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Anatomy and morphology

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Types of Dentition
1. Deciduous (baby) teeth a. Twenty ( 20) primary teeth. b. Arches - maxillary and mandibular. c. Quadrants - each arch divided in half. (1) Maxillary right and left. (2) Mandibular right and left.
Enamel is thinner, pulp is thicker

Deciduous Teeth
d. Teeth in each quadrant. (1) Central incisor (2) Lateral incisor (3) Cuspid (4) 1st molar (5) 2nd molar

Types of Dentition
2. Permanent teeth. a. Thirty-two (32) permanent teeth. b. Arches - maxillary & mandibular.

Permanent Teeth
c. Quadrants. (1) Maxillary right and left.
(2) Mandibular right and left.
R L

Permanent Teeth
d.

Teeth in each quadrant.

(1) Central incisor. (2) Lateral incisor. (3) Cuspid (canine).

Permanent Teeth
(4) (5) (6) (7) (8) 1st bicuspid 2nd bicuspid 1st molar 2nd molar 3rd molar (wisdom tooth)

Numbering or Coding Systems

Tooth Identification Systems

1.Palmer Notation System

2.Universal System
3.International FDI System (two digit system)

1-Palmer Notation System

for Permanent Teeth
1 1 2 3 3 2

Right
8-1
7 8 4 5 4

Left
1-8
5 6
7 8

8-1
1 2 3

5 4

1-8

It represents the four quadrants of the dentition

as if you are facing the patient.

In upper right In lower right In upper left In lower left

Horizontal and vertical lines = symbol for the quadrant

The permanent teeth are numbered from 1-8 on each side from the midline.
8 7 6 5 4 3 2 1

Upper right

1 2 3 4 5

Upper left

6 7 8

8 7 6 5 4 3 2 1

Lower right

1 2 3 4 5

Lower left

6 7 8

Palmer Notation System

for Primary Teeth
E-A
A B C D E

A-E

E-A

A-E

The deciduous teeth are lettered from A-E on each side from the midline Upper right E E D D C C B B A A A A B B Upper left C C D D E E

Lower right

Lower left

Palmer Notation System

2-The International Numbering System

FDI Federation Dentaire International

(the two digit system)

The teeth are designated by using two-digits:
a. The first digit of the code is located at the left side of the number and indicates the quadrant: In permanent dentition In deciduous dentition

U.R. 1
L.R. 4

2
3

U.L.
L. L.

U.R.
L.R.

5
8

6
7

U.L
L.L.

2-International For permanent Teeth System 12 11 21 22 13 23 (Two Digit System) 14 24 15 25 FDI 16

Federation Dentaire International

First Digit = quadrant

17 18
48

26 27 28

1 2 4 3

47 36 46 35 45 44 34 43 42 41 31 3233

38 37

Second Digit = Tooth number in the quadrant

b- The second digit is located at the right side of the number
and indicates the number of the tooth in the quadrant. The two digits should be pronounced separately.

Permanent teeth
18 17 16 15 14 13 12 11 48 47 46 45 44 43 42 41 21 22 23 24 25 26 27 28 31 32 33 34 35 36 37 38

2-International System (Two Digit System) FDI

Federation Dentaire First Digit = quadrant International

For Primary Teeth

52 53 54 55 51 61 62 63

64

5 8

65

First Digit = quadrant 5 8 6 7

85 84
83

7
75

74 82 81 71 72
73

For Primary Teeth First Digit = quadrant

5
8

6 7

Second Digit = Tooth number in the quadrant

Primary Teeth
55 54 53 52 51 85 84 83 82 81 61 62 63 64 65 71 72 73 74 75

Universal system for Permanent Teeth

Universal System for Primary Teeth

Mixed Dentition: Presence of both dentitions

Figure from Ten Cates Oral Histology, Ed., Antonio Nanci, 6th edition

Remember that during all these 3 stages is the progression that happens from primary to permanent dentition which involves the shedding (exfoliation) of primary teeth Dentition: Diphodont: two sets of dentition in humans Primary vs Secondary dentition Deciduous vs Permanent dentition Mixed dentition: presence of two dentition

Teeth in primary dentition are smaller and fewer in number than permanent dentition to conform to the smaller jaw size
Primary dentition: ~ 2 to 6 years of age Mixed dentition: ~ 6 to 12 years Permanent dentition: > 12 years

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

The rate of tooth eruption depends on the phase of movement

Intraosseous phase: 1 to 10 m/day

Extraosseous phase: 75 m/day Environmental factors affecting the final position of the tooth: Muscular forces Thumb-sucking

Clinical crown: During eruption, the exposed crown extending from the cusp tip to the area of the gingival attachment Anatomic crown: Entire crown, extending from cusp tip to the cementoenamel (CE) junction

Sequence and chronology of tooth eruption

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

The six/four rule for primary tooth emergence

Four teeth emerge for each 6 months of age 1. 2. 3. 4. 5. 6 months: 4 teeth (lower centrals & upper centrals) 12 months: 8 teeth (1. + upper laterals & lower laterals) 18 months: 12 teeth (2. + upper 1st molars & loer 1st molars) 24 months: 16 teeth (3. + upper canines & lower canines) 30 months: 20 teeth (4. + lower 2nd molars & upper 2nd molars)

Summary
1. 2. 3. 4. By 5 months in utero, all crowns started calcification By 1 year old, all crowns completed formation By 2.5 years, all primary teeth erupted By 4 years old, all primary teeth completed root formation

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

Chronology of Human Permanent Dentition

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

The rules of Fours for permanent tooth development (3rd molars not included)
At birth, four 1st molars have initiated calcification At 4 years of age, all crowns have initiated calcification At 8 years, all crowns are completed At 12 years, all crowns emerge At 16 years, all roots are complete

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

Rules of sixes in dental development

6 weeks old in utero: beginning of dental development 6 months old: emergence of the first primary tooth 6 years old: emergence of first permanent tooth

Source: http://www.columbia.edu/itc/hs/dental/d9903/lectures/lecture4.pdf

Problems of Primary Tooth Eruption

Natal and Neonatal Teeth

Submerged primary teeth

Hyper or supra eruption

Ankylosis

Source: Color atlas of clinical oral pathology. Neville, Damm and White. 2nd edition

Congenitally Missing Teeth

Cleidocranial Dysplasia

Osteopetrosis Defect in Osteoclasts