Monday, January 9, 2023

mouth, lips and teeth

Mouth

The mouth, also known as the buccal cavity (Latin bucca= cheek) or oral cavity (Latin cavum oris), is the opening through which humans take in food and issue vocal sounds called voice. It is the cavity found at the upper end of the alimentary canal, bounded on the outside by the lips and inside by the pharynx and containing the tongue and teeth. 

Lips

The lips are two fleshy folds that surround the oral orifice. They are covered on the outside by skin and are lined on the inside by mucous membrane. The substance of the lips is made up by the orbicularis oris muscle and the muscles that radiate from the lips into the face. Also included are the labial blood vessels and nerves, connective tissue, and many small salivary glands. The philtrum is the shallow vertical groove seen in the midline on the outer surface of the upper lip. Median folds of mucous membrane-the labial frenulae, connect the inner surface of the lips to the gums.

The Mouth Cavity

The mouth extends from the lips to the pharynx. The entrance into the pharynx, the oropharyngeal isthmus is formed on each side by the palatoglossal fold. The mouth is divided into the vestibule and the mouth cavity proper.

Vestibule

The vestibule lies between the lips and the cheeks externally and the gums and the teeth internally. This slit like space communicates with the exterior through the oral fissure between the lips. When the jaws are closed, it communicates with the mouth proper behind the third molar tooth on each side. The vestibule is limited above and below by the reflection of the mucous membrane from the lips and cheeks to the gums.

The lateral wall of the vestibule is formed by the cheek, which is made up by the buccinator muscle and is lined with mucous membrane. The tone of the buccinator muscle and that of the muscles of the lips keeps the walls of the vestibule in contact with one another. The duct of the parotid salivary gland opens on a small papilla into the vestibule opposite the upper second molar tooth.

Mouth Proper

The mouth proper has a roof and a floor. The roof of the mouth is formed by the hard palate in front and the soft palate behind. The floor is formed largely by the anterior two thirds of the tongue and by the reflection of the mucous membrane from the sides of the tongue to the gum of the mandible. A fold of mucous membrane called the frenulum of the tongue connects the undersurface of the tongue in the midline to the floor of the mouth.

Lateral to the frenulum the mucous membrane forms a fringed fold, the plica fimbriata. The submandibular duct of the submandibular gland opens onto the floor of the mouth on the summit of a small papilla on either side of the frenulum of the tongue .The sublingual gland projects up into the mouth, producing a low fold of mucous membrane, the sublingual fold. Numerous ducts of the gland open on the summit of the fold.

Mucous Membrane of the Mouth

In the vestibule, the mucous membrane is tethered to the buccinator muscle by elastic fibers in the submucosa that prevent redundant folds of mucous membrane from being bitten between the teeth when the jaws are closed. The mucous membrane of the gingiva, or gum, is strongly attached to the alveolar periosteum.

Sensory Innervation of the Mouth

Roof: The greater palatine and nasopalatine nerves from the maxillary division of the trigeminal nerve.

Floor: The lingual nerve (common sensation), a branch of the mandibular division of the trigeminal nerve. The taste fibers travel in the chorda tympani nerve, a branch of the facial nerve.

Cheek: The buccal nerve, a branch of the mandibular division of the trigeminal nerve and the buccinator muscle by the buccal branch of the facial nerve

The Teeth

Deciduous Teeth- There is 20 deciduous teeth in each jaw-

·        4 incisors

·        2 canines

·        4 molars  

They begin to erupt about 6 months after birth and have all erupted by the end of 2 years. The teeth of the lower jaw usually appear before those of the upper jaw. Permanent Teeth- There are 32 permanent teeth: in each jaw these are as follows-

·        4 incisors

·        2 canines

·        4 premolars

·        6 molars

They begin to erupt at 6 years of age. The last tooth to erupt is the third molar, which may happen between the ages of 17 and 30. The teeth of the lower jaw appear before those of the upper jaw.

Parts

Enamel is the hardest and most highly mineralized substance of the body. It has its origin from oral ectoderm. It is one of the four major tissues which make up the tooth, along with dentincementum, and dental pulp. It is normally visible and must be supported by underlying dentin. 96% of enamel consists of mineral, with water and organic material comprising the rest.

The normal color of enamel varies from light yellow to grayish white. At the edges of teeth where there is no dentin underlying the enamel, the color sometimes has a slightly blue tone. Since enamel is semi translucent, the color of dentin and any restorative dental material underneath the enamel strongly affects the appearance of a tooth. Enamel varies in thickness over the surface of the tooth and is often thickest at the cusp, up to 2.5mm, and thinnest at its border, which is seen clinically as the CEJ. The wear rate of enamel, called attrition, is 8 micrometers a year from normal factors.

Enamel's primary mineral is hydroxyapatite, which is a crystalline calcium phosphate. The large amount of minerals in enamel accounts not only for its strength but also for its brittleness. Dentin, which is less mineralized and less brittle, compensates for enamel and is necessary as a support. 

Unlike dentin and bone, enamel does not contain collagenProteins of note in the development of enamel are-

·        ameloblastins

·        amelogenins

·        enamelins  

·        tuftelins

These proteins help in the development of enamel by serving as framework support, among other functions. In rare circumstances enamel can fail to form, leaving the underlying dentine exposed on the surface.

Dentin

Dentin is the substance between enamel or cementum and the pulp chamber. It is secreted by the odontoblasts of the dental pulp. The process is known as dentinogenesis. The porous, yellow-hued material is made up of the following-

·        Inorganic materials

70%

·        Organic materials

20%

·        Water by weight

10%. 

Because it is softer than enamel, it decays more rapidly but dentin still acts as a protective layer and supports the crown of the tooth. Dentin is a mineralized connective tissue with an organic matrix of collagenous proteins. Dentin has microscopic channels, called dentinal tubules, which radiate outward through the dentin from the pulp cavity to the exterior cementum or enamel border. The diameter of these tubules range from 2.5 μ near the pulp, to 1.2 μ in the mid portion, and 900 nm near the dentino-enamel junction. Length is variable. These tubules do not intersect with each other.

Types of dentin

There are three types of dentin-

·        Primary

·        Secondary  

·        Tertiary 

Primary dentine is original structure. Secondary dentin is a layer of dentin produced after root formation and continues to form with age. Tertiary dentin is created in response to stimulus, such as cavities and tooth wear.

Cementum

Cementum is a specialized bone like substance covering the root of a tooth. It is composed approximately of the following-

·        Inorganic material mainly hydroxyapatite

45% 

·        Organic material mainly collagen

33%

·         Water

22%

Cementum is excreted by cementoblasts within the root of the tooth and is thickest at the root apex. Its coloration is yellowish and it is softer than dentin and enamel. The principal role of cementum is to serve as a medium by which the periodontal ligaments can attach to the tooth for stability.

At the cement to enamel junction, the cementum is acellular due to its lack of cellular components, and this acellular type covers at least ⅔ of the root. The more permeable form of cementum, cellular cementum, covers about ⅓ of the root apex.

Dental pulp

The dental pulp is the central part of the tooth filled with soft connective tissue. This tissue contains blood vessels and nerves that enter the tooth from a hole at the apex of the root. Along the border between the dentin and the pulp are odontoblasts, which initiate the formation of dentin. Other cells in the pulp include fibroblasts, preodontoblasts, macrophages and T lymphocytes. The pulp is commonly called the nerve of the tooth.


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