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Although the nation’s oral health is believed to be the best it has ever been, oral diseases remain common in the United States. In May 2000, the first report on oral health from the US Surgeon General, Oral Health in America: A Report of the Surgeon General, called attention to a largely overlooked epidemic of oral diseases that is disproportionately shared by Americans. This epidemic strikes, in particular, the poor, young, and elderly. The report stated that although there are safe and effective measures for preventing oral diseases, these measures are underused. The report called for improved education about oral health, for a renewed understanding of the relationship between oral health and overall health, and for an interdisciplinary approach to oral health that would involve primary care providers.


In utero, the 20 primary teeth evolve from the expansion and development of ectodermal and mesodermal tissue at approximately 6 weeks of gestation. The ectoderm forms the dental enamel, and the mesoderm forms the pulp and dentin. As the tooth bud evolves, each unit develops a dental lamina that is responsible for the development of the future permanent tooth. The adult dentition is composed of 32 permanent teeth. Figure 46–1 shows the anatomy of the tooth and supporting structures. Table 46–1 outlines the eruption pattern of the teeth.

Figure 46–1.

Anatomy of the tooth and supporting structures.

Table 46–1.Eruption pattern of teeth.



  • Nonlocalized pain when exposed to heat, cold, or sweats.

  • Painless white spot (demineralized areas of enamel) near gingival margins (white or brown spots).

  • As infection proceeds to pulp, pain becomes localized.

  • Visible pits or holes in the teeth.

  • Poor oral hygiene and frequent snacking between meals are risk factors.

General Considerations

Dental caries (tooth decay) is the single ...

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