Homeostasis after tooth eruption. Resistance to carious tooth enamel damage. Impact on the processes of

formation, mineralization and maturation of enamel to prevent tooth decay.

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Introduction

Knowledge of the structures of the mouth, their locations, and nomenclature is important in helping children maintain good oral health.

The ability to recognize normal from abnormal and to communicate that information to families and other health professionals will aid in education and provision of care.

This PowerPoint will review key anatomic structures in the mouth and typical and atypical development of these structures.

Paper permission on file by Diona Reeves

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Learner Objectives

Upon completion of this presentation, participants will be able to:

Recognize and properly label oral anatomic sites. Describe the location of a tooth lesion using the correct tooth

name, letter or number designation, and surface label. Recall the layers of a tooth and their basic functions.

Paper permission on file by Diona Reeves

http://www.aap.org/oralhealth/pact

Lips

The lips form the entryway of the mouth.

The following structures underlie the epithelium of the skin of the lips:

Vasculature Sweat glands Hair follicles Muscles that function to move the lips

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Lips, continued

The mucous membrane of the lips is non-keratinized with many capillary

vessels close to the surface, giving it the pinkish/red color.

Examination of the lips is valuable in recognizing signs of illness, such as cyanosis, herpetic lesions, or trauma.

Permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital

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Cheeks

The cheeks form the sides of the mouth.

Like the lips, the cheeks are muscles covered with skin on the outside and

mucous membranes on the inside.

Examination of the oral mucosa is especially important in adolescents who

chew tobacco to screen for oral cancer.

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Cheeks, continued

Along with trauma, you may also note the following:

Aphthous ulcers Mucoceles

Permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital

Permission from Martha Ann Keels, DDS, PhD; Division Head of Duke Pediatric Dentistry, Duke Children's Hospital

http://www.aap.org/oralhealth/pact

Gums

The gingiva (gums) is the mucosal membrane that covers the periodontal

ligaments, the alveolar sockets, bones of the jaw, and borders the teeth at

their neck.

The periodontal ligament is made up of bundles of connective tissue fibers

that anchor the teeth within the jaws.

As the teeth erupt, ridges of bone called alveolar processes develop around

the teeth to provide support.

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Gums, continued

Examination of the gingiva can help reveal gingivitis.

If untreated, gingivitis can progress to bone involvement, or periodontitis.

Severe periodontitis can lead to tooth loss.

Permission from Noel Childers, DDS, MS, PhD; Department of Pediatric Dentistry, University of Alabama at Birmingham

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Palate

The palate is the area in the roof of the mouth that starts behind the upper teeth and extends to the uvula.

A normal hard palate consists of the fusion of bones in the upper jaw and the palatine bones.

The soft palate is mostly muscle and has an important role in swallowing and speech.

Examination of the hard and soft palate may uncover thrush.

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Tongue

The tongue is composed entirely ofmuscle and connective tissue and hasventral and dorsal surfaces.

The ventral surface (underside) issmooth. The dorsal surface (top) is most visible on examination.

The dorsal surface includes the fungiform, foliate, and circumvallatepapillae, which are associated with the sense of taste.

Used with permission from shutterstock.com

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Floor of the Mouth

Beneath the tongue is the floor of the mouth.

The frenulum connects the floor of the mouth to the tongue.

In some infants, the frenulum is thick and severely limits the movement of the tongue. This disorder is called ankyloglossia.

In cases where breastfeeding is inhibited, a frenectomy may be done to release the tongue.

Permission from Rocio B. Quinonez, DMD, MS, MPH; Clinical Assistant Professor Department of Pediatric Dentistry, School of Dentistry University of North Carolina

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Salivary Glands

Near the frenulum are the tiny openings of the submandibular salivary glands. These openings are called Wharton’s ducts.

There are 2 large salivary glands, known as the Parotid glands. These glands empty through tiny holes called Stenson’s ducts. Failure of the Parotid glands to produce saliva leads to xerostomia, an abnormal dryness of the mouth.

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Teeth

There are 4 kinds of teeth:  

1. Incisors 2. Canines 3. Premolars 4. Molars

Used with permission from the American Dental Association

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Teeth, continued

The 4 front teeth are the central and lateral incisors. Next to the incisors are the cuspids.

Next to the cuspids are the 8 premolars, or bicuspids.

The final 12 teeth are the molars.

The molars have pits and fissures that can harbor cariogenic bacteria and are commonly the site of dental caries.

Used with permission from the American Dental Association

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Sides of the Tooth

These terms describe the sides of the tooth:

Buccal/labial/facial – Side that faces outward, toward the cheeks or lips Lingual/palatal – Inside surface facing the tongue or the palate Mesial - Sides of the teeth that face the front of the mouth Distal - Surfaces of the teeth that face the back of the mouth Occlusal - Surface of the back teeth where biting and chewing takes place  Incisal - Biting surface of the front teeth

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Anatomy of a Tooth

The tooth consists of a crown and a root.

The crown is visible above the gums.

The root is covered with cementum, which anchors it to the periodontal membrane.

Used with permission from Miller Medical Illustration & Design

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Anatomy of a Tooth, continued

The hard, outer surface of the crown is the enamel.

The enamel is mostly composed of hydroxyapatite.

Binding of fluoride to the hydroxyapatite leads to the formation of fluoroapatite, which makes the enamel harder and more resistant to decay.

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Anatomy of a Tooth, continued

The enamel protects the dentin, a hard, thick substance containing thousands of tubules that surround the nerve.

These tubules contain tiny projections of the nerve and are sensitive to exposure to air, acid, and touch.

The pulp is the soft core of the tooth that contains blood vessels, connective tissue, and the nerve itself.

Used with permission from the American Dental Association

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Question #1

Which of the following can lead to xerostomia?

A. Antihistamines.

B. Medical conditions such as lupus or sarcoidosis.

C. Crystal Meth.

D. All of the above.

E. None of the above.

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Answer

Which of the following can lead to xerostomia?

A. Antihistamines.

B. Medical conditions such as lupus or sarcoidosis.

C. Crystal Meth.

D. All of the above.

E. None of the above.

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Question #2

Which teeth are the most common site for caries?

A. Pre-molars.

B. Incisors.

C. Molars.

D. Canines.

E. None of the above.

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Answer

Which teeth are the most common site for caries?

A. Pre-molars.

B. Incisors.

C. Molars.

D. Canines.

E. None of the above.

http://www.aap.org/oralhealth/pact

Question #3

The hard, thick substance of the tooth that surrounds the nerve is known as the:

A. Enamel.

B. Dentin.

C. Hydroxyapatite.

D. Cementum.

E. Pulp.

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Answer

The hard, thick substance of the tooth that surrounds the nerve is known as the:

A. Enamel.

B. Dentin.

C. Hydroxyapatite.

D. Cementum.

E. Pulp.

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Question #4

Which term describes the sides of the teeth that face the front of the mouth?

A. Mesial.

B. Distal.

C. Buccal.

D. Occlusal.

E. Incisal.

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Answer

Which term describes the sides of the teeth that face the front of the mouth?

A. Mesial.

B. Distal.

C. Buccal.

D. Occlusal.

E. Incisal.

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Question #5

How many types of teeth are there?

A. 2.

B. 3.

C. 4.

D. 5.

E. 6.

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Answer

How many types of teeth are there?

A. 2.

B. 3.

C. 4.

D. 5.

E. 6.

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References

1. Anatomy of orofacial structures. 7th edition. RW Brand and DE Isselhard eds. St Louis. Mosby. 2003.

2. Netter's head and neck anatomy for dentistry. NS Norton. Philadelphia. Saunders Elsevier. 2007.

3. Wheeler's dental anatomy, physiology and occlusion, 8th Edition. MM Ash and SJ Nelson eds. Philadelphia. Saunders. 2003.