English Midterm

Dental Specialities
Endodontics
- An endodontist is a dentist who is specialised in the diagnosis
and treatment of diseases and injuries of the pulp and the
periapical tissues of teeth
- Root canal treatment is the most common
o Removal of infected pulp
o Sealing up the tooth
- Pulp – The soft tissue forming the inside of the tooth. Contains
blood vessels and nerves, this is the part that allows us to feel
pain in the teeth
- Inflamed – Hot, swollen and reddened
- Pus – Yellowish-white substance, produced in infected tissue
- Anaesthetic – A drug that temporarily reduces neuronal
functions and therefore causes the complete or partial loss of
sensation with or without the loss of consciousness
- Swollen – Enlarged by swelling
- Root Canal – The passage going through the middle of the tooth.
This is where the blood vessels and nerves travel through the
tooth.
Orthodontics
- Malocclusion – Having an incorrect bite
- Crowding – Occurs when the patient’s jaw is too narrow, there
may not be enough space for all the teeth to fit
- Impacted Tooth – When the tooth is unable to erupt from the
gums and attain its normal position in occlusion
- Asymmetrical Teeth – When the upper and lower teeth do not
match, especially visible when the teeth are clenched
- Overbite – When teeth are clenched, the upper teeth come down
over the lower ones too far
- Underbite – The upper teeth are too far back, giving the
appearance of a bulldog
- Open bite – When a gap remains between the upper and lower
jaw regardless of occlusion happening
 - Crossbite – Caused by having one or more teeth that are too far
buccally or lingually, which prevents the front teeth from
coming down in front of the tooth like in normal occlusion
- Braces – The most common fixed appliance, consists of bands,
wires, and brackets:
o Bands – Fixed to the teeth and are used to support the
appliance
o Wires – Passed through the brackets and are tightened to
provide a pulling force which pulls the teeth into their
correct and intended position in the jaw
o Brackets – These are bonded onto the individual teeth and
are used as the binding place for the brackets onto the teeth
- Special Fixed Appliances – Such as appliances to control things
such as thumb sucking and tongue thrusting. These are very
uncomfortable when eating – last resort
- Fixed Space Maintainers – These are used in the event of an
early loss of a primary tooth and are important to make sure the
permanent teeth can erupt correctly and reduce the risk of
malocclusion later in life
Prosthodontics
- Crown – An artificial substitute for the natural crown of the
tooth
- Bridge – A dental appliance that can consists of one or more
artificial teeth all joined together. This is usually secured to the
natural, healthy teeth around the missing teeth.
- Veneer – A thin layer of material that is placed on the front
surface of the tooth either to improve aesthetics or to protect the
tooth from damage
- Inlay – A filling that is made of either gold, porcelain, or
amalgam etc. and is inserted into a cavity and is held in position
with the help of cement
- Onlay - Indirect restoration which improves the structure of the
cusps of the teeth
- Complete Dentures – Are worn by patients who are missing all
their teeth in a dental arch
- Partial Dentures – Are worn by patients who are missing some
of their teeth in their arch
 - Implants – An artificial tooth that is anchored into the jawbone
of the patients

Periodontics
- Periodontology is the study of the hard and soft tissues that
surround and support the teeth.
- This is called the periodontium; it has important functions:
o Securely attaches the teeth to the jaws
o Acts as a shock absorber during eating and therefore
prevents the teeth from becoming damaged
o Maintains the teeth in a stable position so that they can
work together efficiently and comfortably during
mastication
- The periodontium is made up of several components:
o Tooth Socket – bony pouches in the jaws, the place where
the teeth are attached
o Cementum – Calciferous bone-like substance that covers
the root of teeth. Only below the gums.
o Periodontal Ligament – Small fibres that extend between
the bony socket and the tooth. It holds the tooth in position
almost like a sling.
- Diseases of the gums:
1) Gingivitis
- Red, swollen gums that can bleed easily
- There is little or no discomfort at this stage
- It is caused by having inadequate oral hygiene
- With professional treatment, this condition is reversible
- Diabetes, smoking, ageing, malnutrition, and hormonal
fluctuations, such as during pregnancy or puberty, can lead to
gingivitis developing
2) Periodontitis
- Untreated gingivitis can lead to a more acute condition,
periodontitis
- Plaque spreads and grows below the gumline. This causes
bacteria to produce toxins which irritate the gums. This causes
the immune system to go overboard and therefore causes it to
 essentially turn on itself and start to break down the bone and
tissues that keep the tooth fixated
- Small gaps between the teeth and gums called pockets form
- Over time, these pockets deepen, and this leads to the gums
receding from the teeth, making them loose and thus they fall out
easily
- There are many forms of periodontitis:
o Aggressive – Occurs in otherwise healthy patients, comes
with rapid attachment loss and bone destruction
o Chronic – The most common type of periodontitis, results
in inflammation of the supporting tissues surrounding the
teeth. Characterised by pocket formation and recession of
the gingiva. Prevalent in adults but can happen at any age
o Necrotising – Necrosis of gingival tissues, periodontal
ligament, and alveolar bone. Found most commonly in
people with HIV, malnutrition, or immunosuppression
Oral Surgery
- What to do before having oral surgery:
1) Consult your dentist:
- Contact your dentist or surgeon and ask if you will require any
medication following your surgery.
- Discuss any fears or concerns you may have with them.
- Discuss sedation and distractions methods.
2) Arrangements for transportation and care:
- Choose someone to accompany you to and from the surgery as
you will not be able to drive afterwards.
- If you have any small children, make any necessary
arrangements for care
3) Eating, drinking, and smoking:
- In the event of receiving a general anaesthetic, do not eat or
drink anything for 8 hours before the surgery start time.
- For a local anaesthetic, have a light meal 1-2 hours before
- Make sure to properly brush and floss your teeth before
- Do not smoke for 12 hours before
- Smoking is not permitted for a minimum of 24 hours after
4) What to wear and items to avoid:
- Short-sleeved, loose-fitting, comfortable clothing
 - Do not wear jewellery, contact lenses or make-up (to reduce the
risk of infection)
- Bring lip-balm
5) Plan your post-surgery diet:
- Should consist of soft food, avoid spicy or acidic foods
- Consider drinking protein shakes as these provide you with all
the nutrients you need in an easily consumable form
- Do not use a straw as this can lead to dry socket
6) Prepare Recovery space:
- Prepare bed and living spacer for the period of rest that will
follow your surgery
- Use old pillowcases to prop yourself up as you won’t be able to
lie flat
- Have several things in close reach to you to keep you busy
The Tooth
Dental Anatomy
- Crown – Covered by enamel, projects beyond the gumline
- Neck – The part between the crown and the root
- Root – Embedded portion of the tooth
- Enamel – The hardest substance in the body, covers the crown
- Dentine – The calcified tissue surrounding the pulp cavity. This
substance gives the bulk portion of the tooth
- Pulp Cavity – Central cavity of the tooth in which is the pulp
- Root Canal – The passage in the root through which its nerves
and blood vessels enter the pulp cavity
- Gum Tissue – The fleshy tissue that covers the jawbones around
the bases of the teeth
- Cement – The bone-like substance that covers the root of the
teeth
- Vessels – Tubular structures that transport bodily fluids, such as
the blood
- Bone – Dense, semirigid, porous, calcified connective tissue that
makes up a large part of the skeleton of most vertebrates
Role of the Teeth
- Teeth are hard structures that aid chewing food, gives shape to
our face, and helps in speaking clearly
- Primary teeth appear around the age of six months and start to be
replaced by age 6
 - The tooth buds which will later form the permanent teeth are
located below the primary teeth, therefore neglecting baby teeth
will lead to a lifetime of dental problems
o This is because the baby teeth guide the growth and
development of the jaws – could lead to crowding
- The second set of teeth are called the permanent set. Consists of
32 teeth. These form slowly and push up through the gums.
- Permanent molars appear behind the primary molars
- 8 bicuspids take over the space of the 8 primary molars
- Incisors and cuspids replace teeth of the same kind
- The roots are reabsorbed into the gums
- The first permanent teeth to come out are the 6es
- The upper canines are the last teeth to be lost
- By the age of 11/13, all the teeth except the wisdom teeth are in
place
- The wisdom teeth appear later, or never
- Sometimes they are impacted (wedged in strange positions)
- Different teeth are adapted to handle food in different ways:
o Incisors – Chisel shaped, for biting off pieces of food
o Cuspids – Cone shaped, for grasping and tearing food
o Bicuspids/Molars – Have flattened surfaces, for grinding
- The enamel that covers the crown can be broken down by acids
in the mouth. This is called tooth decay
- To prevent decay, a good level of oral hygiene is required
Differences between Permanent and Primary Teeth
- 20 Primary teeth, 32 permanent teeth
- 2 incisors, 1 cuspid, 2 molars in a primary quadrant, 2 incisors, 1
cuspid 2 premolars and 3 molars in a permanent quadrant
- Primary teeth are all smaller than the permanent teeth that
replace them
- The cusps are more pointed, and the crowns are more bulbous,
they have smaller contact areas than permanent
- The enamel is less transparent, which is why they have a more
whitish, milky appearance. Permanent teeth are more blueish
white due to the enamel being more transparent
- Primary roots are smaller than the permanent ones, the molar
roots diverge to give space for the developing primary teeth.
 Permanent roots are longer and stronger. They have a trunk,
where the roots do not diverge.
- The enamel is more permeable than in permanent teeth which
means that it is less calcified and shows attrition to a greater
degree.
Effective Tooth Brushing
- Patients must be able to brush their teeth effectively to maintain
good oral hygiene and to prevent caries
- Patients should develop a good sequence of brushing:
1) Start with the upper arch of the teeth. Clean the posterior buccal
surfaces and come round to the anterior surfaces on both sides.
2) Move on to the anterior and posterior palatal surfaces.
3) Brush all occlusal surfaces
4) Clean the posterior buccal surfaces of the lower arch, then move
to the anterior surfaces
5) Move on to the lingual surfaces of the teeth.
6) Finish by brushing all the occlusal surfaces.
- The average brushing time is 45-60 seconds which is not enough
to properly remove all plaque
- Dentists recommend 3 minutes of brushing time, but with
correct techniques 2 minutes should be enough
- Should brush twice a day, once in the morning and again before
bed
- Ideally should brush after every meal
Tooth Developmental Disorders
- Anodontia – Having a complete lack of teeth. This is very rare.
- Hypodontia – Missing one or more teeth. Caused by the absence
of dental lamina which can be caused by infection,
chemotherapy drugs or certain disorders such as Trisomy 21.
Causes visible spacing in the mouth.
- Hyperdontia – Having more teeth than usual. Occurs more
frequently in people from Asian backgrounds. In 86% of cases
the extra tooth is a maxillary incisor. It is caused by having an
excess of dental lamina.
- Dilaceration – Characterised by a severe bend on the root of the
tooth. It is caused by trauma that hits the developing tooth bud,
moving it slightly out of place. It can also be caused by cysts or
tumours.
- Regional Odontodysplasia – Developmental disturbance of the
teeth, leading to the cusps not erupting fully and therefore gives
the look of wispy “ghost” teeth. Exact cause is unknown but is
likely to be caused by things such as mouth infections and
radiation to the jaws.