson TM, Heymann HO, Swift EJ Jr, eds. Sturdevant’s Art and Science of Operative Dentistry. 4th ed. Mosby: St. Louis, MO; 2002:13-61. 3. Strassler HE, Drisko CL, Alexander DC. Dentin hypersensitivity: its inter-relationship to gingival recession and acid erosion. Inside Dentistry. 2008;29(5 Special Issue):3-4. 4. Imfeld T. Dental erosion. Definition, classification and links. Eur J Oral Sci. 1996;104(2 (Pt 2)):151-155. 5. Dentin hypersensitivity: current state of the art and science. In: Pashley DH, Tay FR, Haywood VB, et al. Dentin Hypersensitivity: Consensus-Based Recommendations for the Diagnosis and Management of Dentin Hypersensitivity. Inside Dentistry. 2008;4(9 Special Issue):8-18. 6. Dorland’s Medical Dictionary. 29th Ed. Philadelphia, PA: W. B. Saunders Company; 2000. 7. Robertson TM, Lundeen TF. Cariology: the lesion, etiology, prevention, and control. In: Robertson TM, Heymann HO, Swift EJ Jr, eds. Sturdevant’s Art and Science of Operative Dentistry. 4th ed. Mosby: St. Louis, MO; 2002:63-132. 8. Tooth Erosion in Children—US Perspective. Inside Dentistry. 2009;5(3 Suppl):8.
  • 37. Dental Anatomy and Physiology For more in-depth, categorized information, please visit the IFDEA at www.ifdea.org