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Home , Deciduous teeth, Stellate reticulum, Teething

Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy

Methodical instructions for independent work for students during training to practical (seminar) classes and in class

Academic discipline The basics of stomatology Module № 1 Organization and types of dental care in Ukraine. The main stages of development of temporary and Topic of the lesson№1 . Terms and signs of physiological Course V Faculty Medical

Poltava-2020

1. Relevance of the topic : The process of eruption of deciduous and permanent teeth, which is a prerequisite for the formation of is an important stage in the formation of the human dental and maxillofacial system. Disruption of these processes, as well as the influence of factors that at first glance do not matter (certain habits in children, the use of certain drugs during pregnancy) can cause a number of morphological, physiological and aesthetic defects that will require complex corrective measures. Dental disease is perhaps the most common human disease. Statistics show that about 95% of the population suffer to a greater or lesser extent from caries and its complications. Carious lesions often become a source of odontogenic infection, which leads to chronic sensitization of the body or cause the development of complex inflammatory diseases. Oral hygiene and other types of prevention of caries and its complications occupy a leading place in reducing the incidence in dentistry. 2. Specific objectives : - To analyze complaints, medical history and life of the dental patient. - Explain the feasibility of additional research methods in dentistry. - To offer the scheme of objective examination of the patient in the conditions of dental polyclinic . - Classify dental disciplines . - Interpret the main signs of physiological changes in the teeth. - Draw diagrams, schedules of dental care. - Analyze the timing of eruption of temporary and permanent teeth . - Make a plan to prevent the development of occlusion anomalies depending on age groups . 3. Basic knowledge, skills, abilities necessary for studying the topic (interdisciplinary integration) Names of previous disciplines Acquired skills To know the anatomical and topographical in structure maxillofacial region.

1. Human Know the embryogenesis of oral tissues. 2. Histology Interpret the data of radiological research 3. Radiation diagnostics methods. 4. Propaedeutic of internal diseases Demonstrate the algorithm of the chicken and the 5. Biochemistry patient , draw up the accompanying documentation . 6. Normal physiology Chemical composition of saliva and oral fluid Fundamentals of physiology of the dental- maxillary system. 4. Tasks for independent work in preparation for class and in class.

4.1. The list of the basic terms, parameters, characteristics which the student should master at preparation for employment: term Definition 1. Stage of development 2. Dental rudiment Separated tissue education 3. Adentia lack of tooth 4.Retention. eruption delay 5. Dystopia The location of the tooth in an atypical place 6. Gill arches Part of the visceral skeleton 4.2. Theoretical questions for the lesson: 1. Special methods used in the examination of dental patients. 2. The main stages of development of temporary and permanent teeth. 3. Terms of development of temporary teeth. 4. Terms of development of permanent teeth. 5. Anatomical differences between temporary and permanent teeth. 6. Classification of tooth - anomalies. 7. Anatomical and physiological features of the maxillofacial region.

4.3. Practical work (tasks) performed in class: 1. Examine the thematic dental patient. 2. Make a treatment plan for a dental patient. 3. Make a plan of preventive measures in the dental clinic. 4. Carry out sanitary and preventive work among dental patients of different age groups. 5. Make a treatment plan for patients with chronic periodontitis. 6. Collect complaints and medical history. 7. Examine the oral cavity. 8. Establish a preliminary diagnosis.

Topic: Teeth develop in close connection with the general development and growth of the child. During the period of formation and growth, they are under the influence of various environmental and internal factors, which are reflected in the growth rate, the degree of mineralization and the timing of teething.

Development of temporary teeth In the development of temporary (falling, deciduous) teeth there are five periods: 1st - bookmarks and intramaxillary formation, 2nd - eruption, 3rd - root and periodontal formation, 4th - stabilization, 5th - and resorption roots. During the period of bookmarking and intramaxillary tooth formation, the formation of tooth rudiments, their differentiation, histogenesis and calcification of tooth hard tissues take place. The first signs of tooth development appear at 6-7 weeks of embryogenesis. The multilayered squamous epithelium of the oral in the areas of future dental arches of the upper and lower thickens and sinks into the mesenchyme. As a result of this process vestibular and lingual dental plates are formed . The epithelial cells of the vestibular dental plate increase rapidly and then degenerate, forming a gap that separates the cheeks and lips from the area where the teeth subsequently appear. Thus, there is an eve of the oral cavity. On the free edge of the lingual dental plate, cell proliferation promotes the formation of epithelial growths - dental papillae in places corresponding to the future temporary teeth. For temporary teeth from above and from below there are 10 such formations from which enamel bodies are formed. At 10 - weeks of embryogenesis in each enamellar body begins to grow mesenchyme that forms . Around the epithelial dental organ and the dental papilla there is a compaction of the mesenchyme, which covers the rudiment of the tooth and is called the dental sac. Thus, the enamel organ, the dental papilla and the dental sac together form the dental germ, from which all the tissue elements of the tooth are formed. Sources of development of tooth tissues in embryogenesis (according to VL Bykova, 1996). Having reached a certain stage of development, the tooth germ begins to separate from the dental plate, maintaining contact with it in the form of thin epithelial cords - the neck of the epithelial dental organ, which is then resorbed, and the tooth germs become separated. This is the end of the first stage of tooth development. It is followed by the stage of differentiation of dental germs. During this period of tooth development, important changes occur in both the dental germs and the tissues that surround them. Initially, the enamel organ is homogeneous - all cells are the same and arranged in layers. Subsequently, between the cells of the central part of the enamel organ begins to accumulate protein fluid, and pushes them away from each other. Between them there is a connection by means of processes. Due to this, the cells of the central part of the enamel organ acquire a star shape and resemble cells of reticular tissue. This area is called the of the enamel organ or the . Cells adjacent to the surface of the dental papilla form a layer of internal enamel cells. These are tall cylindrical cells, which later form (enameloblasts), ie cells that form enamel. Along the edge of the enamel organ, the inner enamel cells pass into the outer enamel cells, which lie on the surface of the enamel organ and have a flat shape. The cells of the enamel organ are externally covered with a basement membrane, which is called the enamel base plate and separates the enamel epithelium from the surrounding mesenchyme. Almost simultaneously, the process of differentiation of the dental papilla begins. It increases and grows even deeper into the enamel organ, blood vessels penetrate into it. On the surface of the dental papilla from the cells of the mesenchyme formed several rows of closely spaced cells with dark basophilic cytoplasm, called dentinoblasts (). The layer of dentinoblasts is directly adjacent to the inner enamel cells and is separated from them only by a thin basement membrane. Beams of bone tissue for the wall of the alveoli continue to form around the dental germs in the mesenchyme. An important point at the stage of differentiation of dental germs is the curvature of the internal enamel epithelium, which determines the shape of the future of the tooth. It is at this stage that the influence of various adverse factors leads to defects in the development of the crown. The differentiation of enamel organ cells is regulated by growth factors, in particular, insulin-like growth factor, transforming growth factor - p. (TGF - p) and epidermal growth factor (EFR). By the end of the 4th month of fetal development begins the period of histogenesis of dental tissues, during which there are tooth tissues - , enamel and pulp. Cement is formed later, in the 4th -5th month of the post-embryonic period, when the roots develop, followed by teething. Dentin formation. Histogenesis of dental tissues begins with the formation of dentin. Dentinoblasts take an active part in this process. These cells form thin precollagen fibers, which later turn into collagen and form the organic basis of predentin. Dentinoblasts synthesize and secrete type I collagen (the main organic component of dentin), glycoproteins, phosphoproteins, proteoglycans, glycosaminoglycans. Specific products of odontoblasts are the so-called phosphorine - phosphorylated proteins are present only in dentin. It is believed that they play an important role in controlling the rate of dentin mineralization. Odontoblasts also produce calcium-binding proteins - osteocalcin and osteonectin, which are found in both dentin and bone. Odontoblasts have not only secretory but also lytic activity. About 15% of the collagen synthesized by them is destroyed by odontoblasts by means of the lysosomal device. Eruption is the process of vertical movement of a tooth from the place of its embedding and development in the middle of the jaw to the appearance of a crown in the oral cavity. The eruption of temporary teeth begins 5 - 6 m of life and ends up to 2.5-3 years. Signs of physiological teething are: timeliness, consistency in certain groups of teeth and parity. The lower central are cut first, followed by their antagonists, followed by the lower lateral incisors, followed by the upper lateral incisors. Terms of development of temporary teeth according to W. Kunzel, 1988. tooth The first Terms of Completion Beginning of root radiological signs eruption, of root development, of tooth crown month of life formation, year mineralization, the year month of embryonic development

1 5 6-8 1.5-2 4 11 5 8-12 2 5 III 6 16-20 4.5-5.0 8 IV 5 12-16 3.5-4.0 6.5-7.0 V 6 20-30 4.5-5.0 7.5-8.0

The average age of eruption of temporary teeth (according to R. Illingworth, 1997)

Tooth Terms of eruption, month of life 1 6 7.5 11 7 9 IV 12 14 III 16 18 V 20-30 22-32

Average terms of eruption and loss of (According to Borovsky EV et al., 1989 and Carlson BM, 1994). The name of the Terms of eruption, month Terms of loss, month of tooth of life life central cutters 6-8 6-7 side cutters 8-12 7-8 fangs 14-20 10-12 the first molars 12-16 9-11 second molars 20-30 10-12 Terms of eruption of temporary teeth temporary timing of Terms of root the beginning of Terms of root teeth eruption formation resorption resorption from the 5th I 6 - 8 +2 years for 2 years year from the 6th II 8 - 12 +2 years for 2 years year from the 8th III 16 - 20 +3 years for 3 years year from the 7th IV 14 - 16 +3 years for 3 years year from the 7th V 20 - 30 +3 years for 3 years year Up to 10-12 months. life erupts all 8 incisors. After a short break (2-3 months) the first temporary molars appear, followed by the canines (lower and upper), the latter erupt the second large molars. The given terms of eruption of teeth can vary from 4 months. up to 2 years (early eruption) or from 8-10 months. up to 3-3.5 years (later erupted). During eruption, the crown of the tooth is covered with remnants of ameloblasts and other cells of the enamel organ, which form several layers of cubic epithelium. The bone tissue above the crown is absorbed. The remnants of the epithelium of the enamel organ merge with the epithelium of the oral cavity, forming a dense epithelial node. Its central cells degenerate, resulting in the formation of a germination channel through which the crown passes. Thus, during eruption, the tooth does not come into contact with the connective tissue of its own plate of the mucous membrane, does not destroy its structural elements, in particular blood vessels. That is why this process is not accompanied by bleeding. Materials for self-control: A. Tasks for self-control (tables, schemes, drawings, graphs): 1. A room is allocated for the organization of a dental office on one chair. What should be the area of this room? (Answer: 14 sq. M) 2. Chisel-shaped tooth with a wide cutting edge. The root is straight, conical. What is this tooth? (Answer: 21) 3. What is the basis of the histological structure of the enamel? (Answer: Beams of enamel prisms and adhesive interprismatic substance) B. Tasks for self-control: 1 . The patient complains of sharp constant pain in the area of 2.1 tooth, radiating to the eye and temple. The use of cold reduces pain, heat increases. Indicates the feeling of "grown" tooth, touching it causes increased pain. Objectively: crown 2.1 is completely destroyed, near the tooth are hyperemic, swollen, palpation of the root is sharply painful. No changes are observed on the radiograph of the alveolar process. Make a diagnosis, make a treatment plan. (Correct answer: Acute purulent periodontitis 2.1. The tooth must be removed under infraorbital and incisional anesthesia with direct forceps). 2 . The patient complains of severe, throbbing pain in the area of 3.5, the presence of a carious cavity in the tooth. The tooth has not been treated before. Objectively: the crown is destroyed by ¾, the percussion of the tooth is sharply painful, the tooth is mobile, the gums are swollen, hyperemic, enlarged and painful submandibular lymph nodes. Make a diagnosis, make a treatment plan. (Correct answer: Acute purulent periodontitis 3.5. The tooth must be removed under torus anesthesia, beak-like forceps).

References Main: 1. Bazhanov NN Dentistry / .- Medicine, 1997.- 515p. 2. Danilevsky NF . / N.F.Danylevskyy, AV . Борисенко - К. : Health, 2000.- 230p. 3. Smolyar NI Prevention of dental diseases in children. / NI Smolyar, Zhirny ZP, Polikanova LG - Lviv: Svit, 1995. - 10-15p. 4. Khomenko LA Therapeutic dentistry for children. / Edited by LA Khomenko. - K., Book Plus, 2007. - 33-37p. 5. Shargorodsky AG Damage to soft tissues and bones of the face. / Shargorodsky AG, Stefantsov NM - M. :, 2000. - 18-24с. Additional: 1. Mukovozov IM Differential diagnosis of diseases of the maxillofacial area. / І.М. Mukovozov. - M. Medicine, 2001 . - 437с. 2. Kabakov BD Textbook on military maxillofacial surgery, therapeutic and orthopedic dentistry. / BD Kabakov, VI Lukyanenko, PZ Arzhantsev - M. :, 1980. - 564с. 3. Bernadsky YI Fundamentals of maxillofacial surgery and surgical dentistry. / YI Bernadsky - Vitebsk: Belmedkniga, 1998.- 404 p. prepared by Steblovskiy D.V.