Pers in Dent

• Extraoral anatomical structures


  • General appearance (healthy walk and posture, normal breathing)
  • Skin, eyes and nodes (Palpation of Salivary glands. Changes in color and texture.)
  • TMJ and neck area (Condyle/joint function)
  • Lips (commissure; nasolabial fold; labiomental groove; tubercle; philtrum; Vermilion zone, mucocutaneous junction.)

  
• Basic anatomy directions


  • Midline
  • Medial
  • Lateral
  • Superior
  • Inferior
  • Posterior
  • Anterior
• Lip anatomy


  • Upper lip (Bounded laterally the cheeks at the nasolabial groove and superiorly by the nose.)
  • Lower lip (Also bounded laterally by the cheeks and is bounded inferiorly by the chin at a horizontal groove called the labiomental groove.)
  • Tubercle (Small rounded nodule of tissue in the center of its lowest part of the upper lips.)
  • Philtrum (Board depression running from the tubercle toward the center of the nose.)
  • Vermilion border (also margin or zone) is the red zone of the lips, which is really a transitional zone between the skin of the face and the mucous membrane or mucosa.)

  
• Lips color – reddish brown due to the presence of brown melanin pigment
• Intraoral anatomical structures


  • Oral cavity (Bounded anteriorly: lips (labial mucosa), Laterally: cheeks (buccal mucosa), Superiorly: roof of the mouth (palate), Inferiorly: floor of the mouth)
  • Oral mucous membrane (Lines any body cavity opening out to where it joints the skin (resembles and covering) on the outside of the body.)
  • Oral cavity proper (Space bounded anteriorly and laterally by the teeth and alveolar processes.)
  • Oral vestibule (Space between cheeks and teeth)
• Intraoral anatomical structures (continued)

  • Frenum (Thin sheet of tissue at the midline that attaches each lip (upper and lower) to the mucosa covering the maxillae or mandible between the central incisors.)
  • Vestibular fornix (Is the lowest part of the vestibule next to the mandible or the highest part next to the maxiallae.)
  • Commissural papule (Usually 4 to 6 mm posterior to the commissure of the lips, a slight bulge of mucous membrane.)
  • Parotid papilla (Rounded flap of tissue on the next mucosa of the cheek next to the maxillary first and second molars at or just superior to the occlusal plane. This papilla covers the parotid duct (Stensen's duct) opening.)
  • Linea alba (Horizontal white line extending anteroposteriorly on each side at the level where the upper and lower teeth come together. It may extend from the commissural area to the third molar region at a level of the occlusal surfaces of the posterior teeth)
  • Fordyce granules (Small, yellowish irregular areas located in buccal mucosa inside the cheek's posterior to the corner of the mouth.)

  
• Palate anatomy


  • Hard palate (Firm anterior part of the roof of the mouth with mucosa over the underlying bone.)
  • Soft palate (Posterior movable part of the roof of the mouth without underlying bony support.)
  • Incisive papilla (Small rounded elevation of tissue in the midline of the palate just lingual to the central incisors.)
  • Palatal Rugae (Series of palatal tissue elevations, or wrinkles, located on the palate just posterior the maxillary anterior teeth. Function: tactilely sensing objects or food position in aiding the tongue's proper placement for the product of certain speech sounds.)
  • Vibrating line (Separates the mouth from the nasal passage. It is sometimes redder than the hard palate because of its slightly increased vascularity.)
  • Fovea palatini (Pair of pits in the soft palate located on either side of the midline, near but just posterior to the vibrating line. They are openings of ducts of minor palatine mucous glands.)
  • Uvula (Small fleshy structure hanging from the center of the posterior border of the soft palate.)

  
• Tongue anatomy


  • Dorsum of the tongue (Principal organ of taste and invaluable during speech, mastication, and deglutition.)
  • Foliate papillae (Large, red, leaf-like projections on the lateral surfaces of the tongue.)
  • Fungiform papillae (Sparse, scattered, and shorter, mushroom-like papillae that can be identified because of their larger round shape and deep red color.)
  • Circumvallate papillae (Forming a V-shaped row on the dorsum near the posterior third of the tongue.)
  • Filiform papillae (Fine hair-like papillae covering the anterior two thirds of the dorsal surface of the tongue.)
  • Ventral of the tongue (Undersurface is shiny, and blood vessels are visible.)
  • Lingual frenum (Thin sheet of tissue in the middle that attaches the undersurface of the tongue to the floor of the mouth.)
  • Plica fimbriata (Delicate fringers of mucous membrane on each side of the frenum on the ventral surface of the tongue.)

  
• Floor of the mouth anatomy

  • Alveololingual sulcus (Broad, valley-shaped space between the mandibular alveolar bone and the tongue.)

  
• Palpation


  To examine (a part of the body) by touch, especially for medical purposes
• Bidigital palpation


  Palpation of the cheeks (or lips) for bumps or lumps can be accomplished by pressing with the thumb on one side against the forefinger on the other side
• Bimanual palpation


  Using the opposing fingers of two hands in order to feel for lumps or bumps (like a salivary duct blockage) within the floor of the mouth
• Anterior teeth


  • Central incisor
  • Lateral incisor
  • Canine

  
• Anterior teeth


  • For esthetics and profile
  • For cutting and shredding of food

  
• Posterior teeth


  • Premolars (1st, 2nd)
  • Molars (1st, 2nd, 3rd)

  
• Posterior teeth


  • Determines the ideal occlusion or bite which guides the proper jaw placement
  • For grinding food
• Dentition


  • Primary dentition (Deciduous dentition - 20 teeth)
  • Permanent dentition (Succedaneous dentition - 32 teeth)

  
• Dental caries is a multifactorial, transmissible, infectious oral disease caused primarily by the complex interaction of cariogenic oral flora (biofilm) with fermentable dietary carbohydrates on the tooth surface over time

  
• Demineralization


  During an acid attack pH level will go down to critical level: 5.5 for enamel, 6.2 for dentin. The low pH level will trigger Phosphate and Calcium minerals from the tooth to the Biofilm in attempt to balance or to reach equilibrium.
• Remineralization


  When pH neutralizes, the concentration of soluble calcium and phosphate is supersaturated relative to the tooth structure, allowing the minerals to be redeposited on the tooth surface
• Teeth in maxillary and mandibular arches

  • 16 per maxillary arch
  • 16 in the lower mandibular arch
  • Total = 32

  
• Tooth types


  • Central Incisors (Ci)
  • Lateral Incisors (Li)
  • Canine (C)
  • Two premolars (Pm)
  • Three molars (M) – 1st M, 2nd M, 3rdM

  
• Dental Caries


  A multifactorial, transmissible, infectious oral disease caused primarily by the complex interaction of cariogenic oral flora (biofilm) with fermentable dietary carbohydrates on the tooth surface over time

  
• Caries activity


  Localized determineralization and loss of tooth structure

  
• Demineralization


  1. During an acid attack pH level will go down to critical level: 5.5 for enamel, 6.2 for dentin

  2. The low pH level will trigger Phosphate and Calcium minerals from the tooth to the Biofilm in attempt to balance or to reach equilibrium
• Remineralization


  When pH neutralizes, the concentration of soluble calcium and phosphate is supersaturated relative to that in the tooth, mineral can then be added back to partially determineralized enamel
• Repeated demineralization events may result from a predominantly pathologic environment causing the localized dissolution and destruction of the calcified dental tissues, evidenced as a caries lesion or a "cavity"

  
• Factors that can affect Demineralization and Remineralization


  • Number and type of microbial flora in the biofilm
  • Diet
  • Oral hygiene
  • Genetics
  • Dental anatomy
  • Use of fluorides and other chemotherapeutic agents
  • Salivary flow and buffering capacity
  • Inherent resistance of the tooth structure and composition
• Understanding the balance between Demineralization and Remineralization is key to caries management
• Streptococcus mutans (S. mutans)


  Main etiologic factor for dental caries
• Dental Plaque


  Soft, tenacious film accumulating on the surface of teeth, also referred to as a plaque biofilm or simply biofilm

  
• Biofilm


  Composed mostly of bacteria, their by-products, extracellular matrix, and water
• Teeth normally have a biofilm community dominated by Streptococcus sanguis and S. mitis

  
• The population size of mutans streptococci (MS) or S. mutans on teeth varies
• Tooth habitats for cariogenic biofilm

  • Pits and fissures
  • Smooth enamel surfaces
  • Root surfaces (cervical areas)
  • Subgingival areas

  
• Pits and fissures


  Provide excellent mechanical shelter for organisms and harbor a community dominated by S. sanguis and other streptococci
• Smooth enamel surfaces


  The proximal enamel surfaces immediately gingival to the contact area are the second most susceptible areas to caries
• Root surfaces


  • The proximal root surface, particularly near the cementoenamel junction (CEJ), often is unaffected by the action of hygiene procedures such as flossing because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel
  • Caries originating on the root is alarming because: it has a comparatively rapid progression, it is often asymptomatic, it is closer to the pulp, and it is more difficult to restore
• Oral hygiene


  • Accomplished primarily by proper tooth brushing and flossing, is another ecologic determinant of caries onset and activity
  • Careful mechanical cleaning of teeth disrupts the biofilm and leaves a clean enamel surface
  • The cleaning process does not destroy most of the oral bacteria but merely removes them from the surface of teeth

  
• Bass Method


  45-degree angle, gentle motion, scoop out, gentle motion