Some Important Information about Your Teeth

Posted by dentist3 in Dental Articles | 0 comments

“Some pains are physical, and some pains are mental, but the one that’s both is dental.” Ogden Nash.

Teeth, Teeth, Teeth! What’s the Big Deal About Something so Little? My Cheeks Need What?

The normal human complement of teeth consists of 20 primary teeth and 32 permanent teeth. The primary teeth typically begin to make their appearance a few months after birth and usually continue to appear in a given sequence over the first couple of years of life. A general rule of thumb is that for every 6 months of life, four teeth will erupt. 

Girls usually precede boys in tooth eruption. Lower teeth usually appear before upper teeth. Teeth usually erupt in pairs in both jaws: one on the right and one on the left. Primary teeth are usually lighter and smaller that permanent teeth. 

By the time a child is 2-3 years of age, all primary teeth should have erupted. Besides eating and speaking, the main function of primary teeth is to act as place holders until the child’s jaws have grown sufficiently to accommodate the permanent set of teeth which will later erupt and replace them. 

Crooked or closely packed primary teeth are a good indication that the child will probably need orthodontic care later on. In the best case scenario, by the time

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the permanent teeth begin to replace their primary placeholders, there should be spacing between the primary anterior upper and lower teeth of a millimeter or more. 

At around six years of age, the first permanent teeth appear behind all of the primary teeth: the first permanent molars. Thereafter, each permanent tooth begins making its appearance in a position first occupied by a primary tooth which is lost after its root system is resorbed (dissolved) by the body as the permanent successor makes its way into position. 

Impacted Wisdom Tooth

After all of the primary teeth are replaced by their permanent successors, another set of permanent molars appears behind the first set at roughly age twelve. Lastly, a third set of molars may develop, the so called “wisdom teeth” which may or may not make an appearance in the mouth in the mid to late teenage years. 

The amount of space remaining in the jaw and certain hereditary factors govern the emergence and position of the third molars. If there is insufficient room or the teeth are improperly angled, the third molars should be removed in most cases.

Leaving them behind because “they are not bothering me” is a poor decision to make since it can lead to some very unpleasant events later in life. I have had a number of cases where such a decision was made against my advice. 

These particular patients were shopping around for the opinion they wanted to hear. The third molars were stuck within the bone at a forty-five degree angle wedged up against the back roots of the second molars. 

Several years later, when the patients returned, it was discovered on x-rays that the pressure the third molars placed on the second molar roots had caused them to resorb (dissolve). The end result was that both second and third molars were lost. 

It is also important to note that many times teeth may be missing due to genetic factors in families. Also, there may be additional teeth, not usually seen, which form due to these same genetic factors. 

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This is one of the reasons it is important to begin regular visits to the dentist early, when pain in not present, to get good x-rays of the jaws to see what is present and determine what, if any, action will need to be taken to ensure the development of as normal a bite as possible through the growth years. 

With this kind of fore-knowledge, your dentist can be an invaluable resource in mapping out a course of treatment which will result in the most beautiful healthy smile possible without unnecessary cost.

Besides chewing your food and providing a nice smile, the teeth are also very important in speech and facial appearance. The pronunciation of certain letters and sounds depends upon the presence and proper position of the teeth (the ‘F”, “V”, and “S” sounds, for example). 

Furthermore, the lack of posterior teeth can age a person’s appearance dramatically. One easy way to see this demonstrated is to have a denture wearer take out their teeth.

Normally the posterior teeth hold out the cheeks and give fullness to the face. The lack of tooth support allows the cheeks to “cave in” and the jaws to over close which produces a hollow look and makes a person look decades older. 

Also, the lack of posterior teeth accelerates the wear of the front teeth, which were never designed for heavy grinding, and therefore prematurely shortens the front teeth which contributes to an aged appearance (“young” teeth are longer; “older” teeth are shorter; check out the fashion magazines and look at the smiles in the ads to see this for yourself).

Suffice it to say that the growth and development of the human dentition is a wonderfully complex process that results in a set of teeth that are necessary for function, speech, and appearance.

In the chart below, the typical tooth formation and eruption schedule is outlined. “I” refers to “Intra Uterine” or time spent in the womb prior to birth.

More complete information on tooth growth, development, and possible developmental problems can be found on web sites run by the Malaysia Oral Health Division Ministry of Health, The Academy of General Dentistry, etc. 

A Google search can also produce a wealth of detailed information. So then, what are the components of an individual tooth? Though each different type of tooth varies in form and function, under the hood, so to speak, they are very much alike.

In an embryo, around the beginning of the fourth month, tooth buds form within the developing jaws. The bud looks like a cap and is comprised of an outer layer of cells called enameloblasts and an inner layer of cells called dentinoblasts. 

These cells are lined along a protein and fiber layer termed the dentino-enamel junction (or DEJ for short). Along the DEJ, the enameloblasts and dentinoblasts start laying down enamel and dentin respectively building away from each other as material is laid down and the tooth takes shape. The material laid down is comprised of a protein-fibrous matrix onto which crystals of hydroxyapatite are deposited. 

Think of the building process as being like pouring concrete onto a flexible rebar structure. The matrix gives added strength and slight flexibility to the whole arrangement.

The enameloblasts build outward, laying down layer after layer of hard crystals onto the protein matrix until the final tooth form is achieved. Note that the presence of fluoride in the diet during this tooth formation phase will result in crystals being deposited which are actually fluoroapetite rather than hydroxyapatite. 

Fluoroapetite is harder and less soluble than hydroxyapatite and is, therefore, more resistant to decay later (That’s why fluoride in the water is much more desirable than fluoride simply painted on during dental visits because the fluoride is incorporated into the tooth structure rather than just applied to the surface).

While enamel is being laid down over the coronal (or visible) portion of the tooth, a similar but softer substance is being laid down on the root surface: cementum. (Another reason for tooth sensitivity later in life is the result of the cementum being abraded away from covering the dentin of the root). 

This abrasion on the root surface and exposure of the underlining dentin can result from recession of the gums or overactive tooth brushing.

At the same time the dentinoblasts are laying down a softer more porous material building tooth structure inward. These pores in dentin contain “fingers” of the dentinoblasts extending from the cells outward to the DEJ of the tooth. 

To give you an idea of the density of the pores or tubules, there are approximately a million per square millimeter. These odontoblast fingers are also what are believed to be responsible for the pain felt when a tooth is cut on. 

Also, exposure of the dentin to the outside world results in fluid movement in the tubules which can cause pain (as in, my tooth hurts if I touch it, or air, or cold water hits it). 

At the center of things is the living tissue called the pulp. The pulp contains the same types of cells found under the skin: blood vessels, nerve fibers (though not nerve cell bodies — a distinction of some importance which will be discussed in more detail later), and connective tissue.

Lining the outer surface of the pulp and the inner wall of the space inside the tooth called the pulp chamber, are the dentinoblasts. As previous noted these cells, present from the time the tooth was being formed, are responsible for laying down the dentin. They continue to do so as the tooth ages, over time making the pulp chamber smaller and smaller as they add to the inner surface of the pulp chamber. This explains why an older tooth may be less sensitive to outside stimuli than a freshly erupted or younger tooth.

Finally, as the tooth erupts into the mouth, the outer layer of cells, the enameloblasts cease to function, and form a thin layer on the surface of the tooth which is quickly abraded away. For this reason, once a tooth is formed and enters the mouth environment, no more enamel can be laid down. A tooth cannot regenerate itself. So, take care of them!

“The longest word in the English language is ‘smiles’ because there is a mile between each ‘s'”

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