Case 1 Flashcards
Clinical Crown
the portion of the tooth we
see above the gumline, exposed to the oral
cavity.
Anatomical Crown
-the portion of the tooth
from the CEJ to the Cusps
periodontal ligaments.
The tooth is attached to the underlying
alveolar bone with fibers known as the
periodontal ligaments
Enamel
Hard calcified tissue covering the dentin
in the crown of tooth. Because it contains no
living cells, tooth enamel cannot repair damage
from decay or from wear. Only a dentist can
correct these conditions.
Anatomical Crown
The visible part of your
tooth. It is normally covered by enamel.
Gums (also called gingiva)
Soft tissues that
cover and protect the roots of your teeth and
cover teeth that have not yet erupted.
• Pulp Chamber:
The space occupied by the pulp—
the soft tissue at the center of your teeth
containing nerves, blood vessels and connective
tissue.
Neck
The area where the crown joins the root.
Dentin
That part of the tooth that is beneath enamel
and cementum. It contains microscopic dentinal
tubules (small hollow tubes or canals). When dentin
loses its protective covering (enamel), the tubules
allow heat and cold or acidic or sticky foods to
stimulate the nerves and cells inside the tooth, causing
sensitivity.
Jawbone (Alveolar Bone).
The part of the jaw that surrounds the roots of the teeth.
alveolar bone supports the teeth and is covered by gingival tissue.
• Root Canal.
The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the
tooth that contains the pulp.
Cementum
Hard connective tissue covering the tooth
root, giving attachment to the periodontal ligament.
• Periodontal Ligament.
A system of collagen
containing connective tissue fibers that connect the
root of a tooth to its socket.
every tooth has 4 components
Enamel
• Dentin
• Cementum
• Pulp
enamel is made by
Created by cells known as Ameloblasts
Because it contains no living cells, tooth enamel cannot repair itself from damage due to decay or wear.
Only a dentist can correct these conditions of damage or wear to the enamel.
Weakened enamel, however, can be strengthen with Fluoride
Dentin is made by
Lies beneath the enamel and cementum in the tooth, created by cells known as Odontoblasts
The enamel and dentin meet at an area known as the “DEJ” or Dentino-enamel junction.
Cementum is made by
Covers the root of the tooth • Secreted by Cementoblasts • If the cementum becomes exposed to the oral cavity through gingival recession, this surface can become very sensitive to temperature changes in the mouth (hot and cold). • The enamel and cementum meet at an area known as the CEJ or cementoenamel junction.
pulp again
Pulp is the soft tissue at the center of the tooth
containing blood vessels, nerve tissue and
connective tissue.
• Pulp is lined by odontoblasts (cells that produce
dentin)
• Is divided into two areas:
• Pulp Chamber [in the crown of the tooth]
• Pulpal Canal(s) [in the root(s) of the tooth]
• If the pulpal area becomes exposed to decay,
a bacterial infection can occur and may
require root canal therapy in order to save
the tooth.
Periodontium
The attachment of the tooth to the surrounding structures (bone) is accomplished through the cementum of the tooth, periodontal ligaments and the alveolar bone. Tissues of the Periodontium: 1) Gingiva 2) Cementum 3) Periodontal Ligament (PDL) 4) Alveolar Bone
Alveolar Bone:
The portion
of the bone that surrounds
the root(s) of the teeth.
Periodontal Ligaments:
The collagenous connective
tissue fibers that connect
the tooth to its socket
Intraoral Radiographs and Their Indications
Dental Radiographs can help the dentist evaluate and definitively
diagnose caries, oral diseases and many conditions .
• ADA guidelines advise that the dentist must conduct a clinical examination
with oral and medical histories to determine the type of imaging and frequency
to formulate the proper diagnosis and evaluation.
Types of X-ray radiographs
Bitewing x-ray Periapical x-ray Occlusal x-ray Panoramic x-ray Cephalometric radiograph Cone Beam x-ray (CBCT)
Bitewing (BWs) Radiographs: Indications
Also called interproximal radiographs
• Visualize contact points between distal
surface of canine and posterior teeth for
detection of caries.
• Visualize alveolar bone level between canine
and posterior teeth for detection of
periodontal bone loss.
Bitewing Radiographs: Detection of Dental Caries (Decay)
Demineralization - makes tooth softer due to caries passing through the enamel
towards or into the dentin
• X-rays can pass through softened areas of tooth hitting the sensor, making these
areas look dark
• Radiolucency: a dark area on a radiograph representing loss of hard tissue, known
as dental caries or destructive lesions in the jaws, or normal soft tissue (pulp space)
• Radiopacity: light or white areas on a radiograph representing normal hard tissue,
increased hardness, or restorative materials
• Radiographs can’t predictably visualize pathological loss of hard tissue until
its affected at least 30% of hard tissue.
• X-rays are limited in detecting small carious (decayed) lesions
• Caries is always deeper than it appears on radiographs
Dental caries is always radiolucent • Enamel, dentin, bone, and most restorations are radiopaque • Radiopacity is a relative term (like a gradient) • Bitewing (BW) radiograph is the best diagnostic image for detecting caries in the posterior teeth
Periapical Radiographs
PA radiographs help in visualizing crowns, contact points, roots, apices (tip of the root) and area around the apices into alveolar bone Peri- = around, apical = apices Indications: • Periapical pathology (infection or disease) • Lesions in alveolar process • Lesions in body of jaws • Proximal caries in anterior teeth
Dental Caries on Periapical Radiographs
Radiographs cannot distinguish active from arrested caries
• Deeper aspect remains radiolucent (or darkened area)
• Radiographic examination and interpretation must be supplemented or
confirmed by visual intraoral examination
• Keep in mind caries is deeper than it appears on radiographs: can’t see
the leading edge of lesion because there must be at least 30%
destruction of hard tissue to see a radiolucency to begin with
Radiographic Interpretation
Pulp horns extend more coronally than the radiograph
indicates for the same reason – fine extent of pulp horns
are not 30% of tooth
• Often underestimate depth of caries and extent of pulp
horns
• Visual examination of teeth may not discover caries if
surface is intact due to remineralization (not cavitated)
• Radiographs may be only way to detect caries if
surfaces are intact
• Proximal surfaces:
Ø Radiolucent triangle with base at enamel surface
Ø Originate just apical to contact point of the teeth
Ø Location important; permits distinction from
cervical burnout
Radiographic Interpretation and dental caries
Caries (Latin for “decay” or “rot”)
• Multifactorial disease involving the tooth, oral
microflora, and diet over time in a susceptible host.
• Causes demineralization of tooth
• Initial lesion: subsurface loss of minerals at outer
surface of enamel
• Appears as a chalky white spot, if active
• Appears as brown or opaque spot, if arrested
• Caries can progress and/or remineralize: it’s a
dynamic process
• Caries can approximate or extend into pulp, causing
pulpitis (infection)
dental caries in general
Dental Caries remains the most prevalent chronic disease in
both children and adults, even though it is largely
preventable.
• Caries is the breakdown of tooth enamel. It is the result of
bacteria breaking down foods that produce acids which
destroy tooth enamel.
• Cavities may appear in many different colors including
chalky white, yellow, brown or even black.
• Symptoms when present, may include sensitivity, pain and
difficulty eating.
• Complications may include inflammation of the gum tissue
around the tooth, tooth loss and infection or abscess
formation.
Types of Caries
Smooth Surface Cavity • Pit and Fissure Cavity (occlusal) • Root Cavity
risk factors for caries
- food, history od decay, visible white spots, low socioec, special needs, premature birth, dry mouth.
preventative caries measures
saliva and sealants, antimicrobials, fluoride, good dietq, pit and fissue sealants
why do caries risk assessment
allows patient and provider to work together and determine the patients risk for caries and for treatment and homecare recs to be patient specific
how does fluoride prevent tooth decay
it is incorporated into developing tooth’s mineralized structure, exchanges Oh in hydroxyapatite with mixed fluorohydroxyapatite which is stronger
- F makes crystals less sol and more resistant
caries risk factors
biological from family, protective (dental care at home) clinical findings (white spot lesions, high strep mutans, plaque)