Mouth (oral cavity) and...
Transcript of Mouth (oral cavity) and...
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1. Oral cavity: vestibule oral cavity proper
2. Floor of the oral cavity3. The human dentition –
permanent and deciduous teeth4. Tooth development (odontogenesis)5. Eruption of the deciduous and permanent teeth6. Abnormalities of teeth
Mouth (oral cavity) and Teeth
Statue at Buddha Park, near Vientiane, Laos
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Oral cavity, cavitas oris
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Cavitas (cavum) orisGr. stoma, stomatos: located in the face
oral fissure, rima oris
throat (fauces), isthmus faucium
Parts: oral vestibule, vestibulum oris
parotid papilla, papilla ductus parotidei
oral cavity proper, cavitas oris propria
boundaries:o gums and teeth
o hard palate
o part of the soft palate
o oral floor, diaphragma oris
content:o tongue
o teeth
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 3
Lips, labia oris
Macroscopic anatomy:
oral fissure, rima oris
angle of mouth, angulus oris
commissure of lips, commissura labiorum
Upper lip, labium superius:
medial and two lateral parts
frenulum of upper lip
nasolabial fold, sulcus nasolabialis
philtral ridges, philtrum
tuberculum labii superioris
Lower lip, labium inferius:
frenulum of lower lip
mentolabial fold, sulcus mentolabialis
buccolabial fold, sulcus buccolabialis
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 4
Lips, labia oris Microscopic structure:
external surface, skin multilayered stratified keratinizing squamous epithelium
hair follicles, sebaceous and sweat glands
vermilion border, modified skin transparent epithelium
rich microvasculature – red margin
internal surface, mucous membrane stratified nonkeratinized squamous
seromucous labial glands
internally – orbicularis oris muscle fibroadipose connective tissue, rich in
nerve fibers and blood vessels
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Cheeks, buccae
Macroscopic anatomy:
form the sides of the mouth
similar to lips structure
composed externally of integument
muscular stratum – m. buccinator
buccal fat-pad tissue (of Bichat) –
corpus adiposum buccae (Bichat)
composed internally of mucous membrane
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Cheeks, buccae
6
Histological structure:
external surface – hairy skin:
stratified keratinized squamous
epithelium
hair follicles, sebaceous and sweat glands
the buccinator muscle, m. buccinator
internal surface – buccal mucosa
stratified non-keratinized squamous epithelium
with a high regenerative capacity
buccal and molar glands
buccal fat-pad tissue (of Bichat)
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 7
Oral cavity proper, cavitas oris propria
Palate, palatum:
roof of the oral cavity proper
resonance in phonation
hard palate, palatum durum (osseum)
soft palate, palatum molle
Hard palate, palatum durum – anterior ⅔:
processus palatinus maxillae
lamina horizontalis ossis palatini
plicae palatinae transversae
papilla incisiva; raphe palati
gll. palatinae
stratified non-keratinized squamous
epithelium keratinization
lamina propria – firmly attached
to the periosteum
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 8
Oral cavity proper, cavitas oris propria
Palate, palatum:
roof of the oral cavity proper
resonance in phonation
hard palate, palatum durum (osseum)
soft palate, palatum molle
Hard palate, palatum durum – anterior ⅔:
processus palatinus maxillae
lamina horizontalis ossis palatini
plicae palatinae transversae
papilla incisiva; raphe palati
gll. palatinae
stratified non-keratinized squamous
epithelium keratinization
lamina propria – firmly attached
to the periosteum
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 9
Oral cavity proper, cavitas oris propria
Soft palate, palatum molle – posterior ⅓
velum palatini with uvula
arcus palataglossus and
arcus palatopharyngeus
stratified columnar epithelium nasally
stratified non-keratinized squamous orally
muscles of the soft palate
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 10
Gums, gingivae:
attached gingiva
marginal gingiva
Macroscopic structure:
free gingival margin
gingival sulcus
gingival papilla (interdental papilla)
vestibular
oral
Microscopic structure:
lamina epithelialis
stratified squamous parakeratinized
epithelium
lamina propria – papillae
rich vascularization
dense innervation
Oral cavity proper, cavitas oris propria
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 11
Floor of the oral cavity
Oral floor:
a muscular layer between the tongue and the mandible
Muscular base: mylohyoid, m. mylohyoideus
geniohyoid, m. geniohyoideus
Mucosa:
thin and loosely attached to the underlying structures
mucosal folds
lingual frenulum
sublingual folds
sublingual papilla (caruncle)
Blood supply and venous drainage: aa. et vv. sublingualis, facialis et thyroidea sup.
Lymphatic drainage: nodi lymphatici submandibulares et cervicales profundi
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 12
Floor of the oral cavity
Oral floor:
a muscular layer betweenthe tongue and the mandible
Muscular base: mylohyoid, m. mylohyoideus
geniohyoid, m. geniohyoideus
Mucosa:
thin and loosely attached to the underlying structures
mucosal folds
lingual frenulum
sublingual folds
sublingual papilla (caruncle)
Blood supply and venous drainage: aa. et vv. sublingualis, facialis et thyroidea sup.
Lymphatic drainage: nodi lymphatici submandibulares et cervicales profundi
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 13
Oral cavity – first pharyngeal arch
maxillary process
mandibular process
frontonasal prominence
middle part of nasal prominence
lateral parts
Nose:
frontonasal prominencenasal root
two medial nasal prominences nasal dorsum and apex
two lateral nasal prominences nasal sidewalls and alae
nasal (olfactory) placode nostrils
Eye – eye rudiments:
lateral nasal prominences
maxillary processes
Embryonic development
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 14
Facial abnormalities Facial clefts:
cleft lip, labium leporinum (harelip)
cleft palate, palatum fissum(palatoschisis s. faux lupina)
congenital macrostoma
congenital microstoma
congenital cleft in the face, meloschisis
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Teeth, dentes
15
Teeth, dentes (Gr. odus, odontos):
mechanical breakdown (chew) of food
help in phonation
derivatives of oral mucosa – cornified papillae
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Phylogenetic development of teeth
16
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Teeth, dentes
17
Characteristics of human dentition:
close contact between teeth
heterodont dentition (Gr. “different teeth”) – teeth differ both morphologically
and functionally
teeth have the same general structure, regardless of their functional segregation
diphyodont dentition – two successions of teeth (two types of dentition)
in a process of evolution – reduction in tooth number
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Dental morphology
18
Anatomical parts of a human tooth: tooth crown, corona dentis – surfaces
margo incisialis (incisivus) – incisors
facies occlusalis (masticatoria) –premolars and molars
o tuberculum dentale (cuspis dentalis)
facies vestibularis (labialis, buccalis)
facies lingualis
facies contactus (mesialis et distalis)
anatomical vs. clinical crown
tooth neck, cervix dentis tooth root, radix dentis – in dental alveolus
apex radicis dentis
dental cavity –cavitas dentis (pulparis) cavitas coronae
canalis radicis dentis
tooth pulp, pulpa dentis pulpa coronalis
pulpa radicularis
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Basic tooth structure
19
Tissue components of the tooth crown: dental cuticle, cuticula dentis – 5-30 µm
ectodermal origin
an amorphous layer thatcovers the tooth crown
non-mineralized layer of organic material
o proteins, glycosaminoglycans
enamel, enamelum(substantia adamantina) ectodermal origin
the hardest substance in the body –thickness 0.01 (tooth neck)-2.5 mm
acellular and nonreplaceable
highly mineralized substance – 96-97%
o hydroxyapatite crystals
o closely packed enamel prisms, prisma
enameli and interprismatic substance
organic matrix – 2-3%
o fibrous keratin-like glycoproteins
produced by secretory ameloblasts enamel defects – dental caries
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Basic tooth structure
20
Tissue components of the tooth root: dental cement, cementum – mesenchyme
hard, avascular material covering the tooth root
bone-like tissue:
o mineral intercellular substance,
substantia intercellularis cementi
• calcium hydroxylapatite – 45-50%
• organic matter and water – 50-55%
• numerous fibrils of type I collagen
• glycoproteins and proteoglycans
o cells, cementocyti
• located in lacunae
• joined together by canaliculi
o the cement is destroyed by odontoclasts
in the tooth neck – acellular cement
o location of tooth decay
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Basic tooth structure
21
Tissue components of the tooth:
dentin, dentinum (substantia eburnea)
located in the tooth crown, neck and root
elastic, yellowish-white, avascular tissue
hard, bone-like tissue:
o inorganic matter – 70%
• calcium hydroxylapatite crystals and
amorphous calcium phosphate
o organic matrix (collagen) – 20%
o water – 10%
o cells, odontoblasts with long
cytoplasmic processes of Tomes
in dentine canals (dentinal tubules)
dentin layers:
o mantle (0.5 mm) – closest to enamel
o predentine – innermost
o secondary dentin
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Basic tooth structure
22
Tissue components of the tooth:
dental pulp, pulpa dentis
inside the dental (pulp) cavity
o crown – pulp chamber
o root – root canal(s)
undifferentiated mesenchyme soft loose connective tissue
microscopic structure:
o cells – odontoblasts and dentinoblasts
• numerous fibroblasts
• undifferentiated mesenchymal cells
• macrophages, monocytes and lymphocytes
o collagen fibers
o ground substance
o abundant myelinated and unmyelinated fibers
o richly vascularized – nutritive function
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Periodontium
23
Attachment apparatus of a tooth – gomphosis
the tissues investing and supporting the teeth
Periodontium (Gr.περι, around + οδονσ, tooth):
alveola dentalis
periosteum alveolare (insertionis)
lig. periodontale
cementum radicis dentis
periodontium protectoris (gingiva)
Desmodontium (Sharpey fibers) – fibroblasts
Parodontium (in German) – functional unit
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Human dentition
24
Permanent teeth, dentes permanentes:
32 teeth into two symmetrical halves
upper dental arch, arcus dentalis superior
lower dental arch, arcus dentalis inferior
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Human dentition
25
Permanent (adult) teeth,dentes permanentes:
anatomical and functional groups:
incisors, dentes incisivi
canine (dogteeth), dentes canini
premolars, dentes premolares
molars, dentes molares
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
The adult human dentition
26
Coding of the permanent teeth: dental formulae for humans:
anatomical – I2C1P2M3
clinical
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Dental radiology
27
Dental
panoramic radiography
(Orthopantomography)
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Incisors, dentes incisivi
28
The incisor teeth, dentes incisivi: used to incise food
total number – 8 (2 in each
jaw quadrant: 4 upper and 4 lower)
crown, corona dentis – chisel shaped
biting edge, margo incisialis
labial surface (facies labialis)
lingual surface – tuberculum dentale
contact surface (mesial and distal)
root, radix dentis – conical shape
root apex, apex radicis dentis
medial (central) incisors
lateral incisors – smaller in size to absent
diastema
“lucky teeth”
cosmetic dentistry
dental consonants
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Canines, dentes canini
29
The canine (dog)teeth, dentes canini:
used primarily for firmly holding food
the longest teeth in mouth – 25 mm in the root
total number – 4 (two in the upper – eye teeth, and two in the lower arch)
root – single, longer and thicker, conical in form
apex radicis dentis – compressed laterally
crown – large and conical; occlusal surface
labial surface – very convex
lingual surface – mesial and distal lingual fossae
tuberculum dentis
sexual dimorphism
much larger in the males than in the females, or are absent in females
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Premolars, dentes premolares
30
The premolar teeth, dentes premolares:
primary functions of both molars and canines in chewing
total number – 8 (two per quadrant) – first and second premolars
crown – quadrangular with at least two cusps – buccal and palatal
occlusal (masticatory) surface (lingual)
buccal surface – quite rounded
lingual surface – rounded in all aspects
root – single (except the maxillary first premolar)
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Molars, dentes molares
31
The molar teeth, dentes molares:
serve to chew, crush and grind food
the largest of the teeth in mouth
total number – 12 (six upper and six lower)
crown – cube-shaped
occlusal surface
o 4-5 cusps
o tuberculum anomale (cusp of Carabelli)
roots – multiple and separated
upper jaw – 3
(two labial and one palatal)
lower jaw – 2
dens serotinus
(wisdom tooth)
generally appear between
the ages of 17 and 25
may never erupt
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Dental arches
32
Dental arches – upper and lower:
superior dental arch, arcus dentalis superior:
larger and semi-ellipsoid
inferior dental arch, arcus dentalis inferior:
has a parabolic shape
dental occlusion and articulation
Orthognathism (Gr. orthos – straight, gnathos – jaw)
Progenism vs. Prognathism
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Tooth abnormalities of size and form
33
Anodontia:
a complete lack of tooth development
rare, most often occurring in a condition
called Hypohidrotic ectodermal dysplasia
Hypodontia:
a lack of some tooth development
affecting 3.5–8.0% of the population
absence of third molars - 20–23%
second premolar and lateral incisor
Hyperdontia:
development of supernumerary teeth
develop from a second tooth bud
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 34
Congenital syphilis – Hutchinson’s teeth:
smaller and more widely spaced teeth
have notches on their biting surfaces
Rickets (rachitis):
delayed and abnormal sequence eruption
dental deformities
enamel defects
Hypocalcemic tetany:
serious abnormalities of enamel of the
canine and molar teeth – hypoplasia
malformed teeth
Elderly face:
alveolar ridge resorption loss of teeth
jaw atrophy
Abnormalities in tooth shape
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Embryonic development of teeth
35
Odontogenesis – around 6th week
molecular control of tooth development transcription factor Lef-9; FGF-8
signaling molecules BMP-2, -4 and -7
homeobox genes
tooth bud (germ) – origin
ectoderm
lamina dentalis
organum epithelum (dentis)
o enamel – amelogenesis
mesenchyme
gemma dentis (papilla dentis)
o dentin – dentinogenesis
o tooth pulp
cementum – cementogenesis
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Histogenesis of dental tissue
36
Odontogenesis:
amelogenesis
enamel organ – bell stage:
o outer enamel epithelium – cuboidal
o enamel pulp, pulpa enamelea
o inner enamel epithelium –
simple columnar epithelium
proameloblasts ameloblasts
dentinogenesis
preodontoblasts young
odontoblasts predentin
mantle dentin
mineralization (maturation) of
predentin apatite crystals
cementogenesis
mesenchymal cells of dental sac
cementoblasts
tooth root development
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Human dentition
37
Deciduous (milk) teeth, dentes decidui: the first set of teeth in the growth
development of humans 20 teeth into two symmetrical halves distinguishing features (traits):
similar morphology; smaller in size slightly blue tone of enamel shorter roots wider root canals and cavity
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Human dentition
38
Deciduous teeth, dentes decidui:
anatomical and functional groups:
incisors, dentes incisivi – 2
canine teeth, dentes canini – 1
molars, dentes molares – 2
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 39
The human deciduous dentition
Coding of the deciduous teeth: human dental formulae –
an expression in symbols of the number and arrangementof teeth in the jaws:anatomical – I2C1M2
clinical
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Human tooth development timeline
40
Deciduous tooth eruption: begin – 6th mo.
central incisor
end – 2nd-3rd yrs.
second molars
formed temporary dentition until 5-6 years of age
Permanent tooth eruption: begin – 5th-6th yrs.
first (six-year) molar
end – 18-30 yrs.
third molar
(wisdom tooth)
Deviations from the established norms:
precocious dentition, dentitio praecox
delayed dentition, dentitio tarda
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Disturbances in tooth formation
41
Dilaceration:
a disturbance in shape of teeth
due to trauma during the period in which tooth is forming
Enamel hypoplasia:
defective enamel matrix formation with a deficiency in the cementing substance
tooth enamel:
hard but thin
deficient in amount
Turner’s hypoplasia:
a tooth enamel defect
missing or diminished enamel
usually affects only one tooth in the mouth (Turner’s tooth)
associated with the dilaceration
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Blood supply of the teeth
42
Upper tooth row:
molars
rr. dentales of a. alveolaris superior posterior
the remaining teeth
rr. dentales of a. alveolaris superior anterior
Lower tooth row: rr. dentales of a. alveolaris inferior
Venous drainage: plexus venosus pterygoideus vv. maxillares
v. retromandibularis
v. facialis
Lymphatic drainage: teeth in upper jaw submandibular nodes
parotid and supraclavicular nodes
teeth in lower jaw submental and submandibular
nodes cervical and paratracheal nodes
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Innervation of the teeth
43
Teeth and gums in upper jaw:
nerve plexus formed by the
infraorbital nerve:
rr. alveolares superiores anteriores
rr. alveolares superiores posteriores
r. alveolaris superior medius
rr. dentales superiores
rr. gingivales superiores
Teeth and gums in lower jaw:
n. alveolaris inferior
plexus dentalis inferior:
rr. dentales inferiores
rr. gingivales inferiores
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Thank you ...
44