Introduction to Dentistry

By MD Yohannes
AAU
June 2012
I. What is Dentistry?

• Dentistry: is a profession concerned with the prevention and

treatment of oral disease, including diseases of the teeth and
.
supporting structures and diseases of the soft tissues of the mouth
Medical Doctor Dentist

Dental Clinical Course

Clinical Courses

Dental Basic Courses

Basic Courses
II. Historical background
• It is believed that the Egyptians practiced oral surgery perhaps as early as 2500 BC.

• An early attempt at tooth replacement dates to Phoenicia (modern Lebanon) around

600 BC, where missing teeth were replaced with animal teeth and were bound into
place with cord.

• Numerous dental bridges and partial dentures of gold have been found in Etruscan
tombs (Italy), which date to about 500 BC.

• Early Chinese practiced some restorative dentistry as early as the year 200 BC, using
silver amalgam as fillings !!

• Because of the proscription in the Quran, against mutilating the body, surgery was not
practiced in Islamic countries. Instead, preventive dentistry through strict adherence
to oral hygiene became paramount. scaling and cleaning of teeth were practiced !!
 Dentistry in 19th century
• In 1896 American dentist Charles Edmund Kells introduced X-ray technology in
dentistry and thereby ushered in an era of accurate diagnosis of dental ailments.
• In 1903 American dentist Charles Land introduced the use of porcelain in crowns,
which led to a new era of aesthetic dentistry.
• In 1907 American dentist William Taggart introduced a precision casting machine
that allowed dentists to create gold restorations of great accuracy with a minimum of
tooth removal.
• In 1913 American dentist Edwin J. Greenfield demonstrated the first modern and
truly functional dental implant, paving the way for today’s highly successful implant
dentistry.
• The introduction in 1953 of the first commercially successful water-driven turbine
drill, developed by American dentist Robert Nelson, led the way to the high-speed
dental drill. The Borden air-turbine drill, introduced in 1957 and today used
universally, reaches speeds of up to 400,000 revolutions per minute and allows for
greater accuracy and control by the dentist and greater comfort of the patient.
• In the United States fluoridation was initiated in 1945, dental caries in children have
decreased by more than 50 percent since then.
 History of Dentistry in Ethiopia
• Ancient times dental practice in Ethiopia is not studied well.

• Egypt 2500BC dental practice------------Ethiopia ???

• Countryside Ethiopia, “WOGESHA” uses nails and pincers to

extract teeth.

• 1940-1949 EC Italian, Romanian & Greek Dentists Practiced in

Ethiopia Hospitals. [their identity is unclear !]

• 1949 EC Dr. Kefer German Dentist Practiced dentistry at Menelik

II Hospital.
• 1949 EC Dr. Nina Tiskana from Greek opened a private dental clinic
at “Piasa” and practiced for 15 years.

• 1956 EC The first Ethiopian Dentist Dr. Bekele Asfaw [a graduate from USA]
started to practice dentistry in Yekatit 12 & Menelik II Hospitals.

• 1979 EC The first dental education for Dental therapists was

provided at the Army hospital.

• 1983 EC The first Dental Therapist School was opened at Yekatit 12

Hospital with the help of the Italian Government.
o Since 1980 Dental Therapists.
o since 2001 Doctor of Dental Medicine [DDM]

• 1996 Jima Faculty of Dentistry opened.

 III. Why do we study Dentistry?

• because oral health affects general health by causing considerable pain and suffering and by
changing what people eat, their speech and their quality of life and well-being.

• Oral health affects people physically and psychologically and influences how they grow,
enjoy life, look, speak, chew, taste food and socialize, as well as their feelings of social well-
being

• Oral diseases are the most common of the chronic diseases and are major public health
problems because of their prevalence, their impact on individuals and society, and the
expense of their treatment.
• Children of three years of age with nursing caries weighed about 1 kg less than control
children because toothache and infection alter eating and sleeping habits, dietary
intake and metabolic processes. Disturbed sleep affects glucosteroid production. In
addition, there is suppression of haemoglobin from depressed erythrocyte production.

• Dental problems that cause chewing to be painful affect intake of dietary fiber and
some nutrient-rich foods; consequently, serum levels of beta carotene, foliate and
vitamin C were significantly lower in those with poorer oral status

• Because of the failure to tackle social and material determinants and incorporate oral
health into general health promotion, millions suffer intractable toothache and poor
quality of life and end up with few teeth in developing countries including Ethiopia .
IV. Subspecialties in Dentistry
• Dentistry also encompasses the treatment and correction of malformation
of the jaws, misalignment of the teeth, and birth anomalies of the oral cavity
such as cleft lip and palate.

• dentistry includes many specialties and subspecialties, including:

1. Orthodontics and dental Orthopedics.

2. Pediatric dentistry
3. Periodontics
4. Prosthodontics
5. Oral and maxillofacial surgery.
6. Endodontics
7. Public health Dentistry
8. Oral and maxillofacial pathology
9. Oral and maxillofacial radiology
10. Implantology ……….etc……….
 Orthodontics
formerly orthodontia (from Greek orthos "straight or proper or perfect"; and
odous "tooth") takes as its aims the prevention and correction of malocclusion
(improper bites), of the teeth and associated dentofacial incongruities.

• Orthodontic treatment can focus on dental displacement only, or can deal with the
control and modification of facial growth. In the latter case it is better defined as
"dentofacial orthopaedics".

• Orthodontics has been practiced since ancient times, but methods of treatment
involving the use of Fixed and removable appliances have been prominent only
since the beginning of the 20th century.
 Prescribe medicine

Internist

prescribe force

Orthodontist
 Removable appliance
Force
Fixed appliance
 Removable Appliances

 generate force that can induce or suppress teeth and/or

anatomical structure in a certain direction.

 There are different kinds of appliances

 Fixed Appliances

• generate force that can move teeth in three planes of

space vertically , apically & rotationally .

• Brackets + Arch wires

 Prosthodontics

 part of Dentistry pertaining to the restoration and maintenance of oral function,

comfort, appearance, and health of the patient by the replacement of missing
teeth and tissues with artificial materials.

 Prosthodontics has three branches:

1) Removable Prosthodontics
2) Fixed Prosthodontics
3) Maxillofacial prosthetics.
 Periodontics

 Part of Dentistry pertaining to the examination, diagnosis, and treatment of

diseases affecting the Periodontium (supporting structures of the teeth).
 Endodontics
is one of the dental specialties that deals with the tooth pulp and
disease of its surrounding
 • Root canal therapy is one of the most common procedures. If
the pulp (containing nerves, arterioles, veins, lymphatic tissue, and
fibrous tissue) becomes diseased or injured, endodontic
treatment is required to save the tooth.

Periapical abscess
Caries / Decay nerve & vessels filling material
  Oral Medicine
• Oral medicine is concerned with clinical diagnosis and non-surgical management of non-
dental pathologies affecting the oral and maxillofacial region, such as oral lichen planus,
Behçet's disease and pemphigus vulgaris.

• Moreover, it often involves the diagnosis and follow-up of pre-malignant lesions of the
oral cavity, like leukoplakia or erythroplakia

•Oral medicine is the dental specialty placed at the interface between medicine and
dentistry

leukoplakia
 Oral and Maxillofacial Surgery

 is surgery to treat many diseases, injuries and defects in the head, neck, face,
jaws and the hard and soft tissues of the oral (mouth) and maxillofacial (jaws
and face) region.

It is an internationally recognized surgical specialty.

In some countries, including the United States, it is a recognized specialty of

dentistry; in others, including the UK, it is recognized as a medical specialty.
V. Course objective and content

o objective
 To give a brief introduction about the content of Dentistry.

 To introduce the different subspecialties of Dentistry.

 To create familiarity on the methods used to prevent, diagnose and treat dental
diseases.

 To make students familiar with the common instruments and appliances that are
used in dental treatment and researches.

To give students the chance of observation and close study to the dental
treatment procedures that are used in the Dental School of AAU.
 o Content
1. Anatomy of the Oral cavity 9. Odontogenic infections

2. Nomenclature 10. Trauma of the Teeth and orofacial

regions.
3. Examination of Dental patients
11. congenital malformations
4. Disease of hard tissue of the teeth
12. principles of preventive dentistry
5. Disease of Dental pulp

6. Periodontal diseases (Gingivitis and

periodontitis)

7. Anesthesia consideration in dental practice

8. Tooth extraction
Exam

• Multiple choices

• Matching

• Definitions

• simple essay questions….

• Total about 100 questions

 Bridge

Partial denture
Silver Amalgam fill
 Porcelain crown

Porcelain utensils
Dental Implant
Dental Drill / Handpiece
 Dental caries

Rampant dental caries

Malocclusions
Removable appliances
Fixed appliance
Removable Prosthesis
Fixed Prosthesis
Maxillofacial prosthetics
 The Periodontium tissues that surround and support the teeth.

1. Gingiva

2. Periodontal ligament

3. Alveolar bone

4. Cementum
Nursing Caries / Baby bottle caries
Anatomy of the Oral Cavity

BY: MD Yohannes
AAU
April 2012
Oral Cavity: refers to the inner
portion of the Mouth.

Borders

Anteriorly: lips

Posteriorly: Oro-pharynx or throat

Superiorly: Palate

Inferior: Tongue with musculature

beneath it.

Bilaterally: Cheeks
 Oral Cavity Proper

Divisions of Oral cavity

Oral vestibule: the area between

the inner side of the lip, or buccal
mucosa and facial surface of the
teeth.

Oral Cavity Proper: extends from

the lingual surface of the teeth to
the oro-pharynx.
 Oral mucosa

• Is a membrane, composed of stratified Squamous epithelium

and the underlying lamina propria.

• The Oral mucosa is pink and occurs in various degree of

thickness.

• It acts as the protective covering for the Oral cavity.

• There are 3 types of Oral mucosa:

1. Masticatory mucosa: covers areas subjected to stress, such as hard palate and Gingiva.
2. Specialized mucosa: covers dorsum of the tongue that has tasting function.
3. Lining mucosa: covers the rest of the oral cavity.
Structure of Oral vestibule
1. Frenum
• Superior labial frenum
• Inferior labial frenum
• Buccal frenum

2. Maxillary tuberosity

3. Retromolar area

4. Gingiva
 Structure of Oral Cavity proper
ROOF
1. Incisive papilla: small raised soft tissue that
labial frenum covers incisive foramen.
Vestibule

2. Palatine rugae: folds of soft tissue on the

anterior portion of the palate.
Buccal frenum

3. Palatine raphe: a junction of soft tissue

Hard palate extending along the entire midline of the hard palate.

4. Fovea palatinus: small indentations , one on

either side of the raphe, located at the junction of
Soft palate:
the hard and soft palate.
posterior third
of the palate. 5. Uvula: A downward projection of the soft palate
made up of connective tissue, muscles, and glands.
 Fauces .
the archway between the pharyngeal & oral cavities; formed by the tongue, anterior tonsilar pillars, and soft palate.

(anterior tonsilar pillar): extends

horizontally from the uvula to the base of
the tongue.

(posterior tonsilar pillar): extends from the

palate to the pharynx.
Tongue .

Epiglottis
Foramen caecum

Circumvallate Papillae: Bitter

Filiform Papillae: rarely Taste buds: are

located in the
papillae
Foliate Papillae: sour

Fungiform Papillae: Sweet, sour,

salty

Function of the tongue:

• tasting
Median sulcus • speech
• Assist during mastication
• Assist during deglutition
 Floor of the Mouth .

Lingual frenum: Elevated fold of soft tissue that

extend from central incisors to tongue undersurface.

Sublingual fold: contains duct opening of

salivary glands called Duct of Rivinus.

Sublingual caruncles: duct opening of

sublingual and submandibular salivary glands..
 Functions of Oral Cavity

1. Chewing of food, or mastication.

2. Tongue is the test organ.

3. Provides an air passage.

4. Speech.
Anatomy of the Tooth

BY: MD Yohannes
AAU
April 2012
 Classification, Function & Numbering of Dentition

• Dentition:
• Primary / Deciduous (Milk teeth) 6mo—2yr #20

• Transition / Mixed 6yr --- 12yr

• Succedaneous / Permanent 6yr—23yr #32

Primary dentition
Permanent Dentition
 Total # Function Cusp Roots

•incising or cutting food

Incisors 8 • Speech 1
• Profile

Canine 4 • Tear / Puncture / pierce 1 1

food

Premolars 8 Assist Canines and also 2 1-2

grind food

Molars 8--12 grind food 4--5 2-3

• Function of Teeth

1. Mastication

2. Pronunciation and Speech

3. keep facial Profile aesthetic & the cheek full.

 Tooth numbering System/ nomenclature
• Short hand- useful for recording data.

1. Position recording system:

 Upper arch
Right 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Left
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
Lower arch
Permanent Dentition

Ua
Rt V IV III II I I II III IV V Lt
V IV III II I I II III IV V
La
Primary Dentition
 continued........

• IV B quadrant the 4th deciduous tooth (left upper 1st primary molar )

• II Right lower primary lateral Incisor.

• 8 Right upper permanent 3rd molar

• III mandibular left deciduous canine

• 5
7 ??
 2. Palmer notations

Right 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Left
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
Lower arch
Permanent Dentition

Ua
Rt E D C B A A B C D E Lt
E D C B A A B C DE
La
Primary Dentition
 3. Universal Numbering System

Right 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Left
32 31 30 29 28 27 2625 24 23 22 21 20 19 18 17
Lower arch
Permanent Dentition

Ua
Rt AB C D E FG H I J Lt
TS R Q P ONM LK
La
Primary Dentition
 4. Federal Dentaire International System (FDI)

Upper arch
Right 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 Left
48 47 46 45 44 43 42 41 31 32 33 34 35 36 3 7 38
Lower arch
Permanent Dentition

Ua
Rt 55 54 53 52 51 61 62 63 64 65 Lt
85 84 83 82 81 71 72 73 74 75
La
Primary Dentition
• Example:

21 = maxillary left 1st tooth (central incisor).

46 = mandibular right 6th tooth (1st molar)

73= Mandibular left 3rd milk tooth (deciduous left mandibular canine)

85= ?
Constituents of Tooth
1.Surface Structure

Cementoenamel Junction
(CEJ), cervical line
 Anatomical crown
1. Crown
Clinical Crown

Anatomical Root
2. Root
Clinical Crown

3. Neck
2. Cross sectional structure
 Enamel
• The hardest tissue in the body
•96% inorganic
Enamel •Has a thickness of 2-2.5 mm

Dentin
• harder than bone
•70% inorganic
•Located beneath the enamel and
Pulp
dentin

Dentin Cementum
• same density as bone
Cementum
•50% inorganic
•Forms a thin layer over the roots
•Has a thickness of 0.05mm.
•Attaches the tooth to the bone by tiny
fibers called Sharpey’s fibers.
 Chronology of tooth development

• Calcification: is the deposition of Calcium salts in an organic matrix to form tooth bud inside the
maxilla and mandibular alveolar process.---------------------------------
Each tooth has got its own specific time for calcification.------------------------------

Knowledge of the calcification time is helpful for assessing the dental as opposed
to chronological age.
 • Eruption: is the migration of a tooth from within its follicle in the alveolar process of the
maxilla and the mandible into the oral cavity.-----------------------------------------------------------

• Teeth eruption has the following physiological characteristics:------------------------------------------

--
1. Tooth Eruption has a specific eruption time and sequence.-----------------------------------

2. A mandibular tooth usually erupts earlier than its counter maxillary tooth- -------

3. Eruption happens symmetrically at the same time on each side of the arch-------------
Chronology of human dentition - deciduous teeth
Calcification Eruption
(weeks in Utero) (Months)

Central incisors (I) 12-16 6-7

Lateral Incisors (II) 13-16 7-8

Canines (III) 15-18 18-20

First molars (IV) 14-17 12-15

Second molars (V) 16-23 24-36

Root calcification complete 1-1.5 years after eruption

 Chronology of human dentition - Permanent teeth
Calcification (months) Eruption (years)
11 / 21 3 –4 7– 8
12 / 22 10–12 8–9
13 / 23 4 –5 11–12
14 / 24 18–21 10–11
15 / 25 24–27 10–12
16 / 26 Around birth 5–6
17 / 27 30–36 12–13
18 / 28 84–108 [9 yrs] 17–25

31 / 41 3-4 6–7
32 / 42 3-4 7–8
33 / 43 4-5 9–10
34 / 44 21-24 10–12
35 / 45 27-30 11–12
36 / 46 Around birth 5–6
37/ 47 30-36 12–13
38 / 48 96-120 [10yrs] 17–25
Root calcification complete 2-3 years after eruption
 The Periodontium tissues that surround and support the teeth.

1. Gingiva

2. Periodontal ligament

3. Alveolar bone

4. Cementum
 I. Gingiva
• The only part of the Periodontium
visible in the oral cavity.

• Made of epithelial tissue covered with

mucosa.

• Attaches to the underling bone,

surrounds the tooth, and fills the
interproximal space.

• Divides into free/marginal Gingiva &

attached Gingiva.
 • Free or marginal Gingiva is unattached
Gingival crest
on the inner surface, creating a space
called Sulcus.

• In normal condition Sulcus has a depth

of 1.2 to 1.8mm

• Attached Gingiva is the pale pink

structure 1.6mm from the gingival
crest.

• It extends apically from the gingival

groove, adhering tightly to the bone
beneath it.

• It extends apically 3 – 9 mm to merge

with the alveolar mucosa at
mucogingival junction.
 II. Cementum: part of the tooth
structure, also considered as constituent
of the Periodontium because it contains
fibers extending to the periodontal
ligament that hold the teeth in the socket.

Gingival group
Alveolar crest group
III. Periodontal Ligament: part of
Horizontal group
the tooth structure, also considered as
constituent of the Periodontium because it
contains fibers extending to the periodontal
Oblique group
ligament that hold the teeth in the socket.
Apical group

Periodontal Ligament
 IV. Alveolar Process:

 separated from the roots by the

periodontal ligament.
Lamina dura
 composed of two layers of bone tissue:

1. Compact or cortical bone

2. Cancellous or trabecular bone

 Nomenclature
• Applicable terminologies:
1. Median line: Line extending b/n the eyes, nasal apex, left and right medial
incisors.
2. Long axis: Imaginary line that pass through the center of crown and root.
3. Contact area: the contact point between two neighboring teeth.
4. Height of contour: the most protruded part of each axial face of the tooth.
 5. Line angle: The angle formed by the contact of 2 crown faces.
Point angle: The angle formed at the contact point of three crown faces.
6. Division into thirds: for better description of each tooth face.
• Faces of the Crown
 •Elevated parts of the crown

1. Dental Cusp: cone shape elevation. Found at tip of canine, occlusal surface
of premolars and molars.
2. Mamelon: lob like structure seen at the newly erupted incisors, gradually it
diminishes due to abrasion.
3. Cingulum/ Girdle: lingual lobe of anterior tooth. It is the anatomical characteristic
of ant. teeth
4. Ridge: any linear elevation on the surface of the tooth and is named according
to its location (e.g. buccal, incisal, or marginal)
 •Triangular ridge: a thin long elevated structure at the occlusal surface of molar
and premolar teeth formed by the junction of neighboring inclined surfaces. (purple line)
•Cusp ridge: a ridge extend from the tip of a cusp to distal or proximal direction
of the occlusal surface. (black line)
 transverse ridge: elevated thin enamel that connects the opposite triangular
ridge. It is an important anatomical characteristics of lower first premolar.
 Oblique ridge: elevated thin enamel line that connects two obliquely positioned
triangular ridges. It is an important anatomical characteristics of maxillary 1st molar.
 • Crown Concavities

• 1. Groove: a thin and long depression found at axial and occlusal surface lying
between cusps and ridges. [it is like a stream between hills]

– Developmental groove: A developmental groove is the junction line

between the inclined walls of a Sulcus. Developmental grooves represent
lines of union between lobes of the crown during its formation. These
grooves appear on labial, occlusal, buccal, and lingual surfaces, and are
least apparent on the labial aspect of anteriors.
– Supplemental Groove : A minor, auxiliary groove that branches off from a
much more prominent developmental groove. Supplemental grooves do not
represent the junction of primary tooth parts.
– Fissure : A linear fault that sometimes occurs in a developmental
groove. A fissure represents a lack of union between the inclined walls
of a Sulcus.

Supplemental grooves

Developmental grooves

Fissure
2. Pit : a small, pinpoint fault on the surface of a tooth; a pit is usually found at the
end of a developmental groove or at a place where two fissures intersect.
3. Fossa: a shallow depression or hollow at the crown surface.
– Lingual Fossa: an irregular, rounded concavity bound by the mesial
marginal ridge, distal marginal ridge, cingulum, and incisal edge of the
lingual surface of an incisor tooth. Lingual fossae are also found on
both sides of the lingual ridge of a cuspid tooth.
• Triangular Fossa: are located adjacent to marginal ridges on the occlusal
surfaces of posterior teeth. There are two kinds of triangular fossae, a
mesial and a distal.
• Central Fossa : is a centrally located depression or concavity found on the
occlusal surface of molars and mandibular second bicuspids. The other
bicuspids have mesial and distal triangular fossae, but do not have a
central fossa.
– Sulcus: an elongated valley or depression in the surface of a tooth
formed by the inclines of adjacent cusps or ridges. As an example, a
central sulcus is a major linear depression that traverses the occlusal
surface of a posterior tooth from mesial triangular fossa to distal
triangular fossa. Developmental grooves are found in the bottoms of
sulci [pl/səlsī.]
 • inclined plane
• Inclined plane : each face of a cusp is formed by inclined planes. To name an
inclined plane you must combine the names of the cusp ridges that define a large
part of its borders, for example, the distolingual incline of the buccal cusp of a
maxillary first bicuspid.
 • lobe
• Lobe : one of the primary anatomical divisions of a crown; all teeth develop
from either four or five lobes (for example, a central incisor forms from
four lobes while first molars develop from five lobes.) Lobes are usually
separated by readily identifiable developmental grooves.
 • Embrasure

• Embrasure: is a space diverging from the contacting proximal surfaces of two

adjacent teeth. There are four of these spaces or embrasures recognized. They are the
facial, lingual, gingival, and occlusal or incisal.
A gingival embrasure has other names like cervical embrasure, apical embrasure,
interproximal space, and septal space. Interdental palillae (gingival tissue) fill
interproximal spaces to a greater or lesser extent
B
10. Distal Marginal
1. Mesio-Buccal Cusp
Ridge
2. Disto-Buccal Cusp
11. Mesial Triangular
3. Mesio-Lingual Cusp
Fossa
4. Disto-Lingual Cusp
12. Distal Triangular
M 5. Buccal Developmental
Groove
6. Lingual
Fossa
13. Central Fossa
14. Disto Buccal
Developmental Groove
Triangular Ridge (Crest)
7. Central Sulcus
15. Oblique Ridge
(Developmental Groove)
16. Mesial Cusp Ridge
8. Supplemental Groove
17. Distal Cusp Ridge
9. Mesial Marginal Ridge
18. Cusp of Carabelli
Blood vessels of the tooth and Oral
Cavity

MD Yohannes
May 2012
 ARTERIES OF THE HEAD AND NECK

• The head and neck are supplied almost entirely by the common carotid artery .
On the left side the common carotid artery arises from arch of the aorta
&
on the right side from brachiocephalic artery.

• The common carotid arteries are found at the lateral sides of the neck.

• At the thyroid cartilage, the common carotid artery bifurcates into the internal and external
carotid arteries.

• Internal carotid artery does not supply the mouth

 The external carotid artery has eight branches

1. Ascending Pharyngeal: Supplies the pharynx

2. Occipital: scalp and associated muscles.

3. Pos. Auricular: outer ear and scalp.

4. Superficial temporal: scalp and associated muscles

5. Superior thyroid : Thyroid gland and associated muscles.

Ext. Carotid artery

 1. Lingual artery

Arises at the level of hyoid bone and enter the base of the tongue and end at the tip of the tongue..

Dorsal lingual artery

Back of the tongue, tonsils, soft palate & Epiglottis

Deep lingual artery

Lingual artery Tip of the tongue along its inferior surface.

Sublingual artery
Floor of the mouth, sublingual gland, mylohyoid muscle & lingual gingiva. .
2. Facial artery

5. Angular artery: supplies the eyelids and skin of

the nose .

4. Superior labial artery: supplies the upper lip.

3. Inferior labial artery: supplies the lower lip and

chin.

2. Submental artery: supplies sublingual and

submandibular glands, mylohyoid muscle, anterior belly of
the digastric muscle.

Facial artery 1. Ascending palatine artery: supplies soft palate, pharynx, pharyngeal
muscles and the tonsils
3. Maxillary artery

•arises from the neck of the mandible.

• it passes forward between the ramus

of the mandible and the sphenomandibular
ligament, and then runs, either superficial
or deep to the lateral pterygoid muscle,
to the pterygopalatine fossa.
The three sections of Maxillary Artery

• supplies the deep structures of the face,

and may be divided into the following portions:

• Mandibular section [1st Part]

•Pterygoid section [2nd part]

•Pterygopalatine section. [3rd part]

 3.1 Mandibular section

1. Deep auricular artery: supplies Tmj, external acoustic meatus, and tympanic membrane.
2. Anterior tympanic artery: supplies the inside of the tympanic membrane.

3. Middle meningeal artery: supplies the dura matter and cranium.

4. Accessory meningeal artery: supplies the dura matter and trigeminal ganglion .

Dental artery.

Mental artery.
5. Inferior alveolar artery:
• travels with the alveolar nerve and supplies mandibular molar and premolar teeth.

• Before the inferior alveolar artery enters the mandibular foramen, it gives off a branch, the mylohyoid artery to
supply mylohyoid muscle.

• Also given off is a lingual branch, which aids in supplying the tongue.

• The inferior alveolar artery travels in the mandible canal until it reaches the mental foramen, then branches into
the mental artery and the incisive artery.

•The mental artery exists the mandibular canal through the mental foramen to supply the chin, while the incisive
artery remains inside the mandibular canal to supply the mandibular anterior teeth . These branches of the arteries
enter the apical foramen of each incisor tooth to supply the pulp.
 3.2 Pterygoid section

1. Ant. And Pos. deep temporal artery: supply the temporalis muscle.

2. Buccal artery: supply the buccinator muscle and cheek.

3. Masseteric artery: supply the masseter muscle.

4. Medial and Lateral pterygoid arteries: supply the medial and lateral pterygoid muscles
 3.3 Pterygopalatine section

2. Infraorbital artery: emerges to the face through the infraorbital foramen

. Anterior superior branch supply maxillary
incisors and canines.

. Middle superior alveolar artery supply maxillary

premolar teeth.

Ext. carotid artery

Maxillary artery

Anterior superior alveolar artery

Descending palatine artery

Middle superior alveolar artery

1. Posterior superior palatine artery: supplies the maxillary

molar teeth, maxillary sinus, and associated Gingiva
 Maxillary
• emerges from the Greater
artery
Palatine Foramen.
Descending
palatine artery • supply Gingiva, palatine
glands & roof of the mouth

Greater
palatine artery

Descending
palatine artery
Lesser
palatine artery

• emerges from the Lesser

Palatine Foramen.

• supply the tonsils and soft

Palate.
 Sphenopalatine artery
Enters the nasal cavity and supply the frontal, maxillary,
ethmoid, and Sphenoid sinuses.

One branch joins with the greater palatine artery at

the incisive foramen.

Artery of Pterygoid canal

Enters the Pterygoid fossa to supply pharynx
Auditory tube and tympanic cavity

Pharyngeal artery
Supplies the sphenoid sinus, pharynx,
and the auditory tube.
 VEINS OF THE FACE

 Veins of the face usually travel with the arteries and have similar name.

 Veins are commonly divided into a superficial and deep groups.

 Variations in venous drainage are common.

 Facial veins do not have valves, so there is a potential danger of infection

to the brain.
• Dangerous area of the face-
infections from face mainly from upper
lip & nose can go to cavernous sinus
through ophthalmic vein and deep
facial vein
 1. Superficial veins 2. Deep veins
 facial and superficial temporal
veins drain facial structures.
Maxillary vein
Superficial temporal vein
 facial veins has several branches
from the nose, lips, eyes,
Pterygoid plexus submental, and submandibular
of vein regions.
Anterior retromandibular vein

Facial vein  The common facial vain is the

Posterior union of the facial and
retromandibular retromandibular veins
vein

 Pterygoid plexus is a network of

veins between the temporalis and
External jugular vein lateral pterygoid muscles and
between the lateral and medial
Common facial vein pterygoids.

 Structures that drain into the

Internal jugular vein plexus include: muscles of
mastication, buccinators, nose,
palate, and the teeth.
Nerve supply of the Tooth
&
the Oral cavity

BY: MD Yohannes
AAU
April 2012
 brain
Central Nervous system
Spinal cord
Nervous system
• 12 pairs of cranial nerves
Peripheral nervous system
• 31 pairs of spinal nerves

Sympathetic – respiration, heart rate, and blood flow to muscle

Parasympathetic -- respiration, heart rate, and blood flow to muscle

Sensory or afferent nerve: carry impulses toward the brain.

Motor or efferent nerve: carry impulses away from the brain.

Autonomic nervous system: regulate those functions over which we got no direct
control, such as heart rate
 • Each one of the 12 cranial nerve can
either be entirely motor or entirely
sensory or a combination of both

1. Trigeminal (V)

2. Facial (VII)
• 4 cranial nerves are closely linked with
the orofacial structures: 3. Glossopharyngeal (IX)

4. Hypoglossal (XII)
Trigeminal nerve(V) (mixed)

V1
V1 Ophthalmic nerve (afferent)

V2 Maxillary nerve (afferent)

V2
V3 V3 Mandibular nerve (mixed)
Ophthalmic nerve (V1)

Supratrochlear N.

 Provides sensory innervations to

Supraorbital N. the eye , nose, lacrimal gland,
and skin of the eyelids, forehead,
and nose.

Infratrochlear N.  It has 3 branches, but non of that

lead to the oral cavity.
 Maxillary nerve (V2)
1. Zygomatic Nerve

Trigeminal
ganglion Maxillary N. has four
branches

Pterygopalatine ganglion 2. Infraorbital Nerve

@ Pterygopalatine fossa

4. Pterygopalatine
3. Posterior superior alveolar (PSA)
 Posterior superior alveolar (PSA)

Middle superior alveolar (MSA)

Anterior superior alveolar (ASA)

Pterygopalatine ganglion

Infraorbital
foramen

Pterygopalatine nerve
1. Zygomatic Nerve

Zygomaticotemporal nerve: supplies the side of the forehead skin

Zygomaticofacial nerve: supplies the skin of the cheek.

 2. Posterior superior alveolar nerve PSA

Zygomatic nerve

Maxillary nerve Posterior superior alveolar nerve

 Supplies the last two maxillary molar’s

Lingual and distobuccal roots.

 Also supplies the adjacent buccal

Gingiva and maxillary sinus.
3. The infraorbital nerve

PSA

Middle superior alveolar nerve (MSA)

Supplies: the mesiobuccal root of 1st molar,
1st & 2nd premolar, adjacent gingiva
and maxillary sinus.

Anterior superior alveolar nerve (ASA)

Supplies: maxillary incisors and canine
teeth, adjacent labial gingiva and
maxillary sinus.

Infraorbital foramen
After passing through divided into:
 Palpebral
 External nasal
 Superior labial
4. Pterygopalatine Nerves

Five Branches

1. Pharyngeal– supplies the pharyngeal

and pharyngeal mucosa

2. Nasopalatine: pass through

Nasopalatine (incisive) foramen to
supply lingual gingiva of incisor teeth.

3. Posterior superior lateral nasal:

supplies nasal conchae and septum

4. Greater palatine: enters the greater

palatine foramen to supply the mucosa
of hard palate and lingual gingiva of the
maxillary molars, premolars, and canine
teeth.

5. Lesser palatine: enters the lesser

palatine foramen to supply the mucosa
of the soft palate and tonsil.
The Mandibular Nerve (V3)

• The largest division of Trigeminal nerve

• Both afferent and efferent.

• Divides into:

1. Anterior division

2. Posterior division
1. Anterior division Deep temporalis nerves: supply temporalis muscle

Masseteric nerve: supplies masseter muscle

Lateral pterygoid nerve: supplies

the pterygoid muscle.
 2. Posterior division
 The lingual and Chorda tympani (facial
nerve VII) join together and move forward. Chorda tympani nerve

 Chorda tympani supplies taste sensation

to the anterior 2/3 of the tongue.

 Lingual nerve supplies afferent nerve to

the tongue, floor of the mouth, lingual
gingiva of the entire arch of the mandible.

 Before the inferior alveolar nerve enters

the mandibular foramen, it gives off the
mylohyoid nerve branch to supply the
mylohyoid muscle and the anterior belly of
the digastric muscle.

 Within the mandibular canal, the inferior

alveolar nerve gives off branches to the
mandibular molars and premolars.

 At the mental foramen, it divides into the

following nerves:
 Mental nerve: supplies chin and lower lips.
 Incisive nerve: supplies anterior teeth and
labial gingiva.
 The facial nerve(VII) (mixed)

• encounters its sensory

Facial nerve canal Stapedius muscle ganglion, the Geniculate
ganglion in the temporal
Incus
bone.

• While in the temporal

Malleus bone it gives off the
following branches:
Geniculate ganglion
1. Great petrosal nerve:
Greater petrosal nerve innervate nose, mouth
and lacrimal glands.

Facial nerve Chorda tympani 2. Nerve to the Stapedius

muscle.
Mastoid bone
3. Chorda tympani nerve:
taste fiber to ant. 2/3 of
the tongue.
 • Facial nerve exits the
Occipital Nerve skull and gives off the
following branches:

Auricular Nerve 1. Posterior auricular nerve:

supplies the posterior
auricular and occipital
muscles..
Posterior auricular nerve
2. Digastric nerve: posterior
belly of the digastric
Digastric nerve muscle.

3. Stylohyoid nerve: innervate

the stylohyoid muscle
Stylohyoid nerve
• at the Parotid gland branches into
Temporofacial and Cervicofacial divisions

Temporofacial division

1. Temporal branch: supply innervations to ear and eye muscles

2. Zygomatic branch: innervate eye muscle

3. Buccal branch: quadratus labii superioris, nasalis,

buccinator, orbicularis oris, risorius muscles.

4. Mandibular branch: lower lip and chin

5. Cervical branch: platysma muscle.

Cervicofacial division
 Bell’s Palsy
Paralysis of muscles of facial
expression due to
damage/inflammation of the
facial nerve.
 The Glossopharyngeal nerve(IX) (mixed)

The branches include:

1. Tympanic nerve: supplies parotid gland and middle ear.

2. Carotid sinus nerve: parotid sinus.

3. Stylopharyngeal nerve: Stylopharyngeal muscle

4. Pharyngeal branches: join with spinal accessory (XI) and Vagus (X) and
supply muscle of soft palate, pharynx, and tonsils.
 The Hypoglossal nerve(XII) (efferent)

 This branch is the motor supply of the tongue.

 It exits the skull through the hypoglossal canal and is entirely efferent.

 Supplies the intrinsic and extrinsic muscles of the tongue.

 Damage to this muscle causes paralysis of the tongue. The tongue

deviates towards the affected side when protruded..
Muscles of the Oral cavity

BY: MD Yohannes
AAU
June 2012
 Muscles make movements possible by their contraction.-------------
-------------------

 Muscles are suspended between an Origin and insertion.--------

---------------------

 Origins are fixed while insertions are movable, hence, muscles

move in direction of their origin, a fact that helps explain their
motion.
 I. Muscles of Mastication

1. Temporalis muscle
Origin: temporal fossa of Temporal bone

Insertion: Coronoid process of the mandible ±

Temporalis muscle mandible distal to the 3rd molar.

Characteristics: the anterior fibers are vertical;

the posterior fibers are somewhat horizontal.

Function:
• whole muscle contract --- Mandible elevated

• Posterior fibers contract -- mandible retruded

 2. Masseter muscle Origin: ---------------------------------------------------
Superficial fiber: anterior 2/3rd of the Zygomatic arch
Deep fiber: Posterior 1/3rd of Zygomatic arch

Insertion:------------------------------------------------
Superficial fiber: outer surface of the angle of the
mandible
Deep fiber: outside surface of mandible and Coronoid
process

Function:
elevation of the Mandible
Deep head
Superficial head
3. Medial Pterygoid muscle

Origin: ---------------------------------------------------
Superficial fiber: maxillary tuberosity-------------
Deep fiber: medial side of lateral pterygoid plate

Insertion:------------------------------------------------
Lateral Pterygoid medial surface of the angle of the mandible

Medial Pterygoid
Function:
elevation of the Mandible
4. Lateral Pterygoid

Origin: --------------------------------------------------------
Superior head: infratemporal surface of the
sphenoid bone
Superior head Inferior head: lateral surface of the lateral
Inferior head
pterygoid plate
Insertion:---------------------------------------------
Superior head : articular disc of TMJ.-----------------
Inferior head : pterygoid fovea of the mandible.
Medial Pterygoid

mandible

Function:
. If both sides contract the mandible protrudes.
. If one side contracts the mandible shifts to the opposite side.
 II. Suprahyoid muscle

 Located above the hyoid bone.

 Between the mandible and the hyoid bone.

 Function is to lower the mandible or raise the hyoid bone.

 Mylohyoid
Digastric muscle
(pos. belly)
Digastric muscle
(ant. belly)

Digastric Raphe
intermediate
tendon
Hyoid bone

Muscle origin insertion

1. Digastic Digastic fossa (inferior surface Intermediate tendon.

ant. belly of the mandible at the midline )
pos. belly Intermediate tendon. Digastic notch (medial to mastoid
process)

2. Mylohyoid Mylohyoid line of the mandible raphe

 Digastric post. belly

Digastric ant. belly

Stylohyoid
Geniohyoid

Mylohyoid

Intermediate tendon Hyoid bone

Muscle origin insertion

3. Geniohyoid Genial tubercle of the mandible Hyoid bone

4. Stylohyoid Styloid process Hyoid bone

 III. Infrahyoid muscle

 Located below the hyoid bone & In front of the neck

 Depress the hyoid bone or fix it so as the Suprahyoid muscles can work.
 Posterior Digastic muscle Stylohyoid muscle

Hyoglossus muscle
Mylohyoid muscle

Anterior Digastic muscle

Thyrohyoid muscle
hyoid bone
Omohyoid muscle (sup. belly)
Trapezius muscle Sternohyoid muscle

Sternocleidomastoid muscle

Omohyoid muscle (Inferior belly)

Muscle origin insertion

1. Omohyoid
inferior Scapula Intermediate tendon
superior Intermediate tendon Hyoid bone

2. Sternohyoid sternum Hyoid bone

3. Sternothyroid sternum Thyroid cartilage

4. Thyrohyoid Thyroid cartilage Hyoid bone

 IV. Muscles of the tongue

 Muscles of the tongue are divided into two groups- Intrinsic and extrinsic.

 These muscles help the tongue to change its shape and position-------------------
 Intrinsic muscles

Muscle orientation function

1. Superior longitudinal anterior to posterior near the • widen the tongue

top surface • Turn the tip up

2. Inferior longitudinal anterior to posterior near the •widen the tongue

bottom surface • Turn the tip down

3. Transverse Lateral edge of the tongue Make the tongue narrow

4. vertical Upper to lower surface aids in widening the tongue tip

 Palatoglossus

Styloglossus
Styloid process
Extrinsic muscles
Dorsum of tongue

Genioglossus

Hyoglossus Hyoid bone

Muscle Origin Insertion function

Genioglossus Genial tubercle/ medial Tongue and Hyoid bone Ant. Fiber—retract the tongue
side of mid mandible. Pos. fiber—push it forward

Hyoglossus Hyoid bone Side of the tongue Depresses the tongue and
draws the sides down
Styloglossus Styloid process Inferior longitudinal and Draws the tongue up and
the one head join with backward
hyoglossus.
Posterior side of the Pull the tongue faucial and back
Palatoglossus Underside of soft tongue & soft palate down
palate
V. Muscles of facial expression

VI. Muscles of soft palate

VII. Muscles of the Pharynx

Good luck