socm dental anatomy and oral examination pfn: somdsl03 · 2016. 8. 6. · contemporary oral and...
TRANSCRIPT
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SOCMDental Anatomy and Oral
ExaminationPFN: SOMDSL03
Hours: 1.0
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Terminal Learning Objective
Action: Identify and describe the anatomy of the human teeth with the proper terminology
Condition: Given a lecture in a classroom environment
Standard: Received a minimum score of 75% on the written exam IAW course standards
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References Anatomy of Orofacial Structures, Brand, Richard W., Issehard, Donald, Elsevier Health Div, 7th ed, 2003
The CIBA Collection of Medical Illustration, Frank H. Netter, MD (1906‐1991)
Introduction to Dental Local Anaesthesia(sic), Evers, Hans; Haegerstam, Glenn; Mediglobe SA, 1990
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References Dental Anatomy, Physiology, and Occlusion, Wheeler, Russell C., 5th ed., Saunders 1974
Contemporary Oral and Maxillofacial Surgery, Peterson, et al, 2d ed, Mosby 1993 (2d ed has best art)
Atlas of Oral Pathology, Smith, Roy M. et al, Mosby 1981
Color Atlas of Oral Pathology, Robinson, Hamilton B.G. et al, Lippincott 4th ed 1983
Medical Subjects ‐ Dental, JSOMTC, as issued.
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Reason
As a SOF Medic you will diagnose and treat dental conditions
You must understand anatomy, terminology, and be able to communicate with other providers
You must distinguish normal from abnormal anatomy
You will evaluate team members prior to deployment and evaluate sick call and indigenous forces on deployment
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Agenda
Identify dental anatomy and terminology
Identify dentition
Identify dental restorations
Define normal and abnormal anatomy
Describe the process of oral evaluations
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Spectacular medical providers are preceded by a great deal of
preparation Dental disease is a significant health problem world wide
You will treat dental emergencies and extract hopeless teeth
You must have a working knowledge of dental anatomy to perform these tasks
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Dental Anatomy and Terminology
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Four Tissues of Teeth
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Enamel
Hardest tissue in the body
Does not grow back
Has no sensation
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Dentin
The bulk of the tooth
Very Sensitive
Thousands of tiny tubules per millimeter
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Cementum
Thin layer on root surface
Allows attachment of the root to bone
Very sensitive
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Pulp
Contains, Nerves, Blood vessels, and Lymphatics.
Swelling in closed space can cause ischemia
Source of odontogenic infections
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Tissues of the Periodontium
Gingiva
Periodontal ligament
Alveolar Bone
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Normal Gingiva
Firm
Stippled‐like the surface of an orange
Non movable firmly attached to bone
Pink , but can be pigmented in certain individuals
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Healthy Gingiva
Mostly connective tissue
Does not bleed when brushed or flossed or properly probed
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Periodontal Ligament (PDL)
Connects the tooth to the bone
Fibers attach to cementum
Trauma can sever ligament
Must keep alive for avulsed tooth
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Alveolar Process (Alveolus)
Portion of the bone which surrounds the roots of the teeth
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Alveolar Bone
Surrounds and supports the teeth
Can fracture it traumatic force is sufficent
Resorbs if tooth is removed
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Alveolar Resorption
Bone reorbs when teeth are removed
Results in a collapse of the midface giving an aged, dished‐in appearance
Educate your patients
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Tooth Removal is Forever
Bone begins to resorb after teeth are removed
Preserve the teeth that can be saved.
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Arch Resorption
Once teeth are removed atrophy begins
Continues throughout life
Atrophic ridges make prosthetic restoration difficult
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Anterior Teeth
The front six, or the ‘Smiling Six’
Central and Lateral Incisors , Cuspids
Upper (Maxillary) and lower (Mandibular)
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Posterior Teeth
Posterior of the mouth
Two Bicuspids and three molars per quadrant
5 in each quadrant equal 20 posterior teeth in adult
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Cusp
Elevation of the Enamel, the ‘pointy part’ on the tooth
Cusps mesh like finely tuned gears when chewing
May be several on one tooth
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Root Apex
Tip or end of the root
Pathology sometimes shows here
Entry/Exit for nerves blood vessels
Apical region= area proximate to root apex
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Dentition
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Universal Numbering System
Adult Teeth‐ used by military and civilian.
Common nomenclature in US
#1 (upper) Right, though #32 (lower) right
Numbers do not change if tooth is missing
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Just so you know…
There are other systems for naming teeth.
FDI used outside US. Each quad given a number 1‐4. Upper rt.Upper lft. Lower lft,
Lower rt.
Tooth #1 is 18 called “one eight”
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Tooth Surfaces
Orientation is based on the mid‐line
Mesial surface closest to midline
Distal surface distant from midline
Facial‐ surface toward the face
Lingual toward the tongue
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Just so you know…
There are synonyms for the surfaces.
Facial=Buccal in posterior teeth
Facial=Labial in anterior teeth
Lingual=Palatal in upper teeth
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The business end…
The biting and chewing surfaces also have designations.
Incisal‐the cutting or tearing edge of the anterior teeth
Occlusal‐the chewing or grinding surface of the posterior teeth.
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The Primary Dentition
Commonly referred to as “Baby Teeth”
Also known as Deciduous teeth because they fall out
They hold space for Adult teeth
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Primary Teeth
Named for letters of the alphabet.
Start at Upper right first tooth is “a”
Finish on Lower right the last tooth is “t”
There are other systems but most often used is lettered.
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Mixed Dentition
This is a transitional state in which the adult teeth are erupting and primary teeth are exfoliating
Teeth Erupt in a pattern, Maxillary from the facial, Mandibular from the lingual
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Dentition
Teeth are oriented according to the forces placed upon them in function
Anterior teeth are inclined facially
Posterior teeth are inclined lingually
Opposite direction of the roots
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Dentition
Root proximity‐ teeth can be located quite close together
This can account for symptoms from one seeming to arise from an adjacent tooth
Must protect neighbor during surgical procedures
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Upper First Premolars
Two spindly roots
Number 5 and 12
On practicum
Extraction requires good technique
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Third Molars : Nos. 1,16,17,32
Only 2% of the population have sufficiently erupted.
Called “Wisdom Teeth”
Best Removed in Late Teens
Have team remove prior to deployment
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Third Molars continued…
The teeth most often malpositioned, malformed , or missing.
Prone to decay
Associated with hidden pathology
Must push to get removed
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Third Molars continued…
Must be sectioned Leaves boney defects
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Third Molars
Low level, Older Patient Boney Defect
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Third Molar Pathology
Rare but significant
Numb (Paresthesia) of the lower lip may be the first sign
Protect your team by looking for these
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Check on Learning
List the tooth numbers for the third molars using the universal system?
Now ,list the number designations for the cuspid teeth using the universal system?
Which teeth have two spindly roots?
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Answer
Third molars are 1, 16,17,and 32.
Cuspid teeth are 6,11, 22, 27.
The spindly rooted teeth of concern are the maxillary first premolars , #5 and #12.
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Dental Restorations
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What is an Amalgam?
A silver‐ mercury restoration material for posterior teeth
Inexpensive, well adapted, long lasting restoration
Corrodes‐turns dark
Safe for after age 6
Used for over 150yrs
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What is Composite?
A tooth‐colored resin material used for anterior teeth
Less durable when used in posterior due to chewing forces
Subject to decay at margin
Adhesive‐glued to tooth
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What is a Crown?
A restoration which covers the coronal surface of the tooth
Protects a damaged tooth
Requires custom fabrication
Porcelain –Anterior
Gold Posterior
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Anterior Crowns
Mostly Porcelain or some type of substrate
Esthetic
Less Durable
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What is a bridge?
A fixed prosthetic replacement for a missing tooth
Uses the support of adjacent teeth called abutments
Durable, 20‐30 yr
Requires considerable expertise
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What is Endodontics? (Root Canal)
Procedure performed by dentists to save a tooth
Cause: bacterial invasion of pulpal tissue/nerve
Done to relieve pain
Once performed tooth can last for the life of the patient.
Must be restored
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What is a Denture?
Prosthetic replacement of teeth
Removable
Can replace some teeth or can replace the entire arch
Poor function
Bone Atrophy continues
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What is an Implant?
Many designs
Have limitations
Multiple uses‐ single tooth replacement to stabilize dentures
Require time an expertise
Smoking may be contraindicated
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What is Orthodontics?
Orthopedic movement of teeth
You may deploy with braces (AR614‐30)
Require extra Hygiene
Newer style Invisalign a series of clear plastic aligners move teeth without metal
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Normal and Abnormal Dental Related Anatomy
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Normal Variant: Torus (Tori)
Hard solid bone
Not neoplastic does not continue to grow after initiator is stopped
Has more to do with the flexion of bone and it’s growth in response
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Normal Variant:Torus
Can occur on Maxillary midline
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Normal Variant: Exostosis
Buccal boney protuberances
Again not Neoplastic
Developmental
Can complicate extraction, think broken roots
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Normal Variant: Toothbrush Abrasion
Acquired Defect
V shaped at gingival margin
No decay but can be sensitive
Use soft brush in up‐down motion
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Normal Variant: Acquired Defect,Attrition
Loss of tooth structure on the Occlusal or Incisal surface
Affects all ages
Abrasive unprocessed food a factor
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Normal Variant: Abrasion from Prosthesis
Loss of tooth structure from mechanical wear
Porcelain=Sand, loss of polished surface
Opposing dentition gets worn, Prosthetic teeth erupt
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Normal Variant: Geographic Tongue
Diffuse multifocal lesion with a white rim
Asymptomatic on dorsal and lateral surface of the tongue
Loss of Filiform Papilla
Affects 2% of the population
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Normal Variant: Varicosity
Blue area on ventral surface of the tongue
Asymptomatic
Vascular will blanch upon pressure
No treatment
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Normal Variant :Ankyloglossia
“Tongue tied”
Developmental
Limited tongue movement
Not simple treatment
Send it up to a higher echelon of care
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Normal Variant: Fissured Tongue
Furrows in tongue
Asymptomatic
1% of population
No treatment
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The Process of Oral Evaluation
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Oral Evaluation
Start from the outside proceeding to the inside
Look for Asymmetry
Look for signs, Rubor, Calor, Dolor
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Examine, the Neck
Look for surface lesions Feel for lymphadenopathy
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Instruments #23 Explorer
Combination explorer and periodontal probe
Used to amplify your sense of feel, and to measure gingival sulcus depth
When probing use a light touch, probe gingiva don’t create pockets
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Examine the soft tissues
Look at the buccal tissue Check tongue , Floor of mouth
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Intraoral Exam
System‐ Upper Right‐Left Lower –Left to Right
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Intraoral Exam
Document Periodontal probe depths
Normal 3mm or less
Six sites per tooth
Over 3mm =Disease
Larger the number the greater severity of disease
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#4 Periodontal Probe
Probe gently
Six sites per tooth
Three on buccal, mesial , middle ,distal
Three on the lingual mesial, middle, distal
Start at tooth #1 ‐16, then #17‐32
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Probe for decay
Start from the distal “Feel “ for a stick
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Probing Decay
Check the darker areas
Feel for a stick
Don’t jab, or jam the explorer tip
Use it to feel the surface of the tooth
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Probe for Decay continued…
Explore the margins of restorations
Check interproximal areas
Check the contact areas
Check crowded teeth
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Explore for Decay
Check the buccal pits on first molar teeth
Check the occlusal surfaces
Be suspicious of anywhere that is difficult to clean
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Look for Discolorations
Note the darker tooth inconsistent with the other teeth
Possibly a devitalized tooth that requires further examination
Radiograph, percussion test, ice test is indicated
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Percussion Test
Done to evaluate suspicious teeth
Could indicate a fracture or periapical disease
Lightly tap the suspect tooth and several teeth on either side
Strongest response= suspect tooth
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Ice or Pulp Cold test
Apply ice till cold is felt Replace ice with finger , time
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Ice Test
If the cold stimulus does not go away after 10 seconds , you have a hyperemic pulp
Endodontics may be necessary
Test a non‐suspicious, similar tooth to compare the response
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Check on Learning
A periodontal probe is…..?
a. Pushed in with firm pressure.
b. Used to place dry socket dressings.
c. Measures the temperature of the gingiva.
d. Measures the gingival sulcus and to check for bleeding
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Answer
D. Measures the gingival sulcus and checks for bleeding
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Terminal Learning Objective
Action: Identify and describe the anatomy of the human teeth with the proper terminology
Condition: Given a lecture in a classroom environment
Standard: Received a minimum score of 75% on the written exam IAW course standards
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Agenda
Identify dental anatomy and terminology
Identify dentition
Identify dental restorations
Define normal and abnormal anatomy
Describe the process of oral evaluations
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Reason
As a SOF Medic you will diagnose and treat dental conditions.
You must understand anatomy, terminology, and be able to communicate with other providers
You must distinguish normal from abnormal anatomy
You will evaluate team members prior to deployment and evaluate sick call and indigenous forces on deployment
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1 Know your
dental subjects and your dental
vocabulary:
Communicate intelligently with other providers