SOCM Dental Anatomy and Oral Examination PFN: SOMDSL03 Hours: 1.0 Slide 1 Terminal Learning Objective Action: Identify and describe the anatomy of the human teeth with the proper terminology Condition: Given a lecture in a classroom environment Standard: Received a minimum score of 75% on the written exam IAW course standards Slide 2 References Anatomy of Orofacial Structures, Brand, Richard W., Issehard, Donald, Elsevier Health Div, 7 th ed, 2003 The CIBA Collection of Medical Illustration, Frank H. Netter, MD (1906 1991) Introduction to Dental Local Anaesthesia (sic), Evers, Hans; Haegerstam, Glenn; Mediglobe SA, 1990 Slide 3 1
References Dental Anatomy, Physiology, and Occlusion, Wheeler, Russell C., 5 th ed., Saunders 1974 Contemporary Oral and Maxillofacial Surgery, Peterson, et al, 2d ed, Mosby 1993 (2d ed has best art) Atlas of Oral Pathology, Smith, Roy M. et al, Mosby 1981 Color Atlas of Oral Pathology, Robinson, Hamilton B.G. et al, Lippincott 4 th ed 1983 Medical Subjects Dental, JSOMTC, as issued. Slide 4 Reason As a SOF Medic you will diagnose and treat dental conditions You must understand anatomy, terminology, and be able to communicate with other providers You must distinguish normal from abnormal anatomy You will evaluate team members prior to deployment and evaluate sick call and indigenous forces on deployment Slide 5 Agenda Identify dental anatomy and terminology Identify dentition Identify dental restorations Define normal and abnormal anatomy Describe the process of oral evaluations Slide 6 2
Spectacular medical providers are preceded by a great deal of preparation Dental disease is a significant health problem world wide You will treat dental emergencies and extract hopeless teeth You must have a working knowledge of dental anatomy to perform these tasks Slide 7 Dental Anatomy and Terminology Slide 8 Four Tissues of Teeth Slide 9 3
Enamel Hardest tissue in the body Does not grow back Has no sensation Slide 10 Dentin The bulk of the tooth Very Sensitive Thousands of tiny tubules per millimeter Slide 11 Cementum Thin layer on root surface Allows attachment of the root to bone Very sensitive Slide 12 4
Pulp Contains, Nerves, Blood vessels, and Lymphatics. Swelling in closed space can cause ischemia Source of odontogenic infections Slide 13 Tissues of the Periodontium Gingiva Periodontal ligament Alveolar Bone Slide 14 Normal Gingiva Firm Stippled like the surface of an orange Non movable firmly attached to bone Pink, but can be pigmented in certain individuals Slide 15 5
Healthy Gingiva Mostly connective tissue Does not bleed when brushed or flossed or properly probed Slide 16 Periodontal Ligament (PDL) Connects the tooth to the bone Fibers attach to cementum Trauma can sever ligament Must keep alive for avulsed tooth Slide 17 Alveolar Process (Alveolus) Portion of the bone which surrounds the roots of the teeth Slide 18 6
Alveolar Bone Surrounds and supports the teeth Can fracture it traumatic force is sufficent Resorbs if tooth is removed Slide 19 Alveolar Resorption Bone reorbs when teeth are removed Results in a collapse of the midface giving an aged, dished in appearance Educate your patients Slide 20 Tooth Removal is Forever Bone begins to resorb after teeth are removed Preserve the teeth that can be saved. Slide 21 7
Arch Resorption Once teeth are removed atrophy begins Continues throughout life Atrophic ridges make prosthetic restoration difficult Slide 22 Anterior Teeth The front six, or the Smiling Six Central and Lateral Incisors, Cuspids Upper (Maxillary) and lower (Mandibular) Slide 23 Posterior Teeth Posterior of the mouth Two Bicuspids and three molars per quadrant 5 in each quadrant equal 20 posterior teeth in adult Slide 24 8
Cusp Elevation of the Enamel, the pointy part on the tooth Cusps mesh like finely tuned gears when chewing May be several on one tooth Slide 25 Root Apex Tip or end of the root Pathology sometimes shows here Entry/Exit for nerves blood vessels Apical region= area proximate to root apex Slide 26 Dentition Slide 27 9
Universal Numbering System Adult Teeth used by military and civilian. Common nomenclature in US #1 (upper) Right, though #32 (lower) right Numbers do not change if tooth is missing Slide 28 Just so you know There are other systems for naming teeth. FDI used outside US. Each quad given a number 1 4. Upper rt.upper lft. Lower lft, Lower rt. Tooth #1 is 18 called one eight Slide 29 Tooth Surfaces Orientation is based on the mid line Mesial surface closest to midline Distal surface distant from midline Facial surface toward the face Lingual toward the tongue Slide 30 10
Just so you know There are synonyms for the surfaces. Facial=Buccal in posterior teeth Facial=Labial in anterior teeth Lingual=Palatal in upper teeth Slide 31 The business end The biting and chewing surfaces also have designations. Incisal the cutting or tearing edge of the anterior teeth Occlusal the chewing or grinding surface of the posterior teeth. Slide 32 The Primary Dentition Commonly referred to as Baby Teeth Also known as Deciduous teeth because they fall out They hold space for Adult teeth Slide 33 11
Primary Teeth Named for letters of the alphabet. Start at Upper right first tooth is a Finish on Lower right the last tooth is t There are other systems but most often used is lettered. Slide 34 Mixed Dentition This is a transitional state in which the adult teeth are erupting and primary teeth are exfoliating Teeth Erupt in a pattern, Maxillary from the facial, Mandibular from the lingual Slide 35 Dentition Teeth are oriented according to the forces placed upon them in function Anterior teeth are inclined facially Posterior teeth are inclined lingually Opposite direction of the roots Slide 36 12
Dentition Root proximity teeth can be located quite close together This can account for symptoms from one seeming to arise from an adjacent tooth Must protect neighbor during surgical procedures Slide 37 Upper First Premolars Two spindly roots Number 5 and 12 On practicum Extraction requires good technique Slide 38 Third Molars : Nos. 1,16,17,32 Only 2% of the population have sufficiently erupted. Called Wisdom Teeth Best Removed in Late Teens Have team remove prior to deployment Slide 39 13
Third Molars continued The teeth most often malpositioned, malformed, or missing. Prone to decay Associated with hidden pathology Must push to get removed Slide 40 Third Molars continued Must be sectioned Leaves boney defects Slide 41 Third Molars Low level, Older Patient Boney Defect Slide 42 14
Third Molar Pathology Rare but significant Numb (Paresthesia) of the lower lip may be the first sign Protect your team by looking for these Slide 43 Check on Learning List the tooth numbers for the third molars using the universal system? Now,list the number designations for the cuspid teeth using the universal system? Which teeth have two spindly roots? Slide 44 Answer Third molars are 1, 16,17,and 32. Cuspid teeth are 6,11, 22, 27. The spindly rooted teeth of concern are the maxillary first premolars, #5 and #12. Slide 45 15
Dental Restorations Slide 46 What is an Amalgam? A silver mercury restoration material for posterior teeth Inexpensive, well adapted, long lasting restoration Corrodes turns dark Safe for after age 6 Used for over 150yrs Slide 47 What is Composite? A tooth colored resin material used for anterior teeth Less durable when used in posterior due to chewing forces Subject to decay at margin Adhesive glued to tooth Slide 48 16
What is a Crown? A restoration which covers the coronal surface of the tooth Protects a damaged tooth Requires custom fabrication Porcelain Anterior Gold Posterior Slide 49 Anterior Crowns Mostly Porcelain or some type of substrate Esthetic Less Durable Slide 50 What is a bridge? A fixed prosthetic replacement for a missing tooth Uses the support of adjacent teeth called abutments Durable, 20 30 yr Requires considerable expertise Slide 51 17
What is Endodontics? (Root Canal) Procedure performed by dentists to save a tooth Cause: bacterial invasion of pulpal tissue/nerve Done to relieve pain Once performed tooth can last for the life of the patient. Must be restored Slide 52 What is a Denture? Prosthetic replacement of teeth Removable Can replace some teeth or can replace the entire arch Poor function Bone Atrophy continues Slide 53 What is an Implant? Many designs Have limitations Multiple uses single tooth replacement to stabilize dentures Require time an expertise Smoking may be contraindicated Slide 54 18
What is Orthodontics? Orthopedic movement of teeth You may deploy with braces (AR614 30) Require extra Hygiene Newer style Invisalign a series of clear plastic aligners move teeth without metal Slide 55 Normal and Abnormal Dental Related Anatomy Slide 56 Normal Variant: Torus (Tori) Hard solid bone Not neoplastic does not continue to grow after initiator is stopped Has more to do with the flexion of bone and it s growth in response Slide 57 19
Normal Variant:Torus Can occur on Maxillary midline Slide 58 Normal Variant: Exostosis Buccal boney protuberances Again not Neoplastic Developmental Can complicate extraction, think broken roots Slide 59 Normal Variant: Toothbrush Abrasion Acquired Defect V shaped at gingival margin No decay but can be sensitive Use soft brush in updown motion Slide 60 20
Normal Variant: Acquired Defect, Attrition Loss of tooth structure on the Occlusal or Incisal surface Affects all ages Abrasive unprocessed food a factor Slide 61 Normal Variant: Abrasion from Prosthesis Loss of tooth structure from mechanical wear Porcelain=Sand, loss of polished surface Opposing dentition gets worn, Prosthetic teeth erupt Slide 62 Normal Variant: Geographic Tongue Diffuse multifocal lesion with a white rim Asymptomatic on dorsal and lateral surface of the tongue Loss of Filiform Papilla Affects 2% of the population Slide 63 21
Normal Variant: Varicosity Blue area on ventral surface of the tongue Asymptomatic Vascular will blanch upon pressure No treatment Slide 64 Normal Variant :Ankyloglossia Tongue tied Developmental Limited tongue movement Not simple treatment Send it up to a higher echelon of care Slide 65 Normal Variant: Fissured Tongue Furrows in tongue Asymptomatic 1% of population No treatment Slide 66 22
The Process of Oral Evaluation Slide 67 Oral Evaluation Start from the outside proceeding to the inside Look for Asymmetry Look for signs, Rubor, Calor, Dolor Slide 68 Examine, the Neck Look for surface lesions Feel for lymphadenopathy Slide 69 23
Instruments #23 Explorer Combination explorer and periodontal probe Used to amplify your sense of feel, and to measure gingival sulcus depth When probing use a light touch, probe gingiva don t create pockets Slide 70 Examine the soft tissues Look at the buccal tissue Check tongue, Floor of mouth Slide 71 Intraoral Exam System Upper Right Left Lower Left to Right Slide 72 24
Intraoral Exam Document Periodontal probe depths Normal 3mm or less Six sites per tooth Over 3mm =Disease Larger the number the greater severity of disease Slide 73 #4 Periodontal Probe Probe gently Six sites per tooth Three on buccal, mesial, middle,distal Three on the lingual mesial, middle, distal Start at tooth #1 16, then #17 32 Slide 74 Probe for decay Start from the distal Feel for a stick Slide 75 25
Probing Decay Check the darker areas Feel for a stick Don t jab, or jam the explorer tip Use it to feel the surface of the tooth Slide 76 Probe for Decay continued Explore the margins of restorations Check interproximal areas Check the contact areas Check crowded teeth Slide 77 Explore for Decay Check the buccal pits on first molar teeth Check the occlusal surfaces Be suspicious of anywhere that is difficult to clean Slide 78 26
Look for Discolorations Note the darker tooth inconsistent with the other teeth Possibly a devitalized tooth that requires further examination Radiograph, percussion test, ice test is indicated Slide 79 Percussion Test Done to evaluate suspicious teeth Could indicate a fracture or periapical disease Lightly tap the suspect tooth and several teeth on either side Strongest response= suspect tooth Slide 80 Ice or Pulp Cold test Apply ice till cold is felt Replace ice with finger, time Slide 81 27
Ice Test If the cold stimulus does not go away after 10 seconds, you have a hyperemic pulp Endodontics may be necessary Test a non suspicious, similar tooth to compare the response Slide 82 Check on Learning A periodontal probe is..? a. Pushed in with firm pressure. b. Used to place dry socket dressings. c. Measures the temperature of the gingiva. d. Measures the gingival sulcus and to check for bleeding Slide 83 Answer D. Measures the gingival sulcus and checks for bleeding Slide 84 28
Terminal Learning Objective Action: Identify and describe the anatomy of the human teeth with the proper terminology Condition: Given a lecture in a classroom environment Standard: Received a minimum score of 75% on the written exam IAW course standards Slide 85 Agenda Identify dental anatomy and terminology Identify dentition Identify dental restorations Define normal and abnormal anatomy Describe the process of oral evaluations Slide 86 Reason As a SOF Medic you will diagnose and treat dental conditions. You must understand anatomy, terminology, and be able to communicate with other providers You must distinguish normal from abnormal anatomy You will evaluate team members prior to deployment and evaluate sick call and indigenous forces on deployment Slide 87 29
1 Know your dental subjects and your dental vocabulary: Communicate intelligently with other providers Slide 88 30