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DENTAL ANATOMY &
PHYSIOLOGY
Represented and Modified by
HELMIN ELYANI
Reviewed by:
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Part A: Oral Embryology
Study of developmental
stages of the individual
Prenatal
Natal
Postnatal
Zygote: First 2 wks
Embryo: 2 wks-8wks
Fetus: 9 wks-birth
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Fertilization
Cell division and
specialization
Proliferation
Cytodifferentiation
Histodifferetiation
Morphodifferentiation
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Embryonic Stage
Three primary
embryonic cell layers
Oral cavity and teeth
derived from ectoderm
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Factors Influencing Prenatal
Development
Genetic
Environment
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Palatal Development
Formed during week 5 or 6
Cleft palate
Cleft lip
Unilateral or bilateral
Opening in hard or soft palate
Missing or malaligned teeth
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Life Cycle of a Tooth
Intitiation
Bud stage
Proliferation
Cap stage
HistodifferentiationBell stage
Morphodifferentiation
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Developmental Problems
Ameloblastomas
Anodontia
Supernumerary
Osteodentin
Dentinogenesis
imperfecta
Amelogenesisimperfecta
Macrodontia
Microdontia
Twinning
Hutchinsons incisors
Enamel hypoplasia
Hypocalcification
Mottled enamel
Tetracycline staining
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Eruption Period
Problems
Impaction
Malpositioned teeth AnkylosisFunctional
Prefunctional
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Factors Contributing to Tooth Eruption
Pressure asroots form
Formation andresorption
of bone
Pressure ofmuscles
Growth ofroots
Formation
of crown
Tooth
eruption
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Maturation Stage
Attrition
Bruxism Erosion
Abrasion
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Dental Anatomy and Physiology
After viewing this lecture, attendees should be able to:
Identify the major structures of the dental anatomy
Discuss the primary characteristics of enamel, dentin, cementum, anddental pulp
Describe the biologic functions that take place within the oral cavity
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Dental Anatomy and Physiology
Primary (deciduous)Secondary (permanent)
Definition (teeth): There are two definitions
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Dental Anatomy and Physiology
A tooth is made up of three elements:
Water
Organic materials
Inorganic materials
Elements
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Primary (deciduous)
Consist of 20 teeth
Begin to form during the firsttrimester of pregnancy
Typically begin erupting around 6months
Most children have a completeprimary dentition by 3 yearsof age
Dental Anatomy and Physiology
Dentition (teeth): There are two dentitions
1. Oral Health for Children: Patient Education Insert. Compend Cont Educ Dent.
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Dental Anatomy and Physiology
Secondary (permanent)
Consist of 32 teeth in most cases
Begin to erupt around 6 yearsof age
Most permanent teeth have eruptedby age 12
Third molars (wisdom teeth) are theexception; often do not appear untillate teens or
early 20s
Dentition (teeth): There are two dentitions
Mandible
Maxilla Incisors
Canine (Cuspid)
Premolars
Molars
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Classification of Teeth:
Incisors (central and lateral)
Canines (cuspids)
Premolars (bicuspids)
Molars
Dental Anatomy and Physiology
Identifying Teeth
Incisor Canine Premolar Molar
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Dental Anatomy and Physiology
Identifying Teeth2
Incisor Canine Premolar Molar
Incisorsfunction as cutting or shearing instruments for
food.
Caninespossess the longest roots of all teeth and arelocated at the corners of the dental arch.
Premolarsact like the canines in the tearing of food
and are similar to molars in the grinding of food.
Molarsare located nearest the temporomandibular joint
(TMJ), which serves as the fulcrum during function.
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Dental Anatomy
and Physiology
Apical Labial
Lingual
Distal
Mesial
Incisal
Teeth: Identification
Tooth Surfaces
Labial
Apical
Lingual
Distal
Apical
Mesial
Incisal Incisal
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Dental Anatomy
and Physiology
Apical: Pertaining to the apex or
root of the tooth
Labial: Pertaining to the lip;
describes the front surface ofanterior teeth
Lingual: Pertaining to the tongue;
describes the back (interior)
surface of all teeth
Distal: The surface of the tooth
that is away from the median line Mesial: The surface of the tooth
that is toward the median line
Labial
Apical
Lingual
Distal
Apical
Mesial
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Enamel
Alveolar Bone
Pulp
Chamber
Dental Anatomy and Physiology
Enamel (hard tissue)
Dentin (hard tissue)
Odontoblast Layer Pulp Chamber (soft tissue)
Gingiva (soft tissue)
Periodontal Ligament (soft tissue)
Cementum (hard tissue)
Alveolar Bone (hard tissue)
Pulp Canals Apical Foramen
The Dental Tissues: Dentin
Odontoblast Layer Gingiva
Periodontal Ligament
Cementum
Pulp Canals
Apical Foramen
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Anatomic Crown
Anatomic Root
Pulp Chamber
The 3 parts of a tooth:
Anatomic Crown
Anatomic Root
Pulp
Chamber
Dental Anatomy and Physiology
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Anatomic Crown
Anatomic Root
Pulp
Chamber
Dental Anatomy and Physiology
The anatomiccrownis the portion
of the tooth covered by enamel.
The anatomic rootis the lower two
thirds of a tooth.
The pulp chamberhouses the
dental pulp, an organ of myelinated
and unmyelinated nerves, arteries,
veins, lymph channels, connective
tissue cells, and various other cells.
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Enamel Dentin
Cementum
Dental Pulp
The 4 main dental tissues:
Dental Anatomy and Physiology
Enamel
Dentin
Cementum
Dental Pulp
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Structure
Highly calcified and hardest tissue inthe body
Crystalline in nature
Enamel rods
Insensitiveno nerves
Acid-solublewill demineralize at a pHof 5.5 and lower
Cannot be renewed
Darkens with age as enamel is lost
Fluoride and saliva can help withremineralization
Dental Anatomy and Physiology
Dental TissuesEnamel2
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Dental TissuesEnamel2
Dental Anatomy and Physiology
Enamel can be lost by:3,4
Physical mechanism
Abrasion (mechanical wear)
Attrition (tooth-to-tooth contact) Abfraction (lesions)
Chemical dissolution
Erosion by extrinsic acids (from diet)
Erosion by intrinsic acids (from the oralcavity/digestive tract)
Multifactorial etiology
Combination of physical and chemicalfactors
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Softer than enamel
Susceptible to tooth wear (physicalor chemical)
Does not have a nerve supply but canbe sensitive
Is produced throughout life
Three classifications Primary
Secondary
Tertiary
Will demineralize at a pH of 6.5 andlower
Dental TissuesDentin2
Dental Anatomy and Physiology
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Three classifications:
Primary dentinforms the initial shape of the tooth.
Secondary dentinis deposited after the formation of the primary dentin on all internal aspects of
the pulp cavity.
Tertiary dentin, or reparative dentin is formed by replacement odontoblasts in response to
moderate-level irritants such as attrition, abrasion, erosion, trauma, moderate-rate dental caries,
and some operative procedures.
Dental TissuesDentin2
Dental Anatomy and Physiology
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Dentin
Pulp
Tubule
Fluid Nerve Fibers
Odontoblast
Cell
Dental Anatomy
and Physiology
Dental TissuesDentin (Tubules)2
Dentinal tubulesconnect the dentinand the pulp
(innermost part of the tooth, circumscribed by the
dentin and lined with a layer of odontoblast cells)
The tubules run parallel to each other in an S-
shape course
Tubules contain fluid and nerve fibers
External stimuli cause movement of the dentinal
fluid, a hydrodynamic movement, which can result
in short, sharp pain episodes
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Dental Anatomy
and Physiology
Presence of tubules renders dentin
permeable to fluorideNumber of tubules per unit area varies
depending on the location because of the
decreasing area of the dentin surfaces in
the pulpal direction
Dental TissuesDentin (Tubules)2
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Association between erosion anddentin hypersensitivity3
Open/patent tubules
Greater in number
Larger in diameter
Removal of smear layer
Erosion/tooth wear
Enamel
Exposed
Dentin
Receding
Gingiva
Tubules
Odontoblast
Dental Anatomy
and Physiology
Dental TissuesDentin (Tubules)2
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Dental Anatomy and Physiology
Thin layer of mineralized tissuecovering the dentin
Softer than enamel and dentin
Anchors the tooth to the alveolarbone along with the periodontalligament
Not sensitive
Dental TissueCementum2
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Innermost part of the tooth
A soft tissue rich with blood vessels andnerves
Responsible for nourishing the tooth The pulp in the crown of the tooth is
known as the coronal pulp
Pulp canals traverse the root of the tooth
Typically sensitive to extreme thermalstimulation (hot or cold)
Dental TissueDental Pulp2
Dental Anatomy and Physiology
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Pulpitisis inflammation or infection of the dental pulp, causing extreme sensitivity and/or pain.
Pain is derived as a result of the hydrodynamic stimuli activating mechanoreceptors in the nervefibers of the superficial pulp (A-beta, A-delta, C-fibers).
Hydrodynamic stimuli include: thermal (hot and cold); tactile; evaporative; and osmotic
These stimuli generate inward or outward movement of the fluid in the tubules and activate thenerve fibers.
A-beta and A-delta fibers are responsible for sharp pain of short duration
C-fibers are responsible for dull, throbbing pain of long duration
Pulpitis may be reversible (treated with restorative procedures) or irreversible (necessitating rootcanal).
Untreated pulpitis can lead to pulpal necrosis necessitating root canal or extraction.
Dental TissueDental Pulp2,5
Dental Anatomy and Physiology
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Gingiva
Alveolar Bone Periodontal Ligament
Cementum
Periodontal Tissues6
Dental Anatomy and Physiology
Gingiva
Alveolar bone
Cementum
Periodontal Ligament
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Gingiva:The part of the oral mucosa overlying
the crowns of unerupted teeth
and encircling the necks of erupted teeth,
serving as support structure forsubadjacent tissues.
Dental TissueDental Tissue6
Dental Anatomy and Physiology
Gingiva
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Alveolar Bone:Also called the alveolar
process; the thickened ridge of bone
containing the tooth sockets in the mandible
and maxilla.
Dental TissueDental Tissue6
Dental Anatomy and Physiology
Alveolar bone
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Periodontal Ligament:Connects the
cementum of the tooth root to the alveolar
bone of the socket.
Dental TissueDental Tissue6
Dental Anatomy and Physiology
Periodontal Ligament
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Cementum:Bonelike, rigid connective tissue
covering the root of a tooth from the
cementoenamel junction to the apex and lining
the apex of the root canal. It also serves as an
attachment structure for the periodontal
ligament, thus assisting in tooth support.
Dental TissueDental Tissue6
Dental Anatomy and Physiology
Cementum
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Dental Anatomy and Physiology
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Dental Anatomy and Physiology
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Plaque
Saliva
pH Values
Demineralization
Remineralization
Oral Cavity/Environment
Dental Anatomy and Physiology
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Dental Anatomy
and Physiology
Plaque:7,8
is a biofilm
contains more than 600 differentidentified species of bacteria
there is harmless and harmful plaque
salivary pellicle allows the bacteria toadhere to the tooth surface, which beginsthe formation of plaque
Oral Cavity
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Dental Anatomy
and Physiology
Saliva:7,8
complex mixture of fluidsperforms protective functions:
lubricationaids swallowing
mastication
key role in remineralization of
enamel and dentin
buffering
Oral Cavity
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Dental Anatomy
and Physiology
pH values:7,8
measure of acidity or alkalinity of asolution
measured on a scale of 1-14
pH of 7 indicated that the solution isneutral
pH of the mouth is close to neutral untilother factors are introduced
pH is a factor in demineralization andremineralization
Oral Cavity
3. Strassler HE, Drisko CL, Alexander DC.
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Dental Anatomy
and Physiology
Demineralization:7,8
mineral salts dissolve into the
surrounding salivary fluid:
enamel at approximate pH of 5.5 or
lower
dentin at approximate pH of 6.5 or
lower
erosion or caries can occur
Oral Cavity
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Dental Anatomy
and Physiology
Remineralization:7,8
pH comes back to neutral (7)
saliva-rich calcium and phosphates
minerals penetrate the damaged enamelsurface and repair it:
enamel pH is above 5.5
dentin pH is above 6.5
Oral Cavity
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ORAL IMMUNOLOGY
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Sistem ImunitasPendahuluan
Rongga Mulut merupakan pintu utamamasuk mikroorganisme
Adanya bakteri oportunis yang dapatmenjadi pathogen
faktor yang terlibat dalam pertahananSECARA anatomis maupun fisiologis,seperti :
Epitel, aliran air liur, anatomi gigi
Imunitas humoral dan seluler
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Sistem ImunitasKomponen Jaringan
Membran Mukosa
..
Makrofag, Antibody
Keratin
Lapisan Granula
Membran Dasar
Air Liur
Pembuluh Darah
..
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Sistem imunitasKomponen Jaringan
Mukosa
merupakan barier protektif yangterdiri atas lapisan-lapisan sel
Nodus LimfatikusAgregasi limfoid intraoral, seperti
tonsil
Kelenjar Air Liur
yang memproduksi IgA
Jaringanterdapat sel-sel imunokompeten dan
molekul-molekul imunitas
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Sistem ImunitasAir Liur
Air Liur disekresikan oleh Kelenjar Besar dan Kecil yang sangat berperandalam membersihkan sisa makanan dan mikroorganisme
Diproduksi 19 ml perjam yang meningkat saat makan. Bila ada penurunandihubungkan dengan penyakit karies gigi dan parotitis
Senyawa yang berperan
Lisosim dan muramidase
Peroksidase (penghambatan pemakaian lisin oleh Lactobacillus)
Laktoferin (bakteriostatik)
Komponen C3.
Leukosit dapat hidup dalam air liur.
Antibodi merupakan unsur penting pada air liur berupa sIgA.
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Sistem ImunitasGusi Celah
Struktur Celah Gusi
1
2
3
4
5
1. Kapiler
2. Jaringan Subepitel
3. Epitel Junctional
4. Cairan Gusi
5. Air Liur
Si I i
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Sistem ImunitasKomponen Seluler dan Humoral
Darah Cairan Celah Gusi
IgG, IgM, IgA
Protein
Komplemen
Enzim-enzimElektrolit
Neutrofil
Sel T, Sel B
Makrofag
Cairan Celah Gusi
Cairan Mulut
sIgA, IgG, IgM
Protein,
Enzim
ElektrolitNeutrofil
sIgA
ProteinEnzim
Elektrolit
Domain air liur
Air LiurAir LiurKelenjar
Air liur
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Respon Imun thd Plak dan BakteriPendahuluan
Mikroorganisme yang pertama ada setelah kelahiranadalah Streptococcus salivarius. Diikuti Veillonellaalcalescens, Lactobacilli dan Candida albicans
Actinomyces dan kuman anaerob lainnya ada setelah1 bulan kemudian
Sedang Streptococcuc sanguinus dan Streptococcusmutans baru tumbuh mengikuti erupsi gigi-gigi.
Plak merupakan agregat sejumlah besar danberbagai macam mikroorganisme pada permukaangigi.
Awal plak gigi dimulai dengan melekatnya bakteriaerob (kuman yang pertama kali melekat adalah S.sanguis)
Begitu gigi erupsi akan dilindungi oleh glikoproteinyang disebut acquired pellicle.
i
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Respon Imun thd Plak dan BakteriPlak dan Respon Imun
Komponen Plak Gigi
Bahan Imunopotensiasi
dan Imunosupresi
Mikroorganisme
Kariogenik
Mikroorganisme
Periodontopati
Streptococcus mutans
Actinomyces viscous
Lipopolisacharida
Dekstran
Levan
Asam Lipotekoat
Actinomyces
Actinobacillus
Vaillonella
Bacteriodes
CapnocytophagaEikenella
Spirochaeta
Respon imun
AntibodiIgG, IgM,IgA, sIgA,
IgE
AktivasiKomplemenJalur klasik
Jalur alternatif
KemotaksisPMN, Makrofag FagositosisPMN dan MakrofagMembunuh,
Penglepasan,
Enzim2 Lisosomal.
Limfosit T dan BMembantu,Menekan,
Proliferasi,
Limfokin,
Memori.
Karies GigiGingivitis
Periodontitis
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PERIO ONTITIS
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Respon Imun thd Plak dan BakteriPlak dan Respon Imun
Bakteri pada plak gigi bervariasi dankomplek.
Produk bakteri, seperti : LPS, LTA, Dekstrandan Levan dapat merangsang respon imun,
a.l. : Komplemen
Proloferasi Limfosit dan pelepasanlimfokin
Pergerakan Makrofag
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Imunologi Kelainan Periodontal
Pendahuluan
Kelainan gusi dan periodontal diinduksioleh plak bakterial.
Respon imun kelainan ini dapatdikelompokkan kedalam 4 stadium
Komponen sistem imun yang ikut berperan
adalah : Sistem imun sekretori
Neutrofil
Antibodi
Komplemen
Limfosit Makrofag
Sitokin (limfokin dan monokin)
I l i K l i P i d l
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Imunologi Kelainan PeriodontalStadium Respon
Stadium Parameter
Stadium I Merupakan respon inf lamasi awal, ter li hat adanya : neutrofil , kompplek imun,akti vasi komplemen dan kemotaksis
Stadium II Terl ihat infi ltr asi lokal Sel L imfosit T dan B. Dalam sir kulasi limfosittersensiti sasi, terl ihat dengan kemampuannya melepas limfokin
Stadium III Lesi menetap, ter l ihat adanya : i nf i l trasi sel plasma lokal , l imfosit padasir kul asi berplori ferasi
Stadium IV Respon imun destrukti f, dii ku ti u lserasi pada epitel celah gusi dan destruksikolagen ser ta destruksi tulang.
Destruksi yang progresif mengakibatkan kehi langan gigi
l G
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Imunologi Karies Gigi
Pendahuluan
Agregat kuman asidogenik(utamanya : S mutans) di
dalam plak gigi akan
memfermentasi dietary
menjadi asam. Glukose
menjadi sakarose.
Ca10(PO4)6(OH)2+ 8H+
10Ca2+ + 6HPO62-+ 2H2O
Karies Gigi, yang berperanadalah sIgA dan yang melaluicelah gusi adalah IgA, IgG danIgM
Bila telah mengenai pulpa, makadiawali dengan inflamasi yangmerupakan respon awal
Imunisasi adalah solusi yangpaling mungkin untukmencegah kerusakan gigi.
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oral bacteria
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dental caries
I l i K i Gi i
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Imunologi Karies GigiSkematik
S. mutans
Sukrosa
sIgA
Plak Gigi
Karbohidrat Diet
Asam
Dekalsifikasi email
dan dentin
Karies Gigi
Peningkatan koloni
kuman asidurik
dan asidogenik
Penurunan pH
plak dan air liur
Sisa makanan
karbohidrat
Faktor lain
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FOCAL INFECTION
OF SISTEMIC DISEASE
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PERIODONTITIS AND SISTEMIC DISEASE
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. VASULAR DISEASE
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VASCULAR DISEASE
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ATEROSKLEROSIS
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diabetes melitus
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diabetes melitus
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low birth infant
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Dental Anatomy & PhysiologyReferences
References
1. Oral Health for Children: Patient Education Insert. Compend Contin Educ Dent. 2005;26(5 Suppl 1):Insert.
2. Sturdevant JR, Lundeen TF, Sluder TB Jr. Clinical significance of dental anatomy, histology, physiology, and occlusion. In: Robertson TM,
Heymann HO, Swift EJ Jr, eds. Sturdevants Art and Science of Operative Dentistry . 4th ed. Mosby: St. Louis, MO; 2002:13-61.
3. Strassler HE, Drisko CL, Alexander DC. Dentin hypersensitivity: its inter-relationship to gingival recession and acid erosion.Inside
Dentistry. 2008;29(5 Special Issue):3-4.
4. Imfeld T. Dental erosion. Definition, classification and links.Eur J Oral Sci. 1996;104(2 (Pt 2)):151-155.
5. Dentin hypersensitivity: current state of the art and science. In: Pashley DH, Tay FR, Haywood VB, et al. Dentin Hypersensitivity:Consensus-Based Recommendations for the Diagnosis and Management of Dentin Hypersensitivity.Inside Dentistry. 2008;4(9 Special
Issue):8-18.
6. Dorlands Medical Dictionary. 29thEd. Philadelphia, PA: W. B. Saunders Company; 2000.
7. Robertson TM, Lundeen TF. Cariology: the lesion, etiology, prevention, and control. In: Robertson TM, Heymann HO, Swift EJ Jr, eds.
Sturdevants Art and Science of Operative Dentistry . 4th ed. Mosby: St. Louis, MO; 2002:63-132.
8. Tooth Erosion in ChildrenUS Perspective.Inside Dentistry. 2009;5(3 Suppl):8.
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Dental Anatomy and Physiology
For more in-depth, categorized information, please
visit the IFDEA at www.ifdea.org
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Dental Anatomy & Physiology
This I FDEA Educational Teaching Resource was
underwritten by an unrestr icted educational grant from:
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