basics of dentistry

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Basics of Dentistry


ContentsWhat is dentistry?

Stomatognathic System: anatomy in brief

- Teeth anatomy

- The Periodontium

- The Maxillary bones

- The Temporomandibular Joints (TMJ)

General Dentistry

- What is it? What is the difference between a GP and a specialized dentist? Whatradiographic exams are required?

The main dental specialties

- Endodontics, Periodontics, Orthodontics, Pediatric Dentistry, Gnathology, Implantology, Prosthodontics, Oral and Maxillofacial Surgery.

- What is it? Who operates? What radiographic exams are required?


ContentsWhat is dentistry?

Stomatognathic System: anatomy in brief

- Teeth Anatomy

- The Periodontium

- The Maxillary bones

- The Temporomandibular Joints (TMJ)

General Dentistry




- What are they? Who operates? What radiographic exams are required?


What is Dentistry?Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention and treatment of diseases, disorders and conditions of the oral cavity, the maxillofacial area and the adjacent and associated structures (maxillar bones, temporomandibular joints, salivary glands, neuromuscular tissues and oral mucosa) and their impact on the human body.

All these components constitute the stomatognathic system (from the greekstoma, stomatos = “mouth” and gnatos = “maxilla”).


STOMATOGNATHIC SYSTEMAnatomy in brief

This complex system consists of:- The teeth, essential for chewing;- The parodontium, that contains the teeth;- The maxillary bones, that holds the teeth and the related structures.

Moreover we can find:- The temporomandibular joint, that allows the jaws to move and to open and

close the mouth;- The chewing muscles, that permit the mastication;- The salivary glands, that produce saliva and, finally, the oral mucosa and

the gum.


Teeth AnatomyThree anatomical parts of teeth may be

distinguished:

The crown is the exposed part of the tooth.

The roots represent the part embedded in jaws: theyare responsible for the position of the teeth and contain nerve endings and blood vessels.The shape and the number of the roots differaccording to the tooth examined.

The neck, or cementoenamel junction (CEJ), represents the area where the enamel, whichcovers the anatomical crown of a tooth, and the cementum, which covers the anatomical root of a tooth, meet.

Image source: Sam Fentress


Dental Numerating Systems

FDI Universal


There are specific names to refer to the various sides and surfaces of the teeth: the OCCLUSAL is the surface that is used for biting and chewing; the VESTIBULAR (or facial or labial) that is the closest to the cheek; the LINGUAL, that is next to the tongue. The mesial and distal surfaces are the sides thatcome into contact with adjacent teeth. They are also called PROXIMAL surfaces. The mesial side faces the front of the mouth. The distal side faces the back of the mouth.


The PeriodontiumThe periodontium consists of the bone, the connective

tissue and the gum surrounding and supporting a tooth.

It is composed by:

- the alveolar bone (B);

- the periodontal ligament (H,I,J,K);

- the gum or gingiva (D) ;

- the cementum, the surface layer of the tooth root (B).

Image source: DRosenbach


Maxillary bonesEvery structure in the oral cavity (gum, teeth and muscles) is supported by two bones:

• Upper jaw: the maxillar bone or maxilla;• Lower jaw: the mandibular bone or mandible.


Temporomandibular Joints (TMJ)The temporomandibular joints connect the upper jaws to the mandible.

The part of the mandible which mates to the under-surface of the disc is the condyle and the part of the temporal bone which mates to the upper surface of the disk is the glenoid (or mandibular) fossa.

The dysfunctions of these joints can provoke serious problems:

- restricted mandibular movement, which can cause difficulty eating or speaking;

- noises during jaw movement;

- headache / earache.


ContentsWhat is Dentistry?

The Stomatognathic System: anatomy in brief

- Teeth Anatomy

- The Periodontium

- The Maxillar bones

- The temporomandibular joints (TMJ)

General Dentistry




- What are they? Who operates? What radiographic exams are required?


GENERAL DENTISTRY

WHAT IS IT?

General Dentistry involves all first aid interventions on the stomatognathic system and includes the study, the diagnostics, the prevention and the treatment of diseases, disturbsand pathological conditions of the oral cavity, the maxillofacial area and the adiacentstructures and their impact on the organism.

WHAT IS THE DIFFERENCE BETWEEN A GP AND A SPECIALIZED DENTIST?

There is a significant difference between the General Practitioner and the Specialized Dentist(Implantologist, Orthodontist, etc.). GP, indeed, are the primary dental care providers forpatients of all ages. They are dental professionals who take responsibility for the diagnosis, treatment and overall coordination of services to meet oral health needs.


WHAT RADIOGRAPHIC EXAMS ARE REQUIRED?The GP frequently uses the orthopantomography (panoramic) and the intraoralexams, that allow a precise study of a single tooth or a group of teeth. It requires the use of films or digital detectors which are positioned and hold in the mouth through specific centrators.


It may be distinguished:

Generic Intraorals: allow to visualize the anatomy of a specific element (crown, roots, gum) when a pathology issuspected. A special centrator helps holding the film (bothin a hygienic disposable protection) and positioning itcorrectly, in order to get a precise X-rays proyection.

Bite-wing: during the exam a special “wing”- centrator is holdbetween the teeth. This particular radiographic proyection allowsa precise examination of the interproximal areas, the crown of a tooth and the periodontal bone, to promptly identify pathologiesof these structures.


Periapicals: thanks to a specific film of smalldimensions, it is possible to display the teeth examined in their entirety (crowns, the roots till the peeks, surroundingtissues). Periapical exams allow to identify abscesses, cysts, cracked teeth, pyorrea, cavities, included teeth.

Posteriors: very similar to periapical proyections, these exams allow to see molar area; they are taken withmouth closed.


Occlusals: during these exams the film is hold still between the two archs, over the examined area, in parallel tothe occlusal plane. It is possible toobtain a proyection of almost the whole upper and lower archs.

Full-mouth: it allows to display the entireset of teeth and the surrounding alveolar bone. It is composed of 18 proyections:

4 bite-wing

8 posterior periapicals

6 anterior periapicals


Main Dental Specialties

1) Endodontics

2) Periodontics

3) Orthodontics

4) Pediatric Dentistry or Paedodontics

5) Gnathology

6) Implantology

7) Prosthodontics

8) Oral and Maxillofacial Surgery


ENDODONTICSWHAT IS IT?

Endodontics (from the Greek endo "inside"; and odons "tooth") is the dental specialty concerned with the study and treatment of the dental pulp (containing nerves, arterioles, venules, lymphatic tissue, and fibrous tissue). Endodontists perform a variety of procedures including endodontic therapy (commonly known as "root canal therapy"), endodontic retreatment, surgery, treating cracked teeth, and treating dental trauma.).

Root canal therapy is one of the most common procedures. If the pulp becomes diseased or injured, endodontic treatment is required to save the tooth. If the tooth is irrimediably compromised the dentist will proceed with the explant and, eventually, implant a new one.


WHO OPERATES ?

The endodontist is a dentist specialized in endodontics; he mostly intervenes on dental pulp or endodontium.

The main interventions are canal therapy for teeth with necrotic pulp, devitalization for compromised teeth with cavity, traumas, pulpotomy, apicoectomy (tooth's root tip is removed and a root end cavity is prepared and filled with a biocompatible material), and endodontic microsurgery.

ENDODONTICS


ENDODONTICSWHAT RADIOGRAPHIC EXAMS ARE REQUIRED?

The X-ray exam is fundamental for the endodontic diagnostics, in order to revealpathological conditions, such as cavities or pyorrea.

In order to identify an endodontic lesion, a radiographic proyection must display both the cortical and the medullary tissues of the maxillary bones. It may be necessary to take an orthopanthomography or, rarely, a local 3D.

The most common are the intraoral exams. In particular:

- Periapicals- Generic Intraoral- Posteriors


PERIODONTICS

WHAT IS IT?Periodontology or Periodontics (from Greek περί peri "around"; and ὀδούς odous "tooth", genitive ὀδόντος odontos) is the specialty of dentistry that studies supporting structures of teeth, diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. Periodontal diseases take on many different forms but are usually a result of a coalescence of bacterial plaque of the gingiva and the teeth. They are usually calledpyorrhea and may be distinguished in:

GENGIVITIS: inflammation of the gum tissue, characterized by swelling, reddening, gums thatare tender and painful to the touch, bleeding gums;

PERIODONTITIS: involves progressive loss of the alveolar bone around the teeth, and if leftuntreated, can lead to the loosening and subsequent loss of teeth.


PERIODONTICS

WHO OPERATES?A periodontologist or periodontist is a

dentist who is specialised in the prevention, diagnosis and treatment of gum diseases. Besides university education, the periodontologist hasundergone extensive professionaltraining. A periodontologist can bealso expert with implantation, plastic and reconstructive surgery, torestore the aesthetic of the smile.

WHAT RADIOGRAPHIC EXAMS ARE REQUIRED?

Periodontal diseases are usuallydiagnosed through a set of bite-wingand periapical proyections, rarely withpanoramics or 3D.


ORTHODONTICSWHAT IS IT?

Orthodontics is the branch of dentistry that corrects teeth and jaws that are positioned improperly. Its aim is to diagnose, prevent and treat irregularities of the teeth and face, in order to:

- Get a good teeth alignment;

- Obtain an efficient chewing function;

- Achieve a good aesthetic of the smile;

- Reach and/or improve the health of the teeth and periodontium;

- Keep the results over time.

WHO OPERATES?

The orthodontist is a dentist who has specialized in orthodontic branch after a Master Degree and many refresher courses. His/Her patients are primarly children or teenagerswho need an orthodontic correction treatment. Recently, the orthodontic care has becomemore common among adults, in order to reduce the smile flaws (Invisalign™).



- Orthopanthomography (panoramic);

- Latero-lateral teleradiography of the skull;

- Radiographic exam of the carpus (carpal index of growth);

- Posteroanterior radiographic exam to reveal asimmetries.


ORTHODONTICSFundamental is the Cephalometric readingin relation to landmarks, that can beexecuted manually or with dedicatedprograms, over the latero-lateralteleradiography and posteroanteriorradiography (when it's necessary).

Image source: Oris Ceph


CEPHALOMETRIC LANDMARKS- A: deepest point on the anterior contour of the maxillary

alveolar arch.

- a: deepest point on the soft tissue contour of the upper jaw.

- ad1: intersection of the line PM-BA and the posteriornasopharyngeal wall.

- ad2: intersection of the line PM-so and the posteriornasopharyngeal wall.

- ANS: tip of anterior nasal spine.

- AR: intersection between the external contour of the cranial base and the dorsal contour of the mandible.

- B: deepest point on the anterior contour of the mandibularalveolar arch.

- b: deepest point of the soft tissue contour of the lower jaw.

- BA (Basion): most inferior point of the clivus of the occipital bone.

- CD (Condylium): most posterior and superior point on the condylar head.


- GN (Gnation): lowest point of chin.- GO (Gonion): intersection between the external contour

of the mandible and the bisector of the angle between the ramus line and mandibular line.

- ME (Menton): most inferior point on mandibularsymphysis.

- N (Nasion): most anterior point on the nasofrontal suture. - n: most concave point in the tissue overlying the area of

the frontonasal suture.- pas (posterior airway space at gonion level): sagittal

depth of pharynx on the line through points B and GO.- PM (Pterygomaxillare): intersection between nasal floor

and the posterior contour of maxilla.- POG (Pogonion): most prominent point of the bony chin. - pog: most anterior point of soft tissue chin. - S: centre of sella turcica. - so: midpoint of the distance from points S to BA.

- u: most inferior tip of soft palate. - ML (mandibular line): tangent to the lower border of

mandible through ME.- NSL (Nasion-Sella line): line through points N and S.


PEDIATRIC DENTISTRY OR PAEDODONTICS

WHAT IS IT?

Paedodontics is the branch of dentistry that includes the following: training the child toaccept dentistry; restoring and maintaining the primary, mixed, and permanent dentitions; applying preventive measures for dental caries and periodontal disease; and preventing, intercepting, and correcting various problems of occlusion.

WHO OPERATES?

Pediatric dentists promote the dental health of children as well as serve as educational resources for parents.It is important to establish a comprehensive and accessible ongoing relationship between the dentist and patient, because early detection is essential to maintain oral health, modifyaberrant habits, and treat as needed and as simply as possible. Additionally, parents are given a program of preventative home care (brushing/flossing/fluorides), a caries riskassessment, information on finger, thumb, and pacifier habits, advice on preventing injuriesto the mouth and teeth of children, diet counseling, and information on growth and development.


PEDIATRIC DENTISTRY OR PAEDODONTICS


Beyond an accurate medical history, it may be useful:

- Intraoral exams;- Orthopanthomography;- Teleradiography; - exam of the Carpus.


WHAT IS IT?Gnathology is a field of dental study that deals with the entire chewing apparatus, including itsanatomic, histologic, morphologic, physiologic, and pathologic characteristics.

WHO OPERATES?First of all, the Gnathologist takes a dental examination, the occlusion of the upper and lowerjaws, that is the fitting of the upper and lower teeth against each other in order to determine howthe joints and muscles of the jaws are functioning. A dysfunctional occlusion, in fact, can cause serious health problems, such as insomnia, facial pain, TMJ disorders and headaches.

WHAT RADIOGRAPHIC EXAMS ARE REQUIRED?- Ortopanthomography- Extraoral TMJ- Teleradiography- Digital Tomography (Cone Beam), which can also display 3D recreation of the examinedareas.

GNATHOLOGY


IMPLANTOLOGYWHAT IS IT?

Dental implantology is a set of surgical techniques aiming at the functional rehabilitationof a patient affected by total or partial edentulism, by using dental implants, i.e. metal elements surgically inserted in the mandibular or maxillary bone, or above them butunder the gum. These elements are fitted with connectors to fasten them to fixed or removable prostheses, to enable chewing functionality.

Dental implantology is subdivided in endosteal and justaosteal. This latter one utilizesonly grid-shaped implants with an exposed fixed head. Depending on how they are loaded, they may be made of chrome-cobalt-molybdenum if they are not destined forosteointegration, or they may be made of titanium and inserted with appropriate surgicaltechniques to favor the formation of bone above their structure.

WHO OPERATES?

Pre-prosthetic and pre-implantar surgery, which is the preparation of the alveolar bonefor dental implant and prosthesis placement, are performed by the dentist or, in some cases, by a maxillo-facial surgeon. Since these surgeries are specialized, it is a goodpractice to verify that the specialist chosen to perform them is properly qualified.



- Intraoral exams- Orthopantomograpghy

- Implant (2D)- Tomography(3D)

Image source: OnDemand3D by CybermedImage source: OnDemand3D by Cybermed

Image source: OnDemand3D byCybermed


PROSTHODONTICSWHAT IS IT?

Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oraland maxillofacial tissues using biocompatible substitutes.

WHO OPERATES?

A prosthodontist is a dental specialist who is skilled in the replacement of missing teethand the restoration of natural teeth. This type of dental specialist is trained to deal with complicated and simple restorations of the whole mouth as well as treating facialdeformities. Common procedures treated by a prosthodontist may include dentures, partial dentures, fixed bridges, crowns, implants, veneers and more.


In order to get a clear image of the tooth affected with cavity, the prosthodontistfrequently uses intraoral radiography: single, bite-wing or posterior.


ORAL AND MAXILLOFACIAL SURGERYWHAT IS IT?

Oral and maxillofacial surgery is surgical intervention to treat many diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region. Treatments include:

- Dentoalveolar surgery;

- Surgery to insert osseointegrated (bone fused) dental implants and Maxillofacial implantsfor attaching craniofacial prostheses and bone anchored hearing aids;

- Cosmetic surgery of the head and neck;

- Surgical treatment and/or splinting of sleep apnea, maxillomandibular advancement, mentoplasty.

WHO OPERATES?

The oral and maxillofacial surgeon is the orthopedic surgeon of the facial region. He or she isan individual who addresses problems ranging from the removal of impacted teeth to the repair of facial trauma.



Rarely:- Intraoral

Frequently:- Orthopantomography- Tomography (3D)

ORAL AND MAXILLOFACIAL SURGERY

Case of mandibular cyst.


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basics of dentistry

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