Chapter 240

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.

###### Figure 240-1.

Normal eruptive patterns of the primary and permanent dentition. mo. = months; yr. = years.

###### Figure 240-2.

Identification of teeth.

### Anatomy of the Teeth

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

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