Basics of Dentistry

Basics of Dentistry
Dr. Md. Arifur Rahman
BDS, MPH
Assistant Professor & Head
North East Medical College Dental Unit
drarifur_rahman@yahoo.com
1

Introduction
• This document has been created to run the
MBBS students through the basics of dental
health, diseases, dental treatments and Oral
Manifestations of Systemic Diseases.
2Dr. Md. Arifur Rahman , NEMC

DENTAL ANATOMY AND
PHYSIOLOGY

Primary (deciduous)
•Consist of 20 teeth
•Begin to form during the
first trimester of
pregnancy
•Typically begin erupting
around 6 months
•Most children have a
complete primary
dentition by 3 years
of age
Dental Anatomy and Physiology
Dentition (teeth): There are two dentitions

Secondary (permanent)
•Consist of 32 teeth in most
cases
•Begin to erupt around 6
years
of age
•Most permanent teeth have
erupted by age 12
•Third molars (wisdom teeth)
are the exception; often do
not appear until late teens or
early 20s
Dentition (teeth): There are two dentitions
Mandible
Maxilla Incisors
Canine (Cuspid)
Premolars
Molars

Classification of Teeth:
•Incisors (central and lateral)
•Canines (cuspids)
•Premolars (bicuspids)
•Molars
Identifying Teeth
Incisor Canine Premolar Molar

Identifying Teeth2
Incisor Canine Premolar Molar
•Incisors function as cutting or shearing
instruments for food.
•Canines possess the longest roots of all teeth
and are located at the corners of the dental
arch. Function as tearing of food.
•Premolars act like the canines in the tearing
of food and are similar to molars in the
grinding of food.
•Molars are located nearest the
temporomandibular joint (TMJ), These teeth
have a major role in the crushing, grinding,
and chewing of food.

•Apical
•Labial
•Lingual
•Distal
•Mesial
•Incisal
Teeth: Identification
Tooth Surfaces
Labial
Apical
Lingual
Distal
Apical
Mesial
Incisal Incisal

•Apical: Pertaining to the apex
or root of the tooth
•Labial: Pertaining to the lip;
describes the front surface of
anterior teeth
•Lingual: Pertaining to the
tongue; describes the back
(interior) surface of all teeth
•Distal: The surface of the tooth
that is away from the median
line
•Mesial: The surface of the
tooth that is toward the median
line
Labial
Apical
Lingual
Distal
Apical
Mesial

Enamel
Alveolar Bone
Pulp
Chamber
•Enamel (hard tissue)
•Dentin (hard tissue)
•Odontoblast Layer
•Pulp Chamber (soft tissue)
•Gingiva (soft tissue)
•Periodontal Ligament (soft
tissue)
•Cementum (hard tissue)
•Alveolar Bone (hard tissue)
•Pulp Canals
•Apical Foramen
The Dental Tissues:
Dentin
Odontoblast Layer Gingiva
Periodontal Ligament
Cementum
Pulp Canals
Apical Foramen

•Anatomic Crown
•Anatomic Root
•Pulp Chamber
The 3 parts of a tooth:
Anatomic Crown
Anatomic Root
Pulp
Chamber

Anatomic Crown
Anatomic Root
Pulp
Chamber
•The anatomic crown is the
portion of the tooth
covered by enamel.
•The anatomic root is the
lower two thirds of a tooth.
•The pulp chamber houses
the dental pulp, an organ
of myelinated and
unmyelinated nerves,
arteries, veins, lymph
channels, connective tissue
cells, and various other
cells.

•Enamel
•Dentin
•Cementum
•Dental Pulp
The 4 main dental tissues:
Enamel
Dentin
Cementum
Dental Pulp

•Structure
•Highly calcified and hardest
tissue in the body
•Crystalline in nature
•Enamel rods
•Insensitive—no nerves
•Acid-soluble—will demineralize at
a pH of 5.5 and lower
•Cannot be renewed
•Darkens with age as enamel is lost
•Fluoride and saliva can help with
remineralization.
Dental Tissues—Enamel

Dental Tissues—Enamel
• Enamel can be lost by:
– Physical mechanism
• Abrasion (mechanical wear)
• Attrition (tooth-to-tooth contact)
– Chemical dissolution
• Erosion by extrinsic acids (from
diet)
• Erosion by intrinsic acids (from
the oral cavity/digestive tract)
• Multifactorial etiology
–Combination of physical and
chemical factors

•Softer than enamel
•Susceptible to tooth wear
(physical or chemical)
•Does not have a nerve
supply but can be sensitive
•Is produced throughout life
•Three classifications
•Primary
•Secondary
•Tertiary
•Will demineralize at a pH
of 6.5 and lower
Dental Tissues—Dentin

Three classifications:
•Primary dentin forms the initial shape of the tooth.
•Secondary dentin is deposited after the formation of the primary
dentin on all internal aspects of the pulp cavity.
•Tertiary dentin, or “reparative dentin” is formed by replacement
odontoblasts in response to moderate-level irritants such as
attrition, abrasion, erosion, trauma, moderate-rate dental caries,
and some operative procedures.
Dental Tissues—Dentin

Dentin
Pulp
Tubule
Fluid Nerve Fibers
Odontoblast
Cell
Dental Tissues—Dentin (Tubules)
•Dentinal tubules connect the dentin
and the pulp (innermost part of the
tooth, circumscribed by the dentin
and lined with a layer of odontoblast
cells)
•The tubules run parallel to each
other in an S-shape course
•Tubules contain fluid and nerve
fibers
•External stimuli cause movement of
the dentinal fluid, a hydrodynamic
movement, which can result in
short, sharp pain episodes

Association between
erosion and dentin
hypersensitivity
• Open/patent tubules
– Greater in number
– Larger in diameter
• Removal of smear layer
• Erosion/tooth wear
Enamel
Exposed
Dentin
Receding
Gingiva
Tubules
Odontoblast
Dental Anatomy
and Physiology
Dental Tissues—Dentin (Tubules)

•Thin layer of mineralized
tissue covering the dentin
•Softer than enamel and
dentin
•Anchors the tooth to the
alveolar bone along with
the periodontal ligament
•Not sensitive
Dental Tissue—Cementum

•Innermost part of the tooth
•A soft tissue rich with blood
vessels and nerves
•Responsible for nourishing the
tooth
•The pulp in the crown of the
tooth is known as the coronal
pulp
•Typically sensitive to extreme
thermal stimulation (hot or
cold)
Dental Tissue—Dental Pulp

• Pulpitis is inflammation or infection of the dental pulp, causing extreme sensitivity
and/or pain.
• Pain is derived as a result of the hydrodynamic stimuli activating mechanoreceptors in
the nerve fibers of the superficial pulp (A-beta, A-delta, C-fibers).
• Hydrodynamic stimuli include: thermal (hot and cold); tactile; evaporative; and
osmotic
• These stimuli generate inward or outward movement of the fluid in the tubules and
activate the nerve fibers.
• A-beta and A-delta fibers are responsible for sharp pain of short duration
• C-fibers are responsible for dull, throbbing pain of long duration
• Pulpitis may be reversible (treated with restorative procedures) or irreversible
(necessitating root canal).
• Untreated pulpitis can lead to pulpal necrosis necessitating root canal or extraction.
Dental Tissue—Dental Pulp

•Gingiva
•Alveolar Bone
•Periodontal
Ligament
•Cementum
Periodontal Tissues
Gingiva
Alveolar bone
Cementum

•Gingiva: The part of the oral
mucosa overlying the crowns
of unerupted teeth
and encircling the necks of
erupted teeth, serving as
support structure for
subadjacent tissues.
Dental Tissue—Dental Tissue
Gingiva

•Alveolar Bone: Also called the
“alveolar process”; the
thickened ridge of bone
containing the tooth sockets in
the mandible and maxilla.
Alveolar bone

•Periodontal Ligament:
Connects the cementum of the
tooth root to the alveolar
bone of the socket.

•Cementum: Bonelike, rigid
connective tissue covering the
root of a tooth from the
cementoenamel junction to the
apex and lining the apex of the
root canal. It also serves as an
attachment structure for the
periodontal ligament, thus
assisting in tooth support.
Cementum

•Plaque
•Saliva
•pH Values
•Demineralization
•Remineralization
Oral Cavity/Environment

Dental Anatomy
and Physiology
Plaque:
•is a biofilm
•contains more than 600
different identified species of
bacteria
•there is harmless and harmful
plaque
•salivary pellicle allows the
bacteria to adhere to the tooth
surface, which begins the
formation of plaque
Oral Cavity

Dental Anatomy
and Physiology
Saliva:
•complex mixture of fluids
•performs protective functions:
– lubrication—aids swallowing
– mastication
– key role in remineralization of
enamel and dentin
– buffering
Oral Cavity

Dental Anatomy
and Physiology
pH values:
•measure of acidity or alkalinity of a
solution
•measured on a scale of 1-14
•pH of 7 indicated that the solution is
neutral
•pH of the mouth is close to neutral
until other factors are introduced
•pH is a factor in demineralization
and remineralization
Oral Cavity
3. Strassler HE, Drisko CL, Alexander DC.

Demineralization:
•mineral salts dissolve into
the surrounding salivary
fluid:
–enamel at approximate
pH of 5.5 or lower
–dentin at approximate pH
of 6.5 or lower
•erosion or caries can occur
Oral Cavity

Remineralization:
•pH comes back to neutral (7)
•saliva-rich calcium and
phosphates
•minerals penetrate the
damaged dentine surface and
repair it:
– dentin pH is above 6.5
Oral Cavity

Maxillary bones
Every structure in the oral
cavity (gum, teeth and
muscles) is supported by
two bones:
• Upper jaw: the maxillary
bone or maxilla;
• Lower jaw: the mandibular
bone or mandible.

Mandible

Maxilla

Blood Supply of teeth

Nerve Supply of Teeth

Temporomandibular Joints
The temporomandibular
joints connect the upper
jaws to the mandible.
The part of the mandible
which mates to the under-
surface of the disc is the
condyle and the part of
the temporal bone which
mates to the upper
surface of the disk is the
glenoid (or mandibular)
fossa.

DIAGNOSIS ID , TOOLS

Four Quadrants ID

Four Quadrants ID
• Upper Right 1st Molar
• Lower Left Canine
• Upper Deciduous Rt. 1st Molar
Dr. Md. Arifur Rahman , NEMC 42
6
3
D

Deciduous Dentition ID

Permanent Dentition ID

RADIOGRAPHIC EXAMS
• orthopantomography
/OPG
• Periapical X-ray
• Bite wing x-ray
• Occulsal view
• CT scan

Major Dental Specialties
1)Conservative/Operative/ Endodontics
2) Periodontics
3) Orthodontics
4) Pediatric Dentistry or Paedodontics
7) Prosthodontics
8) Oral and Maxillofacial Surgery

Conservative/Operative/
Endodontics
Endodontics (from the Greek endo "inside"; and odons
"tooth") is the dental specialty concerned with the study
and treatment of the dental pulp. Endodontists perform a
variety of procedures including filling, endodontic therapy
(commonly known as "root canal therapy"), treating
cracked teeth, and treating dental trauma.).
Root canal therapy is one of the most common procedures.
If the pulp becomes diseased or injured, endodontic
treatment is required to save the tooth.

How Caries Occurs?

treatment options in caries
• Filling (if cavity doesn’t reach pulp
chamber)

• Root Canal Treatment (RCT)

Root Canal Treatment (RCT)

• Dental Extraction – If the
infection is out of control,
teeth become 3rd degree
mobile or Patient doesn’t
have time/money for RCT.

Periodontics
Periodontology or Periodontics is the specialty of dentistry that studies
supporting structures of teeth, diseases and conditions that affect
them. The supporting tissues are known as the periodontium, which
includes the gingiva (gums), alveolar bone, cementum, and the
periodontal ligament. Periodontal diseases take on many different
forms but are usually a result of a coalescence of bacterial plaque of
the gingiva and the teeth. They are usually called:
GINGIVITIS: inflammation of the gum tissue, characterized by swelling,
reddening, gums that are tender and painful to the touch, bleeding
gums;
PERIODONTITIS: involves progressive loss of the alveolar bone
around the teeth, and if left untreated, can lead to the loosening and
subsequent loss of teeth.

GINGIVITIS & PERIODONTITIS

Treatment options
• Scaling – Ultrasonic/
Air/Hand Scaling
• Root Planning
• Gingivectomy

Orthodontics
Orthodontics is the branch of dentistry that corrects teeth
and jaws that are positioned improperly.
Its aim is to diagnose, prevent and treat irregularities of the
teeth and face, in order to:
- Get a good teeth alignment;
- Obtain an efficient chewing function;
- Achieve a good aesthetic of the smile;
- Reach and/or improve the health of the teeth and
periodontium;

Orthodontics

Orthodontics
darsheel safary

Orthodontics

Orthodontics
Nicholas Cage

Orthodontics
Morgan freeman

Orthodontics
Tom Cruise

Orthodontic appliances
Orthodontic treatment uses appliances to
correct the position of the teeth. The
two main types are:
fixed braces – a non-removable brace
made up of brackets that are glued to
each tooth and linked with wires
removable braces – usually plastic
plates that cover the roof /floor of the
mouth and clip on to some teeth;
they can only carry out very limited
tooth movements

Pediatric Dentistry or
Paedodontics
• training the child to accept dentistry;
• restoring and maintaining the
primary, mixed, and permanent
dentitions;
• applying preventive measures for
dental caries and periodontal
disease;
• preventing, intercepting, and
correcting various problems of
occlusion.
Paedodontics is the branch of dentistry that includes the
following:

Prosthodontics
Prosthodontics is the dental specialty pertaining to
the diagnosis, treatment planning, rehabilitation
and maintenance of the oral function, comfort,
appearance and health of patients with clinical
conditions associated with missing or deficient
teeth and/or oral and maxillofacial tissues using
biocompatible substitutes.

Dental Prosthesis
• Dental Crown / Cap
• Dental Bridge
• Partial Denture
• Complete Denture
• Dental Implant

Dental Crown / Cap

Dental Bridge

Partial Denture

Complete Denture

Dental Implant

Oral and Maxillofacial Surgery
Oral & Maxillofacial
surgery (OMS) specializes in
treating many diseases,
injuries and defects in the
head, neck, face, jaws and
the hard and soft tissues of
the Oral (mouth) and
Maxillofacial (jaws and face)
region.

OMS Deals with Diagnosis and
treatment of:
-benign pathology (cysts, tumors etc.)
-malignant pathology (oral & head and neck cancer) with
(ablative and reconstructive surgery, microsurgery)
-cutaneous malignancy (skin cancer), lip reconstruction
-congenital craniofacial malformations such as cleft
lip and palate.
-temporomandibular joint (TMJ) disorders
-soft and hard tissue trauma of the oral and maxillofacial region
(jaw fractures, cheek bone fractures, nasal fractures, LeFort
fracture, skull fractures and eye socket fractures).

ORAL MANIFESTATION OF
SYSTEMIC DISEASES

Systemic diseases manifesting oral
ulcers are:
Microbial disease-
Herpetic stomatitis
Chicken pox
Hand ,foot and mouth disease
Infectious mononucleosis
HIV
ANUG
TB
Syphilis

Contd..
 Blood disorders
• Disorders of Red Blood Cells
and Hemoglobin
• Disorders of White Blood
Cells
• Bleeding Disorders

Anemia (cont.)
• Clinical features
– Pallor of skin and oral mucosa
– Angular cheilitis
– Erythema and atrophy of oral
mucosa
– Loss of filiform and fungiform
papillae on the dorsum of the
tongue
11/10/2015 77

.Thrombocytopenia
O/M: petechia , purpura, ecchymosis, hemorhagic bullae,
hematomas

Oral Manifestations of Aplastic Anemia
• Infection,
• spontaneous bleeding
• purpuric spots
11/10/2015 79

Oral Manifestations of Acute Leukemias
• Gingival enlargement
• Oral infection
• Bleeding gums, petechiae
and ecchymosis
11/10/2015 80

Mucocutaneous disease
Lichen planus
Pemphigus vulgaris
Erythema multiforme
Dermatitis herpetiformis
Linear IgA disease
ulcerative stomatitis

Vitamin deficiency disorders
Vitamin B complex
deficiency
Reddening of oral mucosa,
tongue with or without
ulceration, swelling and
burning
Scurvy (vitamin C
deficiency)
Petechiae in oral mucosa
and swollen bleeding gums
Pernicious anaemia,
Iron deficiency
Pellagra
Bald tongue (atrophic
glossitis )

Contd…
• Gastrointestinal disease
– Coeliac disease
– Crohns disease
– Ulcerative colitis
• Rheumatic diseases
– Lupus erythematosus
– Sweet syndrome
– Reiter syndrome
• Endocrine disorders
– Diabetes

. Oral lesions
1.Lichen planus-
O/M : Erosive – diffuse erythema and painful ulceration
with peripheral radiating striae
Reticular – white lacy striae, especially on bilateral
buccal mucosa

Management
• In symptomatic patients, oral lesions may
be treated with a topicalcorticosteroid gel
or rinse

Candidiasis (oral thrush)
• CONDITIONS ASSOCIATED WITH INCREASED
VULNERABILITY :
Poor oral hygiene, xerostomia
Recent antibiotic treatment
Dental appliance
Early infancy
Genetic immune deficiency, aids
Corticosteroid therapy
Pancytopenia, anaemia, malnutrition,
malabsorbtion
Diabetes , advanced systemic disease

Systemic factors causing
periodontal disease
 Neutropenia
 Immunodficiency state
 Downs syndrome
 Diabetes melitus
 Pregnancy
 Oral contraceptives
 Drug induced-Dilantin sodium, phenytoin, nifedipine
 Idiopathic hereditory familial fibrosis

Periodontal bleeding and
inflammation
• Diabetes melitus
O/M: gingivitis , periodontitis,
candidiasis, generalized
atrophy of the tongue
papillae,taste dysfunction,
salivary dysfunction, burning
mouth syndrome, delayed
wound healing

HIV – associated periodontal
disease
O/M: linear gingival erythema
necrotising ulcerative gingivitis
necrotising ulcerative periodontitis

ALTERATION IN TEETH IN
SYSTEMIC DISORDERS
Morphological change Teeth involved Disease/condition
Enamel hypoplasia Primary & permanent
teeth
Rickets , Osteomalacia,
Malabsorption,
Coeliac disease,
Hypoparathyroidism
Enamel hypoplasia with
discoloration
Primary & permanent
teeth
Tetracyclines given
during
pregnancy,infancy and
childhood upto 8years
of age
Enamel
discolouration(mottling)
Primary & permanent
teeth
Dental fluorosis
Loss of deciduos
dentition
Primary Downs syndrome,
Juvenile
hypophosphataemia

Syndromes associated with cleft lip
and palate
• Most common is Pierre Robin syndrome
(micrognathia, cleft palate and glossptosis,
airway distress )
• Other syndromes includes Goldenhar syndrome,
median cleft face syndrome, orofacial digital
syndrome, Perts syndrome , Nagar syndrome,
Oto palato digital syndrome, Down syndrome
and Marfan syndrome

Sjogren syndrome
• Oral signs and symptoms
• -dry mouth
• -cracker sign
• -burning
• -salivary swelling
• -caries
• -candidiasis

Management :
• Follow up regularly
• Salivary substitutes
• Eye drops
• Caries control
• Soft diet
• Control of secondary infections

Somebody asked: "You're a Doctor? How much do you
make?“
I replied: "HOW MUCH DO I MAKE?" ...
I can make holding your hand seem like the most
important thing in the world when you're scared...
I can make your child breathe when they stop..
I can help your father survive a heart attack...
I can make myself get up at 4AM to make sure
your mother has the medicine she needs to
live...and I will work straight
through until 4am to keep her alive and start the
day all over again!
I work all day to save the lives of strangers...

I will drop everything and run a code blue for
hours trying to keep you alive!!!
I make my family wait for dinner until
I know your
family member is taken care of...
I make myself skip lunch so that
I can make sure that everything I did for your wife today
was correct...
I work weekends and holidays and all through the
night because people don't just get sick Monday
though Saturday and during normal working
hours.

Today, I might save your life.
How much do I make?
All I know is, I make a difference.

THANK YOU

Basics of Dentistry

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