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27.10 : Teeth

The formation of teeth, also known as odontogenesis, is a complex process that begins in utero, around the sixth week of embryonic development. There are three stages to this process: the bud stage, the cap stage, and the bell stage.

In the bud stage, the tooth germ (an aggregation of cells) starts to form in the developing jawbone. During the cap stage, the tooth germ differentiates into enamel organ, dental papilla, and dental sac, which will later develop into the tooth's enamel, dentin and pulp, and cementum and periodontal ligament, respectively. The bell stage is characterized by the shaping of the tooth and the differentiation of ameloblasts (which form enamel) and odontoblasts (which form dentin).

Anatomical Positions and Names:

Human teeth are located in the upper (maxillary) and lower (mandibular) jaws. Beginning with the middle and moving outward, the sequence of adult teeth is as follows: central incisor, lateral incisor, canine (or cuspid), first premolar (or first bicuspid), second premolar (or second bicuspid), first molar, second molar, and third molar. The third molar teeth are often referred to as 'wisdom teeth.'

In children, the sequence is similar but lacks the premolars and third molars: central incisor, lateral incisor, canine (cuspid), first molar, and second molar.

Milk/Baby Teeth and Adult Teeth:

Humans typically have two sets of teeth during their lifetime: deciduous teeth (commonly known as milk or baby teeth) and permanent teeth (adult teeth).

Deciduous teeth begin to erupt at around six months of age, and by age 3, most children have a full set of 20 deciduous teeth. These teeth are temporary and are eventually replaced by permanent teeth.

The first permanent teeth to erupt are usually the first molars, around the age of 6. This is often accompanied by the loss of the first deciduous teeth. By the age of 12 to 14, most of the deciduous teeth have been replaced by permanent teeth. The third molar teeth are the last to emerge, usually between the ages of 17 and 21.

Changes with Age:

The dentition undergoes significant changes with age. The teeth may become discolored, worn, and less sensitive due to a lifetime of use and exposure to substances like caffeine and tobacco. There may also be a reduction in saliva production, which can increase the risk of oral health issues such as tooth decay and gum disease.

Furthermore, periodontal disease (gum disease) can lead to tooth loss in adults. In fact, among adults above 35 years of age, this is the primary reason for tooth loss. To maintain healthy teeth and gums throughout life, it is crucial to practice good oral hygiene, eat a balanced diet, avoid tobacco, and have regular dental check-ups.

Wisdom Teeth:

Wisdom teeth, also known as third molars, are the final set of molars that usually make their appearance in late adolescence or early adulthood, typically between the ages of 17 and 25. The emergence of wisdom teeth is often associated with certain complications, such as impaction, infection, and crowding due to insufficient space in the jaw.

From a genetic perspective, the development and presence of wisdom teeth in humans is an interesting field of study. It is generally believed that human ancestors needed these robust molars for their coarse and fibrous diet, but as evolution progressed and diet became softer from cooking food, the need for these teeth diminished. As a result, some people may never develop their wisdom teeth, a trait that could be inherited. Scientific research has shown that certain genes, such as the PAX9 and MSX1 genes, play a crucial role in tooth development. Mutations in these genes can lead to missing teeth, including wisdom teeth. However, the genetics of wisdom teeth development and presence is complex and likely involves several genes.

Dental Formula:

The dental formula is a concise way to represent the type and number of each kind of tooth in one half of the mouth for a given species. The formula is always doubled, as it represents one half of the mouth - one side of the upper and lower jaw. For instance, the human dental formula for permanent teeth is 2-1-2-3. This means that for one-half of the mouth, there are two incisors, one canine, two premolars, and three molars. This formula is a simple and efficient method for recording dental traits and is particularly useful in the fields of dentistry, anthropology, and veterinary medicine.

Endodontics, orthodontics, and periodontics are three specialized fields within dentistry that address different aspects of oral health. Endodontics primarily focuses on the prevention, diagnosis, and treatment of diseases affecting the dental pulp, typically involving root canal treatments. Orthodontics, on the other hand, deals with correcting teeth and jaw alignment issues using braces, aligners, and other devices. It plays a crucial role in improving oral function and aesthetics. Lastly, periodontics pertains to the prevention, diagnosis, and treatment of periodontal disease (gum disease), as well as the placement of dental implants. It's a vital field for maintaining the health of the supporting structures of teeth.

From Chapter 27:

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