Portal:Dentistry/Selected article

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Portal:Dentistry/Selected article/1

Enamel and cementum of a tooth

Tooth enamel is the hardest and most highly mineralized substance of the body, and with dentin, cementum, and dental pulp is one of the four major tissues which make up the tooth. It is the normally visible dental tissue of a tooth and must be supported by underlying dentin. Ninety-six percent of enamel consists of mineral, with water and organic material composing the rest. The normal color of enamel varies from light yellow to grayish white. At the edges of teeth where there is no dentin underlying the enamel, the color sometimes has a slightly blue tone. Since enamel is semitranslucent, the color of dentin and any restorative dental material underneath the enamel strongly affects the appearance of a tooth. Enamel varies in thickness over the surface of the tooth and is often thickest at the cusp, up to 2.5 mm, and thinnest at its border, which is seen clinically as the cementoenamel junction (CEJ).

Enamel's primary mineral is hydroxyapatite, which is a crystalline calcium phosphate. The large amount of minerals in enamel accounts not only for its strength but also for its brittleness. Dentin, which is less mineralized and less brittle, compensates for enamel and is necessary as a support.

Unlike dentin and bone, enamel does not contain collagen. Instead, it has two unique classes of proteins called amelogenins and enamelins. While the role of these proteins is not fully understood, it is believed that they aid in the development of enamel by serving as a framework support, among other functions.

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Radiograph of teeth in different developmental stages.

Tooth development is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. Although many diverse species have teeth, non-human tooth development is largely the same as in humans. For human teeth to have a healthy oral environment, enamel, dentin, cementum, and the periodontium must all develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth weeks in utero, and permanent teeth begin to form in the twentieth week in utero. If teeth do not start to develop at or near these times, they will not develop at all.

A significant amount of research has focused on determining the processes that initiate tooth development. It is widely accepted that there is a factor within the tissues of the first branchial arch that is necessary for the development of teeth. Tooth development is commonly divided into the following stages: the bud stage, the cap, the bell, and finally maturation. The staging of tooth development is an attempt to categorize changes that take place along a continuum.

Enamel formation occurs after the initiation of dentin formation. Cementum begins to form late in the development of a tooth. Supporting structures of teeth must also develop during this time. Tooth eruption occurs when the teeth enter the mouth and become visible. Baby teeth start to appear at about eight months of age, and permanent teeth appear at six years of age.

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Cevical decay on a premolar.

Dental caries, also described as tooth decay or dental cavities, is an infectious disease which damages the structures of teeth. The disease can lead to pain, tooth loss, infection, and, in severe cases, death. An estimated 90% of schoolchildren worldwide and most adults have experienced cavities, with the disease being most prevalent in Asian and Latin American countries and least prevalent in African countries. In the United States, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary cause of tooth loss in children. Between 29% and 59% of adults over the age of fifty experience caries.

There are numerous ways to classify dental caries, but the risk factors and development among distinct types of caries remain largely similar. Tooth decay is caused by certain types of acid-producing bacteria which cause the most damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. The resulting acidic levels in the mouth affect teeth because a tooth's special mineral content causes it to be sensitive to low pH. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure. Instead, dental health organizations advocate preventative measures, such as regular oral hygiene and dietary modifications, to avoid dental caries.

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A maxillary right central incisor.

The maxillary central incisor is a human tooth in the front upper jaw, or maxilla, and is usually the most visible of all teeth in the mouth. It is located mesial to the maxillary lateral incisor. As with all incisors, their function is for shearing or cutting food during mastication (chewing). There are no cusps on the teeth. Instead, the surface area of the tooth used in eating is called an incisal ridge or incisal edge. Formation of these teeth begin at 14 weeks in utero for the deciduous (baby) set and 3–4 months of age for the permanent set.

There are some minor differences between the deciduous maxillary central incisor and that of the permanent maxillary central incisor. The deciduous tooth appears in the mouth at 10 months of age and is replaced by the permanent tooth around 7–8 years of age. The permanent tooth is larger and is longer than it is wide. The maxillary central incisors contact each other at the midline of the face. The mandibular central incisors are the only other type of teeth to do so. The position of these teeth may determine the existence of an open bite or diastema. As with all teeth, variations of size, shape, and color exist among people. Systemic disease, such as syphilis, may affect the appearance of teeth.

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A maxillary right central incisor.

Osteonecrosis of the jaw (ONj) is a severe bone disease that affects the jaws, including the maxilla and the mandible. Jaw bone (osteo-) damage and death (-necrosis) occurs as a result of reduced local blood supply (ischaemia). The condition is thus included in the general category of ischaemic or avascular osteonecrosis (literally "dead bone from poor blood flow.").

Various forms of ONj have been described over the last 160 years, and a number of causes have been suggested in the literature. In recent years, an increased incidence of ONj has been associated with the use of high dosages of bisphosphonates, required by some cancer treatment regimens, especially when the patient undergoes subsequent dental procedures. The possible risk from lower oral doses of bisphosphonates, taken by patients to prevent or treat osteoporosis, remains uncertain. Various treatment options have been explored, however severe cases of ONj still require surgical removal of the affected bone. Careful medical history and assessement of pre-existing systemic problems and possible sites of dental infection are required to help prevent the condition, especially if bisphosphonate therapy is considered.

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Teeth visible in a smile.

A tooth (plural, teeth) is a structure found in the jaws of many vertebrates that are used to tear, scrape, and chew food. Some animals, particularly carnivores, also use teeth for hunting or defense. The roots of teeth are covered by gums. Teeth are among the most distinctive features of mammal species. Paleontologists use teeth to identify fossil species and determine their relationships. The shape of an animal's teeth is related to its diet. For example, plant matter is hard to digest, so herbivores have many molars for chewing. Carnivores, on the other hand, need canines to kill and tear meat.

Humans are diphyodont, meaning that they develop two sets of teeth. The first set (the "baby," "milk," or "deciduous" set) normally appears at about six months of age, although some babies are born with one or more visible teeth, known as neonatal teeth. Normal tooth eruption at about six months is known as teething and can be quite painful for an infant.

Some animals develop only one set of teeth (monophyodont) while others develop many sets (polyphyodont). Sharks, for example, grow a new set of teeth every two weeks to replace worn teeth. Rodent incisors grow and wear away continually through gnawing, maintaining relatively constant length. Some rodent species, such as the sibling vole and the guinea pig, have continuously growing molars in addition to incisors.

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