NEET MDS Lessons
Dental Anatomy
CEMENTUM vs. BONE
Cementum simulates bone
1) Organic fibrous framework, ground substance, crystal type, development
2) Lacunae
3) Canaliculi
4) Cellular components
5) Incremental lines (also known as "resting" lines; they are produced by continuous but phasic, deposition of cementum)
Differences between cementum and bone
1) Cementum is not vascularized
2) Cementum has minor ability to remodel
3) Cementum is more resistant to resorption compared to bone
4) Cementum lacks neural component
5) Cementum contains a unique proteoglycan interfibrillar substance
6) 70% of bone is made by inorganic salts (cementum only 46%)
Relation of Cementum to Enamel at the Cementoenamel Junction (CEJ)
"OMG rule"
In 60% of the teeth cementum Overlaps enamel
In 30% of the teeth cementum just Meets enamel
In 10% of the teeth there is a small Gap between cementum and enamel
MANDIBULAR FIRST BICUSPID
Facial: The outline is very nearly symmetrical bilaterally, displaying a large, pointed buccal cusp. From it descends a large, well developed buccal ridge.
Lingual: This tooth has the smallest and most ill-defined lingual cusp of any of the premolars. A distinctive feature is the mesiolingual developmental groove
Proximal: The large buccal cusp tip is centered over the root tip, about at the long axis of this tooth. The very large buccal cusp and much reduced lingual cusp are very evident. You should keep in mind that the mesial marginal ridge is more cervical than the distal contact ridge; each anticipate the shape of their respective adjacent teeth.
Occlusal: The occlusal outline is diamond-shaped. The large buccal cusp dominates the occlusal surface. Marginal ridges are well developed and the mesiolingual developmental groove is consistently present. There are mesial and distal fossae with pits,
Contact Points: When viewed from the facial, each contact area/height of curvature is at about the same height.
Root Surface:-The root of the mandibular first bicuspid is usually single, but on occasion can be bifurcated (two roots).
Age changes in the dentition
I. After the teeth have reached full occlusion, microscopic tooth movements occur to compensate for wear at the contact area (Mesial Drift) and occlusal surfaces (by Deposition of cementum at the root apex)
2. Attrition of incisal ridges and cusp tips may be so severe that dentin may become exposed and intrinsically stained
3. Secondary dentin may be formed in response to dental caries, trauma, and aging and result in decreased pulp size and tooth sensation
Enamel
Structural characteristics and microscopic features
a. Enamel rods or prisms
(1) Basic structural unit of enamel.
(2) Consists of tightly packed hydroxyapatite crystals. Hydroxyapatite crystals in enamel are four times larger and more tightly packed than hydroxyapatite found in other calcified
tissues (i.e., it is harder than bone).
(3) Each rod extends the entire thickness of enamel and is perpendicular to the dentinoenamel junction (DEJ).
b. Aprismatic enamel
(1) The thin outer layer of enamel found on the surface of newly erupted teeth.
(2) Consists of enamel crystals that are aligned perpendicular to the surface.
(3) It is aprismatic (i.e., prismless) and is more mineralized than the enamel beneath it.
(4) It results from the absence of Tomes processes on the ameloblasts during the final stages of enamel deposition.
c. Lines of Retzius (enamel striae)
(1) Microscopic features
(a) In longitudinal sections, they are observed as brown lines that extend from the DEJ to the
tooth surface.
(b) In transverse sections, they appear as dark, concentric rings similar to growth rings in a tree.
(2) The lines appear weekly during the formation of enamel.
(3) Although the cause of striae formation is unknown, the lines may represent appositional or incremental growth of enamel. They may also result from metabolic disturbances of ameloblasts.
(4) Neonatal line
(a) An accentuated, dark line of Retzius that results from the effect of physiological changes
on ameloblasts at birth.
(b) Found in all primary teeth and some cusps of permanent first molars.
d. Perikymata
(1) Lines of Retzius terminate on the tooth surface in shallow grooves known a perikymata.
(2) These grooves are usually lost through wear but may be observed on the surfaces of developing teeth or nonmasticatory surfaces of formed teeth.
e. Hunter-Schreger bands
(1) Enamel rods run in different directions. In longitudinal sections, these changes in direction result in a banding pattern known as HunterSchreger bands.
(2) These bands represent an optical phenomenon of enamel and consist of a series of alternating dark and light lines when the section is viewed with reflected or polarized
light.
f. Enamel tufts
(1) Consist of hypomineralized groups of enamel rods.
(2) They are observed as short, dark projections found near or at the DEJ.
(3) They have no known clinical significance.
g. Enamel lamellae
(1) Small, sheet-like cracks found on the surface of enamel that extend its entire thickness.
(2) Consist of hypocalcified enamel.
(3) The open crack may be filled with organic material from leftover enamel organ components, connective tissues of the developing tooth, or debris from the oral cavity.
(4) Both enamel tufts and lamellae may be likened to geological faults in mature enamel.
h. Enamel spindle
(1) Remnants of odontoblastic processes that become trapped after crossing the DEJ during the differentiation of ameloblasts.
(2) Spindles are more pronounced beneath the cusps or incisal edges of teeth (i.e., areas where occlusal stresses are the greatest).
Maxillary Third Permanent Molar
They are the teeth most often congenitally missing
Facial: The crown is usually shorter in both axial and mesiodistal dimensions. Two buccal roots are present, but in most cases they are fused. The mesial buccal cusp is larger than the distal buccal cusp.
Lingual: In most thirds, there is just one large lingual cusp. In some cases there is a poorly developed distolingual cusp and a lingual groove. The lingual root is often fused to the to buccal cusps.
Proximal: The outline of the crown is rounded; it is often described as bulbous in dental literature. Technically, the mesial surface is the only 'proximal' surface. The distal surface does not contact another tooth.
Occlusal: The crown of this tooth is the smallest of the maxillary molars. The outline of the occlusal surface can be described as heart-shaped. The mesial lingual cusp is the largest, the mesial buccal is second in size, and the distal buccal cusp is the smallest.
Root Surface:-The root may have from one to as many as eight divisions. These divisions are usually fused and very often curved distally.
MORPHOLOGY OF THE DECIDUOUS TEETH
Deciduous Anterior Teeth.
-The primary anteriors are morphologically similar to the permanent anteriors.
-The incisors are relatively simple in their morphology.
-The roots are long and narrow.
-When compared to the permanent incisors, the mesiodistal dimension is relatively larger when compared to axial crown length
-At the time of eruption, mamelons are not present in deciduous incisors
-They are narrower mesiodistally than their permanent successors.
HISTOLOGY OF SALIVARY GLANDS
Parotid: so-called watery serous saliva rich in amylase
Submandibular gland: more mucinous
Sublingual: viscous saliva
Parotid Gland: The parotid is a serous secreting gland.
There are also fat cells in the parotid.
Submandibular Gland
This gland is serous and mucous secreting.
There are serous demilunes
This gland is more serous than mucous
Also fat cells
Sublingual Gland
Serous and mucous secreting
Serous cells in the form of demilunes on the mucous acini.
more mucous than serous cells
Minor Salivary Glands
Minor salivary glands are not found within gingiva and anterior part of the hard palate
Serous minor glands=von Ebner below the sulci of the circumvallate and folliate papillae of the tongue; palatine, glossopalatine glands are pure mucus; some lingual glands are also pure mucus
Functions
Protection: lubricant (glycoprotein); barrier against noxious stimuli; microbial toxins and minor traumas; washing non-adherent and acellular debris; calcium-binding proteins: formation of salivary pellicle
Buffering: bacteria require specific pH conditions; plaque microorganisms produce acids from sugars; phosphate ions and bicarbonate
Digestion: neutralizes esophageal contents, dilutes gastric chyme; forms food bolus; brakes starch
Taste: permits recognition of noxious substances; protein gustin necessary for growth and maturation of taste buds
Antimicrobial: lysozyme hydrolyzes cell walls of some bacteria; lactoferrin binds free iron and deprives bacteria of this essential element; IgA agglutinates microorganisms
Maintenance of tooth integrity: calcium and phosphate ions; ionic exchange with tooth surface
Tissue repair: bleeding time of oral tissues shorter than other tissues; resulting clot less solid than normal; remineralization