Oral emergencies generally can be divided into three categories:
(1) orofacial pain; (2) orofacial trauma, specifically dentoalveolar
trauma; and (3) hemorrhage. Early manifestations of many systemic
illnesses are evident in the oral environment and may provide clues
to the diagnosis of systemic illnesses. Oral lesions may cause pain
or anxiety, and it is important that the emergency physician be
familiar with common oral pathology and its management.
The normal adult dentition consists of 32 permanent teeth. The
adult dentition has four types of teeth: 8 incisors, 4 canines,
8 premolars, and 12 molars. The primary or deciduous dentition consists
of 20 teeth of three types: 8 incisors, 4 canines, and 8 molars. Figure 240-1 shows the eruptive pattern of
both the primary and permanent dentition. Each tooth type is designed
for a specific function in the process of mastication. Incisors
are used for biting and cutting, canines and premolars for ripping,
and molars for grinding. Figure 240-2 illustrates
one commonly used tooth numbering system; however, description by
the emergency physician of the tooth type and location is appropriate.
Mastication is an important initial step in the digestive process,
and thus, nutrition. The dentition is also important in the development
of the mandible and maxilla and aesthetic development of the midface.
Normal eruptive patterns of the primary and permanent
dentition. mo. = months; yr. = years.
Table 240-1 lists commonly used dental
nomenclature. A tooth consists largely of dentin, which
surrounds the pulp, or neurovascular supply of the
tooth in the core of the tooth (Figure 240-3).
Dentin is a homogeneous material produced by pulpal odontoblasts
throughout life. Dentin is deposited as a system of microtubules
filled with odontoblastic processes and extracellular fluid. The crown, or the visible portion of tooth, consists
of a thick enamel layer overlying the dentin. Enamel,
the hardest substance in the human body, consists largely of hydroxyapatite
and is produced by ameloblasts before eruption of the tooth into
the mouth. The root portion of the tooth extends
into the alveolar bone and is covered with a thin layer of cementum.
Table 240-1 Commonly
Used Dental Terminology |Favorite Table|Download (.pdf)
Table 240-1 Commonly
Used Dental Terminology
Terms for Tooth Surfaces|
|Interproximal||The surface between two adjacent teeth|
|Mesial||The interproximal surface facing anteriorly or toward the midline|
|Distal||The interproximal surface facing posteriorly or away from
|Occlusal||The chewing surface|
|Facial||Toward the face, a general term applicable to all teeth|
|Labial||Toward the lips, specific to the anterior teeth|
|Buccal||Toward the cheek, specific to the posterior teeth|
|Palatal||Toward the palate, ...|