ORAL ANATOMY

ORAL CAVITY
Divisions: a. Oral Vestibule bounded by cheeks and alveolar process. b. Oral Cavity Proper inside; where you can find the tongue. ORAL VESTIBULE * Vestibularis Oris / Fornix Vestibuli shadow Buccal cheeks Buccal Vestibule Mucobuccal Fold Labial lips Labial Vestibule Mucolabial Fold Mucous Membrane --- covers bone; soft tissues that covers the alveolar processes.

-> Alveolar Mucosa beneath fornix vestibule. Alveolar Bone / Alveolar Processes

-> Gingiva (gums) adjacent to freeborder. *Mucogingival Junction separates alveolar mucosa and gingiva. MAXILLARY MUCOUS MEMBRANE RETROALVEOLAR NOTCH / Hamular Notch at the back of the alveolar tubercle RETROMOLAR piece of tissue; at the last molar or 3rd molar. MAXILLARY TUBEROSITY / ALVEOLAR TUBERCLE depression in the area of the molars; end of the 3rd molar.

Retromolar Maxillary Tuberosity Retroalveolar notch Notch depression Retro behind / back MANDIBULAR MUCOUS MEMBRANE RETROMOLAR PAD supports denture; stress absorber

RETROMOLAR PAPILLA piece of tissue FREANAE / SAGITTAL FOLDS: o o Labial labial frenae Buccal buccal frenae Lingual frenum holds tongue

ORAL CAVITY PROPER ROOF o HARD PALATE palatine processes of maxilla and horizontal plates of palatine bones. Fuse at the center. INCISIVE PAPILLA o Most stable landmark in the oral cavity. Back in between two maxillary central incisors. Reference point for the midline Covers the incisive foramen where the anesthesia is injected

MEDIAN PALATINE RAPHE Union in between the left and right palate

PALATINE RUGAE / TRANSVERSE PALATINE FOLDS Fold of mucosa from the midline For speech and production of sounds Mastication and absorption

SOFT PALATE made up of muscular tissue that is covered by epithelial tissue. PALATINE FOVEA or PALATINE FOVEOLA OF STIEDA Ducts for passageway; for secretion. Coming together of ducts

HAMULUS OF PTERYGOID PROCESS bulge of hamulus; junction of hard and soft palates.

*BONE RESORPTION constant use will destroy the bone. POSTERIOR WALL o PTERYGOMANDIBULAR RAPHE o It connects the mandible to the maxilla.

PALATINE UVULA / UVULA A bell-shaped hanging from the center of the posterior border of the soft palate.

PALATOGLOSSAL FOLD Arch from the tongue of the palate.

PALATOPHARYNGEAL FOLD Arch from the pharynx or throat behind it.

LATERAL WALL o MYLOHYOID muscle o o o Premylohyoid anterior Mylohyoid main Retromylohyoid last molar, deep lingual

INFERIOR BOUNDARY floor of oral cavity SUBLINGUAL SULCUS below tongue ALVEOLOLINGUAL alveolar process Floor mouth depression

PARAORAL TISSUES
LIPS CHEEKS TONGUE SALIVARY GLANDS TONSILS PARANASAL SINUSES FUNCTIONS: 1. Mastication 2. Speech 3. Articulation 4. Digestion 5. Ingestion 6. Deglutition 7. Taste 8. Respiration

PARAORAL TISSUES

LIPS - skin and mucous membrane

LABIUM SUPERIUS upper LABIUM INFERIUS lower ORBICULARIS ORIS main musculature a. Covered by skin on the outside and mucous membrane on the inside. >> LABIAL GLANDS for lubrication BOUNDARIES: A. NASOLABIAL GROOVE either side of the cheeks B. LABIOMENTAL GROOVE separates lip from chin C. LABIAL COMMISURE at corners of the mouth D. TUBERCLE OF UPPER LIP protrusion in the mid E. PHILTRUM shallow depression

CHEEKS lateral boundary of oral vestibule, vestibular fornix and posteriorly pterygomandibular raphe.

BUCCINATOR MUSCLE main muscle BUCCAL FAT PAD peculiar body of fat tissue, rounded biconvex structure with distinct capsule; infants suckling pad PAROTID PAPILLA 2nd molar a. Opening of parotid duct b. At the vestibular area of the cheeks at the upper 2nd molar. * parotid gland secrete saliva; opening near molar area.

TONGUE largest musculature organ.

BONE AND CENTRAL PART a. Floor of the mouth. INFERIOR SURFACE a. Free and accessible in sublingual sulcus.

TERMINAL SULCUS a. marks the boundaries Zones of innervations nerves that makes tongue naughty

b. Anterior 2/3 trigeminal ----- Posterior 1/3 glossopharyngeal nerve

FORAMEN CECUM a. At the midline of terminal sulcus which mark the development of the thyroid gland started. COVERING OF TONGUE Ventral (anterior) and dorsal (posterior) surface

Dorsal mucosa lined by specialized mucosa 3 TYPES OF MUCOSA SPECIALIZED MUCOSA tongue MASTICATORY MUCOSA covers hard palate LINING MUCOSA covers cheeks

Anterior 2/3 irregular because of presence of papillae ----- Posterior 1/3 irregular prominence of lingual tonsils.

PAPILLAE taste a. Circumvallate Papillae mushroom-shaped; largest near midline; v-shaped; 8 in number; bitter b. Filiform Papillae grayish pink; conical c. Fungiform Papillae deep red; irregularly distributed d. Foliate Papillae sharp low parallel folds in the posterior part of the lateral border; sour

--- EXTRINSIC MUSCLES OF THE TONGUE ---- arise from bones and insert into tongue

GENIOGLOSSUS : strongest muscle o o o Origin: genial tubercle of the mandible Insertion: free surface of tongue Action: protractor; depression

STYLOGLOSSUS: draws tongue up and back o o o O: anterior surface of styloid process I: free surface of tongue A: retracts and elevates

PALATOGLOSSUS: does not move o o o O: lower surface palatine aponeurosis, palatoglossus posterior I: tongue A: sphincter for swallowing; closes and opens an opening Separates oral cavity from pharyngeal

HYOGLOSSUS: o o o O: hyoid bone I: tongue A: depressor / contractor

---INTRINSIC MUSCLES OF THE TONGUE----within the tongue; muscle fibers in the tongue INTRINSIC: o o All location inside the tongue Changes shape of the tongue

EXTRINSIC: o Have names ending in glossus (greek word for tongue)

Ventral Mucosa of the tongue a. Ventral mucosa smooth and thin b. Transverse in the midline by lingual frenum c. Fimbriated Folds irregularly scalloped fold at interior end of frenum which runs laterally and posteriorly on the inferior surface of tongue.

SALIVARY GLANDS showers saliva

Secretes saliva moistens and lubricates food Enzymes initiate 1st phase of digestion Has antibacterial action

MAJOR SALIVARY GLANDS a. PAROTID GLAND superficial lobe (the bulk), deep lobe --superficial above, deep from within Duct STENSENS DUCT

b. SUBMANDIBULAR GLAND biconvex body that occupies the mandibular. Duct WHARTONS DUCT

c. SUBLINGUAL GLAND long flattened body -- near the medial surface of mandible Duct BARTHOLINS DUCT (((Sublingual caruncle)))

MINOR SALIVARY GLANDS a. labial b. buccal c. palatine d. lingual e. incisive

TONSILS mass of lymphoid tissue; filtration of food and air PHARYNGEAL TONSIL at roof of pharynx 2 PALATINE TONSILS superior and inferior -- between anterior(palatoglossal fold) and posterior (palatopharyngeal fold) palatine pillars. LINGUAL TONSILS base of tongue Pharyngeal Lymphatic Ring of Waldeyer

PARANASAL SINUSES PNEUMATIC AIR-FILLED CAVITIES Lined by respiratory mucous membrane like that of the mucous cavity Covered by ciliated pseudostratified columnar epithelium Membrane is inelastic, poor in glands and blood vessels.

SPHENOID FRONTAL ETHMOIDAL MAXILLARY ANTRUM OF HIGHMORE

TEETH
FUNCTIONS OF TEETH 1. MASTICATION reduction of food by cutting, tearing, crushing and grinding 2. SHAPING OF THE FACE for esthetics, stabilization of dental arches, maintains vertical realtions (occluding of teeth, maxilla and mandible) 3. SPEECH aids in production of sounds 4. PROTECTIVE for self-defense 5. PREHENSILE (lower forms, animals) grasping or seizing of food. ANATOMICAL FEATURES 1. CROWN a. ANATOMICAL CROWN covered by enamel from cervix until the tip of the crown. b. CLINICAL CROWN visible part and exposed to oral fluids; tip of crown until gingival sulcus. 2. ROOT a. ANATOMICAL ROOT covered by cementum from cervix to the apex of the root. b. CLINICAL ROOT implanted and surrounded by periodotium; from bottom, not visible 3. CERVICAL LINE Meeting point of enamel and cementum Line of separation between crown and root portions; located at the neck potion

Apical Foramen opening of apex of root. Dentin shape of tooth Pulp life to tooth Cementum covers the roots HISTOLOGICAL FEATURES (DENTAL TISSUES) A. Tooth Tissue Proper a. Hard Dental Tissues 1. Enamel 2. Dentin 3. Cementum b. Soft Dental Tissue 1. Pulp / Pulp Tissue i. Coronal Pulp ii. Radicular Pulp

B. Periodontium a. Attachment Apparatus (supporting structure) 1. Cementum 2. Periodontal Ligament 3. Alveolar bone b. Investing Structure 1. Gingiva Dental Tissues A. Tooth Tissue Proper a. Hard Dental Tissues 1. Enamel Hard mineralized tissue that covers the dentin of the anatomical crown of a tooth. Hardest calcified tissue of the body Degree of calcification = 96 98% Primary mineral is hydroxyapatite (crystalline calcium phosphate) o Large amount of minerals in enamel accounts not only for its strength but also for its brittleness. Functions: Protective covering of the crown dentin Resist forces of mastication

Physical Properties: Hardest calcified Brittle and inelastic Translucent Permeable in young individual Color (comes from dentin) - yellowish white to grayish white - darkest at the cervical area (thinnest)

2. Dentin Hard tissue that forms the main bulk of the tooth on its entire length. Surrounded by the pulp cavity Covered by enamel in anatomical crown and covered by cementum. Mineralized connective tissue; collagenous (soft strand of CT)

Contains organic matter It has microscopic channels called dentinal tubules.

Physical Properties: Highly elastic; subject to slight deformation Harder than bone and cementum but softer than enamel Birefringent or double refraction. More radiolucent than enamel in x-ray o o Radiopaque white in x-rays (hard tissues Radiolucent black (soft tissues)

Light yellowish

3. Cementum Doesnt resorb and grows by apposition Calcification = 45 55% [inorg comp + org comp (22% h2o & 33% org mat)] Lacks luster Layer of bony hard tissue that covers the dentin of the anatomical root Physical Properties: Functions: Attach root and tooth to the alveolar bone Contributes to passive eruption of tooth (continues vertical eruption) Regulates periodontal space Protects root dentin Repairs resorbed parts of the cementum surface; fractured roots and provides new surface for reattachment of periodontal fibers.

b. Soft Dental Tissues 1. Pulp / pulp tissue funnel shaped Soft tissue occupying the central cavity of a tooth Contains the nutrient supple in the form of blood vessels as well as nerve supply. Uncalcified Parts: Coronal Pulp pulp housed by pulp chamber Radicular pulp part of pulp in the root canal, funnel-shaped, wide at cervix and narrows easily; white * nerve broach used to remove the nerve or pulp.

Pulp Cavity life (nerves & blood vessels) Parts: o o o Pulp Canal located in root Pulp Chamber located in the crown = central portion of anatomical crown Pulp Horns excluding out; extension protruding out -- corresponds to cusps; lobes of teeth -- elongation or extension of pulp chamber Innermost pulp layer contains fibroblasts and undifferentiated mesenchymal cells. Cusps in the premolars = atleast two pulp horns --- first exposed in cavities Functions: Nutritive supply nutritional elements Formative production of dentin Defensive- reparative forms Protective contains protective cells to combat inflammation Sensory sensitive to any irritant due to presence of nerves B. Periodontium a. Attachment Apparatus (supporting structure) 1. Cementum 2. Periodontal ligament Dense fibrous connective tissue in the periodontal space Uncalcified Functions: Supportive / Suspension Function principal Formative / Developmental Resorptive presence of cementoblast (form cementum) and fibrolast ( form dentin) replacement as well as resorption

Nutritive transport metabolic waste and substance because of blood supply within PL Sensory carried out by nerves, helps detect applied on teeth? 3. Alveolar bone Calcified connective tissue Forms the socket Calcification = 66% Functions for support and encloses the teeth

b. Investing Structure 1. Gingiva

Gingival unit o Free gingiva freely mobile and not attached to underlying structure i. Marginal ii. Interdental iii. Free gingiva o Attached gingiva pinpoint depressions stiplings

Gingival sulcus surrounding; between free gingiva and tooth surface Principal bundle of fibers 2 Transeptal or Interdental Support interproximal gingiva interdental Maintain mesio-dental relationship Free Gingival Ligament o o Holds gingiva firmly to the tooth Cementum of tooth

Alveolo lingual Ligament o o o Oblique group found at the apical 2/3 of the alveolar bone Occlusal stress Apical group

DENTAL NOTATION
Location : upper / lower ; right / left Dentition: temporary / permanent Specific Type: incisor / canine / pre-molar / molar --Maxillary --Mandibular Division of Arches - quadrant

3 SYSTEMS USED UNIVARSALLY 1. ADA system (America Dental Association) a. Army type i. 2. Palmers Notation 3. FDI System (Federacion Dentaire International)

a. Binomial system (2-digit system) b. Universal system * CASE NOTATION Mesial ] 21 X 23 [ Distal ----- x is 22 = missing

DEVELOPMENT OF DENTITION
3 PERIODS
Primary / Deciduous Teeth Mixed / Transitional Dentition Permanent / Succedaneous Dentition

PRIMARY o o 6months to 6 years Ends at six years of first permanent tooth (mandibular first molar) FROM 6-6 AGE OF ERUPTION From 6 24 months (2 yrs) 9 months B B 7 months 18 months C C 16 months 14 months D D 12 months 24 months E E 20 months

7 months A A 6 months

MIXED o o 6 12 years At age 12 it will end (exfoliation of the last deciduous teeth) maxillary canine EARLY 68 YEARS MIDDLE 8 10 YEARS LATE 10 12 YEARS 7 7 Extracted intentional Exfoliated without intention 6 6 6 6 6 6 E E 5 E 5 5 D D 4 4 4 4 C C C 3 3 3 B 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 B 2 2 2 2 2 C C C 3 3 3 D D 4 4 4 4 E E 5 E 5 5 6 6 6 6 6 6 7 7

PERMANENT DENTITION o o Only permanent sequence Permanent arch

7 8 years

8 9 years

11 12 yrs.

10 11 yrs.

10 12 yrs.

6 7 years

12 13 yrs.

17 21 yrs.

1
6 7 years

2
7 8 years

3
9 10 yrs.

4
10 11 yrs.

5
11 12 yrs.

6
6 7 years

7
11 13 yrs.

8
17 21 yrs.

ACCESSIONAL TEETH
MOLARS OF THE PERMANENT TEETH, SO CALLED BECAUSE THEY HAVE NO CORRESPONDING DECIDUOUS TOOTH PREDECESSORS.

DENTAL FORMULA
A SYSTEM WHEREIN YOU CAN COMPUTE WITH THE TOTAL NUMBER OF TEETH PRESENT. Example : 6 YEARS OLD

1D1P 2P

1D 1D

PM

0 0

2D1P 2D1P

6 6

6 + 6 = 12 x 2 = 24
DENTAL NOMENCLATURE

--- 24 teeth in six years old ---

Crowns of teeth have surfaces which is named according to: Facial Surfaces labial and buccal o o o Labial (La) towards the lips Buccal (Bu) towards the cheeks Lingual (Li) / Palatal towards the tongue or palate

Lateral / Proximal Surfaces towards adjoining teeth o o Mesial towards the midline Distal away from the midline

Mesial side middle 3rd of 21

Incisal 3rd of 21 distal

Biting Surfaces surface that come in contact with those of the opposite jaws during closure o o Incisal biting edge of anteriors Occlusal biting surfaces of posteriors (molars and premolars)

ANTERIOR TEETH LABIAL, LINGUAL, MESIAL, DISTAL, INCISAL POSTERIOR TEETH BUCCAL, LINGUAL, MESIAL, DISTAL, OCCLUSAL

GEOMETRIC
CROWN SURFACE FORM FACIAL AND LINGUAL SURFACES All teeth are roughly TRAPEZOIDAL Incisal and occlusal side forms the base Cercical forms the lateral side. PURPOSE: Allows for interproximal spaces between teeth FOR BREATHING Shorter parallel side on the cervical will allow adequate bone support around roots or neck of teeth. MESIAL AND DISTAL SURFACE (maxillary posterior teeth) Viewed from proximal has a TRAPEZOID form Base is at the cervical while Bu & Li sides constricts towards the occlusal Posterior: Distribute forces of mastication Aid to cleansing / self-cleansing Give adequate bulk or support PROXIMAL SURFACE OF MAXILLARY POSTERIOR TEETH LABIAL AND LINGUAL SURFACE OF THE ANTERIOR

LINGUAL AND BUCCAL SURFACE OF THE POSTERIOR MESIAL AND DISTAL SURFACE (anterior) viewed proximally are TRAINGULAR cervical is the base, apex is the incisal PURPOSE: wedge for incising, cutting, biting, tearing (APEX) provide strength to the crown PROXIMAL SURFACE OF ALL ANTERIOR TEETH MANDIBULAR POSTERIOR TEETH Proximally = RHOMBOIDAL Purpose: Allows proper interlocking with opposing teeth in the arch during mastication (maxillary and mandibular) ALL MANDIBULAR TEETH PROXIML ASPECT

LOBES OF THE TEETH

LOBE Primary anatomical position Usually identifiable developmental grooves or depression are seen separating each o o 3 labial ( ) MLa ( ) Middle Labial ( ) DLa 1 lingual ( ) Li o o o 1ST LOCATION, 2ND SURFACE

2 4
*

MLa (1&2) and DLa (2&3) Developmental Depression developmental depressions separating lobes Central Groove (occlusally) between buccal and labial MBu and DBu Developmental Grooves separates buccal lobes

Mesial lobe biggest ; inlines to the right MAXILLARY MOLARS Normally has 4 lobes o o o o Central groove Buccal groove Distolingual groove separates lingual lobes; more on in the distal side Cusp of Carabelli separated from MLi cusp. Only in the MAXILLARY 1ST MOLAR

MANDIBULAR MOLAR Mandibular 1st Molar has 5 lobes o o 5th lobe distal lobe Distobuccal groove separates distoduccal lobe and distal lobe

Mandibular 2nd Molar has four lobes o Cross-shaped groove

MANDIBULAR 2ND PREMOLAR ONLY PREMOLAR WITH 5 LOBES

LINE ANGLES
8 LINE ANGLES ON EACH TOOTH (broad) 2 SURFACES COME TOGETHER ANTERIORS Mesiolabial LINE ANGLE Mesiolingual Distolabial Distolingual Labioincisal Linguoincisal Mesioincisal Distoincisal

POSTERIORS Mesiobuccal Mesiolingual Distobuccal Distolingual Bucco-Occlusal Linguo-Occlusal

POINT ANGLES
4 POINT ANGLES 3 CROWNS MEET AT A POINT ANTERIORS Distolabioincisal POINT ANGLE Mesiolabioincisal Distolinguoincisal Mesiolinguoincisal

POSTERIOR Distobucco-occlusal Mesiobucco-occlusal Distolinguo-occlusal Mesiolinguo-occlusal

PHYSIOLOGIC FORMS OF TEETH

1. CONTACT AREA b. It keeps food from wedging between teeth. c. Stabilize dental arches 2. INTERPROXIMAL SPACES a. For breathing b. V-shaped or triangular which allow adequate support around roots. 3. EMBRASSURES (spillways) Space that widen up from contact area a. Escape of food b. It reduces force when occluding or incising. c. Prevents food from being pushed through the contact areas. 4. FACIAL AND LINGUAL HEIGHT OF CONTOUR a. It keeps food away from the gingival margin during mastication. b. Protective curvatures are most functional when the teeth are in proper alignment. 5. HEIGHT OF EPITHELIAL ATTACHMENT a. Seals the soft tissue to the tooth.

ANATOMICAL LANDMARKS
Crown elevations
1. CUSPS Elevated projection on the crown of teeth. Forms main bulk a. Incisor none b. Canines one c. Pre-molars 2 or 3 d. Molars 4 or more

2. TUBERCLES Small projection in the crown 3. CINGULUM Bulbous convexity at the lingual surface, cervical third. 4. RIDGES Linear elevations TYPES OF RIDGES: MARGINAL o Elevated crest --Occlusal surface of posterior teeth --Lingual surface of anterior teeth TRIANGULAR o Linear ridge from the tip of the cusps of posterior teeth towards the central area of the occlusal surface TRANSVERSE RIDGE o Triangular ridge of buccal and lingual cusp. OBLIQUE o o Special type of transverse ridge Distobuccal to mesiolingual -- > DB R DCR to MLC (distobuccal triangular ridge of distal cusp ridge to mesiolingual cusp) CUSP RIDGES o o Elevations which extends in a M & D direction Bu & Li direction From cusp tips which forms the occlusal surface of posterior teeth of the cuspids

INCISAL RIDGE o 5. MAMMELONS Small rounded projection on enamel of incisal ridges Normally worn away soon after eruption 6. INCLINED PLANES Sloping area found between 2 cusp ridges Named by combining names of the 2 cusp ridges between which they lie 4 INCLINED PLANE o o MBu IP MLi IP Incisal portion of newly erupted anterior teeth

o o

DBu IP DLi IP

Crown depression
1. FOSSA Depression on tooth surface Below cingulum between 2 marginal ridges

a. Lingual fossa broad shallow depression on the lingual surface of incisors and canines b. Central fossa relatively broad; central portion of the occlusal surface of a molar; occlusal surface of posterior teeth only c. Triangular fossa shallow pyramid-shaped on the occlusal surf of posterior teeth within the confines of the MMR & DMR 2. SULCUS 3. GROOVE Shallow linear depression of the surface of the tooth An indistinct linear depression irregular in extent and direction, which doesnt demarcale major division portions of a tooth. a. Developmental Groove or Primary marks boundaries between adjacent cusps and often major divisional parts of a tooth. b. Supplementary 1. Mesial triangular fossa 2. Distal triangular fossa 4. PIT Small depressed area where development groups join Normally deepest portion of a fossa Groove at the bottom of the sulcus Elongated valley in the surface of a tooth formed by the inclines of adjacent cusps or ridges which meet at an angle Long narrow depression; v-shaped, most often located in the occlusal surface