Combined Lecture Notes PDF

Preview

Summary

Clinical DentistryNAMESTUDENT NO:DENTAL TERMS & CHARTSThe Adult Mouth MandibleMaxillaPrimary / Deciduous dentitionThe Teeth - Temporary- 20 teeth - 4 Quadrants- 5 Teeth in each - Whiter + Smaller- NO premolarsSecondary dentition (permanent)- 32 Teeth- 4 Quadrants- 8 Teeth in each - In one qu...

Description

Clinical Dentistry

NAME STUDENT NO:

DENTAL TERMS & CHARTS The Adult Mouth

Maxilla Mandible

Secondary dentition (permanent) 32 Teeth 4 Quadrants 8 Teeth in each In one quadrant 1. Central Incisor 2. Lateral Incisor 3. Canine / Cuspid 4. First premolar 5. Second premolar Takes place of 6. First molar primary molars 7. Second molar Develop as jaw grows 8. Third molar 3rd molar → wisdoms

The TTeeth eeth Primary / Deciduous dentition Temporary 20 teeth 4 Quadrants 5 Teeth in each Whiter + Smaller NO premolars

Mixed dentition starts when the first permanent molar appears → lasts until the last primary tooth is lost 5 / 6 years → 10, 11, 12 years Permanent teeth eat away root of primary dentition UGLY DUCKLING STAGE

Tooth Anatomy

Tooth + Surrounding Structures

2 Main Tissues of the tooth Crown Root Crown Covered by enamel (whiter) Inner tissue layer = dentine Root Covered by cementum (yellowish) Inner tissue layer = dentine Central layer of tooth PULP CHAMBER Houses the pulp Pulp = nerves + blood vessels Pulp goes thru root via pulp canal

Dentinoenamel Junction (DEJ) junction where the enamel + dentine meet Cementoenamel Junction (CEJ) junction where the cementum + enamel meet on the gingiva ‘neck’ of tooth Gingiva usually at tooth neck Where is the tooth? The tooth is embedded in alveolar bone Sides that hold the tooth in place is the alveolar process The area between the tooth and bone = lamina dura Lamina dura consists of periodontal fibres Attach tooth to bone

ROOT

-

Space allows movement of the teeth Apex Tip of tooth (nerves + blood vessels leave apex via apical foramen)

MIDLINE

The TTooth ooth Surfaces Anterior tooth surfaces (ATS) Canine to Canine Central Incisor Lateral Incisor Canine

distal

mesial

mesial

distal

INTERPROXIMAL SPACE

Posterior tooth surfaces (PTS) Premolars → molars (2ndary) ONLY molars (primary) Tooth Surface

Definition

LABIAL

The surface of the teeth in contact with the lips.

BUCCAL

The surface of the teeth in contact with the cheeks.

LINGUAL

The surface of the lower teeth in contact with the tongue.

PALATAL

The surface of the upper teeth in contact with the palate.

OCCLUSAL

The biting surface of the posterior teeth.

INCISAL

The biting/cutting surface of the anterior teeth.

PROXIMAL

The surface of the tooth in contact with the adjacent tooth (mesially or distally).

MESIAL: The surface of the tooth nearest to the midline. DISTAL: The surface of the tooth furthest away from the midline.

Eruption Dates

HEALTHY MOUTH

-

Gingiva Healthy Gums

Diseased Gums

Coral pink in colour or pigmented

Changes from coral pink → more reddish colour (increase blood flow)

No swelling

Changes from sharp, tapered form → swollen, rounded form

Firmly attached to crown of tooth

Loses stippling appearance → shiny

Resilient tissue when gentle pressure applied

Bleeds on probing and sometimes spontaneous bleeding

Interdental papillae fits to make a sharp point

Increased fluid causes enlargement of the tissues

Gingival margin meets tooth with tapered knife edged papillae

Stippling Appearance

Gingivitis

-

Non-destructive disease and inflammation of the gums Reversible with good oral hygiene Can progress into periodontitis Inflammation of gums and surrounding structures of the teeth resulting in bone resorption and tissue destruction around the teeth

Periodontitis Definition: Inflammation of gums and surrounding structures of the teeth resulting in bone resorption and tissue destruction around the teeth -

Inflammation, bleeding on probing Spongy marginal gingiva Alveolar bone loss only detectable Aid of radiograph and probing Mobility of teeth Gingival regression

Gingival appearance changes Bulbous Papillae A papilla that is enlarged and bulges out of the interproximal space interdental space Features Enlarged interproximal papillae Papillae appear to be "squeezed out" of the embrasure space Usually a result of severe edema (swelling) May become chronic and firm with long standing inflammation Enlarged gingiva (due to medication) Features An increase in the size of the gingiva (gums) Common feature of gingival disease Causes: Inflammatory conditions side effects of certain medications - The treatment is based on the cause

Buccal Mucosa 1. 2. 3.

Leukoedema Fordyce Granules Linea Alba

1. 2. 3. -

Leukoedema Firmly appearance or diffuse whiteness of buccal mucosa Folded, wrinkled appearance Pigmentation present May be associated with smokers Less white when cheek is stretched Fordyce Granules Flat / elevated yellow grains Located beneath mucosal surfaces Its asymptomatic Derived from sebaceous glands 1-3 mm in dimension Most common on buccal mucosa Linea Alba Appears as white line It starts at oral cavity corners and extends posteriorly at occlusal plane level Bilateral Thickened epithelial changes due to frictional activity of teeth Composed of keratinized oral mucosa

ANATOMY OF PERIODONTIUM Tissues of the periodontium 1. 2. 3. 4.

Gingiva Periodontal Ligament Cementum Alveolar Bone

FUNCTIONS OF THE GINGIVA 1. Attaches the dental hard tissues to the oral mucosa 2. Protects the periodontal tissues from bacterial invasion Part Free (marginal)

Attached

Visible components of the periodontium Lines the oral cavity Covered by epithelium Attached above the CEJ

COLOUR: Coral CONSISTENCY: SIZE: TEXTURE:

pink, may have pigmentation Firm + resilient Firm, tightly adapted Free gingiva → smooth Attached gingiva → stippled SULCUS DEPTH: 3 mm

-

Gingiva is divided into 3 parts 1. Free Gingiva 2. Attached gingiva 3. Interdental papillae Mucogingival junction separates the Alveolar mucosa from Attached gingiva

-

Gingiva -

Description

-

Interdental Papilla

-

Not attached to bone Surrounds the tooth completely Its 0,5 - 2mm from the free gingival margin coronally Forms the soft wall of the sulcus Found apical to the free gingival margin Found coronally to the mucogingival junction Its firm, resilient tissue Its 1 - 9mm in width Width depends from individual to individual, area to area, tooth to tooth Keratinized Its bound to the bone via → mucoperiosteum Covers the embrasures between teeth Commonly stippled It is triangular Btw anterior teeth It is flatter Btw posterior teeth Col area Depression in gingiva Buccal g + lingual g meet

Oral Mucosa Name Masticatory Mucosa

→ All soft tissues in the mouth Description -

Covers hard palate + gingiva Its unmovable Its attached to the underlying bone Keratinized / parakeratinized → mechanical toughness!! It withstands the frictional forces of food

Specialised Mucosa

-

Covers the dorsum of the tongue Contains taste buds / many papillae Accommodate the sensation of taste

Lining Mucosa

-

Covers the rest of the mouth Lips Buccal Mucosa Floor of the mouth Ventral surfaces of tongue Uvula Soft palate Its movable + not attached Non- keratinized Consists of slender C/Tissue + Rich elastic fibre plexus Allows the LM to stretch + recoil, permits wide mouth movements and allows speech + mastication

-

FUNCTIONS OF ORAL MUCOSA 1. It protects against compressive + shearing forces 2. It provides a barrier against microorganisms, toxins + various antigens 3. It has a role in immunological defence 4. It contains minor glands, which provide a. Lubrication b. Buffering c. Secretion of some antibodies 5. It is richly innervated to make the OM sensitive to a. Touch b. Pain c. Taste d. Proprioception (displacement sensitivity)

Epithelium of Oral Cavity Oral epithelium (OE)

Sulcular epithelium

Junctional epithelium (JE)

Outer gingival epithelium

Extensions of OE into sulcus

Where different types of tissue join

Consists of stratified squamous

Keratinized / parakeratinized

→ Flattened → Multiple layers → Protects against

Forms when reduced enamel epithelium + OE → fuse

1 - 3 mm in depth

mechanical + chemical insult Protection Keratinized/ parakeratinized

As tooth moves into occlusion, OE moves apically It normally stabilizes at CEJ Location unpredictable → tooth erupts in stages

Gingival Crevicul Crevicular ar Fluid DEFINITION: GCF goes from the underlying gingival connective tissue, through the cells of the junctional epithelium and into the sulcus

Fibre bundl bundles es Fibre bundles

Location + Function

Dentogingival Fibres

- Goes from cementum → free + attached gingiva

→ Fluid increases during inflammation FUNCTIONS OF GCF It rinses and cleanses the sulcus It promotes attachment It has antibacterial + antibody properties

5 Main Fibre Bundles of Gingiva

- Function: provides support of gingiva Alveologingival fibres

- Goes from periosteum → attached gingiva - Function: attached gingiva to the alveolar bone

Dentoperiosteal fibres

- Goes from cementum → crest of alveolar bone - Function: anchors tooth to alveolar bone

Circular Group fibres

- Circles the tooth coronally to the alveolar bone crest - Function: supports the gingiva

Transseptal Group fibres

- Goes from cementum of 1 tooth → cementum of adjacent tooth - Function: maintains relationship btw adjacent teeth

FUNCTIONS Protects and supports the JE Forms a fibrous cup around tooth Provides tonus of gingiva Protects the periodontal ligament

DADCT

Periodontal Ligament DEFINITION: Formed by fibroblast cells which secures the tooth in the tooth socket by organized fibre bundles

Periodontal Ligament Fibre Bundl Bundles es Fibre bundle type

Description

Alveolar crestal group

- goes from cementum to just opical to the crest of the alveolar bone

Horizontal fibre bundles

- attaches to the most coronal 10-15% of the root surface with alveolar bone

Oblique group fibres

- largest group - covers 80-85% of the cemental surface

Apical fibres

- goes from the apex of the root to the bone - both lateral + apical to the apex

Interradicular fibres

- found in multirooted teeth - spreads epically → bone from functional area

LOCATION: Between bone + cementum SHAPE: Hourglass FEATURES: 1. Rich nerve + blood supply 2. Innervated by superior + inferior alveolar nerve 3. 0,2 mm in width → Varies according to age, tooth location, degree of stress tooth is subjected to 4. 0,4 - 1,5 mm space between root surface + bone FUNCTIONS OF THE PDL 1. The tooth is suspended in the alveolus via the PDL fibres → allows limited tooth individual mvt 2. Anchors tooth → alveolar bone 3. Acts as shock absorber 4. Acts as suspensory cushions btw root surface + bone 5. Responsible for fibrous tissue formation + maintenance 6. Responsible for calcified tissue development + maintenance 7. Transports nutrients + metabolites 8. Has a sensory function → touch, pain, percussion + proprioception

HAAIO

FUNCTIONS OF PDL FIBRE BUNDLES 1. Attach the tooth → bone 2. Transmit occlusal forces → bone 3. Counteract + oppose occlusal forces 4. Protect vessels + nerves → damage

Cementum DEFINITION: Calcified avascular mesenchymal tissue that forms the outer covering of the root. →ONLY tissue of periodontium that is part of tooth and periodontium FEATURES - Covers the root surface - Similar to bone, but less resorbed → reasons unclear - Regenerate / resorb → Orthodontic treatment - Cementum is capable of repairing itself to a limited degree and is not reabsorbed under normal conditions. - Calcified structure - Varies in thickness - Cemento-enamel junction thickness → 20-50µm - Contains Sharpey’s fibres → mineralised collagen fibres → anchors tendons -Attaches fibre bundles of the PDL → root - Is avascular → divided into: Acellular/primary–living tissue that does not incorporate cells into its structure and usually predominates on the coronal half of the root; in conjunction with root formation/eruption. Cellular/secondary -occurs more frequently on the apical half.after tooth eruptionfunctional demands at apex of tooth-on top of acellular –functional period of tooth

FUNCTIONS OF CEMENTUM 1. Helps w/ anchoring the tooth via principal fibres of PDL 2. Protects + strengthens the roots 3. Maintains occlusal relationships 4. Supplies a seal for the dentinal tubuli 5. Always forms when the root surface is in contact w/ the PDL fibres

Al Alveol veol veolar ar Process DEFINITION: Specialised structure (thickened ridge of bone) that contains tooth sockets (dental alveoli) and supports the teeth The tooth-bearing bones = maxillae + mandible The bone is the same as any other bone in the body. Bone that lines the alveoli → cribriform plate (plate of bone) → a layer of dense bone - Is visible as the lamina dura on radiograph - Tooth socket = alveolus (each tooth has its own) - Functions as a unit - Tooth dependant - Undergoes slow resorption when teeth → lost - Alveolar crest follows the outline of CEJ of the teeth in a healthy situation - The margin of the crest lies 2-3 mm apical → CEJ Three components of alveolar process 1. Alveolus or cribriform plate 2. Compact bone (forms the facial and lingual cortical plates) 3. Trabecular (or marrow bone) between the cortical plates and the alveoli

Al Alveol veol veolar ar Process TYPES OF ALVEOLAR BONE 1. Radicular bone → forms on lingual surfaces 2. Interproximal Bone / Interdental Septa → found btw adjacent teeth 3. Interradicular Bone / Interradicular Septa → found btw the roots of multirooted teeth 4. Crestal Bone → the crest of alveolar bone btw adjacent teeth Lamina dura - Attached to cementum of the roots by the periodontal ligament -Is the bone lining the alveolus -It is a dense white line in clinical radiographs

Bone deposition & resorption: → the two basic mechanisms by which the bone changes Deposition and resorption together = bone remodelling The changes it can produce: Change in: size, shape, proportion and change in the relationship of the bone with adjacent structures -

Physiological tooth mvt (drifting, migration, mastication) Bone resorption and deposition Compact bone → cortical plates facial/lingual Bone dependant on angulation/arrangement of teeth Less trabecular bone in mandible > maxilla

FUNCTIONS OF ALVEOLAR BONE Protection → Alveolar bone forms and protects the sockets for the teeth Attachment → Gives the attachment to the periodontal ligament fibers (principle fibers) → These fibers which enter the bone are regarded as Sharpey’s fibers Support → Supports the tooth roots on the facial and on the palatal/lingual sides. Shock-absorber → Helps absorb the forces placed upon the tooth by disseminating the force to underlying tissues.

Notes

Variations → not caused by any pathology Fenestration: an isolated area of resorbed bone over the facial surfaces of roots Dehiscence: an area of resorbed bone over the facial, lingual surfaces or roots

Causes / Predispositions of these variations - Prominent root contours - Malpositioning of teeth - Labial protrusion of root - Tiny bony plates

My Little Pony Tails

Random definitions Free Gingival Margin: The interface between the sulcular epithelium and the epithelium of the oral cavity Sulcus: Area / space btw free gingiva + tooth In disease/ degradation → called periodontal pocket ∵of disease the JE moves apically along the cementum of tooth

Waste management Why waste management? 1. 2. 3.

To prevent the spread of disease To protect the environment from the damage our waste products can do To protect the safety of the people who handle our waste

Dental Office W Waste aste 1. -

Non-regulated waste General waste

2. -

Regulated waste Medical waste → Contaminated waste → Infectious waste

3. -

Chemical waste Hazardous waste Toxic waste

Clinical W Waste aste Includes: 1. Sharps (needles, scalpels, sutures) 2. Human tissue (NOT teeth) 3. Blood + blood products 4. Blood stained → disposable material → cotton wool swabs

- All items soiled w/ saliva + blood → Gloves → Masks → Paper towels → Gauze → Cotton rolls Go into Biohazard box!! Sharp re-capping: 1. Place cap on stable surface 2. Use 1 hand to slide needle into cap 3. Place syringe into small hole on sharp bin 4. Turn anti-clockwise until needle falls in 5. Dispose syringe Sharps 1. 2. 3. 4.

disposal: Injection needles Scalpel blades Suture needles Matrix bands

How to dispose sharps: Deposit after use → Sharps container - Rigid impermeable material - Wide opening at top but not so wide that hand can go inside container - Never be more than ¾ full - Universal color of the container is: Yellow - Label: Yellow with black lettering stating: “contaminated waste”

Chemical disposal Chemicals should be disposed as per: 1. Manufacturers guidelines and instructions 2. The Legislation 3. Always make use of a licensed waste disposal contractor Clinical waste to be collected in strong plastic bags clearly labeled as infectious waste carrying the bio hazardous symbol Color of the bag for hazardous waste: Internationally used: Yellow/red

Extracted teeth -

Regulated waste Could be disinfected and returned to patient Sterilize extracted teeth → DO NOT STERILIZE IF AMALGAM FILLINGS Immerse in disinfectant 30 minutes Dispose as approved by local authorities

Engineering/work practice controls: Physical equipment and mechanical devices to Safeguard and protect the employee: splash guards on model trimmers Puncture resistant sharp containers Ventilation hoods for hazardous materials

Contamination of the eyes: After -

splash with saliva/blood Stop procedure Remove gloves Wash hands Flush eyes at eye-wash station

Occupational exposure to bl bloodborne oodborne pathogens: -

-

Report immediately Medical evaluation Documentation of the exposure incident date, incident keep copy in employees file Counselling and testing Post exposure go for follow-up evaluation

Fluoride -

Crucial in tooth development years Natural element, the ionic form: fluorine 50 – 80% of our fluoride is absorbed via food 95% of ingested fluoride → bone and teeth

What’s so cool about fluorides? - An optimum level of fluoride → reduces dental caries - Beneficial? → during and after tooth development - Derived from the 13th fluorspar - ESSENTIAL for bone and teeth formation (like calcium and phosphate) - Calcium → largest quantity of minerals → NB for muscle contractions, nervous and blood systems - Phosphorus → involved in energy metabolism and maintenance of blood pH

Fluoride Content Bone: 0.01 – 0.3 % Enamel: 0.01 – 0.02 % Carious teeth: 0.0069%

History of fluorides - Early 1900’s GV Black and Dr F mckay found people with ‘mottled enamel’ aka fluorosis - Mottled enamel results in less dental decay...