Basics of Dentistry

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.

1. Basics of Dentistry
Dr. Md. ArifurRahman
BDS, MPH
Assistant Professor & Head
North East Medical College Dental Unit
[email protected]
1

2. 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

3. DENTAL ANATOMY AND
PHYSIOLOGY
3Dr. Md. Arifur Rahman , NEMC

4. 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
4Dr. Md. Arifur Rahman , NEMC

5. Dental Anatomy and Physiology
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
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6. Classification of Teeth:
•Incisors (central and lateral)
•Canines (cuspids)
•Premolars (bicuspids)
•Molars
Dental Anatomy and Physiology
Identifying Teeth
Incisor Canine Premolar Molar
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7. Dental Anatomy and Physiology
Identifying Teeth
2
Incisor Canine Premolar Molar
•Incisorsfunction as cutting or shearing
instruments for food.
•Caninespossess the longest roots of all teeth
and are located at the corners of the dental
arch. Function as tearing of food.
•Premolarsact like the canines in the tearing
of food and are similar to molars in the
grinding of food.
•Molarsare located nearest the
temporomandibularjoint (TMJ), These teeth
have a major role in the crushing, grinding,
and chewing of food.
7Dr. Md. Arifur Rahman , NEMC

8. Dental Anatomy and Physiology
•Apical
•Labial
•Lingual
•Distal
•Mesial
•Incisal
Teeth: Identification
Tooth Surfaces
Labial
Apical
Lingual
Distal
Apical
Mesial
Incisal Incisal
8Dr. Md. Arifur Rahman , NEMC

9. Dental Anatomy and Physiology
•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
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10. Enamel
Alveolar Bone
Pulp
Chamber
Dental Anatomy and Physiology
•Enamel (hard tissue)
•Dentin (hard tissue)
•OdontoblastLayer
•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
OdontoblastLayer Gingiva
Periodontal Ligament
Cementum
Pulp Canals
Apical Foramen
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11. •Anatomic Crown
•Anatomic Root
•Pulp Chamber
The 3 parts of a tooth:
Anatomic Crown
Anatomic Root
Pulp
Chamber
Dental Anatomy and Physiology
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12. Anatomic Crown
Anatomic Root
Pulp
Chamber
Dental Anatomy and Physiology
•The anatomiccrownis the
portion of the tooth
covered by enamel.
•The anatomic rootis the
lower two thirds of a tooth.
•The pulp chamberhouses
the dental pulp, an organ
of myelinated and
unmyelinated nerves,
arteries, veins, lymph
channels, connective tissue
cells, and various other
cells.
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13. •Enamel
•Dentin
•Cementum
•Dental Pulp
The 4 main dental tissues:
Dental Anatomy and Physiology
Enamel
Dentin
Cementum
Dental Pulp
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14. •Structure
•Highly calcified and hardest
tissue in the body
•Crystalline in nature
•Enamel rods
•Insensitive—no nerves
•Acid-soluble—will demineralizeat
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 Anatomy and Physiology
Dental Tissues—Enamel
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15. Dental Tissues—Enamel
Dental Anatomy and Physiology
•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
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16. •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 demineralizeat a pH
of 6.5 and lower
Dental Tissues—Dentin
Dental Anatomy and Physiology
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17. Three classifications:
•Primary dentinforms the initial shape of the tooth.
•Secondary dentinis 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
Dental Anatomy and Physiology
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18. Dentin
Pulp
Tubule
Fluid Nerve Fibers
Odontoblast
Cell
Dental Anatomy and Physiology
Dental Tissues—Dentin (Tubules)
•Dentinal tubulesconnect 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
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19. 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)
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20. Dental Anatomy and Physiology
•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
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21. •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
Dental Anatomy and Physiology
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22. •Pulpitisis 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
•Pulpitismay be reversible (treated with restorative procedures) or irreversible
(necessitating root canal).
•Untreated pulpitiscan lead to pulpalnecrosis necessitating root canal or extraction.
Dental Tissue—Dental Pulp
Dental Anatomy and Physiology
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23. •Gingiva
•Alveolar Bone
•Periodontal
Ligament
•Cementum
Periodontal Tissues
Dental Anatomy and Physiology
Gingiva
Alveolar bone
Cementum
Periodontal Ligament
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24. •Gingiva:The part of the oral
mucosa overlying the crowns
of uneruptedteeth
and encircling the necks of
erupted teeth, serving as
support structure for
subadjacenttissues.
Dental Tissue—Dental Tissue
Dental Anatomy and Physiology
Gingiva
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25. •Alveolar Bone:Also called the
“alveolar process”; the
thickened ridge of bone
containing the tooth sockets in
the mandible and maxilla.
Dental Tissue—Dental Tissue
Dental Anatomy and Physiology
Alveolar bone
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26. •Periodontal Ligament:
Connects the cementumof the
tooth root to the alveolar
bone of the socket.
Dental Tissue—Dental Tissue
Dental Anatomy and Physiology
Periodontal Ligament
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27. •Cementum:Bonelike, rigid
connective tissue covering the
root of a tooth from the
cementoenameljunction 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.
Dental Tissue—Dental Tissue
Dental Anatomy and Physiology
Cementum
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28. •Plaque
•Saliva
•pH Values
•Demineralization
•Remineralization
Oral Cavity/Environment
Dental Anatomy and Physiology
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29. 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
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30. 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
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31. 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.
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32. Dental Anatomy and Physiology
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
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33. Dental Anatomy and Physiology
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
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34. 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.
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35. Mandible
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36. Maxilla
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37. Blood Supply of teeth
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38. Nerve Supply of Teeth
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39. TemporomandibularJoints
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
condyleand the part of
the temporal bone which
mates to the upper
surface of the disk is the
glenoid(or mandibular)
fossa.
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40. DIAGNOSIS ID , TOOLS
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41. Four Quadrants ID
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42. Four Quadrants ID
•Upper Right 1
st
Molar
•Lower Left Canine
•Upper Deciduous Rt. 1
st
Molar
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6
3
D

43. Deciduous Dentition ID
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44. Permanent Dentition ID
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45. RADIOGRAPHIC EXAMS
•orthopantomography
/OPG
•PeriapicalX-ray
•Bite wing x-ray
•Occulsalview
•CT scan
45Dr. Md. Arifur Rahman , NEMC

46. Major Dental Specialties
1)Conservative/Operative/ Endodontics
2) Periodontics
3) Orthodontics
4) Pediatric Dentistry or Paedodontics
7) Prosthodontics
8) Oral and Maxillofacial Surgery
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47. 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. Endodontistsperform 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.
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48. How Caries Occurs?
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49. treatment options in caries
•Filling (if cavity doesn’t reach pulp
chamber)
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50. treatment options in caries
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•Root Canal Treatment (RCT)

51. Root Canal Treatment (RCT)
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52. treatment options in caries
•Dental Extraction –If the
infection is out of control,
teeth become 3
rd
degree
mobile or Patient doesn’t
have time/money for RCT.
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53. Periodontics
Periodontologyor Periodonticsis 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 gingivaand 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.
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54. GINGIVITIS & PERIODONTITIS
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55. Treatment options
•Scaling –Ultrasonic/
Air/Hand Scaling
•Root Planning
•Gingivectomy
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56. Orthodontics
Orthodonticsis 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;
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57. Orthodontics
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58. Orthodontics
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darsheelsafary

59. Orthodontics
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60. Orthodontics
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Nicholas Cage

61. Orthodontics
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Morgan freeman

62. Orthodontics
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Tom Cruise

63. 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 bracketsthat areglued to
each tooth and linked with wires
removablebraces–usually plastic
platesthat cover the roof /floor of the
mouth and clip on to some teeth;
theycan only carry out very limited
tooth movements
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64. 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.
Dr. Md. Arifur Rahman , NEMC 64
Paedodonticsis the branch of dentistry that includes the
following:

65. Prosthodontics
Prosthodonticsis 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.
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66. Dental Prosthesis
•Dental Crown / Cap
•Dental Bridge
•Partial Denture
•Complete Denture
•Dental Implant
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67. Dental Crown / Cap
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68. Dental Bridge
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69. Partial Denture
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70. Complete Denture
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71. Dental Implant
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72. 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.
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73. OMS Deals with Diagnosis and
treatment of:
-benignpathology(cysts,tumorsetc.)
-malignantpathology (oral &head and neck cancer) with
(ablative andreconstructive surgery,microsurgery)
-cutaneousmalignancy (skin cancer),lip reconstruction
-congenitalcraniofacialmalformations such ascleft
lipandpalate.
-temporomandibularjoint (TMJ) disorders
-soft and hard tissue trauma of the oral and maxillofacial region
(jaw fractures, cheek bone fractures,nasalfractures, LeFort
fracture,skullfractures andeye socket fractures).
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74. ORAL MANIFESTATION OF
SYSTEMIC DISEASES

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

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

77. Anemia (cont.)
•Clinical features
–Pallor of skin and oral mucosa
–Angular cheilitis
–Erythema and atrophy of oral
mucosa
–Loss of filiformand fungiform
papillae on the dorsum of the
tongue
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78. .
Thrombocytopenia
O/M: petechia, purpura, ecchymosis, hemorhagicbullae,
hematomas

79. Oral Manifestations of AplasticAnemia
•Infection,
•spontaneous bleeding
•purpuricspots
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80. Oral Manifestations of Acute Leukemias
•Gingival enlargement
•Oral infection
•Bleeding gums, petechiae
and ecchymosis
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81. Mucocutaneousdisease
Dr. Md. Arifur Rahman , NEMC 81
Lichen planus
Pemphigusvulgaris
Erythemamultiforme
Dermatitis herpetiformis
Linear IgAdisease
ulcerative stomatitis

82. Vitamin deficiency disorders
VitaminB complex
deficiency
Reddeningof oral mucosa,
tongue with or without
ulceration, swelling and
burning
Scurvy (vitamin C
deficiency)
Petechiaein oral mucosa
and swollen bleeding gums
Pernicious anaemia,
Iron deficiency
Pellagra
Bald tongue (atrophic
glossitis)

83. Contd…
•Gastrointestinal disease
–Coeliacdisease
–Crohnsdisease
–Ulcerative colitis
•Rheumatic diseases
–Lupus erythematosus
–Sweet syndrome
–Reiter syndrome
•Endocrine disorders
–Diabetes

84. .
Oral lesions
1.Lichen planus-
O/M : Erosive –diffuse erythemaand painful ulceration
with peripheral radiating striae
Reticular –white lacy striae, especially on bilateral
buccalmucosa

85. Management
•In symptomatic patients, oral lesions may
be treated with a topicalcorticosteroidgel
or rinse

86. 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

87. Candidiasis(oral thrush)

88. Systemic factors causing
periodontal disease
Neutropenia
Immunodficiencystate
Downs syndrome
Diabetes melitus
Pregnancy
Oral contraceptives
Drug induced-Dilantinsodium, phenytoin, nifedipine
Idiopathic hereditoryfamilial fibrosis

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

90. HIV –associated periodontal
disease
O/M: linear gingival erythema
necrotisingulcerative gingivitis
necrotisingulcerative periodontitis

91. ALTERATION IN TEETH IN
SYSTEMIC DISORDERS
Morphologicalchange Teeth involved Disease/condition
Enamel hypoplasia Primary & permanent
teeth
Rickets , Osteomalacia,
Malabsorption,
Coeliacdisease,
Hypoparathyroidism
Enamel hypoplasiawith
discoloration
Primary & permanent
teeth
Tetracyclinesgiven
during
pregnancy,infancyand
childhood upto8years
of age
Enamel
discolouration(mottling)
Primary & permanent
teeth
Dental fluorosis
Lossof deciduos
dentition
Primary Downssyndrome,
Juvenile
hypophosphataemia

92. Syndromes associated with cleft lip
and palate
•Most common is Pierre Robin syndrome
(micrognathia, cleft palate and glossptosis,
airway distress )
•Other syndromes includes Goldenharsyndrome,
median cleft face syndrome, orofacialdigital
syndrome, Pertssyndrome , Nagar syndrome,
Otopalatodigital syndrome, Down syndrome
and Marfansyndrome

93. Sjogrensyndrome
•Oral signs and symptoms
•-dry mouth
•-cracker sign
•-burning
•-salivary swelling
•-caries
•-candidiasis

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

95. Somebody asked: "You're a Doctor? How much doyou
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...

96. 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.
Dr. Md. Arifur Rahman , NEMC 96

97. Today, I might save your life.
How much do I make?
All I know is, I make a difference.
Dr. Md. Arifur Rahman , NEMC 97

98. THANK YOU
Dr. Md. Arifur Rahman , NEMC 98