Lecture 1

Pathology of Teeth and

Supporting Structures
Prof. Kogan E.A.
2016
Theeth Anatomy
Teeth are firmly implanted in the jaw and are
surrounded by the gingival mucosa .
The anatomic crown of the tooth projects
into the mouth and is covered by enamel, a
hard, inert,acellular tissuethe most highly
mineralized tissue in thebody.
The enamel rests upon dentin, which is a
specialized form of connective tissue that
makes up most of the remaininghard-tissue
portion of the tooth. Unlike enamel, dentin is
cellular and contains numerous dentinal
tubules, which containthe cytoplasmic
extensions of odontoblasts.
Cells line the interface between the dentin
and the pulp and can, when properly
stimulated, produce new (secondary) dentin
within the interior of the tooth

The pulp chamber itself is surroundedby the

dentin and consists of loose connective
tissue stroma rich in nerve bundles,
lymphatics, and capillaries.
 Attachment
In mammals, teeth are attached to the alveolar
ridge of the jaws by the periodontal ligament,
which provides a strong yet fl exible attachment
that can withstand the forces of mastication. The
periodontal ligamentattaches to the alveolar
bone of the jaw on one side and to cementum,
present on the roots of the teeth, which acts as
a cement to anchor the periodontal ligament to
the tooth.
 CARIES (TOOTH DECAY)

Dental caries, caused by focal degradation of the tooth structure,

is one of the most common diseases throughout the
world and is the most common cause of tooth loss before age
35.
Carious lesions are the result of mineral dissolution of
tooth structure by acid metabolic end products from bacteria
that are present in the oral cavity and are capable of fermenting
sugars.
Traditionally, the rate of caries has been higher in
industrialized countries, where there is ready access to processed
foods containing large amounts of carbohydrates.
 Factors influence on
demographics of caries
The rate of caries has markedly dropped in countries
such as the United States, where improved oral hygiene and
fl uoridation of the drinking water has become a standard
practice.
Fluoride incorporates into the crystalline structure
of enamel, forming fl uoroapatite, and contributes to resistance
to degradation by bacterial acids.
Second, with globalization
of the worlds economy, increased amounts of processed
foods with high carbohydrate content are being imported into
developing nations. With these trends, one can expect the rate
of caries to increase dramatically in the less-developed world
over the next several decades
Types and stages of caries
Caries classification
Morphological stages of caries
Base and margines of caries
cavaty
Early caries
Superficial caries
Intermediate caries
Deep caries
Deep caries
Deep caries with pulpa penetration
Reactive changes
Reactive changes in pulpa
Reactive changes in pulpa
Acute and chronic appical pulpitis
Chron sup pulpitis appicalis
 GINGIVITIS

Gingiva is the designation of the

squamous mucosa in between the teeth
and around them.
Gingivitis is inflammation of the mucosa
and the associated soft tissues.
Typically, the development of gingivitis is
the result of a lack of proper oral hygiene,
leading to an accumulation of dental
plaque and calculus.
 Epidemiology of Gingivites
Gingivitis occurs at any age but is most
prevalent and severe in adolescence
(ranging from 40% to 60%), after which
the incidence tapers off. It is a reversible
disease;
 Dental plaque
Dental plaque is a sticky, usually colorless, biofi lm
that builds in between and on the surface of the teeth.
It is formed by a complex of the oral bacteria, proteins
from the saliva, and desquamated epithelial cells. If
plaque continues to build andis not removed, it becomes
mineralized to form calculus (tartar).
The bacteria in the plaque release acids from
sugarrich foods, which erode the enamel surface of the
tooth.
Repeated erosions lead to dental caries. Plaque
build-up beneath the gumline can cause gingivitis.
 Chronic gingivitis
Chronic gingivitis is characterized by
gingival
erythema,
edema,
bleeding,
Changes in contour,
loss of soft-tissue adaptation to the teeth.
 Therapy of Gingivites

Therapy is primarily aimed at reducing the

accumulation of plaque andcalculus via
brushing, fl ossing, and regular dental visit
 PERIODONTITIS

Periodontitis refers to an inflammatory process that

affects the supporting structures of the teeth:
periodontal ligaments,
alveolar bone,
cementum.

With progression, periodontitis can lead to serious

sequelae, including the loss of attachment caused by
complete destruction of the periodontal ligament and
alveolar bone.
Loosening and eventual loss of teeth are possible.
 Pathogenesis of Periodontitis
Until the 1960s it was believed that longstanding
gingivitis uniformly progressed to periodontal
disease. However, this is no longer thought to be the case.

Development of periodontal disease is now considered

to be an independent process, which, for reasons that
are still unclear, is associated with a marked shift in the
types and proportions of bacteria along the gingiva. This
shift, along with other environmental conditions such as
poor oral hygiene, is believed to be important in the
pathogenesis of periodontitis.
Periodontal and systemic diseases
Periodontal disease can also be a component of several different
systemic diseases, including acquired immunodefi ciency
syndrome (AIDS), leukemia, Crohns disease, diabetes mellitus,
Down syndrome, sarcoidosis, and syndromes associated
with polymorphonuclear defects (Chdiak-Higashi syndrome,
agranulocytosis, and cyclic neutropenia).

Periodontal infections can also be etiologic factors in several

important systemic diseases. These include, for example, infective
endocarditis, pulmonary and brain abscesses, and adverse
pregnancy outcomes.