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Dental Anatomy

Structure

There are 3 pairs

 The functional unit is the adenomere.

The adenomere consists of secreting units and an intercalated duct, which opens, in a striated duct.

An secreting unit can be:

- mucous secreting

- serous secreting

THE SECRETING UNIT

THE CELLS

Serous cells

(seromucus cells=secrete also polysaccharides), They have all the features of a cell specialized for the synthesis, storage, and secretion of protein
 Pyramidal, Nuclei are rounded and more centrally placed,  In the basal 1/3 there is an accumulation of Granular EPR,  In the apex there are proteinaceous secretory granules,  Cells stain well with H & E (red),  Between cells are intercellular secretory capillaries

Rough endoplasmic reticulum (ribosomal sites-->cisternae)
Prominent Golgi-->carbohydrate moieties are added
Secretory granules-->exocytosis
The secretory process is continuous but cyclic
There are complex foldings of cytoplasmic membrane
The junctional complex consists of: 1) tight junctions (zonula occludens)-->fusion of outer cell layer, 2) intermediate junction (zonula adherens)-->intercellular communication, 3)desmosomes-->firm adhesion

Mucus cells

Pyramidal,  Nuclei are flattened and near the base,  Have big clear secretory granules

Cells do not stain well with H & E (white)

Production, storage, and secretion of proteinaceous material; smaller enzymatic component
-more carbohydrates-->mucins=more prominent Golgi
-less prominent (conspicuous) rough endoplasmic reticulum, mitochondria
-less interdigitations
 

Myoepithelial cells

Star-shaped, Centrally located nucleus, Long cytoplasmic arms - bound to the secretory cells by desmosomes, Have fibrils like smooth muscle, Squeeze the secretory cell

One, two or even three myoepithelial cells in each salivary and piece body, four to eight processes
Desmosomes between myoepithelial cells and secretory cells myofilaments frequently aggregated to form dark bodies along the course of the process. The myoepithelial cells of the intercalated ducts are more spindled-shaped and fewer processes
Ultrastructure very similar to that of smooth muscle cells (myofilaments, desmosomal attachments)
 

Functions of myoepithelial cells
-Support secretory cells
-Contract and widen the diameter of the intercalated ducts
-Contraction may aid in the rupture of acinar cells of epithelial origin

Ductal system

Three classes of ducts:
Intercalated ducts

They have small diameter; lined by small cuboidal cells; nucleus located in the center. They have a well-developed RER, Golgi apparatus, occasionally secretory granules, few microvilli. Myoepithelial cells are also present. Intercalated ducts are prominent in salivary glands having a watery secretion (parotid).
Striated ducts

They have columnar cells, a centrally located nucleus, eosinophilic cytoplasm. Prominenty striations that refer to indentations of the cytoplasmic membrane with many mitochondria present between the folds. Some RER and some Golgi. The cells have short microvilli.
The cells of the striated ducts modify the secretion (hypotonic solution=low sodium and chloride and high potassium). There is also presence of few basal cells.
Terminal excretory ducts

Near the striated ducts they have the same histology as the striated ducts. As the duct reaches the oral mucosa the lining becomes stratified. In the terminal ducts one can find goblet cells, basal cells, clear cells. The terminal ducts alter the electrolyte concentration and add mucoid substance.

Connective tissue
Presence of fibroblasts, inflammatory cells, mast cells, adipose cells
Extracellular matrix (glycoproteins and proteoglycans)
Collagen and oxytalan fibers
 

 Nerve supply
The innervation of salivary glands is very complicated. There is no direct inhibitory innervation. There are parasympathetic and sympathetic impulses, the parasympathetic are more prevalent.
The parasympathetic impulses may occur in isolation, evoke most of the fluid to be excreted, cause exocytosis, induce contraction of myoepithelial cells (sympathetic too) and cause vasodialtion. There are two types of innervation: epilemmal and hypolemmal. There are beta-adrenergic receptors that induce protein secretion and L-adrenergic and cholinergic receptors that induce water and electrolyte secretion.

Hormones can influence the function of the salivary glands. They modify the salivary content but cannot initiate salivary flow.

Age changes

Fibrosis and fatty degenerative changes
Presence of oncocytes (eosinophilic cells containing many mitochondria)

Clinical considerations

Role of drugs, systemic disorders, bacterial or viral infections, therapeutic radiation, obstruction, formation of plaque and calculus.

    - Rich capillary networks surround the adenomeres.

Introduction. The Jaws and Dental Arches

 

The teeth are arranged in upper and lower arches. Those of the upper are called maxillary; those of the lower are mandibular.

 

  1. The maxilla is actually two bones forming the upper jaw; they are rigidly attached to the skull..
  2. The mandible is a horseshoe shaped bone which articulates with the skull by way of the temporomandibular joint the TMJ.
  3. The dental arches, the individual row of teeth forming a tooth row attached to their respective jaw bones have a distinctive shape known as a catenary arch.

Permanent teeth

1. The permanent teeth begin formation between birth and 3 years of age (except for the third molars)

2. The crowns of permanent teeth are completed between 4 and 8 years of age, at approximately one- half the age of eruption

The sequence for permanent development

Maxillary                     

First molar → Central incisor → Lateral incisor → First premotar → Second pmmolar  → Canine → Second molar → Third molar

Mandibular

First molar → Central incisor → Lateral incisor → Canine → First premolar → Second premolar → Second molar → Third molar

Permanent teeth emerge into the oral cavity as

                                      Maxillary                       Mandibular

Central incisor               7-8 years                        6-7 years

Lateral incisor                8-9 years                        7-8 years

Canine                           11-12 years                    9-10 years

First premolar                10-Il years                      10-12 years

Second premolar            10-12 years                  11-12 years

First molar                       6-7 years                      6-7 years

Second molar                 12-13 years                    11-13 years

Third molar                      17-21 years                    17-21 years

 

The roots of the permanent teeth are completed between 10 and 16 years of age, 2 to 3 years after eruption

SURFACES OF THE TEETH

Facial, Mesial, Distal, Lingual, and Incisal Surfaces

  • The facial is the surface of a tooth that "faces" toward the lips or cheeks. When there is a requirement to be more specific, terms like labial and buccal are used. The labial is the surface of an anterior tooth that faces toward the lips. The buccal is the surface of a posterior tooth that faces toward the cheek.
  • The mesial is the proximal surface closest to the midline of the arch. The distal is the opposite of mesial. The distal is the proximal surface oriented away from the midline of the arch.
  • The lingual is the surface of an anterior or posterior tooth that faces toward the tongue. Incisal edges are narrow cutting edges found only in the anterior teeth (incisors). Incisors have one incisal edge
  • Proximal Surfaces

A tooth has two proximal surfaces, one that is oriented toward the midline of the dental arch (mesial) and another that is oriented away from the midline of the arch (distal).

 

Maxillary (upper) teeth

Primary teeth

Central
incisor

Lateral
incisor


Canine

First
molar

Second
molar

Initial calcification

14 wk

16 wk

17 wk

15.5 wk

19 wk

Crown completed

1.5 mo

2.5 mo

9 mo

6 mo

11 mo

Root completed

1.5 yr

2 yr

3.25 yr

2.5 yr

3 yr

 

 Mandibular (lower) teeth 

Initial calcification

14 wk

16 wk

17 wk

15.5 wk

18 wk

Crown completed

2.5 mo

3 mo

9 mo

5.5 mo

10 mo

Root completed

1.5 yr

1.5 yr

3.25 yr

2.5 yr

3 yr

 

 

 

 

 

 

Maxillary Second Deciduous Molar.

-The notation is A or J.

-It looks like a first permanent molar

-There are three roots.

-Usually it has four well developed cusps.

-It is somwhat rhomboidal in outline.

-They often have the Carabelli trait.

- the shape the maxillary first permanent molar strongly resembles that of the adjacent deciduous second molar.

Tooth eruption Theories

Tooth eruption occurs when the teeth enter the mouth and become visible. Although researchers agree that tooth eruption is a complex process, there is little agreement on the identity of the mechanism that controls eruption. Some commonly held theories that have been disproven over time include: (1) the tooth is pushed upward into the mouth by the growth of the tooth's root, (2) the tooth is pushed upward by the growth of the bone around the tooth, (3) the tooth is pushed upward by vascular pressure, and (4) the tooth is pushed upward by the cushioned hammock. The cushioned hammock theory, first proposed by Harry Sicher, was taught widely from the 1930s to the 1950s. This theory postulated that a ligament below a tooth, which Sicher observed on under a microscope on a histologic slide, was responsible for eruption. Later, the "ligament" Sicher observed was determined to be merely an artifact created in the process of preparing the slide.

The most widely held current theory is that while several forces might be involved in eruption, the periodontal ligaments provide the main impetus for the process. Theorists hypothesize that the periodontal ligaments promote eruption through the shrinking and cross-linking of their collagen fibers and the contraction of their fibroblasts.

Although tooth eruption occurs at different times for different people, a general eruption timeline exists. Typically, humans have 20 primary (baby) teeth and 32 permanent teeth. Tooth eruption has three stages. The first, known as deciduous dentition stage, occurs when only primary teeth are visible. Once the first permanent tooth erupts into the mouth, the teeth are in the mixed (or transitional) dentition. After the last primary tooth falls out of the mouth—a process known as exfoliation—the teeth are in the permanent dentition.

Primary dentition starts on the arrival of the mandibular central incisors, usually at eight months, and lasts until the first permanent molars appear in the mouth, usually at six years. The primary teeth typically erupt in the following order: (1) central incisor, (2) lateral incisor, (3) first molar, (4) canine, and (5) second molar. As a general rule, four teeth erupt for every six months of life, mandibular teeth erupt before maxillary teeth, and teeth erupt sooner in females than males. During primary dentition, the tooth buds of permanent teeth develop below the primary teeth, close to the palate or tongue.

Mixed dentition starts when the first permanent molar appears in the mouth, usually at six years, and lasts until the last primary tooth is lost, usually at eleven or twelve years. Permanent teeth in the maxilla erupt in a different order from permanent teeth on the mandible. Maxillary teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) first premolar, (5) second premolar, (6) canine, (7) second molar, and (8) third molar. Mandibular teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) canine, (5) first premolar, (6) second premolar, (7) second molar, and (8) third molar. Since there are no premolars in the primary dentition, the primary molars are replaced by permanent premolars. If any primary teeth are lost before permanent teeth are ready to replace them, some posterior teeth may drift forward and cause space to be lost in the mouth. This may cause crowding and/or misplacement once the permanent teeth erupt, which is usually referred to as malocclusion. Orthodontics may be required in such circumstances for an individual to achieve a straight set of teeth.

The permanent dentition begins when the last primary tooth is lost, usually at 11 to 12 years, and lasts for the rest of a person's life or until all of the teeth are lost (edentulism). During this stage, third molars (also called "wisdom teeth") are frequently extracted because of decay, pain or impactions. The main reasons for tooth loss are decay or periodontal disease.

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