Human Teeth

Grays Anatomy
Except in mankind, teeth are necessary for survival in most mammals and other
vertebrates, and longevity is related to the endurance of the dentition under the abrasive process of
mastication. In non-mammalian vertebrates, teeth are constantly replaced, a condition known as
polyphyodonty, related to the need for successively larger teeth in animals which grow throughout
life. In mammals, where skeletal growth is typically limited to an early period of life, there are
generally two dentitions, the first deciduous and the other permanent, the condition of diphyodonty;
in some mammalian species, e.g. the rat, there is only one set (monophyodonty, there being
continuous growth of individual teeth. Emergence and success of the phyodonty was probably
related to the evolution of occlusion during mastication in non-mammalian vertebrates, the !aw !oint
is formed between the "uadrate bone of the upper !aw and the articular bone of the lower one,
structures homologous respectively with the incus and malleus of mammalian skulls.
#he evolution of mammals was associated with the posterosuperior growth of the
dentary bone (one of several lower !aw elements existing in all non-mammalian vertebrates towards
the s"uamosal, a bone homologous with the s"uamous temporal in most mammals. In accord with
this skeletal changes, the !aw muscles were also rearranged to move the mandible (now formed
entirely by the dentary transversely. #ogether with these trends, there was a change in the shape of
the teeth; from the simple conical structures of reptilian ancestors, mammals involved teeth with
complex sharing plans. $ateral movements of the mandible were now possible, allowing the lower
teeth to grind across the upper to produce a more effective trituration.
%fter a few months of active use, the newly erupted teeth in mammals are worn to
produce precisely matching upper and lower shearing edges. % continued eruption of new teeth
would constantly disrupt this relationship and therefore be disadvantageous. &owever, because of
the need to accommodate teeth in small, young !aws, a deciduous dentition is an almost universal
re"uirement in mammals. 'ith this reduction of replacement, dental tissues evolved to minimi(e
the effects of wear. #hus a harder, thicker enamel emerged in mammals, with a prismatic structure
which evolved and diversified into a variety of complex and distinctive patterns to resist wear and
breakage through fracture, and produce sharp cutting edges.
#he introduction of refined carbohydrates in the human diet has made human teeth
susceptible to caries and periodontal disease. )utside human culture such dental impairment would
probably have led to extinction, but this problem has to some extent been overcome by breaking
down, softening or in a sense predigesting food by cooking and other types of culinary preparation.
*evertheless, chewing does facilitate the digestion of most foods, including cooked meat and
vegetables and the natural dentition comminutes food much more efficiently than an artificial
replacement. &owever, teeth are no longer vital to survival and therefore selective pressure leading
to further evolutionary change in the human dentition will probably be limited.
General arrangement of dental tissues
% tooth consists of a crown, covered by very hard translucent enamel and a root covered
by yellowish bone-like cement. #hese meet at the neck or cervical margin. % longitudinal section
reveals that a tooth is mostly dentine (ivory with enamel covering about +., mm thick, while the
cement is usually much thinner. #he dentine contains a central pulp cavity, expanded at its
coronal end into a pulp chamber and narrowed in the root as a pulp canal, opening at or near its tip
by an apical foramen, occasionally multiple.
#he root is surrounded by alveolar bone, its cement separated from the osseous socket
(alveolus by the soft periodontal ligament, about -.. mm thick. /oarse bundles of collagen fibres,
embedded at one end in cement, cross the periodontal ligament to enter the osseous alveolar wall.
In most non-mammalian vertebrates teeth are rigidly connected directly to bone, a rather brittle
attachment. )nly in mammals does a periodontal ligament provide an independent, tough
suspension for each tooth. *ear the cervical margin, the tooth, periodontal ligament and ad!acent
bone are covered by the gingiva (gum, clearly recogni(able in health by its pale pink, stippled
appearance.
#his is continuous at the mucogingival !unction with the red, smooth oral mucosa lining
much of the oral cavity and is adherent to the tooth near the cervical margin by an epithelial
attachment. #he pulp is a connective tissue, continuous with the periodontal ligament via the apical
foramen. It contains vessels for the support of the dentine and sensory nerves.
The central incisior
#he central incisors play a leading part in showing the physical character of a person. #hey
are the first to be seen, and, as they can raise a lot of profound and complex problems, they
represent the touchstone of all dentists. #hey support the lips while smiling and through si(e, shape
and colour concentrate an important assessment of the entire arch.
0esides the general characteristics, there are some situations when a smaller or a greater
number of morphological features can be different from normal.
1ome authors established different connections between the shape of the front teeth and the facial
shape, or the general configuration of the body.
Restoring a Tooth
#he first step in restoring a tooth is to determine the extent of decay. 'e do this with an x-
ray. #o the left, you see a large area of decay in the bottom tooth, second from the right. #he bright
areas in the teeth are all old amalgam fillings. #he decay is seen as the dark area to the left of the
amalgam in that tooth. #he dark area in the center of the teeth are where the nerves are located. 2ou
can see that the decay has gotten very close to the nerve.
%fter the patient has been made numb, the tooth is prepared with a high speed hand piece
removing all the old fillings, and all the decayed areas in the tooth. %fter the tooth is completely
clean, all the holes are filled with light cured composite, and the tooth is carved to resemble the
form it had before the decay occurred. #his tooth looks wonderful now, but it is important to
remember that the original decay was very close to the nerve, and it is not possible to guarantee that
the nerve will not become inflamed and start to swell causing a toothache later.
#he white covering on the tooth is called enamel. It really is white in color, but somewhat
translucent and allows the color of the underlying structures to shine through. It is also very hard
and "uite resistant to acid attack. #he brownish yellow material underlying the enamel is called
dentin, and it too is hard, but it is much less hard than enamel.
#he dentin has a density like that of hard bone. It is much less resistant to acid attack.
3nderlying the dentin is the nerve of the tooth. #he nerve is actually a complex organ. In a healthy
state, it is pink and soft, like the lining of your mouth, and is composed of blood vessels, connective
tissue and, of course, nerve fibers. #he dentin is permeated with thousands of tiny tubules which
run perpendicularly from the nerve to the enamel4dentin interface, and also to the outer surface of
the root in areas which are not covered by enamel. #hese tubules are filled with fluid. #he fluid is
actually contained within tiny pro!ections from cells that line the inside of the nerve space. #hese
cells are part of the nerve complex and are called odontoblasts.
#ouching the living dentin produces movement of the fluid in the tubules which transmits
impulses back to the nerve making the dentin sensitive to any type of direct stimulus. 0ecause of
the presence of these tubules, the dentin is actually "uite permeable to fluids.
*ote that while the hole in the enamel is relatively small, the decay has rapidly progressed
within the dentin to a much larger extent due to the relative softness and permeability of the dentin
as compared with the enamel. #he decay has a tendency to spread along the dentinal tubules from
the enamel surface toward the nerve from which the tubules arise. #here are a number of treatment
options for any damaged tooth. #he choice of restoration depends on the extent of the damage. 2our
dentist will discuss with you which type of restoration is most suitable.