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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
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Oral cavity, cavitas oris
2
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
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
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
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
5
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)
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
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
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
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
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
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
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
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
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
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Phylogenetic development of teeth
16
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
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
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
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
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
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
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
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
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
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
The adult human dentition
26
Coding of the permanent teeth: dental formulae for humans:
anatomical – I2C1P2M3
clinical
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Dental radiology
27
Dental
panoramic radiography
(Orthopantomography)
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Thank you ...
44