SOCM Dental Anatomy and Oral Examination PFN: SOMDSL03slides.jsomtc.org/SOMDSL03/SOMDSL03.pdf · Dental Anatomy and Oral Examination PFN: SOMDSL03 ... Dental Anatomy, Physiology,

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Slide 1JSOMTC, SWMG(A)

SOCMDental Anatomy and Oral

ExaminationPFN: SOMDSL03

Hours: 1.0


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


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.


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


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


Dental Anatomy and Terminology


Four Tissues of Teeth

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Enamel

Hardest tissue in the body

Does not grow back

Has no sensation


Dentin

The bulk of the tooth

Very Sensitive

Thousands of tiny tubules per millimeter


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


Tissues of the Periodontium

Gingiva

Periodontal ligament

Alveolar Bone


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


Periodontal Ligament (PDL)

Connects the tooth to the bone

Fibers attach to cementum

Trauma can sever ligament

Must keep alive for avulsed tooth


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


Alveolar Resorption

Bone reorbs when teeth are removed

Results in a collapse of the midface giving an aged, dished‐in appearance

Educate your patients


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


Anterior Teeth

The front six, or the ‘Smiling Six’

Central and Lateral Incisors , Cuspids

Upper (Maxillary) and lower (Mandibular)


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


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


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


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”


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


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.


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.


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


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


Upper First Premolars

Two spindly roots

Number 5 and 12

On practicum

Extraction requires good technique


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


Third Molars continued…

Must be sectioned Leaves boney defects


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


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?


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


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


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


Anterior Crowns

Mostly Porcelain or some type of substrate

Esthetic

Less Durable


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


What is a Denture?

Prosthetic replacement of teeth

Removable

Can replace some teeth or can replace the entire arch

Poor function

Bone Atrophy continues


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


Normal and Abnormal Dental Related Anatomy


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


Normal Variant: Exostosis

Buccal boney protuberances

Again not Neoplastic

Developmental

Can complicate extraction, think broken roots


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


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


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


Normal Variant :Ankyloglossia

“Tongue tied”

Developmental

Limited tongue movement

Not simple treatment

Send it up to a higher echelon of care


Normal Variant: Fissured Tongue

Furrows in tongue

Asymptomatic

1% of population

No treatment

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The Process of Oral Evaluation


Oral Evaluation

Start from the outside proceeding to the inside

Look for Asymmetry

Look for signs, Rubor, Calor, Dolor


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


Examine the soft tissues

Look at the buccal tissue Check tongue , Floor of mouth


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


#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


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


Probe for Decay continued…

Explore the margins of restorations

Check interproximal areas

Check the contact areas

Check crowded teeth


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


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


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


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


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


Agenda

Identify dental anatomy and terminology

Identify dentition

Identify dental restorations

Define normal and abnormal anatomy

Describe the process of oral evaluations


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

Documents

SOCM Dental Anatomy and Oral Examination PFN: SOMDSL03slides.jsomtc.org/SOMDSL03/SOMDSL03.pdf · Dental Anatomy and Oral Examination PFN: SOMDSL03 ... Dental Anatomy, Physiology,