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Preface

Acknowledgments

About the Author

1. The Origins of Teeth

1.1 Evolution

1.2 The Teeth as Tools

1.2.1 Tooth Strength

1.2.2 Tooth Design

1.2.3 Tooth Wear in Man

2. Dental Hard Tissues

2.1 Enamel: Clinical Aspects

2.1.1 Enamel Minerals

2.1.2 Enamel: Non-Minerals

2.1.3 Enamel Etching

2.1.4 Early Enamel Caries

2.1.5 Arrested Enamel Caries

2.2 Pulp–Dentin: Clinical Aspects

2.2.1 Physical Properties

2.2.2 Tubules

2.2.3 Permeability

2.2.4 Response to Irritation

2.2.5 Secondary Dentin

2.2.6 Dental Pulp Hyperemia

2.2.7 The Pulp Chamber and Root Canal

2.3 Response of the Pulp–Dentin to Caries

2.3.1 Bacterial Penetration

2.3.2 Secondary Caries

2.3.3 Conservative Management of Deep Caries

2.3.4 Arrested Caries in Dentin

2.3.5 Regeneration after Pulpal Exposure

2.3.6 The Origin of Replacement Odontoblasts

3. Oral Mucosa and Periodontium

3.1 Structure of Oral Mucosa

3.1.1 Oral Epithelium

3.1.2 Lamina Propria

3.2 Function of Oral Mucosa

3.2.1 Rates of Turnover of Oral Mucosa

3.3 Regional Variation of Oral Mucosa

3.3.1 Masticatory Mucosa

3.3.2 Lining Mucosa

3.3.3 Gustatory Mucosa

3.4 Alveolar Bone

3.5 The Periodontal Ligament

3.5.1 Periodontal Ligament Fibers

3.5.2 Response of the Periodontal Ligament to Loading

3.5.3 Cells of the Periodontal Ligament

3.5.4 Vascular Supply of the Periodontal Ligament

3.5.5 Functions of the Periodontal Ligament

3.6 Cementum

3.6.1 Functions of Cementum

3.6.2 Origins of Cementum

3.6.3 Changes in Cementum with Aging

3.6.4 Cementum Formation in Healing

3.7 Junctional Epithelium

3.7.1 Loss of Epithelial Attachment

3.7.2 Influence of Female Hormones

4. The Ecology of the Oral Cavity

4.1 Introduction

4.2 The Oral Environment

4.2.1 Salivary Pellicle

4.2.2 How Saliva Defines the Oral Environment

4.2.3 Rate of Flow of Saliva

4.2.4 Gingival Crevicular Fluid

4.3 The Biofilms of the Oral Environment

4.3.1 Biofilms

4.3.2 Calculus

4.3.3 Growth of a Biofilm

4.3.4 Dental Plaque

4.3.5 Variations in Plaque

4.3.6 From Symbiont to Pathobiont

4.3.7 Cross-Infection Control

4.3.8 Single Organism or Consortium

4.3.9 Dental Caries

4.3.10 Periodontal Disease

4.4 Oral Ecology and Dental Caries

4.4.1 Diet and Control of Dental Caries

4.4.2 Risk Factors in Predicting Dental Caries

4.4.3 Dental Caries, Infection, or Dietary Disorder?

4.5 Nutrition and Oral Ecology

4.5.1 Oral Manifestation of Malnutrition

4.5.2 Trace Elements, Minerals, and Vitamins

4.6 The Influence of Fluorides on the Oral Ecosystem

4.6.1 Distribution of Fluoride in Teeth

4.6.2 Fluoride Protection of Enamel

4.6.3 Administration of Fluoride

4.7 Mucosal Immunity and Oral Ecology

4.7.1 General Barriers to Infection

4.7.2 Mucosal Immunity

4.7.3 Antigen Tolerance

4.7.4 A Caries Vaccine

5. Cell Differentiation in Embryology and Repair

5.1 Cell Interactions in Differentiation

5.1.1 Cell Differentiation

5.1.2 Cell Differentiation during Embryology

5.1.3 Cell and Matrix Interactions in Tooth Development

5.2 Tooth Morphogenesis

5.2.1 Generic Tooth Forms

5.2.2 Cusp Morphology

5.3 Cell Interactions in Repair and Regeneration

5.3.1 Wound Healing

5.3.2 Healing of a Tooth Socket

5.3.3 Healing of a Pulp Exposure

5.3.4 Cytokines and Extracellular Matrix in Healing

5.3.5 Comparison between Repair and Embryology

5.3.6 Nutrition, Embryology, and Healing

6. The Extracellular Matrix

6.1 Glycosaminoglycans

6.1.1 Types of Glycosaminoglycans

6.1.2 Properties of Glycosaminoglycans

6.2 Glycoproteins

6.2.1 Bone Glycoproteins

6.2.2 Fibronectin

6.2.3 Laminin

6.2.4 Metalloproteins

6.2.5 Periostin

6.3 Fibrous Matrix Proteins

6.3.1 Collagen

6.3.2 Elastin

6.3.3 Keratin

6.4 Matricellular Proteins

7. The Physiology of Bone

7.1 The Mineralization Process

7.1.1 Composition of Biological Apatites

7.1.2 Solubility of Apatites

7.1.3 Production of Apatite Crystals

7.2 Mechanisms of Mineralization

7.2.1 Control of Mineralization by Organic Components

7.2.2 Control of Mineralization by Cells

7.3 Methods of Bone Formation

7.3.1 Origins of Bone

7.3.2 Structure of Cartilage

7.3.3 Cartilage as a Skeletal Material

7.3.4 Intramembranous Bone Formation

7.3.5 Growth of Intramembranous Bone

7.3.6 Endochondral Bone Formation

7.3.7 Summary of Differences between Cartilage and Bone

7.4 Development of the Skull and Jaws

7.4.1 Development of the Mandible

7.4.2 Development of the Temporomandibular Joint

7.4.3 Synchondrosis of the Cranial Base

7.5 General Features of Growth

7.5.1 Phases of Growth

7.5.2 Measuring Growth

7.5.3 Soft Tissue (Functional) Matrices

7.6 Growth of the Skull and Jaws

7.6.1 Growth of the Cranium and Face

7.6.2 Growth of the Mandible

7.7 Bone Remodeling

7.7.1 Mechanical Loads and Bone Remodeling

7.7.2 Cellular Process of Bone Remodeling

7.7.3 Transformation of Stress to Bone Cells

7.7.4 Tooth Repositioning

7.7.5 Remodeling of the Tooth Socket

7.7.6 Tooth Displacement and Cell Rests of Malassez

7.7.7 Response of Alveolar Bone to Dentures

7.7.8 Response of Bone to Implants

7.7.9 Systemic Factors and Bone Turnover

8. Eruption, Occlusion, and Wear

8.1 Eruption

8.1.1 Phases of Eruption

8.1.2 Formation of the Epithelial Attachment

8.1.3 Eruptive Mechanisms

8.1.4 Tooth Position after Eruption

8.1.5 Incomplete Eruption

8.1.6 Deciduous Dentition

8.1.7 Differences between Deciduous and Permanent Teeth

8.1.8 Mixed Dentition

8.2 Occlusion

8.2.1 Stability of the Dentition

8.2.2 Arch Stability

8.2.3 Tooth Stability

8.2.4 The Distribution of Bite Forces on Teeth

8.2.5 Summary

8.2.6 Purpose of Cusps

8.2.7 Arch and Tooth Relationships

8.2.8 Curves of Occlusion

8.2.9 Tooth Contacts during Function

8.2.10 Anterior Tooth Contact

8.2.11 Summary of Arch and Tooth Relationships

8.2.12 Class II Arch and Tooth Relationships

8.2.13 Occlusion and Wear

8.3 Tooth Wear

8.3.1 Types of Tooth Wear

8.3.2 Consequences of Tooth Wear

8.3.3 Other Compensatory Mechanisms for Continued Eruption

9. The Temporomandibular Joint

9.1 The Mechanics of the Temporomandibular Joint

9.1.1 A Load-Bearing Joint

9.1.2 Variable Forces at the Teeth

9.1.3 Joint Stability

9.1.4 Joint Instability and Muscle Fatigue

9.2 The Structure of the Temporomandibular Joint

9.3 Movement at the Temporomandibular Joint

9.3.1 Constraints of Jaw Movements

9.3.2 Disk Displacement

9.3.3 Condyle Position

9.4 Temporomandibular Dysfunction

9.4.1 Diagnosis

9.4.2 General Description of Temporomandibular Dysfunction

9.4.3 Research Diagnostic Criteria

9.4.4 Axis I—Physical Factors (Signs)

9.4.5 Axis II—Psychosocial Factors (Symptoms)

9.4.6 Evidence-Based Etiology

9.4.7 Diagnostic Tests

9.4.8 Illness Behavior

9.4.9 Management of Temporomandibular Dysfunction

10. Oral Sensations and Functions

10.1 The Nature of Pain

10.1.1 Injury without Pain

10.1.2 Pain without Injury

10.1.3 Chronic Pain

10.1.4 Measuring Pain

10.2 Psychological Factors and Pain

10.2.1 Culture

10.2.2 Past Experience

10.2.3 The Meaning of Pain

10.2.4 Control over Pain

10.2.5 Suggestion and Placebo

10.2.6 Hypnosis

10.2.7 “Psychological” Pain

10.2.8 Pain at Death

10.3 Some Types of Clinical Pain

10.4 Pain Mechanisms

10.4.1 Pain Pathways

10.4.2 Nerve Synapses

10.4.3 Innervation of the Pulp–Dentin

10.4.4 Dentin Sensitivity

10.4.5 Pulp–Dentin Pain

10.4.6 Neurogenic Inflammation of the Pulp Tissue

10.4.7 Facial Pain of Muscular Origin

10.4.8 Trigger Points in Muscles

10.4.9 Referred Pain

10.4.10 Nerve Injury

10.4.11 The Gate Theory

10.4.12 Pain and Stress

10.5 Oral Pain Control

10.5.1 Controlling Sensations

10.5.2 Controlling Emotions

10.5.3 Chronic Pain Management

10.5.4 Pain Control Mechanisms

10.6 Taste

10.6.1 General Features of Taste

10.6.2 Modalities and Distribution

10.6.3 Taste Buds

10.7 Oral Proprioception

10.7.1 Skin and Mucosa

10.7.2 Periodontal Receptors

10.7.3 Altered Feedback

10.7.4 Temporomandibular Joint Receptors

10.8 Oral Reflexes

10.8.1 Jaw Reflexes

10.9 Mastication

10.9.1 Evolutionary Aspects

10.9.2 Suckling

10.9.3 Masticatory Efficiency and Digestion

10.9.4 Masticatory Forces

10.9.5 Functional Jaw Movements

10.9.6 Muscle Activity

10.10 Swallowing

10.10.1 The Oral Phase of Swallowing

10.10.2 The Pharyngeal Phase

10.10.3 The Esophageal Phase

10.10.4 Muscle Activity of Swallowing

10.10.5 Forces during Swallowing

10.11 Speech

10.11.1 Phonation and Articulation

10.11.2 Defects in Speech

11. Aging

11.1 General Features of Aging

11.2 Age Changes in the Teeth

11.2.1 Abrasion and Attrition

11.2.2 Stains and Discoloration

11.2.3 Secondary and Sclerotic Dentin

11.2.4 Age Changes in the Dental Pulp

11.3 Age Changes in Tooth Support

11.3.1 The Periodontal Ligament

11.3.2 Cementum

11.3.3 Alveolar Bone

11.3.4 Oral Mucosa

11.3.5 Changes in the Temporomandibular Joint

11.4 Age Changes in Saliva

11.5 Nutritional Changes in Aging

11.6 Forensic Features of Eruption and Wear

11.7 Emotional Changes in Aging

Appendices

Appendix A. The Origins of Teeth

A.1 Mastication and Mammals

A.1.1 The Evolution of Mammalian Teeth

A.1.2 The Mammalian Work Ethic

A.1.3 A Voracious Appetite

A.1.4 A Robust Skeleton and Powerful Muscles

A.1.5 Mammalian Teeth

A.1.6 The Mammalian Tooth Socket

A.1.7 The Mammalian Jaw Joint

A.2 The Mechanics of Tooth Use

A.2.1 Piercing Food

A.2.2 Cutting Food

A.2.3 Shredding Food

A.2.4 Grinding Food

Appendix B. Dental Hard Tissues

B.1 Physical Properties of Enamel and Dentin

B.2 Enamel Proteins

B.3 Composites and Resistance to Fracture

Appendix C. Oral Mucosa and the Periodontium

C.1 Tooth Displacement

C.2 Tooth Mobility

Appendix D. The Ecology of the Oral Cavity

D.1 Saturated Solutions

D.2 Salivary Gland Secretion

D.3 Gaia Theory

D.4 Gene Regulation in Biofilms

D.5 Strategies for Controlling Biofilms

D.6 Gram Staining Bacteria

D.7 Microenvironments

D.8 The Vipeholm Study

D.9 Fluoride Availability, Toxicity, and Fluorosis

D.9.1 Availability of Fluoride

D.9.2 Toxicity of Fluoride

D.9.3 Fluorosis

Appendix E. Cell Interactions in Embryology and Repair

E.1 Epigenetic Modulation

E.2 Morphogenesis

E.2.1 Adhesion and Contact Inhibition

E.2.2 Apoptosis

E.2.3 Integrins

Appendix F. The Physiology of Bone

F.1 Stress and Trabecular Orientation

F.2 Remodeling to Achieve Optimal Stress

Appendix G. Oral Sensations and Functions

G.1 Peripheral Sensitization

G.2 Central Sensitization

G.3 Central Connections of Pain Impulses

Appendix H. Endnotes

H.1 Cracks, Composites, and Teeth

H.2 On Growth and Form

H.3 The Heritage of Fibrous Polymers

H.4 Anecdotal Evidence; a Poor Substitute for Science

H.4.1 Convictions and Reality

H.4.2 The Lessons of Bloodletting

H.4.3 Evidence-Based Knowledge

H.4.4 The Deficiencies of the Process of Induction

Glossary of Terms in Biology

Index