DADH New Corrections Final

DADH
Dental Anatomy | Dental Histology
Made Easy
Exam Oriented Qs & As
and
Practical Guide to Tooth Carving
for First Year BDS Students
• LAQs • Carving
• SAQs • Identification of Teeth
• MCQs • Age Determination of Casts
DADH
Made Easy
and
for First Year BDS Students
• LAQs • Carving
• SAQs • Identification of Teeth
• MCQs • Age Determination of Casts
Jayshree Daiya Mavani

Lecturer
Dental Anatomy
Yerala Dental College and Hospital
Navi Mumbai
Sheetal Korde Choudhari

Associate Professor
Department of Oral Pathology and Microbiology
Navi Mumbai
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DADH
Made Easy
and
ISBN: 978-93-?????-??-?
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Printed at
Foreword
I t gives me immense pleasure to foreword the book titled “DADH Made

Easy—Exam Oriented Qs & As and Practical Guide to Tooth Carving”
pertaining to the subject of Dental Anatomy and Dental Histology. This
book is authored by Dr. Jayshree Daiya Mavani and Dr. Sheetal Korde
Choudhari which is presented in question and answer format. It gives basic
understanding of the subject and caters to the needs of the students for
preparation of examination. I appreciate their efforts in striving towards
this particular endeavour primarily keeping student welfare in mind.
The subject DADH warrants extensive reading for which various reference text books are
available but due to limited time for preparation of examination, it is often difficult for the
students to frame appropriate answers. In view of this difficulty and keeping in mind the
overall significance of this subject in dental curriculum, I believe that this book, will be of
great help to the students. Section III of this book, “The Practical Guide to Tooth Carving”
would help both as a technique and as a hands-on to remember the details of morphology of
each tooth.
I congratulate the authors for this venture and wish them all success.
Sangeeta Patankar
Professor and Head
Department of Oral Pathology,
Navi Mumbai
Preface
W e take great pleasure in presenting this book titled, “DADH Made Easy—Exam
Oriented Qs & As and Practical Guide to Tooth Carving” for the first year BDS students.
The subject of Dental Anatomy and Dental Histology is an important subject in the dental
curriculum which forms the basis for understanding of various aspects of dentistry.
It is our observation that understanding this voluminous subject within a limited time-
space is indeed a challenge especially in concising the information for an exam oriented answers.
This book has been compiled to help the students, acquire comprehensive knowledge of the
subject while familiarizing them with the questions frequently asked in university examination.
In Section III of this book, “The Practical Guide to Tooth Carving” has been included with
schematic representations that are easy to follow. It will also serve as a valuable aid to perfect
the technique. Along with carving, guidelines for identification of teeth and age determination
of dental casts have been included.
It is our earnest belief that our objectives will be accomplished and that the book will help
the students to acquire comprehensive knowledge of the subject and deal with the exams
confidently.

Acknowledgements
O ur sincere gratitude to all those who have traversed with us in the making of this book.
We thank Dr Sangeeta Patankar, Professor and Head, Department of Oral Pathology,
Yerala Dental College & Hospital for her scholarly and practical insights towards contents
and format of the book.
We appreciate and acknowledge the assistance and efforts of Dr Komal Khot, Dr Sheeba
Alex, Dr Kriti Bagri Manjrekar, Dr Gokul Sridharan and Dr Vaishali Joshi, faculty, Department
of Oral Pathology, Yerala Dental College and Hospital.
Our sincere gratitude to Dr. Rajkumar Maurya for his willing cooperation and contributory
efforts.
We extend our sincere thanks to the DTP operator Sunita Tikare, artist Wadekar and CBS
Publishers & Distributors of this book for bringing this matter to print.

Contents
Foreword by Sangeeta Patankar v

Preface vii
Acknowledgments viii
Abbreviations xi
Section I—Dental Anatomy

Dr Mavani
1. Terminology Related to Tooth Morphology 3
2. The Permanent Incisors 28
3. The Permanent Canines 38
4. Premolars 45
5. The Permanent Molars 67
6. Differences between Deciduous and Permanent Dentition 99
7. Occlusion 115
8. Blood and Nerve Supply to Teeth and Tongue 137
9. Muscles of Mastication 141
10. Deglutition 145
11. Temporomandibular Joint 148
12. Maxillary Sinus 151
Section II—Dental Histology

Dr Choudhari
13. Development of Tooth and Face 157
14. Enamel 181
x DADH Made Easy
15. Dentin 204

16. Pulp 222
17. Cementum 237
18. Periodontal Ligament 251
19. Bone 266
20. Oral Mucous Membrane 282
21. Salivary Glands 307
22. Tooth Eruption 327
23. Shedding of Deciduous Teeth 334
24. Preparation of Specimen for Histologic Study 342
Section III—Practical Guide

Dr Mavani and Dr Choudhari
25. Carving of Teeth 353

Incisors 359
Canines 370
Premolars 378
Molars 393
26. Guide for Identification of Teeth 408

27. Age Determination of Dental Casts 424
Bibliography 433
Index 435
Terminology Related to Tooth Morphology xi
Abbreviations
ABBREVIATIONS USED IN THE BOOK ARE FOR EASE OF REPRESENTATION ONLY

Class of Teeth Cervical ridge CR
Incisor I Triangular ridge TR
Canine C Mesial marginal ridge MMR
Premolar PM Buccal triangular ridge BTR
Molar M Oblique ridge OR
Lingual triangular ridge LiTR
Side/Surface Palatal triangular ridge PTR
Incisal I
Grooves
Mesial M
Central groove CG
Distal D
Buccal groove BG
Occlusal O
Lingual groove LG
Cervical C
Palatal groove PG
Labial La
Mesiolingual groove MLG
Lingual Li
Mesial marginal ridge groove MMRG
Buccal B
Mesiobuccal developmental groove MBDG
Palatal P
Distobuccal developmental groove DBDG
Angle Mesiolingual developmental groove MLDG
Mesioincisal angle MIA Distolingual developmental groove DLDG
Distoincisal angle DIA Fossa
Dimension/distance Central Fossa CF
Cervicoincisal CI Canine Fossa CF
Mesiodistal MD Mesial triangular fossa MTF
Labiolingual LaLi Distal triangular fossa DTF
Buccolingual BL
Cusps
Buccopalatal BP
Mesiobuccal MB
Outline Mesiopalatal MP
Distolabial DL Mesiolingual ML
Mesiolabial ML Distobuccal DB
Distopalatal DP
Ridges
Distolingual DL
Labial ridge LaR
Lingual ridge LiR Other
Buccal ridge BR Mesial Cusp Slope/Ridge MCS/MCR
Palatal ridge PR Distal Cusp Slope/Ridge DCS/DCR
Section I
Dental Anatomy
1. Terminology Related to Tooth Morphology
2. The Permanent Incisors
3. The Permanent Canines
4. Premolars
5. The Permanent Molars
6. Differences between Deciduous and Permanent Dentition
7. Occlusion
8. Blood and Nerve Supply to Teeth and Tongue
9. Muscles of Mastication
10. Deglutition
11. Temporomandibular Joint
12. Maxillary Sinus
1
Terminology Related to
Tooth Morphology
SAQs (3 Marks)
Q 1. What are elevations on the surface of the tooth?

(Oct. 2003, May 2008, 2013, Nov. 2010, 2015)
Ans. Elevations on the surface of the tooth are cusps, tubercle, cingulum, lobe, ridge, and
mamelons.
Cusp (Fig. 1.4)

• It is an elevation or mound on the crown portion of a tooth making up a divisional part of
the occlusal surface.
• A cusp can also be defined as an elevation or a point or a peak on the chewing surface of a
molar or a premolar and on the incisal edge of the canine.
• Cusps are named according to their location on the tooth surface.
• The number of cusps varies according to the type of the tooth. Canine has one cusp, maxillary
first premolar has two cusps, mandibular second premolar may have three cusps. Maxillary
first molar has four cusps and the mandibular first molar has five cusps.
• Maxillary first molar has an accessory cusp on the palatal surface of the mesiopalatal cusp
called “cusp of Carabelli”.
• The cusp includes the ridges that form an angle at the cusp tip.
• Each cusp has four sides or four ridges which run down from the cusp tip.
Mesial and distal cusp ridges or slopes.
Buccal and lingual cusp ridges or triangular ridges.
• The cusp ridges are named according to the direction in which they extend from the cusp tip.
Tubercle
• It is a smaller elevation on some portion of a crown formed by enamel only.
• It can be called a mini cusp.
• It is deviation from typical form. It is variable in size and shape. For example: Cusp of Carabelli
on the maxillary first molar is a tubercle. On the lingual surface of some maxillary anterior
teeth especially deciduous canine a tubercle may be present.
3
4 DADH Made Easy
Cingulum (Fig. 1.1)

• It is a Latin word for girdle since it encircles the
cervical third of the lingual surface of the tooth
mesiodistally in the form of a girdle.
• It is the lingual lobe of the anterior teeth.
• It is a bulge, a rounded protuberance or an elevation
on the lingual surface of the anterior teeth in the
cervical third of the crown.
• It makes up the bulk of the cervical third of the
lingual surface of anterior teeth.
Fig. 1.1: Cingulum
Lobe (SAQ, May 2007) (Fig. 1.2)
• It is one of the primary sections of formation in the development of the crown of the
tooth.
• Development of tooth takes place by formation of 3 or 4 centres. Each centre proceeds until
there is coalescence of all of them. Each of these centres is called lobe.
• In terms of evolution of dentition, tooth crowns are said to have developed from lobes or
primary centres or primary anatomic divisions on teeth separated by primary grooves.
Cusps and mamelons are representive of lobes.
• Cingulum represents the lingual lobe on anterior teeth and mamelons represent the labial
lobes on anterior teeth.
• All normal permanent teeth develop from minimum of 4 lobes.
• Permanent anterior teeth, maxillary premolars, and mandibular first premolar develop from
four lobes (3 labial, 1 lingual).
• Mandibular second premolars and mandibular first molars develop from five lobes (3 buccal,
2 lingual).
• Permanent maxillary molars develop from four lobes (2 buccal, 2 lingual).
• Exception is some maxillary third molars which develop from 3 lobes.
• Peg-shaped maxillary lateral incisors develop from less than 3 lobes.
Fig. 1.2: Lobes

Terminology Related to Tooth Morphology 5
Ridge (SAQ, May 2009) (Fig. 1.6)

It is any linear elevation on the surface of a tooth and is named according to its location.
• Incisal ridge is the incisal edge of the incisor.
• Labial ridge is the vertical ridge on the labial surface of the canine that runs cervico-incisally
from the cervical line to the cusp tip.
• Cusp ridge: Each cusp has four ridges. They are named by the direction in which they
extend from the cusp tip.
– Mesial and distal cusp ridges extend from the cusp tip in mesial and distal direction.
– Buccal cusp ridge extends from the cusp tip towards the cervical line on the buccal surface
of the cusp of premolars and molars.
– Lingual cusp ridge extends on the lingual surface from the cusp tip.
• Cervical ridge extends mesiodistally in the cervical one-third of the facial surface of the
crown. It is found on all deciduous teeth but in permanent teeth it is more prominent on
mandibular second molars.
• Marginal ridges are rounded borders of enamel on mesial and distal borders of the lingual
surface of the incisors and canines and on mesial and distal borders of the occlusal surface
of premolars and molars (Fig. 1.1).
• Triangular ridge is the ridge from the tip of the cusp of premolars and molars towards the
centre of the occlusal surface (Fig. 1.4).
• It is so named because the slopes of each side of the ridge are inclined to resemble two sides
of a triangle.
– It is named after the cusp to which it belongs. For example: Triangular ridge of buccal
cusp, triangular ridge of lingual cusp.
– Triangular ridge which extends from the cusp tip to the centre of the occlusal surface is
same as one of the four cusp ridges (lingual cusp ridge).
– All posterior teeth cusps have one triangular ridge each, except for the mesiolingual
cusp of maxillary first molar which has two triangular ridges, mesial and distal separated
by Stuart groove.
• Transverse ridge is the ridge that extends in buccolingual direction on the occlusal surface
of the posterior teeth. It is formed by the union of triangular ridge of the buccal cusp and
the lingual cusp.
• Oblique ridge (SAQ, 2001, May 2007, 2012) is a special type of transverse ridge, which
extends buccolingually in oblique direction. It crosses the occlusal surface of the maxillary
first molar of both the dentitions in an oblique direction from the mesiolingual cusp to the
distobuccal cusp.
– Function of oblique ridge: Central fossa of mandibular molar and
oblique ridge of maxillary molar act as mortar-pestle and aid in
mastication.
Mamelons (SAQ, 2000) (Fig. 1.3)

• Mamelons represent the lobes.
Mamelons are the three rounded protuberances found on the incisal
ridge of the newly erupted permanent incisor.
• They are normally worn away rather soon after eruption if the teeth
are in normal occlusion. Fig. 1.3: Mamelons
6 DADH Made Easy
• Mamelons occasionally do not wear out when the teeth are malaligned, e.g. when there is
an anterior open-bite relationship.
• Mamelons are extensions made of enamel with no dentin layer underneath and because of
their thinness they appear more translucent as opposed to the rest of the clinical crown
which is always more opaque than the mamelons.
Q 2. What are depressions on the surface of the tooth? (SAQ, Nov. 2011, 2014, 2015)
Ans. Depressions on the surface of the tooth are sulcus, groove, fissure, fossa, and pit.
Sulcus (Fig. 1.4)

• It is a broad and long
depression or valley between
the ridges and cusps on the
occlusal surface of posterior
teeth, the inclines of which
meet at an angle and extends
outward to the cusp tip.
• Sulcus is an elongated valley
or depression on the surface
of the tooth formed by the
inclines of adjacent cusps or Fig. 1.4: Sulcus
ridges, e.g. a central sulcus is a major linear depression that traverses the occlusal surface of
a posterior tooth from mesial triangular fossa to distal triangular fossa.
• A sulcus has a developmental groove at the junction of its inclines. (The term sulcus must
not be confused with the term groove).
• It is the occlusal depression between cusps (valley) that is seen on all posterior teeth.
Groove (SAQ, Nov. 2004) (Fig. 1.5)

Developmental Groove
• It is a shallow groove or line between the
primary parts of the crown or root.
• It is a shallow groove, narrow or linear
depression, short or long formed during tooth
development, and usually separating lobes or
major portions of the tooth. Fig. 1.5: Grooves
The major grooves are named according to their location.
Grooves are important escape-ways for cusps during lateral and protrusive jaw movement
and for food morsels during mastication.
Buccal and lingual developmental grooves are present on the B and L surfaces of posterior
teeth.
Central groove is present on the occlusal surface of posterior teeth.
Supplemental Grooves
• A supplemental groove, less distinct is also a shallow linear depression on the surface of
the tooth but it is supplemental to a developmental groove and does not mark the junction
of primary parts.
• They are small, irregularly placed grooves, not at the junction of lobes or major portions of
a tooth, found usually on occlusal surfaces.
Fissure
Fissure is a narrow crevice, sometimes deep, present at the depth of the developmental
groove formed during development and extending inward toward the pulp from the
groove.
Decay begins in a deep fissure.
Fossa
Fossa is an irregular depression or concavity found on the surface of the tooth.
Lingual Fossa (Refer Fig. 1.1)

Lingual fossa is present on the incisal two-thirds of the lingual surface of the anterior teeth.
It is bounded by incisal ridge, mesial and distal marginal ridges, and cingulum.
The lingual fossa of canine is divided into mesial and distal lingual fossae by the prominent
lingual ridge running cervico-incisally from the cingulum to the tip of the cusp.
Central fossa is present on the occlusal surface of the molars and premolars. It is formed by
the covergence of the ridges terminating at a central point in the bottom of the depression
where there is junction of grooves (Fig. 1.7).
Triangular fossae: They are present on the occlusal surfaces of the posterior teeth towards
the mesial and distal marginal ridges.
The mesial triangular fossa is present distal to mesial marginal ridge (MMR) and the distal
triangular fossa is present mesial to distal marginal ridge (DMR) (Fig. 1.7). They are sometimes
found on the lingual sufaces of maxillary incisors at the edge of the lingual fossae where the
marginal ridges and cingulum meet.
Canine fossa is a small concavity present on the mesial surface of the crown of the maxillary
first premolar just above the cervical line to accomodate the distoincisal angle of the canine or
It is a mesial developmental depression on the mesial surface of the maxillary first premolar
where distal rounded surface of the canine rests. It is believed to be produced due to the
pressure of the distal aspect of maxillary canine as it develops earlier than the first premolar
(Fig. 1.4).
Ridges and Fossae: Maxillary first premolar, occlusal aspect TBC.

Tip of buccal cusp; MBCR, mesiobuccal cusp ridge MBDG
mesiobuccal developmental groove; MTR, mesial triangle fossa,
MMDG, mesial marginal development groove; MMR, mesial marginal
ridge; MLCR, mesiolingual cusp ridge; LTR, lingual triangular ridge;
TLC, tip of lingual cusp CR, central groove; DLCR, distolingual cusp
ridge; DMR, distal marginal ridge; DTF, distal triangular fossa, DBDG,
distobuccal development groove; BTR, buccal triangular ridge, DBCR,
distobuccal cusp ridge.
Fig. 1.6
8 DADH Made Easy
Pit
Pits are small pinpoint depressions
located at the junctions of developmental
grooves or at terminals of those grooves.
Pit is the deepest portion of the fossa.
Central pit is at the depth of the central
fossa where developmental grooves join. Fig. 1.7: Pits and fossae
Buccal pit is on buccal surface of molars at the terminal end of buccal developmental groove.
Lingual pit is on lingual surface of molars.
Lingual pit is also present on lingual surface of maxillary lateral incisor.
Q 3. What are inclined planes? (SAQ, 2000, May 2002, 2011, Nov. 2010)
Ans. Inclined planes are the sloping areas found between the two cusp ridges.
Each cusp has four inclined planes. They take the name of the two cusp ridges between
which they lie.
Inclined planes of buccal cusp are (Fig. 1.8):
Mesiobuccal inclined plane (MBIP)
Mesiolingual inclined plane (MLIP)
Distobuccal inclined plane (DBIP)
Distolingual inclined plane (DLIP)
Functions: They give stability to the posterior teeth during lateral movement of the mandible.
Fig. 1.8: Inclined planes
Q 4. What is human dentition?

Ans.
• Dentition means a set of teeth.
• The human dentition is termed heterodont which means it comprises of different classes of
teeth to perform different functions in the mastication process.
Human dentition has two sets of teeth—the primary set of teeth and the permanent set of
teeth. Such a condition where two sets of teeth exist is known as diphyodont.
• The primary teeth are small in size, milky white in colour, 20 in number. 10 teeth in upper
jaw and 10 teeth in lower jaw.
They are also called deciduous teeth, baby teeth, lacteal teeth, milk teeth, temporary set,
and first set of teeth.
The primary teeth begin to form at about 6 weeks in utero.
They begin to calcify between 4–6 months in utero.
The crown is completed within first year after birth.
The root formation is complete one year after eruption.

They erupt between 6 months and 24 months of age.
Pattern of eruption is from anterior to posterior.
Sequence of eruption is A B D C E.
Primary dentition period is from 6 months to 6 years of age.
The first teeth to erupt are the mandibular central incisors between 6–10 months and the
rest of the teeth follow.
The primary teeth are shed to be replaced by the permanent teeth. The permanent teeth
that replace the primary teeth are called succedaneous teeth.
At around 6 years the permanent first molars erupt distal to the primary second molars.
Permanent molars are called accessional teeth.
Primary maxillary canines are the last primary teeth to be shed.
• The permanent teeth are larger in size, yellowish white in colour and 32 in number.
16 teeth in each jaw.
The permanent teeth are also called secondary teeth.
They begin to form at birth and calcify between birth and 3 years of age except third molars
which begin to calcify between 7–10 years.
The crowns of permanent teeth are completed between 4 and 8 years except third molars
which are completed between 12 to 16 years.
Root is completed 3 years after eruption.
Pattern of eruption is from posterior to anterior.
Sequence of eruption in mandibular arch is 6 1 2 3 4 5 7 8 and in maxillary arch is
6 1 2 4 5 3 7 8 or 6 1 2 4 3 5 7 8.
Permanent dentition period is 12 years onward.
The first permanent tooth to erupt is the first molar at around 6 years of age.
The central incisor is the second permanent tooth to emerge in the oral cavity. Eruption
time occurs quite close to that of the first molar, i.e. 6–7 years.
The mandibular permanent teeth tend to erupt before the maxillary permanent teeth.
Before the permanent central incisor can come into position, the primary CI must be exfoliated.
This is brought about by the resorption of the roots of the primary CI.
Second molars erupt at around 12 years of age distal to the first molars.
The maxillary canines occasionally erupt along with the second molars, but in most instances
they precede the eruption of second molars.
The third molars erupt at around 17 years or later.
Mixed Dentition (SAQ 2000)

• In human beings there are three periods or stages of dentition.
– The primary dentition period from 6 months to 6 years. During this period oral motor
behaviour and speech are established.
– The mixed dentition period from 6 years to 12 years.
– The permanent dentition period from 12 years onwards.
• During mixed dentition period both primary and permanent teeth are present in the oral
cavity.
• It begins with the eruption of permanent first molars distal to the primary second molars.
10 DADH Made Easy
• It is a transition stage when primary teeth are exfoliated in a sequential manner, followed
by the eruption of their permanent successors.
• In the first transitional stage eruption of permanent first molars and replacement of primary
incisors by the permanent incisors occurs.
• In the second transitional stage replacement of the primary molars and canines by the pre-
molars and permanent canine occurs. It also involves the eruption of permanent second molars.
• Significant changes in occlusion occur during this stage.
Q 5. What is clinical and anatomical crown. (SAQ, May 2002)

Ans. Each tooth features two components the crown and the root (Fig. 1.9).
• The crown is that portion of the tooth which is above gum line and projects into the oral
cavity.
• The root is that portion of the tooth which is anchored into the socket and under the gingiva
and not exposed to the oral cavity.
• Anatomic crown is that part of the tooth which is covered by enamel.
• Anatomic root is that part of the tooth which is covered by cementum.
• A cervical line separates anatomic crown from anatomic root. It signifies the
cemento-enamel junction. This relationship does not change with age.
• Clinical crown and clinical root definition is applicable only when the tooth is in the oral
cavity and at least partially erupted.
• Clinical crown is that part of tooth which is visible in the oral cavity. The clinical crown
may be larger or smaller than the anatomical crown.
In newly erupted tooth the clinical crown is shorter than the anatomic crown.
In case of gum recession the clinical crown is longer than the anatomic crown because part
of exposed root is also visible.
Clinical root is that part of tooth which is not visible in the oral cavity and is covered by
gingiva.
This also could be either shorter than the anatomic root or longer than the anatomic root.
• The clinical crown and clinical root are separated by gingival margin (gum line).
Fig. 1.9: Tissues of a tooth

Q 6. What is contact point and contact area? (SAQ, July 2005)

Ans. Contact Areas/Points (Refer Fig. 1.12)
Contact areas or points are the crests of curvatures on the proximal surfaces of the tooth crowns
where the adjacent teeth contact each other in the same arch and when the teeth are in proper
alignment.
Contact areas may be in the incisal third, middle third, or at the junction of incisal and
middle third. They are never located more cervically than the middle of the tooth crown.
Mesial surfaces of all teeth face (approximate) the distal surfaces of the adjacent teeth except
for the central incisors where the mesial surfaces approximate another mesial surface.
Every tooth in the dental arch except-third molar has two contact points.
Distal surfaces of permanent third molars and distal surfaces of primary second molars
until 6 years of age have no teeth distal to them.
The contact of each tooth with adjacent tooth has important functions.
1. It stabilizes the tooth within the bony socket which thereby stabilizes the dental arch.
2. It helps prevent food impaction which can lead to decay and periodontal problem.
3. It protects the interdental papilla by shunting food towards buccal and lingual areas.
Contact areas of teeth are at first contact points, then as the teeth rub together in function
they become flattened and become contact areas.
Q 7. What are developmental lobes? (May 2007)

Ans. Answer is same as in elevation on tooth surface.
Q 8. Define bifurcation and trifurcation. (SAQ, Dec. 2005)

Ans. Furcation (Fig. 1.4)
It is a place or area on multirooted teeth where the root trunk divides into two or three separate
roots.
Bifurcation is two root branches from the root trunk. For example, maxillary first premolar
and mandibular molars.
Trifurcation is three root branches from the root trunk. For example, maxillary molars.
The spaces between the roots at the furcation are called “furcation crotches”.
Teeth with two roots have two furcation crotches.
Teeth with three roots have three furcation crotches.
Such crotches can be facial and lingual or mesial and distal depending on tooth type.
It may be close to CEJ or far from it.
Root concavities are also found on many root branches as well as on the furcal surfaces.
Q 9. State human dental formula. (SAQ, Dec. 2005)

Ans. Dental Formula
• Dental formula is the number-letter designation of various teeth in a dentition.
• The number and type of teeth present in a dentition can be expressed in the form of a dental formula.
• The denomination and number of all mammalian teeth are expressed by formulae that are
used to differentiate the human dentition from that of other species.
• Since the right and left halves of the dental arches are exact mirror images, the dental formula
includes the teeth in both the arches but of one side of the mouth only.
• Dental formula is different for both primary and permanent dentition.
12 DADH Made Easy
• The class of each tooth is represented by its initial letter – I for incisors, C for canine, PM for
premolars, M for molars.
Each letter is followed by a horizontal line and the number of each class of tooth is placed
above the line for the upper jaw and below the line for lower jaw. The formula is indicative
of one side only.
The dental formula for primary teeth in humans
2 1 2
I C M = 10
2 1 2
The dental formula for permanent teeth is
2 1 2 3
I C PM M = 16
2 1 2 3
This formula should be read as incisors two maxillary and two mandibular; canines, one
maxillary and one mandibular; premolars, two maxillary and two mandibular; molars,
3 maxillary and 3 mandibulars.
Q 10. What is eruption sequence?
Ans. Eruption Sequence
• The emergence of primary teeth takes place between the 6th and 13th months of postnatal
life.
• The sequence of eruption of primary teeth in each jaw is central incisor A, lateral incisor B,
1st molar D canine C, 2nd molar E.
• The lateral incisors, first molars and canines tend to erupt earlier in maxilla than in mandible.
• The eruption sequence of primary dentition can be represented as follows:
AB D C E
A B D CE
• In general, the teeth erupt earlier in females than in males.
• The mandibular permanent teeth tend to erupt before their maxillary counterparts.
• The sequence of eruption of permanent dentition is more variable than that of the primary
dentition.
There is a significant difference in the sequence of eruption between the two arches.
• Most common sequence of eruption in the maxillary arch is
6-1-2-4-3-5-7-8 or
6-1-2-4-5-3-7-8
• Most common sequence of eruption in the mandibular arch is
6-1-2-3-4-5-7-8
• Mandibular canines usually erupt before the mandibular premolars.
• Maxillary canines erupt after the eruption of maxillary premolars, due to which very often
they erupt labially or palatally because of loss of space due to mesial shift of erupted
premolars.
• Usually the first permanent teeth to erupt are the first molars around 6 years of age. They
are thus called 6 years molars also.
• The mandibular central incisors erupt simultaneously or immediately after the first molars
at around 6–7 years.
• Maxillary central incisors erupt next at around 7–8 years.

• Maxillary first premolars and mandibular canines follow the maxillary lateral incisors at
around 10 years.
• Second premolars follow the next year and then the maxillary canines.
• The next are the second molars around 12 years of age. They are also called as
12 years molar.
• The third molars erupt between 17–21 years. They may be impacted or even absent.
Q 11. Explain nomenclature system.

Ans. Nomenclature System/Tooth Numbering System/Notation System (NS)
• Tooth numbering system has been developed in order to have a standard way of referring
to particular teeth.
• When identifying a specific tooth one has to list the dentition, the dental arch, the quadrant
and the tooth name. Listing all this information in words is cumbersome and time-consuming.
• The numbering system acts like a dental ‘short hand’ used in the clinic to simplify tooth
identification providing a standard and easy way of communication among dental
professionals, students and care providers.
• It also gives a convenient method of record keeping in dental practice.
• Although there have been many different numbering systems, three systems are in common
use.
• It is necessary to be familiar with all the three notation systems (NS) so that communication
between the dental offices is efficient. However, it is important to stick to one NS in a dental
practice so as to avoid confusion. Also it is important to specify which system is used.
The three numbering systems in common use are:
1. Palmer notation or Zsigmondy’s NS/quadrant system/grid system.
2. FDI International NS is Federation Dentaire Internationale.
3. Universal NS.
Palmer notation is the oldest method in use and most papular system.
• In palmer NS the symbol for the quadrant is derived from an imaginary cross, with the
horizontal bar placed between the upper and lower teeth and the vertical bar running
between the right and left central incisors (quadrants).
• Each quadrant is assigned a specific symbol.
UR = Upper right
UR UL UL = Upper left
LL = Lower left
LR LL LR = Lower right
• Permanent teeth are numbered 1 to 8 in each quadrant from midline.

• Deciduous teeth are lettered A to E in each quadrant from the midline where A represents
central incisor and E represents second molar.
• Only one digit is used.
6 is maxillary right first molar.

1 is mandibular right central incisor.
14 DADH Made Easy
• In this notation: 1 represents the central incisor and 8 represents the third molar.
• Palmer NS is not accepted by computer.
In this system verbal communication is difficult.
Federation Dentaire Internationale (FDI) NS: (SAQ, June 2004, May 2009)
• In FDI system, the quadrants are represented by numbers and no letters of alphabet are
used.
• For permanent and deciduous dentition the quadrants are numbered as:
– Permanent dentition
UR = 1, UL = 2, LL = 3, LR = 4
– Deciduous dentition
UR = 5, UL = 6, LL = 7, LR = 8
• In this system permanent teeth are numbered 1 to 8 starting from midline and deciduous
teeth are numbered 1 to 5 from the midline.
• This system uses two digits.
The first digit always denotes the dentition, arch, and side.
The second digit denotes the tooth number: For example, 51 symbolizes deciduous
maxillary right central incisor and 26 symbolizes permanent maxillary left first molar.
• The notation is read as five one and two six.
• FDI NS is accepted by WHO and by computer.
• In this system verbal communication is easier.
Universal NS:
• In permanent dentition the teeth are numbered 1 to 32 starting with maxillary right third
molar.
• In UR quadrant the teeth are numbered 1 to 8
where 1 represents maxillary right third molar, and
8 represents maxillary right central incisor.
• In UL quadrant the teeth are numbered 9 to 16,
where 9 represents maxillary left central incisor, and
16 represents maxillary left third molar.
• In LL quadrant the teeth are numbered 17 to 24,
where 17 represents mandibular left third molar, and
24 represents mandibular left central incisor.
• In LR quadrant the teeth are numbered 25 to 32,
where 25 represents mandibular right central incisor, and
32 represents mandibular right third molar.
• In deciduous dentition the teeth are lettered A to T starting with maxillary right second
molar.
• In UR quadrant the teeth are lettered A to E,
where A represents maxillary right second molar, and
E represents maxillary right central incisor.
• In UL quadrant the teeth are lettered F to J,
where F represents maxillary left central incisor, and
J represents maxillary left second molar.
• In LL quadrant the teeth are lettered K to O,

where K represents mandibular left second molar, and
O represents mandibular left central incisor.
• In LR quadrant the teeth are lettered P to T,
where P represents mandibular right central incisor, and
T represents mandibular right second molar.
NUMBERING SYSTEMS
PERMANENT DENTITION/MAXILLA/UPPER JAW/MAXILLARY ARCH
RIGHT LEFT
Quadrant 1 Quadrant 2
U Universal NS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
F FDI NS 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
P Palmer 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
Class of Teeth M M M PM PM C LI CI Mid-line Mesial Distal
P Palmer 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
F FDI NS 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
U Universal 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
CI LI C PM PM M M M
Quadrant 4 Quadrant 3
Mandible/lower jaw/mandibular arch
e.g. Maxillary Left Central incisor

P FDI U
1 21 9
DECIDUOUS DENTITION/SET
Maxillary Teeth
Universal A B C D E F G H I J
FDI NS 55 54 53 52 51 61 62 63 64 65
Palmer E D C B A A B C D E
Class of Teeth M M C LI CI CI LI C M M
Palmer E D C B A A B C D E
FDI 85 84 83 82 81 71 72 73 74 75
Universal T S R Q P O N M L K
RIGHT LEFT
Mandibular Teeth
Q 12. What are the functions of teeth?

Ans. Functions of Teeth (May 2009, Nov. 2010)
• The primary function of teeth is to prepare food for swallowing and to facilitate digestion.
• Different types of teeth with their respective forms are adapted to incise, shear and grind
food.
16 DADH Made Easy
• The teeth with their proper form and alignment protect the supporting periodontal tissues
against trauma during mastication, facilitate jaw movement, speech, and enhance esthetic
appearance of face by supporting lips and cheeks.
• In deciduous dentition the primary teeth maintain space in the dental arch for the
development and eruption of permanent teeth.
• They function in the development of speech.
• Ability to use teeth for pronunciation is acquired entirely with the aid of primary dentition.
Early and accidental loss of primary anterior teeth may lead to difficulty in pronouncing
the sounds f, v, s, z, th.
Q 13. What are line angles and point angles? (SAQ, Nov. 2015)
Ans. Line Angles
A line angle is formed by the junction of two surfaces and derives its name from the combination
of the two surfaces that join (Fig. 1.10).
The ‘al’ of the first term is changed to ‘o’. For example, on the anterior tooth the junction of
the mesial and labial surface is termed “mesiolabial”.
Line angles of anterior teeth are 6 Line angles of posterior teeth are 8
1. Mesiolabial Mesiobuccal
2. Mesiolingual Mesiolingual
3. Distolabial Mesioocclusal
4. Distolingual Distobuccal
5. Labioincisal Distolingual
6. Linguoincisal Distoocclusal
Because the mesioincisal and distoincisal Buccoocclusal
angles are rounded they are usually Linguoocclusal
considered nonexistent and spoken as
mesial incisal and distal incisal angle.
Fig. 1.10: Line angles
Point Angles
A point angle is formed by the junction of three surfaces. A point angle also derives its name
from the combination of three surfaces (Figs 1.11A and B).
Point angles of both anterior and posterior teeth are four.
Anterior teeth [4] Posterior teeth [4]

1. Mesiolabioincisal Mesiobuccoocclusal
2. Mesiolinguoincisal Mesiolinguoocclusal
3. Distolabioincisal Distobuccoocclusal
4. Distolinguoincisal Distolinguoocclusal
(A) (B)
Figs 1.11A and B: Point angles
Q 14. What are embrasures? (Oct. 2002, June 2006, May 2011, 2013)
Ans. Embrasures
When the teeth in the same arch contact each other, there are four continuous spaces surrounding
the contact area, these triangular shaped spaces or V-shaped spillway spaces adjacent to the
contact area are called embrasures (Figs 1.12A and B).
They are named according to their location, which depends on the aspect from which the
teeth are viewed.
When viewing the teeth from facial or lingual aspect, the two embrasures are incisal/occlusal
and gingival/cervical.
The cervical embrasure corresponds to interproximal space and is normally larger in area
than the incisal embrasure.
When viewing the teeth from the incisal/occlusal aspect the two embrasures which are
visible are the facial and palatal embrasure.
Ideally if an imaginary line is drawn to bisect the embrasure space, the two portions would
be symmetrical.
Embrasures have two physiologic purposes.
a. To serve as spillway for food during mastication.
b. To serve as an integral part of the self-cleansing process of the teeth.
Some general rules regarding normal embrasure form:
1. From facial and lingual aspect
Incisal embrasure increases in size from anterior to posterior.
Cervical embrasure decreases in size from anterior to posterior.
2. From incisal aspect, the labial and lingual embrasures are nearly equal in size in anterior
teeth.
18 DADH Made Easy
(A)
(B)
Figs 1.12A and B: Embrasures
3. From occlusal aspect, the lingual embrasure is normally larger than the buccal embrasure
in the posterior teeth.
4. One side of the embrasure has a certain contour, the other side of the embrasure will
normally have a similar contour.
It should now be easy to recognize the interrelationship between contact areas and
embrasure form.
For example as the contact area becomes more cervically placed from anterior to posterior,
the relative size of the incisal embrasure increases in size.
MULTIPLE CHOICE QUESTIONS (MCQs)
1. The information written about both 8. A line that separates the anatomic crown
maxillary and mandibular teeth of one from the anatomic root is the
side only is known as: a. Gum line
a. Dental formula b. Cervical line
b. Palmer notation c. Cemento-enamel junction
c. FDI system d. Both b and c
d. Universal system 9. The relationship between the following
2. A trait that distinguishes the charac- does not change over a patient’s life time
teristics between the same class of teeth a. Clinical crown and anatomic crown
is: b. Clinical root and anatomic root
a. A set trait b. Arch trait c. Anatomic crown and anatomic root
c. Class trait d. Type trait d. Clinical crown and clinical root
3. A trait that distinguishes the features 10. The hard, white, shiny, protective outer
between the maxillary and the mandi- covering of the anatomic crown is
bular teeth is the a. Dentin b. Cementum
a. Class trait b. Type trait c. Enamel d. Pulp
c. Arch trait d. Dentition trait 11. The dull yellow external surface of the
4. A trait that distinguishes the features anatomic root is
between the permanent and the primary a. Enamel b. Dentin
teeth is the c. Pulp d. Cementum
a. Set trait b. Dentition trait 12. The inner surface of cementum lining the
c. Class trait d. a and b root is
5. The part of a tooth which has enamel as a. The cementoenamel junction
the outer surface is b. The cementodentinal junction
a. Anatomic crown c. The dentinoenamel junction
b. Anatomic root d. The dentinopulpal junction
c. Clinical crown 13. The surface of the tooth which is next to
d. Clinical root face is
6. The part of a tooth which has cementum a. The labial surface
as the outer surface is b. The buccal surface
a. Clinical crown c. The facial surface
b. Clinical root d. All of the above
c. Anatomic crown 14. The surface of the tooth which is next to
d. Anatomic root the adjacent tooth is the
7. The part of a tooth that is visible in the a. Proximal surface
oral cavity is b. Mesial surface
a. Anatomic crown b. Anatomic root c. Distal surface
c. Clinical crown d. Clinical root d. All of the above
1-a, 2-d, 3-c, 4-d, 5-a, 6-d, 7-c, 8-d, 9-c, 10-c, 11-d, 12-b, 13-d, 14-d
20 DADH Made Easy
15. An elevation on the chewing surface of 22. A shallow, narrow, linear depression
a molar or a premolar and on the incisal formed during tooth development and
edge of the canine is known as separating lobes is known as
a. Tubercle b. Cingulum a. Fissure
c. Cusp d. Ridge b. Developmental groove
16. A longitudinal convexity or any linear c. Supplemental groove
elevation on the surface of a tooth is d. Sulcus
known as 23. An irregular depression or concavity
a. A groove b. A ridge found on the sur face of the tooth,
c. Tubercle d. Cingulum bounded by ridges is known as
17. A rounded protuberance in the cervical a. Sulcus
third of the lingual surface of the anterior b. Groove
teeth is c. Fossa
a. Cusp b. Tubercle d. None of the above
c. Ridge d. Cingulum 24. The central fossa is found on the following
18. The numbering system in which the surface of the tooth
permanent teeth in each quadrant are a. Lingual surface of the anterior teeth
numbered 1 to 8 and the deciduous b. Occlusal surface of all the posterior teeth
teeth are numbered 1 to 5 or A to E is c. Occlusal surface of all molars
a. Palmer notation d. Occlusal surface of y-shaped mandi-
b. FDI system bular second premolar
c. Universal system e. Both c and d
d. Both a and b 25. The convex bulge or curvature on the
19. The numbering system which uses two crown of a tooth, that determines the
digits where the first digit denotes arch, direction of food as it is pushed cervi-
dentition and side and the second digit cally over the tooth surface during
denotes the tooth number is mastication is the
a. Universal NS a. Height of contour
b. Zsigmondy’s NS b. Crest of curvature
c. FDI NS c. Both a and b
d. All of the above. d. None of the above
20. The primary centres of tooth development 26. The height of contour on the facial
or primary anatomic divisions of tooth surface of all the crowns of tooth (as seen
are known as from mesial and dental aspect) is in the
a. Lobes b. Ridges a. Incisal third b. Middle third
c. Pits d. Grooves c. Cervical third d. All of the above
21. The sloping areas found between the two 27. The crest of curvature on the lingual
cusp ridges are known as inclined planes, surface of all the anterior teeth is in the
the number of inclined planes for each a. Incisal third
cusp are b. Middle third
a. 2 b. 6 c. Entire lingual surface
c. 4 d. 8 d. Cervical third
15-c, 16-b, 17-d, 18-d, 19-c, 20-a, 21-c, 22-b, 23-c, 24-e, 25-c, 26-c, 27-d
28. The crest of curvature on the lingual/palatal 35. Teeth may have one or more roots, but
surface of the posterior teeth is in the all the roots of both the dentitions have
a. Middle third b. Incisal third common traits which are
c. Cervical third d. Entire surface a. Widest at CEJ and taper towards the
29. Crest of cur vature on the proximal
apex
surfaces of the crowns of the teeth, where b. Taper facial to lingual
the adjacent teeth in the same arch c. Bulbous uniformly
touch each other are known as d. Both a and b
a. Contact point b. Contact area 36. The occlusal view demonstrates the
c. Both a and b d. None of the above relative position of contact area
30. Contact areas are located in a. Faciolingually
a. Incisal third b. Cervicoocclusally
b. Middle third c. Both of the above
c. In the cervical third d. None of the above
d. Both a and b 37. The only tooth other than maxillary third
31. The continuous triangular spaces molar which has only one antagonist is
surrounding the contact area between a. Mandibular CI
the two adjacent teeth in contact with b. Mandibular LI
each other is known as
c. Mandibular second PM
a. Incisal embrasure
d. Mandibular third molar
b. Cervical embrasure
38. The largest embrasure in the dental arch
c. Labial embrasure
is
d. Lingual embrasure
a. Between maxillary canine and maxillary
e. All of the above
first PM
32. The relative position of contact area in b. Between maxillary LI and maxillary
the facial view of teeth is demonstrated canine
a. Cervicoocclusally
c. Between maxillary CI and maxillary LI
b. Buccolingually
d. None of the above.
c. Both of the above
d. None of the above 39. The height of epithelial attachment is
dependent on
33. In teeth, embrasures are
a. Height of contact area
a. Wider facially than lingually
b. Curvature of cervical line
b. Wider lingually than facially
c. Height of alveolar bone
c. Same facially and lingually
d. All of the above
d. None of the above
40. Midline foramina of incisive canal is
34. Although there are two dentitions, the
called
primary and the secondary, the ‘dentition
periods’ that occur during a patients a. Foramen of Scarpa
lifetime are b. Foramen of Larschak
a. One b. Two c. Foramen of Stenson
c. Three d. Four d. Foramen rotundum.
28-a, 29-c, 30-d, 31-e, 32-a, 33-b, 34-c, 35-d, 36-a, 37-a, 38-a, 39-c, 40-a
22 DADH Made Easy
41. The number of line angles in the crowns 48. The mesial contact is at the junction of
of mandibular first molar are incisal and middle third and distal
a. 4 b. 6 contact is at the centre of middle third
c. 8 d. 10 in
a. Maxillary central and lateral inciser
42. Human dentition has different classes of
teeth incisors, canines, premolars, and
b. Maxillary lateral incisor and canine
molars such a condition where more c. Maxillary canine and first premolar
than one type of teeth are present is d. Maxillary first and second premolar
called 49. In maxillary arch posterior embrasures are
a. Homodont b. Heterodont larger on the lingual side in all teeth
c. Haplodont d. None of the above except between
43. The last succedaneous tooth to erupt a. First and second premolar
is b. Second premolar and first molar
a. Maxillary canine c. First premolar and canine
b. Maxillary first premolar d. First and second molar
c. Mandibular canine 50. In posterior teeth, wider lingual embrasure
d. Mandibular first premolar and shallow occlusal embrasure are due
to the position of contact
44. The palatal cusp of upper first premolar
develop from a. Buccoocclusally
a. One lingual lobe b. Buccogingivally
b. Lingual lobe and distal lobe c. Linguogingivally
c. Lingual lobe and mesial lobe d. Linguoocclusally
d. Distal and mesial lobe 51. The largest occlusal embrasure is found
45. Which of the premolars develop from five between maxillary
lobes? a. Second and third molars
a. Upper first premolar b. Canine and first premolar
b. Upper second premolar c. First premolar and second premolar
c. Lower first premolar d. First and second molar
d. Lower second premolar 52. The widest incisal embrasure is found
46. Main function of proximal contact area between
a. Stabilizes the dental arch a. Maxillary central incisors
b. Helps prevent food impaction b. Maxillary central and lateral incisor
c. Distribution of occlusal forces c. Maxillary lateral incisor and canine
d. All of the above d. Mandibular central incisors
47. The line angle which does not exist in any 53. Which of the following does not contri-
tooth bute to arch stability
a. Mesiobuccal a. Embrasure
b. Mesiolingual b. Contact areas
c. Mesiodistal c. Root form
d. Distolingual d. Periodontal fibres
41-c, 42-b, 43-a, 44-a, 45-d, 46-d, 47-c, 48-b, 49-b, 50-a, 51-b, 52-c, 53-a
54. The part of the tooth outlined by its 61. The height of the clinical root is deter-
developmental grooves is called as mined by the position of the
a. Fissure b. Lobes a. CEJ b. Gingival margin
c. Sulci d. Cusps c. Alveolar bone d. Both a and b
55. In the intercuspal position, which of the 62. All are hard tissues of tooth except
following anterior teeth contact one a. Pulp b. Cementum
anterior and one posterior antagonists
c. Dentin d. Enamel
a. Maxillary canine
b. Mandibular canine 63. Tissues of tooth which develop from
mesodermal structure are
c. Maxillary lateral incisor
a. Enamel b. Dentin
d. Mandibular lateral incisor
c. Pulp d. Both b and c
56. Wilson curve in mandibular arch is
a. Concave 64. The fibres which attach or anchor the
teeth to the alveolus are
b. Convex
a. PDL fibres b. Gingival fibres
c. Concave-convex
c. Both a and b d. None of the above
d. Convexo-concave
65. The opening present at the apex of the
57. Mesial contact area is found in incisal
tooth is termed
third of the crown surface of
a. Maxillary central incisor a. Apical foramen
b. Mandibular central incisor b. Accessory foramen
c. Mandibular lateral incisor c. Both a and b
d. Mandibular canine d. None of the above
e. All of the above 66. Compared to incisal embrasure between
58. Contact area present at the junction of maxillary central and lateral incisor, the
incisal and middle third of the crown incisal embrasure between the maxillary
surface are at central incisors is
a. Distal surface of maxillary CI a. Larger b. Smaller
b. Mesial surface of maxillary LI c. The same size d. None of the above
c. Mesial surface of maxillary canine 67. The first succedaneous tooth to erupt
d. Distal surface of mandibular canine is a
e. All of the above a. Maxillary central incisor
59. The distal contact point is in the middle b. Maxillary lateral incisor
of the middle third of the distal surface c. Mandibular central incisor
of the crown of d. Mandibular first molar
a. Maxillary LI b. Maxillary canine 68. The following groove separates cusp
c. Both a and b d. None of the above ridges from marginal ridges
60. What is the term used for the division of a. Supplemental
the root into 3 segments b. Developmental
a. Furcation b. Bifurcation c. Mesiomarginal developmental
c. Trifurcation d. All of the above d. Marginal ridge developmental
54-b, 55-a, 56-a, 57-e, 58-e, 59-c, 60-c, 61-b, 62-a, 63-d, 64-a, 65-a, 66-b, 67-c, 68-b
24 DADH Made Easy
69. Mamelons are present on 76. The crown and root are separated by
a. Newly erupted deciduous incisors a. Cervical line
b. Newly erupted permanent incisors b. Dentinoenamel junction
c. Newly erupted canines c. Cementoenamel junction
d. All newly erupted anteriors d. Both a and c
70. In reptiles the mandible consists of 77. Occlusal and incisal surface are together
termed as
a. Dentary b. Quadrate
a. Proximal surfaces
c. Articulare d. All of the above
b. Facial surfaces
71. Out of the three bones found in reptile c. Masticatory surfaces
mandible the bone retained in human
d. Both a and b
mandible is
a. Dentary b. Quadrate 78. The angle formed by junction of 3
surfaces is
c. Articulare d. None of the above
a. Point angle b. Line angle
72. The proper contact relation between c. None d. Both
neighbouring teeth in each arch is
important 79. Fossa is
a. To prevent food lodgement a. A shallow depression seen between the
primary parts of a tooth
b. Stabilize the dental arches
b. An irregular depression on the surface
c. Protect interdental papilla
of a tooth
d. All the above
c. It is a linear depression separating the
73. The last molars are prevented from cusps
drifting distally d. All the above
a. By the angulation of their occlusal 80. According to the Universal notation
surface with their roots system ‘E’ denotes
b. By the angle of the direction of the a. Primary second molar
occlusal forces in their favour b. Primary right central incisor
c. Both a and b c. Primary first molar
d. None of the above d. Primary left central incisor
74. The interproximal space is affected by 81. In the universal notation system,
or depends on maxillary permanent right central incisor
a. Form of teeth and maxillary left canine are designated
b. Relative position of contact areas as
c. Both a and b a. 1 and 3 b. Number 8 and 11
d. None of the above c. 11 and 23 d. 9 and 12
75. All aspects of each tooth crown except 82. The numbering system accepted by
the incisal or occlusal aspect may be World Health Organisation is
outlined schematically within geometric a. The universal notation system
figures b. The palmer notation
a. A triangle b. Trapezoid c. The FDI system
c. Rhomboid d. All of the above d. All the above
69-b, 70-d, 71-a, 72-d, 73-c, 74-c, 75-d, 76-d, 77-c, 78-a, 79-b, 80-b, 81-b, 82-c
83. The numbering system acceptable to 90. Cusps and mamelons represent
computer language is a. Tubercule b. Ridge
a. FDI c. Lobe d. None
b. Palmer notation
91. The longest uneven side of each of the
c. The universal system trapezoid outlines of the facial and
d. Both a and c lingual aspects of all teeth forms the
84. A two digit system for numbering is a. Occlusal line b. Cervical line
a. FDI c. Buccal line d. Lingual line
b. The universal system
92. The longest uneven side of the trapezoid
c. None of the above outline of the mesial and distal aspect
d. Palmer notation of maxillary posterior represents the
85. According to FDI system, the permanent a. Occlusal line
maxillary right first molar and the primary b. Buccal line
maxillary left canine are designated as
c. Lingual line
a. 16 and 63 b. 6 and c
d. Base of the crown (cervical line)
c. 46 and 73 d. 3 and H
93. Cervical portion of a posterior tooth is
86. Calcification and eruption of both
smaller than that of occlusal portion
deciduous and permanent teeth was
when viewed from
given by
a. Nolla a. Mesial or distal
b. Anderson b. Buccal or lingual aspect
c. Logan and Kronfeld c. Both
d. Mccall and Schour d. None of the above
87. The number of centers for formation of 94. When the posterior tooth is viewed from
each tooth are mesial or distal aspect the occlusal
a. One b. Two portion is
c. Three d. Four or more a. Smaller than cervical
88. Mesial surface of one tooth contacts the b. Larger than cervical
distal surface of its neighbour except for c. Equal to cervical
the distal surfaces of d. None of the above
a. Distal surfaces of third molars of 95. With increasing age
permanent teeth a. Anatomical crown > clinical crown
b. Distal surfaces of second molars of
b. Anatomical crown < clinical crown
deciduous teeth
c. Anatomical crown = clinical crown
c. Both a and b
d. None of the above d. Any of the above
89. The teeth which have their mesial 96. Which tooth occupies the centre of the
surfaces contacting each other are fully developed adult jaw?
a. Maxillary central incisors a. First premolar
b. Mandibular central incisors b. Second premolar
c. Both are correct c. Second molar
d. Both are wrong d. First molar
83-d, 84-a, 85-a, 86-c, 87-d, 88-c, 89-c, 90-c, 91-a, 92-d, 93-b, 94-a, 95-b, 96-d
26 DADH Made Easy
97. Deepest position in tooth is 104. The surfaces of the following teeth have
a. Pit b. Fossa a trapezoid outline
c. Groove d. Marginal ridge a. Lingual and labial of posterior teeth
98. Transverse ridge is formed by b. Lingual and facial of all teeth
a. The junction of the buccogingival c. Lingual and labial of anterior only
ridge with marginal ridge d. Proximal of anterior teeth only
b. Joining of buccal and lingual triangular
ridges 105. The divergence of two proximal surfaces
from the area of contact facially, lingually,
c. Junction of two marginal ridge with
occlusally and gingivally create a space
cingulum
called
d. The buccal ridge of distolingual cusp
with the lingual ridge of mesiolingual a. A contact area
cusp. b. An occlusal curvature
99. The nature has provided sufficient c. A gingival space
overlap of maxillary and mandibular d. An embrasure
teeth in buccal segment. This is to 106. Cemento-enamel junction of teeth
a. Increase chewing efficiency curves in the following two directions
b. Add to esthetic value a. Towards the apex on the facial and
c. Prevent soft tissue from cheek bite lingual surfaces
d. None
b. Away from the apex on the facial and
100. Main function of proximal contact area is lingual surfaces
a. To guide the food over occlusal table c. Away from the apex on the mesial and
b. For distribution of occlusal stresses distal surfaces
c. To prevent impaction of food in inter-
d. Towards the apex on the mesial and
proximal areas
distal surfaces
d. All
e. Both a and c
101. The tooth anatomy common to anterior
teeth only is 107. The two ridges which are present on all
a. Cingulum b. Fossa teeth are
c. Pits d. Marginal ridges a. Triangular ridge
102. Any union of two triangular ridges b. Mesial and distal cusp ridge
produces a single ridge which is c. Oblique ridge
a. Cusp ridge d. Mesial and distal marginal ridge
b. Transverse ridge 108. A primary centre of growth or calcifica-
c. Marginal ridge tion on a tooth is called
d. Proximal ridge
a. Lobe b. Ridge
103. The surfaces of the following teeth have c. Cingulum d. Groove
a triangular outline
a. Mesial and distal of anterior teeth 109. The arrangement of natural teeth was first
b. Mesial and distal of posterior teeth described by
c. Labial of anterior teeth a. GV Black b. Bolton
d. Lingual of anterior teeth c. Wilson d. Graf Von Spee
97-a, 98-b, 99-c, 100-d, 101-a, 102-b, 103-a, 104-b, 105-d, 106-e, 107-d, 108-a, 109-d
110. Anisognathus refers to 112. Humans have two sets of dentition, one
a. Unequal teeth primary and the other permanent, such
a condition where two sets of teeth are
b. Unequal jaws present is called
c. Unequal cusps a. Polyphyodonty
d. Nonuniform teeth b. Diphyodonty
111. The tooth in the closest relation to the
c. Monophyodonty
zygomatic buttress is d. None of the above
a. Maxillary second PM 113. The embrasures that increae in size from
anterior toposteror are
b. Maxillary first M
a. Occlusal b. Lingual
c. Maxillary second M c. Labial d. Gingival
d. Maxillary third M e. a and b
110-b, 111-b, 112-b, 113-e

2
The Permanent Incisors
SAQs (3 Marks)
Q 1. Describe type traits of maxillary incisors. (May 2008, Nov. 2015)

What are differences between maxillary central and lateral incisor? (May 2009)
Ans. Incisors are anterior teeth. They are 8 in number, 4 in each arch. Their functions is incising,
esthetics, and phonetics.
Type Traits of Maxillary Incisors
Central incisor (CI) Lateral incisor (LI)

Labial aspect (La)
Fig. 2.1 Fig. 2.2

• Crown has more square or rectangular appearance • Crown is oblong, narrower, shorter and has more
and smooth surface. It is wider and longer. curvature.
• The mesial (M) border is less convex distal (D) • Same as CI.
border is more convex.
• Mesioincisal angle (MIA) is sharp and disto- • Both mesioincisal and distoincisal angles are
incisal angle (DIA) is rounded. rounded, where distoincisal angle is more
rounded.
(Contd.)
28
The Permanent Incisors 29
Central incisor (CI) Lateral incisor (LI) (Contd.)

• Mesiodistally the incisal ridge is almost straight. • Incisal ridge is rounded. Mesial half in relatively
straight and distal half is more rounded curving
(sloping) towards the cervical line to join the distal
border.
• Root is cone-shaped with blunt apex.
• In proportion to crown, root is not much longer. • In proportion to crown, the root is much longer
and has a distal bend.
Lingual view (Li)
Fig. 2.3 Fig. 2.4
• The crown and root are narrower towards lingual • The crown and root are narrow towards lingual
and marginal ridges are less prominent. and marginal ridges are prominent.
• The surface is not smooth. • Same as CI.
• There is concavity, fossa in the incisal two-thirds • Same as CI.
and convexity, cingulum in cervical third.
• Lingual fossa has shallow concavity. • Lingual fossa has more concavity.
• The cingulum is off-centered to distal due to • The cingulum is centered but still the MMR is
which mesial marginal ridge (MMR) is longer longer than the DMR due to the slope of the incisal
than the distal marginal ridge (DMR). ridge from M to D.
• Developmental grooves extend from cingulum • More often a deep developmental groove is present
into the fossa. at the distal side of the cingulum which may extend
up onto the root.
Proximal view
Fig. 2.5 Fig. 2.6

(Contd.)
30 DADH Made Easy

• The outline of the crown is triangular. • The outline of crown is also triangular.
• The crown is larger in size. • The crown is shorter.
• Incisal ridge centered over root axis. • The incisal ridge is centered over root axis.
• The crest of curvature on both labial and lingual • The crest of curvature on both labial and lingual
surfaces in the cervical third of the crown. surfaces is in cervical third of the crown.
• Crown from this aspect appears thicker in the • Crown from this aspect appears thicker because
incisal third due to distolingual slope of the of the more rounded distoincisal angle.
labial surface.
• The cervical line curvature on mesial aspect is • The cervical line curvature on mesial aspect is
more than that on the distal aspect. The cervical more than that on the distal aspect.
curvature is greater on the mesial surface of this
tooth than on any other tooth in the mouth.
• Root from this aspect is conical and apex bluntly • Root from this aspect is conical, longer and has a
rounded. pointed apex.
Incisal aspect (I)
Fig. 2.7 Fig. 2.8
• The crown outline is triangular • The crown outline is ovoid.

• Crown is wider mesiodistally than labiolingually. • The crown may be wider labiolingually than
mesiodistally (MD).
• Labial outline is broad and flat compared to lingual. • Labial and lingual outlines are more convex.
• The incisal ridge is slightly curved from mesial to • The incisal ridge is straight.
distal.
Q 2. Describe the roots of anterior teeth. (June 2010)

Ans.
• More often the anterior teeth have single roots.
• The roots taper from cervix to apex.
• The roots are wider on labial than on lingual.
• The roots are wider faciolingually than mesiodistally except maxillary central incisor where
the root is conical.
• The roots may have a distal bend at the apex except in the root of the maxillary central
incisor.
• Roots are longer than the crown except in case of maxillary CI where the root is not much
longer than the crown.
• Maxillary incisors have developmental depressions on the mesial surface.
• Mandibular incisors, maxillary, and mandibular canines have root depressions on both M
and D surfaces with distal depression being more distinct.
• Maxillary canine has the longest root of all the teeth.
Q 3. What are variations in permanent maxillary incisors? (Nov. 2010)

Ans. Central Incisor
• Hutchinson’s incisors are found in congenital syphilis. They are screw-driver shaped with
notched incisal edge.
• Central incisors may have very short root or very long root.
• Talon’s cusp, fusion, gemination may be found.
• Shovel-shaped CI is one of the variations found in maxillary CI.
Lateral Incisor
• Peg-shaped is relatively common.
• The crown may be distorted.
• The tooth may be missing.
• The tooth may have a twisted root.
• Incisal side of cingulum may show a tubercle.
• Talon’s cusp, an accessory cusp may be present on the lingual surface.
• Lingual surface may have a deep lingual pit.
• Deep palatogingival groove from cingulum to root may be present.
Q 4. Explain about type traits of permanent mandibular incisors.

Ans. Mandibular incisors are 4 in number.
They have uniform development and have narrowest of mesiodistal dimension.
Type Traits of Mandibular Incisors
Central incisor (CI) Lateral incisor (LI)

Labial aspect (La)
Fig. 2.9 Fig. 2.10
• The labial surface is regular and convex. • Same as central incisor.

• The crown is long and narrow and is bilaterally • The crown is slightly wider and longer than that of
symmetrical. central incisor and is not bilaterally symmetrical.
• Mesial and Distal incisal angles (MIA and DIA) • MIA is sharp whereas DIA is rounded.
are sharp (90°). • DIA is rounded.
(Contd.)
32 DADH Made Easy

• Incisal ridge (IR) is straight and at right angles to • Incisal ridge is not straight.
long axis.
• The root from this aspect is very thin mesiodistally. • Same as that of CI.
• It may have a distal bend in the apical third. • The root is longer and may have a distal bend.
Lingual aspect (Li)
Fig. 2.11 Fig. 2.12
• The lingual surface is smooth and shallow. • Same as central incisor.

• The cingulum is small, convex, and centered. • The cingulum is small, convex and off-centered
to distal.
• No developmental grooves or pits. • Same as central incisor.
• M and D developmental grooves on roots are • Same as central incisor.
visible from this aspect.
Proximal aspect
Fig. 2.13 Fig. 2.14
• Mesial (M) and distal (D) surfaces are wedge-shaped. • Same as central incisor.
• M and D surfaces are similar. • M side of the crown is longer than the distal side.
• The incisal ridge is on or lingual to the root axis. • The distoincisal twist of the incisal ridge places
the distal portion of the incisal ridge more lingual
than mesial portion.
• Crest of curvature on both labial and lingual • Same as central incisor.
surfaces is in the cervical third of the crown.
• The cervical line curvature on mesial is more than • Same as central incisor.
on distal surface.
(Contd.)
• The root from this aspect is wider labiolingually • Same as central incisor.
(LaLi) than mesiodistally (MD)
• Developmental depressions present on both M • Same as central incisor.
and D surface of the root.
Incisal aspect (I)
Fig. 2.15 Fig. 2.16
• The tooth is bilaterally symmetrical. Mesial half is • It is not bilaterally symmetrical.

identical with the distal half.
• Incisal ridge is straight and at right angles to the • Incisal ridge not straight twisted towards distal.
line bisecting the cingulum. It follows the curvature of the mandibular arch.
• Labiolingually (LaLi) dimension > mesiodistally • Same as central incisor.
(MD) dimension.
• Labial (La) surface wider than lingual surface (Li). • Same as central incisor.
• Cingulum is centered. • Cingulum is toward distal.
34 DADH Made Easy
1. The scallops found on the newly erupted 7. The mesial curvature of the cervical line
teeth are known as is deepest on which of the following?
a. Perikymata a. Mandibular central incisors
b. Mamelons b. Maxillary canine
c. Imbrication lines c. Maxillary central incisors
d. None of the above d. Maxillary lateral incisors.
2. All incisors have roots wider faciolingually 8. The distal marginal ridge is shorter in
than mesiodistally except both, the maxillary central Incisors and
a. Maxillary central incisors maxillary lateral Incisors because
b. Maxillary lateral incisors a. In central incisors the cingulum is
c. Mandibular central incisors located off center to the distal side
d. Mandibular lateral incisors b. In lateral incisors the incisal edge
slopes cervically from mesial to distal
3. The incisal wear pattern on maxillary
c. Both a and b
incisors is as
a. Incisal edge slopes cervically towards
labial 9. A longitudinal depression is found on the
middle of the mesial surface of the root of
b. Incisal edge slopes cervically towards
lingual fossa a. Maxillary central incisors
b. Maxillary lateral incisors
c. Incisal edge with no slope
c. Both
4. In mandibular incisors the incisal edge
10. The incisor more likely to have a
wear slopes
bifurcated root is a variation found in
a. Cervically towards labial
a. Maxillary lateral incisors
b. Cervically towards lingual fossa
b. Mandibular central incisors
c. Neither labially nor lingually
c. Mandibular lateral incisors
d. Maxillary central incisor
5. For all human teeth, contact areas are 11. Shovel shaped incisors and a deep
located groove running cervicoincisally on the
a. In incisal or occlusal thirds cingulum are associated with dentition
b. At the junction of incisal and middle in the following ethnic group
thirds a. Caucasian b. Negro
c. Cervical thirds c. Mongoloid d. None of the above
d. Both a and b 12. The only incisor that is symmetrical,
6. Maxillary central incisor is generally having M and D contact points at the
considered to be a poor abutment tooth same level and is difficult to tell Right
when making a dental bridge because from Left is
a. Of its position a. Maxillary central incisors
b. Root being short and conical b. Mandibular central incisors
c. Due to size of the crown c. Mandibular lateral incisors
d. None of the above d. Maxillary lateral incisor
1-b, 2-a, 3-b, 4-a, 5-d, 6-b, 7-c, 8-c, 9-c, 10-c, 11-c, 12-b
13. The labiolingual dimension is more than 19. In maxillary central incisors outline of the
mesiodistal dimension in pulp chamber is
a. Maxillary central incisors a. Round b. Oval
b. Maxillary lateral incisors c. Triangular d. Square shaped
c. Mandibular incisors
20. The distolingual twist of the incisal edge
d. Both a and b
to the root axis is common to
14. From proximal view, incisal edge is lingual a. Mandibular central incisors
to mid root axis, root is thin mesiodistally
with inconspicuous marginal ridges and b. Mandibular lateral incisors
lingual fossa, is characteristic of c. Both a and b
a. Maxillary incisors d. None of the above
b. Mandibular incisors 21. Most common incisors to show morpho-
c. Maxillary canine logic variation is
d. Mandibular canine a. Permanent maxillary lateral incisors
15. Longitudinal root depressions on both M b. Permanent mandibular central incisors
and D root surface is characteristic of
c. Deciduous maxillary central incisors
a. Maxillary incisors
d. Permanent mandibular lateral incisor
b. Mandibular incisors
c. Premolars 22. The apex of the roots are generally tilted to
d. Molars a. Buccal side b. Lingual side
16. The cingulum is centred in c. Distal side d. Mesial side
a. Maxillary central incisors and mandibular 23. The only root which is triangular in cross-
central incisors section at cervix is of
b. Maxillary lateral incisors and mandibular a. Maxillary canine
lateral incisors
b. Maxillary lateral incisor
c. Maxillary lateral incisors and mandibular
central incisors c. Maxillary central incisor
d. Only maxillary central incisors d. Mandibular central incisor
17. Palatal gingival groove, peg-shape, 24. The curve of the cervical line is deepest
missing tooth are the variations found in incisally on the mesial surface of
a. Maxillary lateral incisors a. Maxillary central incisors
b. Mandibular lateral incisors b. Maxillary lateral incisors
c. Mandibular canines c. Mandibular central incisors
d. Maxillary central incisors d. Mandibular lateral incisors
18. Crown bent distally on root, the bulge
25. A deep lingual pit is usually found on the
on the distal side of the crown and distal
lingual surface of
placement of the cingulum are charac-
teristics of a. Permanent maxillary central incisors
a. Maxillary lateral incisors b. Permanent maxillary lateral incisors
b. Mandibular lateral incisors c. Permanent maxillary canine
c. Maxillary central incisors d. Permanent maxillary mandibular
d. Mandibular canine incisors
13-c, 14-b, 15-b, 16-c, 17-a, 18-b, 19-c, 20-b, 21-a, 22-c, 23-c, 24-a, 25-b
36 DADH Made Easy
26. The tooth least likely to have a divided 33. The first evidence of calcification of
pulp canal is permanent mandibular LI takes place at
a. Maxillary central incisor the age of
b. Maxillary first PM a. 3–4 months after birth
c. Mandibular central incisor b. 3–4 years after birth
d. Mandibular first PM c. 3–4 months in intrauterine life
27. The mesial contact area between the two d. 6–8 months in intrauterine life
maxillary and the two mandibular central 34. In all the permanent incisors first evidence
incisors is present in the of calcification takes place at about
a. Incisal third 3–4 months after birth except
b. Middle third a. Maxillary central incisor
c. Cervical third b. Maxillary lateral incisor
d. At the junction of middle and cervical c. Mandibular central incisor
third d. Mandibular lateral incisor.
28. The first evidence of calcification of 35. An anatomic feature that is most likely
permanent central incisors take place to complicate root planing of a maxillary
at lateral incisor is
a. 3–4 months after birth a. A root bifurcation
b. 3–4 months in intrauterine life b. A mesial concavity
c. 6 months after birth c. An enamel projection
d. 8 months after birth d. A distolingual groove
29. The first evidence of calcification of 36. The following structure calcifies first in an
permanent maxillary LI takes place at anterior tooth
a. 8 months in intrauterine life a. Cingulum
b. 8 months in after birth b. Cervical ridge
c. 10 to 12 months after birth c. Marginal ridge
d. At birth d. Incisal ridge
30. Eruption of permanent maxillary CI takes 37. The wear facets on the incisal edges of
place at the age of the mandibular lateral incisors are
a. 4–5 years b. 6–7 years caused by occlusion with the
c. 7–8 years d. 9–10 years a. Maxillary central incisors only
31. Eruption of permanent maxillary LI takes b. Maxillary central and lateral incisors
place at the age of c. Maxillary lateral incisors and canines
a. 6–7 years b. 7–8 years d. None of the above
c. 8–9 years d. 9–10 years 38. Developmental depressions are not pre-
32. The crown completion of permanent sent on both mesial and distal surfaces
central incisors takes place at the age? of the roots of permanent.
a. 4–5 years a. Mandibular central incisors
b. 5–6 years b. Maxillary central incisors
c. 6–7 years c. Maxillary canine
d. 3–4 years d. None of the above
26-a, 27-a, 28-a, 29-c, 30-c, 31-c, 32-a, 33-a, 34-b, 35-d, 36-d, 37-b, 38-b
39. The maxillary permanent central incisor a. Maxillary central incisor

develops from b. Mandibular central incisor
a. Two lobes and has two mamelons c. Mandibular lateral incisor
b. Four lobes and has three mamelons d. Mandibular canine
c. Three lobes and has three mamelons 42. The root of permanent tooth which is
d. Four lobes and has two mamelons completed by 10 years is
40. The permanent anterior tooth which may a. Maxillary central incisors
have a lingual groove extending from b. Maxillary first molars
enamel to cementum of root c. Mandibular first molars
a. Maxillary canine d. None of the above
b. Maxillary lateral incisor
43. Depressions on the M and D aspect of
c. Maxillary central incisor the root is seen in
d. None of the above. a. Mandibular central and lateral incisors
41. The permanent anterior tooth having b. Maxillary canines
developmental grooves extending from c. Maxillary central and lateral incisors
the cingulum into the lingual fossa is d. Maxillary first premolars
39-b, 40-b, 41-a, 42-a, 43-a

3
The Permanent Canines
LAQ (10 Marks)
Q 1. Compare and contrast maxillary canine with mandibular canine in tabular form.
(June 2006)
Ans.
Maxillary canine Mandibular canine
Introduction: Introduction:
It is the third tooth from the midline in the maxillary It is the third tooth from the midline in the mandi-
arch. bular arch.
Numbering system: Numbering system:
Palmer 3 3 Palmer 3 3
Universal Right-6 Left-11 Universal Right-27 Left-22
F.D.I. Right-13 Left-23 FDI Right-43 Left-33
Chronological data: Chronological data:
First evidence of calcification 4–5 months First evidence of calcification 4–5 month
Enamel completion 6–7 years Enamel completion 6–7 years
Eruption 11–12 years Eruption 9–10 years
Root completion 13–15 years Root completion 12–14 years
Canine from each aspect

Labial aspect (La) (SAQ, Nov. 2015)
Crown: Crown:
Shape, size, and surface: Shape, size, and surface:
• It has trapezoid or pentagon shape due to 2 incisal • It also has pentagon shape with two incisal ridges
ridges meeting at cusp tip which is pointed. meeting at cusp tip which is not pointed.
• The length of the crown is short – (10 mm). It is • The crown is longer (11 mm), and narrower. It is
7.5 mm wide at contact area and 5.5 mm wide at 7 mm wide at contact area and 5.5 mm wide at
cervix. cervix.
• The labial ridge (LaR) is more prominent. • The labial ridge is not prominent.
(Contd.)
38
The Permanent Canines 39
Maxillary canine Mandibular canine (Contd.)
Fig. 3.1 Fig. 3.2
Outlines: Outlines:
• The mesial (M) and distal (D) outlines of the • The mesial and distal outlines of the crown are
crown converge towards the cervix less converging, they are more or less parallel.
• The M outline is convex from cervix to the contact • M outline of the crown is more or less straight in
point. line with the mesial outline of the root.
• D outline is concave near the cervix and convex at • D outline is slightly concave in the cervical third.
the contact point.
• Mesial cusp slope (MCS) is shorter than the distal • It is same as Maxillary Canine.
cusp slope (DCS).
Both the cusp slopes may have concavity before
wear.
• M and D cusp slopes make an acute angle at the • M and D cusp slopes make an obtuse angle at the
cusp tip which is centred over the root axis. cusp tip which is centered over the root axis.
• The cusp slopes and the cusp make-up for the • The cusp slopes and the cusp make-up for the
incisal one-third of the crown. incisal one-fifth of the crown.
• The cervical line is convex towards the root apex. • The cervical line is convex towards the root apex.
• Mesioincisal angle (MIA) is sharp. Distoincisal
angle (DIA) is rounded.
Contact point: Contact point:
• Mesial contact point is at the junction of incisal • Mesial contact point is in the incisal third near
and middle third. the mesioincisal angle.
• Distal contact point is in the middle third of the • Distal contact point is cervical to the mesial contact
crown and is rounded. point.
• M and D contact areas are at different levels.
Root: Root:
• The root is long, (17 mm), slender, and conical. • The root is 16 mm. It is shorter and narrower
mesiodistally than that of maxillary canine.
• The apex is bluntly pointed and may have a distal • The apex is sharply pointed.
bend.
(Contd.)
40 DADH Made Easy

Lingual aspect (Li)
Fig. 3.3 Fig. 3.4

Crown: Crown:
• The crown and root are narrower towards lingual. • Same as maxillary canine.
• The lingual ridge (LiR) is prominent, runs from • The lingual ridge is faint except at the cusp tip
the cusp tip to the cingulum. where it may be raised.
• The lingual surface is not smooth. • The lingual surface is smooth regular and flatter.
• The mesial and distal fossa (MLF and DLF) lie on • Fossa is less prominent. Marginal ridges are less
either side of the lingual ridge and are usually distinct.
shallow. Marginal ridges are strongly developed.
• The cingulum is large and centered and in some • The cingulum is smooth and poorly developed
cases it is pointed like a small cusp or tubercle. and off-centred distally or may be centered.
Outline: Outline:
• Outlines are similar to the labial surface. • Outlines are similar to the labial surface.
• The mesial marginal ridge (MMR) is longer • MMR is longer because of shorter mesial cusp slope
compared to the (DMR) because of the shorter as well as the cingulum being off-centred to distal.
mesial cusp slope.
Root:
• Root is narrow on the lingual side therefore it is • The lingual portion of the root is relatively narrower
possible to see the M and D surfaces of the root as than that of the maxillary canine.
well as the M and D developmental depressions.
Proximal aspect
Fig. 3.5 Fig. 3.6

(Contd.)

Crown: Crown:
• The crown is wedge-shaped with smooth surface. • It is same as maxillary canine.
• Mesial surface is convex except the area between • Mesial surface is not convex except at the contact
the contact point and the cervical line which is point.
slightly concave or flat.
• On the distal surface there is more concavity in the • On the distal surface there is more concavity in the
area between the contact point and the cervical line. area between the contact point and the cervical line.
Outlines: Outlines:
• The labial (La) outline of the crown is more convex • The labial (La) outline has very less curvature, with
in the cervical third and is less convex in the incisal very little curvature directly above the cervical
two-thirds and becomes more or less straight near line.
the cusp.
• The lingual (Li) outline is represented by a convex • The lingual (Li) outline is very less convex.
line describing the cingulum. In the middle third Cingulum is low and somewhat flattened. There
the outline is straight and becomes convex again is almost continuous crown-root outline.
in the incisal third.
• The crest of curvature on both labial and lingual • The crest of curvature on both labial and lingual
surface is in the cervical third of the crown which surfaces is in the cervical third but the bulk is much
shows greater bulk labiolingually (LaLi) than less and closer to the cervical line.
any other anterior tooth.
• The cusp tip is thicker labiolingually and is • The cusp tip is thinner labiolingually and is
located either labial to root axis or centred over it. located lingual to the root axis or may be centered
over it.
• The cervical line curvature is towards incisal and • The cervical line curvature is more on the mandi-
more so on the mesial surface than on the distal bular than on the maxillary canine and more so
surface. on the mesial surface than the distal surface.
• Distoincisal angle (DIA) is in line with the mesio- • Distoincisal angle is slightly more lingually
incisal angle (MIA). placed than the cusp tip because of the disto-
lingual twist of the crown, so much so that the
lingual surface is visible from the mesial aspect.
Root: Root:
• Root is wide labiolingually in cervical third and • Root from this aspect is very similar to that of
middle third, it tapers at the apex. Labial outline is maxillary canine except that the root tip is more
slightly convex while lingual outline is more convex. pointed.
• Developmental depression on the distal surface is • Both the M and D root depressions are more pro-
more pronounced whereas mesial depression is nounced in the apical third.
shallow.
Incisal aspect
Fig. 3.7 Fig. 3.8
(Contd.)
42 DADH Made Easy

• The crown outline is not symmetrical. • The crown outline is more symmetrical.
• Labiolingual dimension (Lali) is more than • The labiolingual dimension is noticeably larger
mesiodistal (MD) dimension. than mesiodistal dimension.
• Labial outline is convex due to prominent labial • Oblong labiolingual outline is characteristic of
ridge. mandibular canine.
• The mesial half of the labial surface (MLa) is very • Mesiolabial outline is convex, distolabial outline
much convex while the distal half (DLa) is slightly flat or slightly concave.
concave giving it the appearance as if it is pinched
or stretched to make contact with the first premolar.
• The cingulum is large and centered mesiodistally. • The cingulum is small and off-centred to distal.
• The incisal ridge is straight mesiodistally. • The incisal ridge is not straight it has a disto-
• The tip of the cusp is labial to the centre of the lingual twist.
crown labiolingually and mesial to the centre
mesiodistally.
SAQ (3 Marks)
Q 1. What are class traits of canines? (May 2014)

Ans. Class Traits of Canines
• Canine is the longest tooth in the oral cavity.
• Maxillary canine has a functional lingual surface.
• It has a single pointed cusp. Incisal ridge of canine is divided into two inclines or slopes by
a cusp as opposed to a straight ridge in the incisors, which gives the crown a pentagon
shape. The mesial slope is shorter than the distal slope. Canine does not have mamelons
but may have a notch on either of the cusp slope.
• It has a single, longest and strongest root of all the teeth providing best anchorage amongst
all anterior teeth.
• It is the only anterior tooth with a labial ridge.
• Canines typically have mesial and distal contact areas at different levels cervicoincisally
because of the mesial and distal contact with different classes of teeth.
1. The longest teeth in the mouth are 8. The anterior teeth most likely to have a
a. Canines b. Incisors bifurcated root is
c. Premolars d. Molars a. Permanent maxillary canine
2. The feature that distinguishes maxillary b. Permanent mandibular lateral incisor
canine from mandibular canine are c. Permanent mandibular canine
a. The pointed, acute angle at cusp tip d. Permanent maxillary lateral incisor
and constriction of crown at the cervix e. Both b and c
b. Asymmetrical outline from incisal view 9. The distinguishing features between
c. Both a and b maxillary right and left canine are
d. Symmetrical outline from incisal view a. Shorter mesial cusp slope
3. Mesiodistal dimension of this tooth is less b. Mesioincisal angle sharp, distoincisal
than labiolingual dimension rounded
a. Permanent maxillary central incisor c. Mesial cervical line is more convex
b. Permanent maxillary canine d. All the above
c. Permanent maxillary lateral incisor
10. The surface of mandibular canine crown
d. None which is relatively straight and is in
4. The characteristic that differentiates continuation with the same on the root is
maxillary canine from mandibular canine a. Mesial b. Labial
a. Cusp tip labial to centre c. Lingual d. Distal
b. Attrition on lingual surfaces
11. The permanent tooth in the oral cavity
c. Cingulum is centred having the longest crown length is
d. All of the above
a. Maxillary canine
5. The tooth having mesial side of the crown b. Mandibular lateral incisor
in line with mesial side of the root is c. Maxillary 1st premolar
a. Maxillary canine
d. Mandibular canine
b. Mandibular canine
c. Mandibular lateral incisor 12. Anterior teeth having two roots, i.e. root
d. Maxillary central incisor divided into labial and lingual part is
variation found in
6. The cingulum is off centred to distal in
a. Maxillary canine
a. Permanent maxillary central incisor
b. Mandibular canine
b. Mandibular lateral incisor
c. Maxillary incisor
c. Mandibular canine
d. Mandibular incisor (lateral)
d. All the above
e. Both b and d
7. The canine eminence ridge on the
anterior surface of maxilla, forms the 13. From incisal view distolingual twist of the
following fossa anterior to it crown is common to
a. Incisive fossa a. Mandibular canine
b. Canine fossa b. Mandibular lateral incisor
c. Triangular fossa c. Both a and b
d. Central fossa d. Maxillary central incisor
1-a, 2-c, 3-b, 4-d, 5-b, 6-d, 7-a, 8-e, 9-d, 10-a, 11-d, 12-e, 13-c
44 DADH Made Easy
14. From incisal aspect the labial outline of 20. The permanent maxillary canine is most
the crown appears to be pinched likely to occlude with mandibular
faciolingually on the distal half, this is the a. Lateral incisor and canine
characteristic of b. Canine only
a. Maxillary canine c. Canine and first premolar
b. Mandibular canine d. First premolar only
c. Both maxillary and mandibular canine
21. The first evidence of calcification of
d. None of the above permanent maxillary canine takes place
15. From incisal view, compared to the axis at the age of
of the root, the cusp tip of maxillary a. 4–5 months after birth
canine is placed b. 4–5 years after birth
a. Labially and distally c. 6 months in intrauterine life
b. Labially and mesially d. None of the above
c. Lingually and distally
22. The crown completion of permanent
d. Lingually and mesially maxillary canine is at
16. The largest labiolingual root dimension a. 6–7 years b. 4–5 years
is of c. 7–8 years d. 8–9 years
a. Maxillary central incisor
23. When a permanent mandibular canine
b. Maxillary lateral incisor has more than one root, usually the
c. Maxillary canine position of the root is
d. Mandibular canine a. Mesial and distal
17. On the lingual surface (in cingulum b. Facial and lingual
region) of permanent maxillary canine c. Mesial and lingual
is a sharp cusp like eminence called d. Distal and facial.
a. Lobe
24. The distal contact point of maxillary
b. Tubercle canine is usually located at
c. Mamelon a. Junction of middle and cervical third
d. Perikymata b. Middle of cervical third
18. The fossa above the roots of premolars, c. Middle third
posterior to canine eminence on maxilla d. Junction of incisal and middle third
is
25. In a maxillary canine, from proximal
a. Canine fossa b. Incisive fossa aspect the line bisecting the root apex
c. Linear fossa d. Central fossa will pass
19. Of the four cusp ridges the longest cusp a. Labial to the cusp tip
ridge of the permanent canines is b. Lingual to the cusp tip
a. Labial ridge b. Lingual ridge c. Through the cusp tip
c. Mesial ridge d. Distal ridge d. None of the above
14-a, 15-b, 16-c, 17-b, 18-a, 19-a, 20-c, 21-a, 22-a, 23-b, 24-c, 25-b
4
Premolars
LAQs (10 Marks)
Q 1. Describe class and arch traits of premolars. Compare and contrast maxillary first
and second premolars. (June 2011)
Ans. Class Traits of Premolars
• Premolars have a single buccal (B) cusp.
• They usually have two cusps, one buccal and one lingual and are called bicuspids but the
term is misnomer because very often mandibular second premolar may have three cusps.
• They may have one or two roots.
Arch Traits of Premolars (SAQ, Oct. 2003, Nov. 2010, 2014)
• Maxillary first premolars are larger than the second premolars whereas mandibular first
premolars are smaller than the second premolars.
• Maxillary first and second premolars are more similar to each other as compared to
mandibular first and second premolars.
• Maxillary premolars usually erupt before the eruption of maxillary canines.
• Mandibular premolars usually erupt after the eruption of mandibular canines.
• From proximal view
– Mandibular premolar crowns appear to be tilted lingual to the root axis.
– In mandibular premolars the lingual cusps are much shorter than the buccal cusps as
compared to those of maxillary premolars.
– Mandibular premolars show rhomboid outline from this aspect due to the lingual tilt of
the crown whereas maxillary premolars show trapezoid outline from this aspect.
• From occlusal view
– The maxillary premolars have hexagonal or ovoid outline.
The crown is wider buccolingually than mesiodistally.
– The mandibular premolars have more or less square outline or rounded or ovoid.
– Lingual cusp-tips are off-centered to the mesial most often on maxillary premolars and may be
off-centered to mesial on mandibular first premolars and second premolars with two cusps.
– Mandibular premolars exhibit more variation in occlusal form as compared to maxillary
premolars.
45
46 DADH Made Easy
Maxillary first premolar Maxillary second premolar

Introduction: Introduction:
• It is located fourth from the midline and contacts • It is located fifth from the midline and contacts
maxillary canine mesially and maxillary second maxillary first premolar mesially and maxillary
premolar distally. first molar distally.
• It is larger than the second premolar. • It is smaller than the first premolar.
Numbering system: Numbering system:
Palmer 4 4 Palmer 5 5
Universal R#5 L # 12 Universal R#4 L # 13
FDI 14 24 FDI 15 25
Chronological data: Chronological data:
First evidence of calcification 1½–13/4 yrs First evidence of calcification 2–21/4 yrs
Enamel completed 5–6 yrs Enamel completed 6–7 yrs
Eruption 10–11 yrs Eruption 10–12 yrs
Root completed 12–13 yrs Root completion 12–14 yrs
Buccal aspect (B)
Fig. 4.1 Fig. 4.2

Crown: Crown:
• The crown has pentagon/trapezoid shape. • Same as that of first premolar.
• The outlines are more angular. • The outlines are less angular.
• The crown is longer than that of the second premolar. • The crown is not as long as that of first premolar.
• Buccal surface (B) is convex with more prominent • The buccal ridge is less prominent.
buccal ridge (BR).
Outlines: Outlines:
• The mesial (M) and distal (D) outlines of the crown • The mesial and distal outlines converge less as
converge towards the cervix. compared to that of first premolar.
• Mesial outline is slightly concave from cervix to • Mesial outline is slightly convex whereas distal
the contact point whereas distal outline is almost outline is more convex.
straight.
• The buccal cusp tip is long and pointed resembling • The buccal cusp tip is short and blunt.
canine but contact areas in this tooth near at same
level.
(Contd.)
Premolars 47
Maxillary first premolar Maxillary second premolar (Contd.)

• Location of buccal cusp tip is towards distal with • Location of buccal cusp tip is towards mesial with
a longer mesial cusp slope (MCS). a shorter mesial cusp slope.
• Mesial and distal cusp slopes (DCS) • M and D cusp slopes meet at an obtuse angle at
meet at right angles at the cusp tip. the cusp tip.
• Cervical line is convex towards the root apex. • Same as that of first premolar.
• Mesial contact point lies at the junction of occlusal • Mesial contact point is at the junction of the
and middle third and it is narrower as compared occlusal and middle third.
to the distal contact point.
• The distal contact point lies in the middle third of the • Distal conact point same as that of first premolar.
crown and slightly cervical to the mesial contact point.
• Both the contact points are broader because the
crown is in contact with posterior teeth.
Root: Root:
• The root tapers from cervix to the apex • Same as that of first premolar.
• Apex of the root may bend distally, mesially or • Same as that of first premolar.
may be straight.
Palatal aspect (P)
Crown and root

less narrower P
P cusp tip
P Cusp is almost
towards M
at same level as
the B cusp
Fig. 4.3 Fig. 4.4
Crown: Crown:
• Crown is narrower on the palatal side. • The crown is less narrower on the palatal side.
• Palatal (P) cusp is smooth, spheroidal and shorter • Palatal cusp is almost of the same height as the
than the buccal (B) cusp. buccal cusp.
• The tip of the unworn palatal cusp is placed • Same as that of first premolar.
mesially. The cusp tip is pointed.
• Because the palatal cusp is narrower and shorter • The palatal cusp is almost as long as the buccal
than the buccal cusp, part of the M and D surfaces cusp. The palatal cusp is slightly narrower than
of the crown and root are seen from this aspect, the buccal cusp.
and also the cusp tips and cusp slopes of both the
buccal and palatal cusps are seen from this aspect.
• M and D outlines are convex and are continuous
with the MCS and DCS.
Root: Root:
• The palatal root of the two rooted first premolar is • The single root is narrow towards the palatal
smooth, convex, and shorter than the buccal roots. aspect.
• The apex of the palatal root is blunt and may have
a mesial or distal bend.
(Contd.)
48 DADH Made Easy

Proximal aspect
Fig. 4.5 Fig. 4.6

Crown: Crown:
Shape, cusp tips, and cusps: Shape, cusp tips, and cusps:
• Proximal surface has trapezoid shape. • The proximal surface has same shape.
• Two cusps are seen from this aspect. The buccal • Two cusps are seen from this aspect. The buccal
cusp is noticeably longer than the palatal cusp. and palatal cusp tips are almost at same level.
• Buccal and palatal cusp tips are closer. • Buccal and palatal cusp tips are more apart.
• Both the cusps are located well in the confines of • Same as that of first premolar.
the root outline.
• Buccal cusp tip is directly below the centre of the
buccal root.
• Palatal cusp tip is in line with the palatal border
of the palatal root.
Outlines and surfaces: Outlines and surfaces:
• Mesial marginal ridge (MMR) is located more • Same as first premolar.
occlusally as compared to distal marginal ridge
(DMR).
• Cervical line is convex towards the occlusal. It is • Same as first premolar.
more convex on the mesial surface.
• Crest of curvature on the buccal surface is in the • Same as first premolar.
cervical third.
• Crest of curvature on the palatal surface is in the • Same as first premolar.
middle third.
Mesial surface has distinguishing features:
• A prominent concavity, the canine fossa (CF) is • There is no concavity on the mesial surface of the
located at cervical to the mesial contact area. crown.
(below the cervical line)
It accommodates the rounded disto-incisal angle
of the canine.
• This crown concavity is in continuation with the • The depression is present on the mesial surface of
concavity on the root. the root.
• A well defined developmental groove, the mesial • There is no MMRG present.
marginal ridge groove (MMRG) crosses the mesial
marginal ridge (MMR) immediately lingual to the
mesial contact area.
It is continuous with the central groove (CG) on
he occlusal surface.
(Contd.)
Premolars 49

Root: Root:
• The root is bifurcated in the apical third or half its • It has a single root which may be longer than the
length with one buccal and one palatal root. root of the first premolar.
• On the mesial surface of the root trunk there is a • On the mesial surface the depression is shallow.
deep developmental depression which is in
continuation with the canine fossa.
• On the distal surface of the root trunk the depression • On the distal surface the depression is deeper.
is shallow.
Occlusal aspect
Fig. 4.7 Fig. 4.8

Shape, surface, outline, and ridges: Shape, surface, outline, and ridges:
• Occlusal surface has hexagonal outline. • Occlusal surface has rounded or oval outline.
• The outline is asymmetrical. • The outline is symmetrical.
• The six sides are the mesiobuccal (MB), mesial (M),
mesiopalatal (MP), distobuccal (DB), distal (D), and
distopalatal (DP).
• The occlusal surface consists of B and P cusps, B • It is same as that of first premolar.
and P triangular ridges, M and D marginal ridges,
triangular fossa, pits, and central groove (CG).
• The angle formed by the mesiobuccal cusp ridge • The angle formed by the mesiobuccal cusp ridge
and the MMR approaches a right angle. and MMR is an obtuse angle.
• The angle formed by the distobuccal cusp ridge • The angle formed by the distobuccal cusp ridge
and the DMR is an acute angle. and the DMR is not an acute angle.
• The MMR is shorter than the DMR. • It is same as that of first premolar.
• Buccal triangular ridge (BTR) of the B cusp is • Buccal triangular ridge (BTR) is less prominent.
prominent and arises near the centre of the CG
and ends at the tip of the B cusp.
• Lingual/palatal triangular ridge (PTR) extends • It is same as that of first premolar.
from the P cusp tip to the CG.
• BTR and PTR join to form a transverse ridge. • It is same as that of first premolar.
Fossa: Fossa:
• Mesial and distal triangular fossa (MTF and DTF) • Mesial and distal triangular fossae are triangular
are triangular depressions closer to the marginal depressions away from the marginal ridge.
ridges.
Grooves and pits Grooves and pits
• Occlusal surface of the first premolar has fewer • Occlusal surface has multiple supplemental
supplemental grooves. grooves radiating from the CG hence it appears
wrinkled.
• A well-defined CG divides the occlusal surface • Same as in first premolar.
evenly buccolingually.
• The length of the CG is longer as compared to that • The length of the CG is shorter.
of second premolar.
(Contd.)
50 DADH Made Easy

• The CG extends from distal pit to mesial pit where • The CG extends from mesial pit to distal pit.
it joins the MMRG.
• M and D pits are closer to the marginal ridges. • M and D pits are farther from marginal ridges.
• Mesial pit is the point of union of three develop-
mental grooves: (1) MMRG, (2) Mesiobuccal
developmental groove (MBDG), (3) CG.
• Distal pit is the point of union of two developmental
groves: (1) distobuccal developmental groove
(DBDG), (2) central groove (CG).
Q 2. Describe the morphology of mandibular first premolar. (May 2007)

Ans. Introduction
• Mandibular premolars are four in number two on either side of the midline in the lower
arch.
• The first premolar has a large buccal cusp, which is long and well-formed with a small non-
functioning lingual cusp.
• It has many of the characteristics of a small canine.
• It is smaller than the second premolar.
Eruption
It erupts between the age of 10–12 years.
Numbering System
• Palmer 4 4
• Universal R - # 28, L - # 21
• FDI R - # 44, L - # 34
Mandibular first premolar from all aspects

Buccal aspect
Crown: Fig. 4.9

Shape, size, and surface: • From this aspect the form of the crown is nearly symmetrical bilaterally.
• The crown is roughly trapezoid in shape.
• The crown is long and narrow at cervix.
(Contd.)
Premolars 51
Mandibular first premolar from all aspects (Contd.)

• The buccal surface is more convex than in maxillary premolars especially at
cervical and middle-thirds.
• The buccal ridge is prominent with developmental depressions on either
side of the buccal ridge.
• The crown tapers form contact area to the cervix.
Outlines and cusp tip: • The mesial outline (M) is straight or slightly concave from cervical line to
the mesial contact area.
• The distal outline (D) is slightly concave from the cervical line to the distal
contact area.
• The mesial cusp slope (MCS) is shorter than the distal cusp slope (DCS).
Both the cusp slopes form an acute angle at the cusp tip.
• There is a shallow notch on the mesial cusp slope.
• Buccal cusp tip is long and pointed and located a little mesial to the root
axis.
• Cervical line slightly convex towards the root.
Contact areas: • Mesial contact area is more cervical than the distal contact area (This is an
exception along with deciduous maxillary canine.)
Root • It has a pointed apex and a distal bend in the apical third.
• Some mandibular first premolars have slight distal tilt of the crown on the
root.
Lingual aspect
Fig. 4.10
Crown:
Shape, size, surface, and cusp: • The crown is narrower on the lingual aspect.
• The major portion of the cown is made-up of the middle buccal lobe.
• The cervical portion of the crown lingually is narrow, and convex with
concavities between the cervical line and the contact areas on the lingual
portion of the mesial and distal surfaces.
• The contact areas and marginal ridges are pronounced and extend above
the narrow cervical portion of crown.
• Lingual cusp is very small, pointed and non-functional.
• Lingual (L) cusp tip is in line with the buccal triangular ridge.
• Because of the smaller lingual cusp much of the buccal profile and occlusal
surface may be seen from this aspect.
• Occlusal surface slopes sharply lingually in cervical direction, down to the
short lingual cusp. Most of the occlusal surface of the tooth is therefore seen
from this aspect.
(Contd.)
52 DADH Made Easy

• A characteristic of the lingual surface is the mesiolingual developmental
groove (MLG).
• It separates the mesial marginal ridge (MMR) from the mesial slope of the
lingual cusp.
Root: • The root tapers from cervix to a pointed apex.
• The root is much narrower on the lingual side due to which the develop-
mental depressions on the root are seen on the mesial and distal surfaces.
• Mesial surface of the root has a deep developmental groove present.
Proximal aspect (M)
Fig. 4.11
Crown:
Shape and size: • From this aspect, the shape of the crown is rhomboid which is characteristic
of all the mandibular posterior teeth.
Outlines and the cusps: • The buccal outline of the crown from this aspect is prominently curved
from the cervical line to the tip of the buccal cusp.
The crest of curvature is at the junction of cervical and middle third more
towards middle third.
• The lingual outline of the crown is a curved outline of less convexity than
that of the buccal surface.
• The crest of curvature is in the middle third of the crown, which is outside
the confines of the root. The curvature ends at the tip of the lingual cusp.
• Cervical line curvature is more on the mesial surface than the distal surface.
• The lingual tilt of the crown over the root is more as compared to that of
the crown of second premolar.
• Occlusal plane is tilted lingually.
• Mesial marginal ridge (MMR) is more cervical as compared to distal
marginal ridge (DMR) because it inclines (slopes) at 45° towards the cervix
and is parallel to the long, prominent buccal triangular ridge (BTR).
• Distal marginal ridge (DMR) is horizontal and more occlusal to the MMR
and is confluent with the lingual cusp slope.
• The lingual triangular ridge (LTR) is short and horizontal.
• Mesiolingual developmental groove (MLG) is present between MMR and
Mesial slope of the lingual cusp (from mesial aspect).
• The buccal cusp tip is in line with the root axis.
• The lingual cusp tip is in line with the lingual surface of the root.
• The lingual cusp is shorter than the buccal cusp by more than one-third of
the total crown length.
(Contd.)
Premolars 53

Contact area: • Mesial contact area is in line with the buccal cusp tip.
• Distal contact area is broader.
Root: • The root tapers evenly from the cervix to a pointed apex which is in line
with the buccal cusp tip.
• Root depressions are present on both mesial and distal root surfaces.
Occlusal aspect
Fig. 4.12
Shape, size, and surface: • Both mandibular premolars exhibit more variations in form occlusally as
compared to maxillary premolars.
• Crown outline is roughly diamond shaped and similar to incisal aspect of
mandibular canine and is asymmetrical.
• Crown converges towards lingual.
Outlines: • Mesial cusp slope is shorter than the distal cusp slope.
• Mesial outline is flat or less curved.
• Distal outline is more curved.
• MMR is shorter and at an acute angle to the mesial cusp slope
• Distal marginal ridge (DMR) is longer and at right angles to the distal cusp
slope.
Contact areas: • Mesial and distal contact areas are broad, distal being broader of the two.
Ridges: • Middle lobe of the buccal cusp makes up for the major bulk of the crown.
• Buccal triangular ridge (BTR) is more prominent, longer, and inclines
lingually from buccal cusp tip to where it joins the short triangular ridge of
the lingual cusp.
• The two triangular ridges join to form a blunt transverse ridge, separating
mesial and distal fossa.
Fossa: • Mesial fossa (MF) is small, shallow, and linear with a mesial pit at its bottom.
It contains mesio-buccal developmental groove (MBDG).
• Distal fossa (DF) is large, deep and circular with a distal pit at its base.
Groove: • Central groove is rarely present.
• The mesiobuccal developmental groove (MBDG) runs buccolingually (BL)
from mesial fossa and it is continuous with the mesiolingual developmental
groove (MLG) as it passes over the mesiolingual surface.
• A distal developmental groove (DDG) or a few supplemental grooves may
extend from distal fossa.
Q 3. Define and enumerate different type traits. Write in detail maxillary first premolar with
endodontic anatomy. (Dec. 2005)
Ans.
• A trait is a distinguishing characteristic.
• Type traits are the characteristics that differentiate the teeth within the same class, i.e. first
premolars from second premolars.
54 DADH Made Easy
Type Traits of Maxillary Premolars
First premolar Second premolar

• Mesial cusp slope is longer than the distal cusp • Mesial cusp slope is shorter than the distal cusp
slope. slope.
• From proximal view the lingual cusp shorter than • Both the cusps are almost of same height and the
the buccal cusp and the cusp tips are closer. cusp tips are farther apart.
• Occlusal outline is sharp and hexagonal. • Occlusal outline is ovoid and is more symmetrical.
Occlusal outline is asymmetrical.
• On occlusal surface, the central groove is longer as • Central groove is shorter.
compared to that on second premolar.
• Occlusal surface is not wrinkled. • Occlusal surface is wrinkled.
• More often it has two roots. • It has a single root.
• Mesial crown and root depressions and mesial • Mesial root depression only.
marginal ridge groove present. • No MMRG.
Type Traits of Mandibular Premolars
First premolar Second premolar

• The buccal cusp tip is more pointed. • The buccal cusp tip is less pointed.
• The lingual cusp is very small and nonfunctional. • In two cusp types the lingual cusp is longer as
compared to that of first premolar and the lingual
cusp tip is towards the mesial.
• In three cusp types there are two lingual cusps the
mesiolingual cusp is larger than the distolingual
cusp.
• MMR is parallel to triangular ridge of buccal cusp.
• The mesial marginal ridge (MMR) is more cervical • The MMR is horizontal and more occlusally
as compared to distal marginal ridge (DMR). placed.
The DMR is more cervically placed.
• Root depressions present on both mesial and distal • Root depression present only on distal surface.
surfaces.
• From occlusal view the crown is diamond shaped. • The crown has more of square or round shape.
• There is presence of mesiolingual groove, • Mesiolingual groove is absent.
separating the mesial marginal ridge from the
lingual cusp.
(Detail description of maxillary first premolar is in Ans. 4)

• Endodontic anatomy of maxillary first premolar:
Pulp chamber:
– is narrow from buccal view and wider from proximal view.
– Roof of the pulp chamber is coronal to the cervical line and floor is below the cervical
line.
– The pulp chamber does not constrict much near the cervical part as there are two separate
roots and two canals.
– One pulp horn is present under each cusp.
– Buccal pulp horn is more prominent.
• Cross-section at the cervical level shows characteristic kidney-shaped outline because of
indentation due to presence of mesial developmental groove.
Premolars 55
Root and Root Canals

• The two well-formed roots divide in the middle third into
buccal and lingual roots.
• A small percentage of teeth may have three roots.
• 40% of teeth have one root with two canals.
• There is possibility of roots having three canals, with one
canal in the lingual root and two canals in the buccal root.
• Lingual canal is larger of the two canals. Fig. 4.13: Maxillary first premolar
Q 4. Describe morphology of maxillary first premolar and chronology.

(Dec. 2005, May 2009, 2014, 2015, June 2013)
Discuss chronology, odontometric data and morphology of maxillary first premolar in
detail. (Nov. 2015)
Ans. Introduction
• Premolars are eight in number. They succeed the deciduous molars.
• They are anterior to molars and present in permanent dentition only.
• They form a transition from anterior to posterior teeth.
Eruption
• It erupts between 10–11 years of age.
Numbering System Chronological Data

Palmer 4 Initiation of calcification 1½–1¾ years
Universal #5 Completion of enamel 5–6 years
FDI # 14 Eruption 10–11 years
Completion of root 12–13 years
Odontometric data
Length of crown 8.5 mm
Length of root 14.0 mm
Mesiodistal width of crown 7.0 mm
Mesiodistal width of crown at cervix 5.0 mm
Labiolingual width of crown 9.0 mm
Labiolingual width at cervix 8.0 mm
Curvature of cervical line on mesial 1.0 mm
On distal 0.0 mm
56 DADH Made Easy
Maxillary first premolar from each aspect

Buccal aspect (B)
Fig. 4.14
Crown:
Shape, size, and surface: • The crown has pentagon/trapezoid shape. It is more angular with buccal
line angles more prominent. It has the widest crown of all the premolars.
• The crown is longer than that of the second premolar.
• Buccal surface is convex with a prominent buccal ridge (BR).
• Mesial and distal to the buccal ridge are the developmental depressions.
Outlines: • The mesial (M) and distal (D) outlines of the crown converge towards the
cervix.
• Mesial outline is slightly concave from the cervical line to the contact point
whereas the distal outline is almost straight.
• The buccal cusp tip is long and pointed. The mesial and distal cusp slopes
meet at right angles.
• Location of buccal cusp tip is towards distal to the vertical axis line with a
longer mesial cusp slope and a shorter distal cusp slope.
• Cervical line is convex towards the apex.
Contact point: • The mesial contact point lies at the junction of occlusal and middle third
and it is narrower as compared to the distal contact point.
• The distal contact point lies in the middle third of the crown and slightly
cervical to the mesial contact point.
• Even so, the contact areas are more nearly at same level than those found
on anterior teeth.
Root: • The root tapers from cervix to the apex.
• The apical end of the root bends distally or may be straight.
Palatal aspect (P)
Crown:
Size, shape, and cusp: • On the palatal side the crown of the first premolar is more narrower than
that of the second premolar.
• The tip of the unworn cusp is pointed and placed mesially.
• Palatal cusp is shorter, smooth, and spheroidal.
• Because the palatal cusp is narrower, part of mesial, and distal surfaces of
crown and root are seen from this aspect.
• Because the palatal cusp is shorter the cusp tips and cusp slopes of both the
cusps are seen from this aspect.
(Contd.)
Premolars 57
Maxillary first premolar from each aspect (Contd.)
Fig. 4.15
Outlines: • From this aspect the gross outline of the crown is reverse of the gross outline
of the buccal aspect.
• Mesial and distal outline of the palatal cusp are convex and straighten at
cervix, they continue with mesial and distal cusp slopes.
Root: • The palatal root of two roots is smooth and convex.
• The apex of palatal root is more blunt compared to buccal root apex.
Proximal aspect
Fig. 4.16
Crown:
Shape, cusp tip, and cusps: • Proximal surface has trapezoid shape. Longest uneven side towards cervical
and shorter towards occlusal.
• 2 cusps are seen from this aspect. The buccal cusp is noticeably longer than
the palatal cusp.
• Both the cusp tips are closer and located well in the confines of the root
outline.
• Buccal cusp tip is directly below the centre of the buccal root.
• Palatal cusp tip is in line with the palatal border of the palatal root.
Outlines and surfaces: • Mesial marginal ridge (MMR) is located more occlusally as compared to
the distal marginal ridge (DMR).
• Cervical line is convex towards the occlusal outline. It is more convex on
the mesial surface.
• Crest of curvature on the buccal surface is in the cervical third.
• Crest of curvature on the palatal surface is in the middle third.
(Contd.)
58 DADH Made Easy

Mesial surface has distinguishing features:
• A prominent concavity the canine fossa (CF) on the crown is located cervical
to the mesial contact area. This concavity is in continuation with the
concavity on the root surface.
• A well-defined developmental groove, the mesial marginal ridge groove
(MMRG) crosses the mesial marginal ridge immediately lingual to mesial
contact area. It is continuous with the central groove on occlusal surface.
• Mesial contact area is broad and at the junction of occlusal and middle third
and buccally placed.
Distal surface:
• It does not have the concavity on the crown and the marginal groove.
• Distal contact area is broader and more buccally placed.
Root: • The root is bifurcated in the apical third with one buccal and one palatal
root.
• On the mesial surface of the root trunk is a deep depression which is in
continuation with the canine fossa.
• On the distal surface the depression is shallow.
Occlusal aspect
Fig. 4.17
Crown:
Shape: • Occlusal surface has hexagonal outline.
• The six sides are the mesiobuccal (MB), mesial (M), mesiolingual (ML),
distobuccal (DB), distal (D) and distolingual (DL).
Outline and surface: • The occlusal surface consists of buccal and palatal cusps, buccal, and palatal
triangular ridges (BTR and PTR), mesial, and distal marginal ridges (MMR
and DMR), triangular fossa (TF), pit, and central groove (CG).
• The angle formed by the mesiobuccal cusp ridge and mesial marginal ridge
approaches a right angle. The angle formed by the distobuccal cusp ridge
and the distal marginal ridge is an acute angle. The mesial marginal ridge is
shorter than the distal marginal ridge.
• Buccal triangular ridge of the buccal cusp is prominent and arises near the
centre of the central groove and ends at the tip of the buccal cusp.
• Palatal triangular ridge (PTR) extends from the palatal cusp tip to the central
groove.
• The buccal and palatal triangular ridges join to from a transverse ridge.
• Fossa: Mesial and distal triangular fossa are triangular depressions closer
to the marginal ridges.
• Grooves: Occlusal surface of the first premolar has fewer supplemental
grooves. A well-defined central developmental groove divides the occlusal
surface evenly buccopalatally (BP).
• The length of the central groove is longer as compared to that of the second
premolar.
(Contd.)
Premolars 59

• The central groove extends from distal pit to mesial pit where it joins the
mesial marginal ridge groove (MMRG).
• Two collateral developmental grooves join the CG inside the MMR and the
DMR. These are the MBDG and the DBDG.
• Junction of these grooves is named as mesial and distal pits.
• Pit: Mesial and distal pits are closer to the marginal ridges. Mesial pit is the
point of union of three primary developmental grooves.
i. Mesial marginal ridge groove (MMRD)
ii. Mesiobuccal developmental groove (MBDG), and
iii. Central groove (CG).
The distal pit is the point of union of two developmental grooves.
i. Distobuccal developmental groove (DBDG), and
ii. Central groove (CG).
SAQs (3 Marks each)
Q 1. Describe arch traits of premolars. (Oct. 2003, Nov. 2014)

Mention morphological differences between maxillary and mandibular premolars. (Nov. 10)
Ans. Same as LAQ Q.1.
Q 2. What is Canine fossa on tooth surface?

(June 2004)
Ans. CANINE FOSSA (CF)
• It is a small concavity present on the mesial surface of the crown of
the maxillary first premolar just below the cervical line to
accommodate the rounded distoincisal angle of the canine.
• It is a mesial developmental depression on the mesial surface of the
maxillary first premolar where distal rounded surface of the canine
rests. It is cervical to the mesial contact area. Fig. 4.18
• It is believed to be produced (formed) due to the pressure of the distal aspect of the maxillary
canine as it develops earlier than the first premolar.
Q 3. Discuss about mesial aspect of maxillary first premolar. (May 2007)
Ans.
• Mesial surface of maxillary first premolar is trapezoid in shape.
• Mesial marginal ridge is more occlusal as compared to distal marginal ridge.
• Cervical line is more convex towards the occlusal as compared to the cervical line on the
distal aspect.
• Crest of curvature on the buccal surface is in the cervical third.
• Crest of curvature on the lingual surface is in the middle third.
• A prominent concavity, the canine fossa is present on the crown just below the cervical
line.
This concavity is in continuation with the concavity on the mesial surface of the root trunk.
• A well-defined developmental groove, the mesial marginal ridge groove (MMRG) crosses
the mesial marginal ridge immediately lingual to the mesial contact area.
It is continuous with the central groove on the occlusal surface.
60 DADH Made Easy
Q 4. Describe the type traits of mandibular premolars.

Ans.
Mandibular first premolar Mandibular second premolar

• It is smaller in size than the second premolar. • It is larger than the first premolar.
Buccal aspect
• Crown is longer and narrower at cervix. • Crown is shorter and is wider at cervix.
• Cusp tip is pointed with steep cusp slopes. • Cusp tip less pointed and cusp slopes meet at an
obtuse angle.
• Buccal ridge is more prominent. • Buccal ridge is less prominent.
Lingual aspect
• The lingual cusp is small and nonfunctional • The lingual cusp is longer and functional.
• One lingual cusp. • One or two lingual cusps.
• Mesiolingual developmental groove separates • Lingual groove separates the two unequal lingual
the mesial marginal ridge from the lingual cusp. cusps in 3-cusp type premolar.
• No groove in two-cusp type premolar.
Proximal aspect
• The lingual tilt of the crown is much more. • The lingual tilt is less.
• The mesial marginal ridge slopes cervically • The mesial marginal ridge is horizontal and more
therefore it is at a lower level than the distal occlusally placed than the distal marginal ridge.
marginal ridge.
• Depression present on both M and D surfaces of • Depression present only on the distal surface of the
root. root.
Occlusal aspect
• Outline of the crown is diamond shaped. • In two-cusp type the crown outline is rounded or
ovoid.
In three-cusp type crown outline is more or less
square.
Q 5. What is occlusal surface of mandibular second premolar?

Ans.
• Mandibular second premolars are of two types.
Two-cusp type, having one buccal and one lingual cusp.
Three-cusp type, having one buccal and two lingual cusps.
• In two-cusp type the crown outline is more or less rounded or oval. The crown converges
lingual to the mesiobuccal and distobuccal cusp ridges.
The lingual cusp is smaller than the buccal cusp but larger than the lingual cusp on the first
premolar.
• In the three-cusp type, the crown outline is more or less square lingual to the mesiobuccal
and distobuccal cusp ridges due to the presence of two lingual cusps, which are uneven in
size and smaller than the buccal cusp and are separated by a lingual groove. Mesiolingual
cusp is longer and wider than the distolingual cusp.
Premolars 61
Ridges, Grooves and Fossa

• Two-cusp type.
– The triangular ridge of the buccal cusp is long and wide. It joins the not so prominent
triangular ridge of the lingual cusp to form a transverse ridge.
– The mesial fossa is small and circular. The distal fossa is large and circular.
In two-cusp type more supplemental grooves present.
In two-cusp type of mandibular second premolar, two types of groove pattern is seen.
U-type (Fig. 4.19A)

The central groove from mesial to distal pit is slightly curved towards lingual.
The central groove, along with the mesiobuccal developmental groove (MBDG) and the
distobuccal developmental groove (DBDG) forms a U-shaped groove which is open and
directed towards the buccal side.
H-type (Fig. 4.19B)

The central groove is straight and short from M to D pit. The CG along with the MBDG,
MLDG, DBDG, DLDG forms the H-shaped groove pattern.
Three-Cusp Type (Fig. 4.19C)

• Each cusp has well-formed triangular ridges separated by deep developmental grooves.
These grooves converge in a central pit (CP) and form a Y-shape, on the occlusal surface.
• There is no transverse ridge.
• The central pit (CP) located midway between the buccal cusp ridge and the lingual margin
of the occlusal surface and slightly distal to the central point between the MMR and DMR.
• Mesial fossa is small and triangular. Distal fossa is smaller and also triangular.
Distal fossa appears to be in the outer edge of the central fossa.
In the three-cusp type mandibular second premolar, the groove pattern is Y-type.
• There is no central groove.
• The longer mesial groove extends in MB direction from the central pit (CP) and ends in the
mesial triangular fossa (MTF).
• The shorter distal groove continues from the central pit in DB direction and ends in Distal
triangular fossa (DTF).
• A lingual groove also unique to the three-cusp type, begins in the CP and extends lingually
between the ML and DL cusps and on to the lingual surface.
• The three grooves together form a Y-shaped groove pattern.
Fig. 4.19A Fig. 4.19B Fig. 4.19C

62 DADH Made Easy
1. The term premolar is used to designate 7. Mesial marginal ridges are more occlusal
any tooth in the permanent dentition of than distal marginal ridges which are
mammals that succeeds more cervical except in
a. A primary first molar a. Mandibular first premolar
b. A primary second molar b. Mandibular second premolar
c. Both a and b c. Maxillary first premolar
d. None of the above d. Maxillary second premolar
2. The maxillary right and left first premolars 8. From the occlusal view the shape of the
can be identified by the universal maxillary premolar crown is
numbering system as
a. Square b. Round
a. 4 and 11 b. 5 and 12
c. 14 and 24 d. 13 and 22 c. Oblong d. Rectangular
3. The facial or buccal surface of all pre- 9. From the occlusal view mandibular second
molars develop from premolar crown is
a. 2 facial lobes a. Square b. Oblong
b. 3 facial lobes c. Round d. Triangular
c. One lobe e. Square or round
d. None of the above 10. All premolar crowns are narrower on the
4. The only premolar with buccal crest of lingual side than on the buccal side
curvature located as far cervically as in except
the anterior teeth is a. Mandibular second premolar (Y-
a. Maxillary first premolar shaped)
b. Mandibular first premolar b. Mandibular first premolar
c. Mandibular second premolar c. Maxillary first premolar
d. Maxillary second premolar d. Maxillary second premolar
5. Permanent canines and all premolars 11. Lingual cusp tips are positioned off
have the mesial slope of the buccal cusp center to the mesial most often in
shorter than the distal cusp slope except
a. Maxillary premolars
a. Mandibular first premolar
b. Mandibular premolars
b. Maxillary first premolar
c. Both a and b
c. Maxillary second premolar
d. Mandibular second premolar d. None of the above
6. Usually premolars have two cusps one 12. The widest crown, buccal cusp long and
buccal and one lingual except one pre- pointed with M and D slopes meeting at
molar which has two lingual cusp; that is right angles is common to
a. Maxillary second premolar a. Maxillary first premolar
b. Mandibular first premolar b. Maxillary second premolar
c. Mandibular second premolar c. Mandibular first premolar
d. Maxillary first premolar d. Mandibular second premolar
1-c, 2-b, 3-b, 4-b, 5-b, 6-c, 7-a, 8-c, 9-e, 10-a, 11-a, 12-a
Premolars 63
13. The premolar commonly having two 20. Pulp chamber floor in maxillary first pre-
roots is molar is at
a. Maxillary first premolar a. Cervical level
b. Maxillary second premolar b. Below cervical level
c. Mandibular first premolar c. Above cervical level
d. Mandibular second premolar d. None of the above
14. Cross-section of maxillary first premolar 21. The only premolar having very small,
at cementoenamel junction is pointed, nonfunctional lingual cusp is
a. Oval shaped
a. Maxillary first premolar
b. Round shaped
b. Mandibular first premolar
c. Kidney shaped
d. Triangular shaped c. Mandibular second premolar
d. Maxillary second premolar
15. In maxillary first premolar, the pulp horn
extends further occlusally under the 22. The groove separating the mesial
a. Buccal cusp b. Lingual cusp marginal ridge from the mesial slope of
c. None d. Both a and b the small lingual cusp is the
a. Mesial marginal groove
16. The lingual root of the two rooted maxillary
first premolar is b. Mesiolingual groove
a. Shorter than buccal root c. Lingual groove
b. Equal to buccal root d. Distal marginal groove
c. Longer than buccal root 23. Mesial marginal ridge is more cervical,
d. None of the above mesial half of lingual surface is like a
17. The mesial marginal ridge groove and canine and distal half is like a molar this
mesial concavity is present in is a unique feature of
a. Maxillary first premolar a. Mandibular first premolar
b. Maxillary second premolar b. Maxillary first premolar
c. Mandibular first premolar c. Maxillary second premolar
d. Mandibular second premolar d. Mandibular second premolar
18. The deepest mid root depression on the 24. On the mandibular second premolar with
distal is common to two lingual cusps the mesiolingual and
a. Maxillary first premolar distolingual cusps are separated by
b. Maxillary second premolar a. Mesiolingual groove
c. Mandibular second premolar b. Distolingual groove
d. Mandibular first molar c. Lingual groove
19. The only premolar with an obvious d. None of the above
concavity or depression on the mesial
surface of the crown and this depression 25. The tip of the buccal cusp is in line with
continues onto the root is the root axis in (Proximal view)
a. Mandibular first premolar a. Mandibular first premolar
b. Maxillary first premolar b. Second premolar
c. Maxillary second premolar c. Maxillary first premolar
d. Mandibular second premolar d. Maxillary second premolar
13-a, 14-c, 15-a, 16-a, 17-a, 18-b, 19-b, 20-b, 21-b, 22-b, 23-a, 24-c, 25-a
64 DADH Made Easy
26. In cross-section of the tooth the classic 32. Buccolingual and mesiodistal dimension
indentation is present because of the are more nearly equal and the occlusal
mesial developmental groove in surface more square in
a. Mandibular first premolar a. Maxillary premolar
b. Maxillary canine b. Mandibular premolar
c. Maxillary first premolar c. Mandibular canine
d. Maxillary second premolar d. Maxillary central incisor
27. The triangular ridge of the lingual cusp 33. The characteristic that differentiates
is in horizontal plane in maxillary first premolar from maxillary
a. Mandibular second premolar with second premolar is
two lingual cusps a. Mesial concavity cervical to contact
b. Mandibular second premolar with one area
lingual cusps b. Long buccal cusp
c. Mandibular first premolar c. Mesial root depression, mesial marginal
d. Maxillary first premolar groove
28. Because of the extreme lingual tilt of the d. All of above are correct
crown of mandibular premolars, the tip 34. Premolar having canal that occasionally
of the lingual cusp bifurcates at the apical third of the root is
a. Is in line with the lingual surface of a. Mandibular first premolar
the root
b. Maxillary first premolar
b. Extends lingually beyond the lingual
c. Maxillary second premolar
surface of the root
d. Mandibular second premolar
c. Placed buccally
d. Is in line with the root axis 35. Buccal and lingual pulpal projection or
fins are present at the level of cemento-
29. Lingual tilt of the crowns is the charac- enamel junction and may show constric-
teristic of all the posterior teeth of tion at same level in
a. Maxillary arch
b. Mandibular arch
b. Maxillary second premolar
c. Both the arches
c. Mandibular first premolar
d. Neither arch
30. Premolars identified as #5 and #12 by
universal numbering system are 36. Wrinkled appearance of occlusal surface
is common in
a. Maxillary R and L first premolar
a. Maxillary 2nd premolar
b. Maxillary R and L second premolar
b. Maxillary 1st premolar
c. Mandibular R and maxillary R second
premolars c. Mandibular 1st premolar
d. None of the above d. Mandibular 2nd premolar
31. By universal numbering system, maxillary 37. Maxillary first premolar erupts at the
R and L second premolar are age of
a. #4 and #13 b. #5 and #12 a. 10–12 b. 9–11
c. #28 and #21 d. #6 and #13 c. 8–10 d. 7–9
26-c, 27-c, 28-a, 29-b, 30-a, 31-a, 32-b, 33-d, 34-c, 35-b, 36-a, 37-a
Premolars 65
38. The first evidence of calcification of the 45. In a longitudinal section of a premolar
maxillary first premolar takes place at the crown, the enamel is thickest in the
age of a. Cervical third
a. 2–3 years after birth b. Middle third
b. 3–4 years after birth c. Occlusal third
c. 1½ to 1¾ years after birth d. Junction of cervical and middle third
d. After birth 46. In a mandibular arch, the greatest lingual
39. The tooth which shows kidney-shaped inclination of the crown from its root is
outline in the cervical cross-section is seen in
a. Mandibular first premolar a. Canine b. First molar
b. Mandibular second premolar c. First premolar d. Central incisor
c. Maxillary first premolar 47. The teeth that erupts at 10–12 years of
d. Maxillary second premolar age is
40. A premolar having a well developed a. Permanent central incisor
mesiolingual groove is b. Permanent first molar
a. Maxillary first premolar c. Premolar
b. Mandibular first premolar d. Permanent second molar
c. Maxillary second premolar 48. In the sequence of eruption of permanent
d. Mandibular second premolar dentition the maxillary canine usually
follows
41. The mandibular second premolar re-
a. Maxillary lateral incisor
sembles mandibular first premolar from
a. Buccal view b. Lingual view
c. Mandibular second premolar
c. Occlusal view d. All of the above
d. Mandibular canine
42. Maximum buccolingual dimension is
49. The three cusp form is seen in
found in
a. Upper first premolar
b. Upper second premolars
c. Lower first premolar
c. Mandibular second premolar
d. Lower second premolar
d. All of them have same dimension
50. The small and non-functional lingual cusp
43. Maximum mesiodistal dimension is pre-
of mandibular first premolar is compared
sent in which premolar?
to
a. Maxillary premolars a. The cusp of Carabelli
b. Mandibular first premolar b. Cingulum of canine
c. Mandibular second premolar c. Distal cusp of molars
d. All of them have same dimension d. None of the above
44. The premolar which frequently has a 51. Which of the following premolars fre-
central pit is quently has only one pulp horn?
a. Maxillary first premolar a. Maxillary first
b. Maxillary 2nd premolar b. Mandibular first
c. Mandibular 1st premolar c. Maxillary second
d. Mandibular 2nd premolar d. Mandibular second
38-c, 39-c, 40-b, 41-a, 42-a, 43-d, 44-d, 45-c, 46-c, 47-c, 48-c, 49-d, 50-b, 51-b
66 DADH Made Easy
52. In the mandibular arch the M and D 53. Lingual cusp is mesial in which maxillary
contact points are at approximately same premolars?
level in all teeth except the mandibular a. First premolar only
a. Canine
b. Second premolar only
b. First molar
c. First premolar c. Both first and second
d. Lateral incisor d. Neither first or second
52-a, 53-c
5
The Permanent Molars
LAQs (10 Marks)
Q 1. Describe morphology of maxillary first molar. (June 2004)

Write class and arch traits of molars. Describe in detail the morphology of maxillary first
molar. (Second BDS) (Nov. 2010)
Ans. Class and arch traits of molars refer page 76.
Morphology of Maxillary First Molar

Introduction
• The maxillary first molar is the largest tooth in the maxillary arch.
• It has four well-developed functioning cusps and one supplemental cusp of little practical
use, the cusp of Carabelli.
• It has three well-developed and well separated roots.
• The crown of the tooth is wider buccopalatally (BP) than mesiodistally (MD).
Eruption
It erupts at around 6 years of age.
Numbering System
Palmer: 6
Universal: #3
FDI: 16
67
68 DADH Made Easy
Maxillary first molar from each aspect

Buccal aspect
Fig. 5.1
Crown:
Shape, size, surface, cusps, • The crown is roughly trapezoidal with shorter cervical and longer occlusal
and outlines: sides representing the uneven sides. The crown is wider mesiodistally
(MD) than cervicoocclusally.
• Crown is shorter from mesial (M) to distal (D).
• The crown tapers from contact area to the cervix.
• Mesial outline is straight from cervix to the contact point.
• Distal outline is convex.
• The cervical line has slight convexity towards the root.
• The two buccal cusps are separated by a buccal groove (BG).
• It has four functional cusps. All four cusps mesiobuccal (MB), distobuccal
(DB) and part of mesiopalatal (MP) and distopalatal (DP) are seen from
this aspect. This is possible because of the obtuse character of the disto-
buccal line angle. This is possible because the two palatal cusps are offset to
the distal in relation to the buccal cusps.
• The mesiobuccal cusp is wider than the distobuccal cusp. The distobuccal
cusp is more pointed.
Contact area: • Mesial contact area is at the junction of occlusal and middle third.
Root: • Distal contact area is in the middle of the middle third.
• All the three divergent roots are seen from this aspect. The three roots are
palatal root, which is longest, the mesiobuccal root and the distobuccal
root.
• Root trunk is shorter (4 mm).
• Roots are about twice as long as the crown.
• The palatal root is longer than the mesiobuccal (MB) root. It is visible
between the two buccal roots from this aspect, and the apex is located almost
in line with the buccal groove (BG).
• Both mesiobuccal (MB) and distobuccal (DB) roots are nearly same length,
both taper apically, mesiobuccal root apex is blunt and is in line with the tip
of the MB cusp.
• The spread of the middle thirds of the two buccal roots is nearly as wide as
the crown.
(Contd.)
The Permanent Molars 69
Maxillary first molar from each aspect (Contd.)

• MB and DB roots bend in such a way that they look like handles on a pair of
pliers.
• Often the MB and DB roots curve distally.
• A deep developmental groove is present on the root trunk from furcation
area to the cervical 1ine.
Palatal/lingual aspect
Fig. 5.2
Crown:
Shape, size, and surface: • The shape is trapezoidal.
• The palatal surface is more convex.
• It is narrower in the cervical third.
• The M and D outline are similar except that distal outline is shorter and
semicircular.
• The palatal developmental groove starts approximately in the centre of
palatal surface mesiodistally, curves sharply to the distal as it extends
between the two palatal cusps on to the occlusal surface.
• On the palatal surface of the mesiopalatal cusp a fifth cusp, the cusp of
carabelli is present. It is mini cusp or tubercle. It is non-functioning. It is
2 mm short of mesiopalatal cusp tip. A groove normally separates the cusp
of Carabelli from the cusp ridges of mesopalatal cusp.
• From this aspect only 2 palatal cusps visible.
• Mesiopalatal cusp is much larger, and before the occlusal wear it is always
the longest cusp. Its mesiodistal width is about three-fifths of the MD crown
diameter. Distopalatal cusp making the remaining two-fifths.
• Mesiopalatal cusp slopes make an obtuse angle.
• Distopalatal cusp is spheroidal.
Root: • All three roots are visible from this aspect.
• The palatal root is longest, conical and tapers in blunt round apex which is
in line with the palatal groove.
• The palatal portion of the palatal trunk is continuous with the entire cervical
portion of the crown palatally.
• Longitudinal depression is present on the palatal aspect of the root.
• The wide mesiodistal spread of the buccal roots is visible from this
aspect.
(Contd.)
70 DADH Made Easy

Proximal aspect
Fig. 5.3
Crown: Mesial aspect:

Shape, size, and surface: • Shape is trapezoidal, wider at cervical and narrow at occlusal.
• Crown is shorter and wide buccopalatally.
Outline: • The height of contour on the buccal surface is in the cervical one-third and
on the palatal surface it is in the middle of the crown.
• Cervical line is slightly convex above the contact area.
• Mesial marginal ridge is confluent with the cusp ridges of MB and ML cusps.
It is concave, longer and more occlusally placed as compared to distal
marginal ridge.
Cusps: • From this aspect two cusps mesiobuccal and mesiopalatal are seen and
the fifth cusp, the cusp of carabelli 2–3 mm below the tip of the mesio-
palatal cusp is also seen.
Contact area: • Mesial contact area is at the junction of middle and occlusal thirds and buccal
to the centre of the crown buccopalatally.
Root: • Roots are more divergent.
• From mesial aspect two roots are seen the mesiobuccal and the palatal root,
the distobuccal root is hidden by the broader mesiobuccal root.
• Mesiobuccal root is broad buccopalatally and flattened on its mesial surface.
It is shorter than the palatal root.
• The apex of the MB root is in line with the tip of the MB cusp.
• MB root has two root canals.
• From the buccal outline to the point of bifurcation, the width of the root on
root trunk is approx two-thirds of the crown measurement BL at the cervix.
• The root trunk is 3 mm long.
• Palatal root is the longest, it is banana-shaped and extends beyond the
crown palatally.
Distal aspect:
Crown:
Shape, size, and surface: • Crown is narrower towards the distal and because of the rhomboid shape
much of the buccal surface of the crown is seen from this aspect.
• Distal marginal ridge is more cervical compared to MMR. Cervical line is
almost straight.
• Tip of MB and MP cusps are seen from this aspect.
(Contd.)

Root: • Distobuccal root is shorter, narrower, and pointed therefore mesiobuccal
root is visible from this aspect
• The root trunk is 5 mm long.
• (The length of the root trunk, from the cervical line to the point of bifurcation:
on the mesial aspect is 3 mm,
on the buccal aspect is 4 mm, and
on the distal aspect is 5 mm.)
Occlusal aspect
Fig. 5.4
Crown:
Shape, outline, and cusps: • From this aspect it has somewhat rhomboidal outline following the four
major cusp ridges and the marginal ridges.
• Buccopalatal (BP) dimension is more than mesiodistal (MD) dimension.
• Crown tapers from mesial to distal.
• In maxillary first molar (only molar) where the palatal side may be wider as
compared to the buccal.
• The four major cusps and one minor cusp present.
• The mesiopalatal cusp is the largest with a rounded cusp tip.
• Distopalatal cusp is the smallest and most variable.
• Mesiobuccal cusp is second largest with sharp cusp tip and slightly larger
than the distobuccal cusp.
• The distobuccal cusp is the third largest with sharpest cusp tip.
Fossa: • There are two major fossae and 2 minor fossae.
• The major fossa is the central fossa (CF) which is roughly triangular and
mesial to the oblique ridge and the distal fossa (cigar fossa) which is linear
and distal to and parallel to the oblique ridge.
• The central fossa has connecting sulci within its boundries with
developmental grooves at the deepest portion of these sulci (sulcate
grooves).
• The two minor fossae are the mesial triangular fossa (MTF) and the distal
triangular fossa (DTF) which are located just distal to and mesial to the
MMR and the DMR.
Ridge: • Each of the four cusps has at least one definite triangular ridge.
The mesiopalatal (MP) cusp has two triangular ridges (few texts refer only
one triangular ridge).
The groove between the two triangular ridges of mesiopalatal cusp is called the
Stuart groove.
The mesial triangular ridge of mesiolingual/palatal cusp (MTRMP) joins the
triangular ridge of mesiobuccal cusp (MB) to form a transverse ridge.
(Contd.)
72 DADH Made Easy

The distal triangular ridge of mesiopalatal cusp (DTRMP) aligns with the
triangular ridge of the distobuccal cusp (TRDB) to form a diagonal ridge
called the oblique ridge. (OR)
Other texts refer to DTRMP by another name the distal cusp ridge of mesio-
palatal cusp (DCRMP). Subsequently the OR is formed by the triangular
ridge of distobuccal cusp and the distal cusp ridge of the mesiopalatal
cusp (Refer page 399 Fig. 25.132).
• The oblique ridge is reduced in height in the centre of the occlusal surface
being about at the level of the marginal ridges of the occlusal surfaces
sometimes it is crossed by a developmental groove that partially joins the
two major fossa by means of a shallow sulcate groove.
• The MMR and the DMR are irregular ridges confluent with the mesial and
distal cusp ridges of the mesial and distal major cusps.
Pits: • The central pit is located at the centre of the central fossa.
• Mesial and distal pits are located at the bottom of the mesial and distal
fossa.
Grooves: • There are 5 major developmental grooves. Central groove (CG), buccal
groove (BG), distal oblique groove (DOG), palatal groove (PG), sometimes the
transverse groove of the oblique ridge, and the fifth cusp developmental
groove (CDG).
• Central groove extends in the mesial direction at an obtuse angle to buccal
groove from the central pit (over the mesial transverse ridge) and ends in
the mesial triangular fossa.
• A short developmental groove radiates from the central pit, extends disto-
palatally where it either crosses the oblique ridge and ends in the distal
fossa or fades out before reaching the oblique ridge.
This part of the CG which extends over the oblique ridge is called the
transverse groove of the oblique ridge, it is a shallow developmental groove.
• Buccal groove extends from the central pit in buccal direction on to the
buccal surface.
• Distal oblique groove or linear groove or distopalatal groove extends
obliquely and traverses the distal linear fossa to join the palatal
developmental groove between the mesiopalatal and distopalatal cusps. It
shows several supplemental grooves.
At distal pit it terminates into two branches which form the two sides of the
distal triangular fossa (DTF).
• Palatal developmental groove (PG) separates the MP and DP cusps and
extends on the palatal surface to terminate at the centre of the crown palatally
below the palatal root.
• Fifth cusp groove outlines the fifth cusp (cusp of carabelli) it joins the palatal
groove near its terminus.
The other grooves are:
• Distal marginal groove.
• Distobuccal triangular groove and distopalatal triangular groove.
• Mesial marginal groove.
• Mesiobuccal triangular groove and mesiopalatal triangular groove.
Q 2. Describe morphology of maxillary second molar. (May 2002)

Ans. Introduction
• The maxillary second molar is the second largest tooth in the maxillary arch.
• It is similar in form to the first molar, but is generally smaller, especially in the distopalatal
arc.
• The buccopalatal dimension is almost the same as the first molar but mesiodistally it is
noticeably narrower.
Eruption
• It erupts at around 12 years of age.
Numbering System
Palmer: 7
Universal: R#2 L # 15
FDI: 17 L 27
Maxillary second molar from each aspect

Buccal aspect
Fig. 5.5
Crown:
Shape, size, and surface: • The crown is roughly trapezoidal with shorter cervical and longer occlusal
sides representing the parallel uneven sides.
• The crown is narrower mesiodistally shorter cervicoocclusally than the
maxillary first molar.
• The crown tapers from contact area to cervix.
• The larger and wider mesiobuccal cusp is separated from the smaller and
sharper distobuccal cusp by a buccal groove.
• Smaller DB cusp allows part of the distal marginal ridge and part of the DP
cusp to be seen from this aspect.
Contact areas: • Mesial contact area is at the junction of occlusal and middle third.
• Distal contact area is little cervical to the mesial contact area.
Roots: • The three roots are less divergent and are seen from this aspect.
(Contd.)
74 DADH Made Easy
Maxillary second molar from each aspect (Contd.)

• The buccal roots are of the same length. These roots are more nearly parallel
and are inclined distally more than those of the maxillary first molar so that the
end of the distobuccal root is slightly distal to the distal extremity of the crown.
• The apex of the MB root is on a line with the buccal groove of the crown
instead of the tip of the MB cusp.
• The root trunk is longer. The chances of fusion of roots is greater.
Palatal/lingual aspect
Fig. 5.6
Crown:
Shape, size, surface, and cusps: • The shape is trapezoidal.
• The palatal surface is more convex.
• The palatal surface is narrower in the cervical third because of the taper of
the crown to join the single palatal root.
• The mesial and distal outlines are same as on the buccal surface except that
distal outline is shorter and semi-circular.
• Due to shorter and smaller distopalatal cusp or nonexistent distopalatal
cusp, the crown on this aspect is less wide.
• Distopalatal cusp is small or absent.
• The fifth cusp is absent.
• The distobuccal cusp is seen through the sulcus between the MP and DP cusps.
• In the 4 cusp type of maxillary second molar, MP and DP cusps are separated
by a palatal groove (PG).
• The palatal root is the longest and has a longitudinal depression on the
palatal aspect.
• It tapers in blunt round apex.
• The palatal root apex is in line with the tip of the distopalatal cusp.
• Buccal roots are more parallel and have a distal bend.
Proximal aspect
Mesial aspect:
Fig. 5.7
(Contd.)

Crown :
Shape, size surface, and cusps: • Shape is trapezoidal, wider at cervix and narrow towards occlusal.
• Crown is shorter.
• Buccopalatally dimension is same as that of first molar.
• From this aspect MB and MP cusps are seen cusp of Carabelli is absent.
Outline: • The height of contour on the buccal surface is in cervical third and on palatal
surface it is in the middle of the crown.
• The mesial marginal ridge (MMR) is concave, longer, and more occlusal.
• The mesial marginal ridge groove (MMRG) is less common.
Contact area: • The mesial contact area is at the junction of middle occlusal third, and buccal
to the centre of the crown buccopalatally.
Root: • The roots are less spread being within the confines of the crown bucco-
palatally.
• The roots are shorter and may be fused.
• Mesiobuccal root has a single canal.
• Palatal root is less curved or may be straight.
Distal aspect:
Shape, size, and surface: • Crown is narrower towards the distal, more of the buccal surface is seen.
• Distal marginal ridge is more cervical compared to MMR.
• Cervical line is almost straight.
Root : • Distobuccal root is shorter and narrower therefore MB root visible from
this aspect.
• The palatal root is less curved and the apex is in line with the tip of the DL
cusp.
Occlusal aspect
(A) (B)
Figs 5.8A and B
Crown:
Shape, outlines, and cusps: • There are two types of occlusal surfaces.
• The rhomboid type of second maxillary molar is more frequent.
• It has four cusps.
• It appears like a twisted parallelogram or accentuated rhomboid, rhomboid
outline is more extreme with palatal portion twisted distally more acute
angle on MB corner due to prominent MB cervical ridge.
• The heart-shaped type of second maxillary molar has three-cusps. The disto-
palatal cusp is absent.
• The occlusal surface is narrower mesiodistally than the first molar.
• The crown tapers from mesial to distal.
(Contd.)
76 DADH Made Easy

• There is more taper from buccal to palatal due to smaller DL cusp or due to
absence of DP cusp.
• The MB and DP acute line angles are smaller.
• MP and DB obtuse line angles are wider.
• MB and MP cusps are well-developed and as large as in first molar whereas
DB and DP cusps are less developed.
• MB cusp is much larger than the DB cusp.
• MB cervical ridge is more prominent.
Fossa: • In the 4-cusp type there are 4 fossae. 2 major fossae, the central fossa, and
the distal fossa.
• 2 minor fossae, the mesial, and distal triangular fossae.
• In the 3-cusp type, there are 3 fossae. The distal fossa is absent.
Ridges: • The oblique ridge is shorter and less prominent.
• MMR is more occlusally placed than the DMR.
• DMR which is more longer and more cervically placed.
• In 3-cusp type there is no oblique ridge or may be faint.
Pits and grooves: • There are 3 pits.
• Central pit, mesial pit and distal pit.
• Central groove extends from central pit to mesial triangular fossa.
• The buccal groove extends from the central pit in the buccal direction
between the MB and DB cusps onto the buccal surface.
• Distal oblique groove, and palatal groove are absent in the 3-cusp type of
second molar.
• It 4-cusp type distal oblique groove, palatal groove present.
• Groove pattern is similar to that of first molar, but is more variable and
supplemental grooves are more numerous.
Q 3. What are arch and class traits of molars? (Oct. 2002)

• Describe the morphology of mandibular first molar. (May 2009)
• Write a note on its pulp cavity. (Nov. 2010, June 2012)
Ans. Class Traits of Molars
1. Molars are wider mesiodistally than cervicoocclusally.
2. They are the largest and strongest teeth. They have the largest occlusal surface of all the
posterior teeth.
3. They are the only teeth having at least two buccal cusps.
4. They have 3–5 cusps and 2–3 roots.
5. Molars are not succedaneous teeth.
Arch Traits of Molars
Maxillary molar Mandibular molar
1. Crowns of maxillary molars are wider bucco- 1. Crowns are wider mesiodistally than bucco-
palatally than mesiodistally. palatally/lingually.
2. 3 roots are present in maxillary molars. 2. 2 roots are present in mandibular molars.
3. There is presence of oblique ridge on the occlusal 3. There is no oblique ridge on the occlusal surface.
surface.
4. Maxillary molars are centred over their root axis. 4. Mandibular molars, from proximal aspect appear
to be tilted lingually.
5. Root trunk is longer. 5. Root trunk is shorter.
MANDIBULAR FIRST MOLAR

Morphology of Mandibular First Molars
Introduction
• It is the largest tooth in the mandibular arch.
• It is located sixth from the midline.
• It has the widest mesiodistal dimension of all the teeth.
• It normally exhibits five functional cusps and two well-developed roots, one mesial and
one-one distal which are very broad buccolingually.
• The crown is wider mesiodistally (MD) than buccolingually (BL).
• Flattened buccal cusps are typical of all mandibular molars.
Eruption
It erupts at around 6 years of age.
Numbering System
Palmer: 6 6
Universal: # 30, 19
FDI: 46, 36
Mandibular first molar from each aspect

Buccal aspect
Fig. 5.9
Crown:
Shape, size, and surface: • It has trapezoidal, shape with longer parallel side towards occlusal and
shorter parallel side towards cervical.
• There is proportionately more taper from contact area to cervix because of
the bulge of the distal cusp.
• The crown is wider mesiodistally than cervicoocclusally.
• The crown is shorter from mesial to distal.
• It has 5 cusps, 3 buccal cusps and 2 palatal cusps which are just visible from
this aspect.
• Mesiobuccal cusp (MB) is the widest, next is distobuccal cusp (DB) and
distal cusp (D) is smallest and more pointed than either of buccal cusp. MB
and DB cusps are relatively flat.
(Contd.)
78 DADH Made Easy
Mandibular first molar from each aspect (Contd.)

• The two buccal cusps make up the major portion of the buccal surface of
the crown.
• The distal cusp provides a very small part of the buccal surface because the
major portion of the distal cusp makes up the distal portion of the crown
providing the distal contact area on the centre of the distal surface of the
distal cusp.
• The mesiobucccal and distobuccal cusps are separated by mesiobuccal
groove (MBG) which is longer and terminates in a pit.
• The distobuccal and distal cusps are separated by a shorter distobuccal
groove (DBG).
Outline: • Mesial outline of the crown is concave from contact area to cervix.
• Distal outline of the crown is straight from contact area to cervix.
• At contact areas both outlines are convex.
• Cervical line is almost straight, dipping apically towards the root bifurcation.
Contact areas: • Mesial contact area is more occlusal.
• It is close to the junction of occlusal and middle third.
• Distal contact area is cervical to the mesial contact area.
Root: • The root is bifurcated near the cervical line.
• The root trunk is shorter (3 mm) and a depression is present.
• The roots are widely separated.
• The mesial root is longer, curved mesially from a point near the cervical
line to the middle third then curves distally so that the tapered apex of the
root is in line with the mesiobuccal groove.
• The distal root is shorter, straighter with pointed apex which extends beyond
the distal of the crown.
• Both roots are wider mesiodistally at the buccal areas than they are lingually.
• The developmental depressions are present on the mesial and distal sides
of both the roots.
Lingual aspect
Fig. 5.10
Crown:
Shape, size, and surface: • The crown is trapezoidal in shape. It is narrower from buccal to lingual.
• The lingual cusps are longer and sharper than the buccal cusps therefore
from this aspect only mesiolingual and distolingual cusps and part of distal
cusp is seen.
• The lingual groove (LG) separates the mesiolingual cusp from the disto-
lingual cusp.
(Contd.)

• Mesiolingual cusp is slightly larger than the distolingual cusp.
• The tip of the mesiolingul cusp is somewhat higher than that of the disto-
lingual tip.
• Cervical line is almost straight may dip cervically over the bifurcation.
Root: • Roots are narrower on this aspect.
• Root trunk is longer on this aspect 4 mm because the cervical line is more
occlusally placed.
Proximal aspect
Fig. 5.11
Crown:
Shape, size, and surface: • The proximal surface has rhomboidal shape due to the lingual tilt of the
crown in relation to root axis.
Cusps and outline: • The crown is shorter, narrower on distal aspect and the crown has a distal
tilt therefore, more of occlusal surface and some part of each of the five
cusps can be seen.
Distalaspect: • And also more of buccal and lingual surface is seen from distal aspect.
Cusps and outline: • Buccolingual dimension of the crown and root is greater on the mesial aspect
than on the distal and because the mesial cusps are higher, from mesial
aspect only mesiobuccal and mesiolingual cusps and mesial root are seen.
Mesial aspect: • Mesial cervical line curves very slightly towards the occlusal.
Cervical line: • Distal cervical line is almost straight.
Marginal ridge: • Mesial marginal ridge (MMR) is longer, more occlusally placed and often
crossed by mesial marginal groove.
• It is confluent with the mesial ridges of the MB and ML cusps.
• MMR is placed about 1 mm below the level of the cusp tips.
• There is a V-shaped notch at the mid-point of both the marginal ridges.
• The distal marginal ridge is short and more cervically placed.
Buccal and lingual outline: • The buccal outline is more convex in the cervical third and in the occlusal
two-thirds it becomes flatter.
• The MB cusp is located directly above the buccal third of the mesial root.
• The cervical ridge is less prominent.
• The lingual outline is straight from the cervix to the maximum convexity in
the middle third, from this point it is curved towards the mesiolingual cusp
tip. The tip of the mesiolingual cusp is in a position directly above the lingual
third of the mesial root.
Contact areas: • The mesial contact area is almost centred buccolingually and is placed at
the junction of occlusal and middle third.
(Contd.)
80 DADH Made Easy

• The distal contact area is placed just below the distal cusp ridge of the distal
cusp at the middle of middle third.
Root: • From mesial aspect only mesial root is seen which is wide buccolingually
and has a deep depression on the mesial as well as inner surface. It has a
blunt, wide apex.
• The distal root is narrower and shorter with a point apex.
• There is a shallow depression present on the distal surface of the distal root.
Occlusal aspect
Fig. 5.12A Fig. 5.12B: Triangular ridges and

Grooves no transverse ridge
Shape and size: • Occlusal surface is quadrilateral in form but due to the presence of buccal
bulge of the distobuccal cusp and small distal cusp, it has a hexagonal shape.
• Mesiodistal (MD) dimension is 1 mm more than the buccolingual (BL)
dimension.
• Crown tapers from mesial to distal therefore the crown is wider bucco-
lingually on mesial half than on the distal half.
• Widest buccolingual (BL) dimension is in the middle third of the distobuccal
cusp.
• Because of the lingual inclination of the crown more of the buccal surface is
visible than the lingual surface.
• The crown narrows from buccal to lingual.
• Outline of the crown is convex on buccal, lingual, mesial, distal.
• The occlusal surface includes the cusps, the ridges, the fossae and the
grooves.
• There are five triangular ridges, 3 fossae, 3 pits and 4 developmental grooves.
Cusps: • Mesiobuccal cusp is larger than mesiolingual and distolingual cusps which
are almost equal in size.
• Distobuccal is smaller than the mesiobuccal, mesiolingual, distolingual, and
distal cusp is the smallest.
Ridges (Fig. 5.12b) • Some texts refer that the occlusal surface of mandibular first molar has no
transverse ridge.
• The triangular ridge of the mesiobuccal cusp (TRMB) extends lingually to
end at the mesial portion of the central groove.
• The triangular ridge of the distobuccal (TRDB) cusp extends mesiolingual
to the area of the central pit.
• The triangular ridge of the distal cusp (TRD) extends mesiolingual to the
distal pit area.
(Contd.)

• The triangular ridge of the mesiolingual cusp (TRML) extends distobuccal
to end at the mesial portion of the central groove.
• The triangular ridge of the distolingual cusp (TRDL) extends mesiobuccally
to end in the area of the junction of the distobuccal groove (DBG) and the
distal portion of the central groove.
Ridges (Fig. 5.12a) • Other texts refer that the occlusal surface of mandibular first molar has two
transverse ridges.
• The triangular ridges (TR) of the mesiobuccal and mesiolingual cusps (TRMB
and TRML) meet to form a transverse ridge.
• The triangular ridges of distobuccal and distolingual cusps (TRDB and
TRDL) form a second transverse ridge.
• Since the lingual cusps are higher, TR of lingual cusps of first molars are
longer than the TR of buccal cusps.
Fossa: • There is one major fossa and two minor fossae.
• The major fossa is the central fossa. It is roughly circular and it is centrally
placed on the occlusal surface between the buccal and lingual cusp ridges.
• All of the developmental grooves converge in the centre of the central fossa
at the central pit.
• Mesial triangular fossa is smaller and distal triangular fossa is smallest.
Grooves: • There are 4 developmental grooves. Central developmental groove (CG),
mesiobuccal developmental groove (MBG), the distobuccal developmental
groove (DBG) and the lingual developmental groove (LG).
• Central groove (CG) extends from mesial pit to distal pit and has a zigzag
course mesiodistally (MD).
• Mesial portion of the central groove extends from central pit mesiobuccally
for short distance, joins the mesiobuccal groove, then separates and
continues mesially to the mesial pit.
• Distal portion of CG extends from Central pit in distobuccal direction to a
point, where it is joined by DBG. From this point, CG courses in distolingual
direction terminating in the distal pit.
• MBG extends mesiobuccally from the central pit for short distance to traverse
on to the buccal surface passing between the MB and DB cusps.
• LG extends lingually from the central pit between the mesiolingual and
distolingual cusps but rarely extends on to the lingual surface.
PULP CAVITY OF MANDIBULAR FIRST MOLAR

Pulp Chamber (PC)
• Roof of pulp chamber is rectangular in cross-section.
• It has four pulp horns MB, DB, ML, DL.
• Floor of the PC is rhomboid in cross-section.
• It has 2 funnel-shaped openings of the mesial root
canals and 1 opening of the distal canal.
Root Canals
Fig. 5.12C: Mandibular first molar
• The molar has two separate and distinct roots :
• The mesial root has 2 distinct canals leaving the floor.
• It has a more complicated RC system because of presence of two root canals.
82 DADH Made Easy
• The mesial canals may be severely curved or straight.

• The two canals may join each other and exit in a single foramen or may exit in separate foramen.
• The distal root has one large, straighter and shorter root canal, may have two canals.
Q 4. Describe morphology of mandibular second molar. (May 2008)

Ans. Introduction
• It is the second largest tooth in the mandibular arch.
• It is located seventh from the midline.
• It resembles the first molar in many respects, although it is more symmetrical and smaller
in all dimensions.
• It has the least complicated occlusal design of any molar.
• Normally only four cusps present.
Eruption
It erupts at around twelve years of age.
Numbering System
Palmer: 7 7
Universal: R # 31 L # 18
FDI: R 47 L 37
Mandibular second molar from each aspect

Buccal aspect
Fig. 5.13
Crown :
Shape, size, surface: • It has trapezoidal shape with longer parallel side towards the occlusal and
shorter towards the cervical.
• The crown tapers from contact area to the cervix.
• The crown is shorter from mesial to distal.
• It has four cusps, two buccal and two lingual which are just visible from the
aspect.
• Mesiobuccal (MB) cusp wider than distobuccal cusp. Two buccal cusps are
separated by a buccal groove which terminates in a pit.
Outline: • Mesial border of the crown is either straight or concave from contact area to
cervix.
(Contd.)
Mandibular second molar from each aspect (Contd.)

• Distal border is either straight or convex from contact area to cervix.
• At contact area both outlines are convex.
• Cervical line is almost straight and points towards bifurcation.
• Occlusal border is flattened.
Contact area: • Mesial contact area is more occlusal. It is close to the junction of occlusal
and middle-third.
• Distal contact area is cervical to the mesial contact area.
Root: • Two roots. Mesial root slightly longer than the distal root.
• Root bifurcation is near the cervical line.
• The root trunk is longer as compared to that of the first molar.
• Roots are more or less parallel, i.e. less separated.
• Either both the root apices are directed towards the centre line or both the
roots curve distally.
• Both the roots taper apically in a pointed apex.
Lingual aspect
Fig. 5.14
Crown:
Shape, size, and surface: • The crown is trapezoidal in shape.
• It is narrow from buccal to lingual.
•Since the lingual cusps are longer and sharper than the buccal cusps, from
this aspect only ML and DL cusps are seen.
• Lingual groove separates the mesiolingual and the distolingual cusps.
• Cervical line is straight, may dip cervically over the bifurcation.
Root: • Roots are narrower on this aspect.
• Root trunk appears longer because cervical line is more occlusal on lingual.
Proximal aspect
Fig. 5.15
(Contd.)
84 DADH Made Easy

Crown:
Shape, size, and surface cusps: • The proximal surface has rhomboid shape due to the lingual tilt of the crown
in relation to root axis.
Distal aspect:
• Due to the distal tilt of the crown and crown being shorter and narrower on
this aspect, more of occlusal surface, part of MB and ML cusps are also seen
behind the DB and DL cusps and also more of buccal and lingual surface is
seen.
Mesial aspect:
• Buccolingual dimension of the crown and root is more on the mesial aspect
than on the distal and because the mesial cusps are longer, from this aspect
only mesiobuccal and mesiolingual cusps and mesial root are seen.
Outline: • Buccal outline is more convex in the cervical third and the lingual outline is
more convex in the middle third.
• The lingual cusp tips more pointed than buccal cusp tips.
• The buccal cervical ridge is more prominent.
• Mesial cervical line is curved very slightly towards the occlusal.
• Distal cervical line is almost straight.
• Mesial marginal ridge is longer, more occlusally placed, has a sharp
V-shaped notch and is crossed by mesial marginal ridge groove.
• DMR is shorter and more cervically placed.
Contact areas: • Mesial contact area is almost centred buccopalatally and is placed at the
junction of occlusal and middle third.
• Distal contact area also centered buccolingually and is placed equidistant
from the cervical line and the marginal ridge.
Root: • From mesial aspect compared to first molar the root is less wide bucco-
lingually and narrower in the cervical third ending in a pointed apex.
• Deep depression on mesial surface of mesial root.
• Distal root is less wide, shorter with pointed apex.
Occlusal aspect
Fig. 5.16
Shape and size: • Occlusal surface has a rectangular shape because of four cusps.
• The crown is wider mesiodistally than buccolingually.
• It is widest at mesiobuccal cusp because of prominent buccal cervical ridge.
• Crown narrows from buccal to lingual.
Outline: • Mesial outline is straight and longer, distal outline is convex and shorter.
Cusp: • The occlusal surface includes cusps fossae, ridges and grooves.
(Contd.)

• The four cusps are more nearly equal even so MB is largest and DL is
smallest.
Palatal cusps are long and sharp.
Ridges: There are four triangular ridges and two transverse ridges.
Groove: Groove pattern is simple cross-type.
Three major grooves present.
• The central groove (CG), the buccal groove (BG), and the lingual groove
(LG). MMRG and supplemental grooves also present.
• The central groove extends from the central pit mesially and distally in a
straight line.
• Buccal and lingual grooves extend from central pit buccally and lingually
onto the buccal and lingual surfaces to form a cross-pattern.
Fossa: There are three fossae:
• The major, large, circular central fossa and two minor mesial and distal
triangular fossae.
SAQ (3 Marks)
Q 1. Describe arch traits of molars. (2000, May 2007)

Ans. Arch traits of molars and differences between maxillary and mandibular molars:
Maxillary molar Mandibular molar

• The crowns of maxillary molars have three large • Mandibular molars have four relatively/large cusps,
cusps and one smaller cusp the distopalatal cusp. two buccal and two lingual.
• Developmentally—three major cusps • Developmentally—four major cusps.
Buccal aspect
• Buccal surface of the crown relatively vertical • Buccal surface of the crown is convex.
and flat.
• The crown does not appear to be tilted. • First molar crown appears to tip distally relative the
root axis due to increase taper from contact area to
the cervical line.
• Buccal cusps not flattened • Buccal cusps flattened.
• Two buccal cusps and one buccal groove • In second molar, two buccal cusps and one buccal
groove but in first M three buccal cusps and two
buccal grooves.
Palatal aspect
• Palatal cusps are unequal in size with MP cusp • Lingual cusps are almost equal in size.
being largest and longest.
• A fifth smaller cusp found on the palatal surface • No cusp of carabelli present on the palatal/lingual
of the MP cusp of the Maxillary first molar. surface.
Proximal aspect
• Maxillary molars are centered over their roots. • Mandibular molar crowns are tilted lingually.
(Contd.)
86 DADH Made Easy
Maxillary molar Mandibular molar (Contd.)

Occlusal aspect
• From this aspect crown is wider bucco-palatally • From this aspect crown are wider mesiodistally
than mesiodistally. than buccolingually.
• The largest and longest MP cusp is connected to • There is no oblique ridge present.
the DB cusp by an oblique ridge.
• There is no palatal tilt, therefore buccal surface • Since the crown is tilted lingually more of buccal
not seen. surface is seen from this aspect.
• One transverse ridge from MB cusp to MP cusp. • Two transverse ridges from MB to ML cusp and from
DB to DL cusp.
• Four fossae. • Three fossae.
• CG from central pit to mesial pit. • CG from mesial pit to central pit to distal pit.
• Palatal groove/LG extends from distal pit and • LG extends from central fossa and at right angles
parallel to oblique ridge. to central groove.
Q 3. Describe type traits of maxillary molars. (June 2006, 2011)

Ans.
Maxillary first molar Maxillary second molar
• It erupts at 6-year of age. • It erupts at 12-year of age.
• It is the largest tooth in the arch. • It is smaller than the first.
• It is least variable of all maxillary molars and it • Three cusps type is heart-shaped or four cusp type has
has rhomboid shape. accentuated rhomboid shape.
• Buccopalatally both molars are same in dimension. • But mesiodistally second molar is narrower than
the first molar.
• The crown is wider on palatal. • Crown is narrower towards palatal.
• MB cusp longer and wider than DB cusp. • MB cusp much wider than DB cusp.
• DP/DL cusp slightly smaller than MP. • DP cusp is much smaller than MP cusp.
• Cusp of Carabelli present on palatal surface of • No cusp of Carabelli.
MP cusp.
• The three roots more divergent and are • The three roots less divergent and are within the
outside the confines of the crown. confines of the crown.
• MB and DB roots are curved like handle of pliers. • MB and DB roots are more or less parallel.
• Palatal root is longest and has banana shape. • Palatal root is straight.
• Less prominent MB cervical ridge. • More prominent MB cervical ridge.
• More prominent oblique ridge (OR) • Smaller and less prominent OR.
• Fewer supplemental grooves • More supplemental grooves.
Q 4. What is Cope Osborn hypothesis? (Nov. 2004)

Ans. Cope Osborn Hypothesis
• The occlusal table of the maxillary first molar may be divided into two distinct components
the trigon and the talon by an oblique ridge.
• The triangular shape is formed by the three major cusps mesiobuccal, distobuccal, mesio-
palatal collectively known as “maxillary molar primary cusp triangle” or “Trigon” made
by tracing the cusp outlines of these cusps, the MMR, and the oblique ridge and ridges of
the occlusal surface.
• Developmentally only three major cusps may be considered as primary cusps the
mesiopalatal cusp which is most primitive and two buccal cusps.
• The distopalatal cusp common to all maxillary molars and cusp of Carabelli on first molar
maybe regarded as secondary cusps.
• Maxillary molar primary cusp triangle supposition follows “Cope Osborn hypothesis of
tooth origin.”
• There was a tritubercular stage in human tooth development when the molars had three cusps.
• The primary triangular design is also reflected in the outline of the root trunk when the
tooth is sectioned in that area.
• One more observation that supports the explanation of maxillary molar having three major
primary cusps is that distopalatal cusp becomes progressively smaller on second and third
molars, often disappears as a major cusp.
Q 5. Draw, label occlusal surface of maxillary first molar.

(June 2005, 2010, 2013, Nov. 2009)
Ans.
Occlusal aspect
Fig. 5.17 Fig. 5.18

Crown:
Shape, outline, cusps: • From this aspect it has somewhat rhomboid outline following the four major
cusp ridges and the marginal ridges (MR).
• Buccopalatal dimension is more than mesiodistal dimension.
• In maxillary first molar the palatal side may be wider as compared to the
buccal.
• The four major cusps and one minor cusp present.
• The mesiopalatal (MP) cusp is the largest with a rounded cusp tip.
• Distopalatal cusp (DP) is the smallest and most variable.
• Mesiobuccal (MB) cusp is second largest with sharp cusp tip and is slightly
larger than the distobuccal cusp.
• The distobuccal cusp (DB) is the third largest with sharpest cusp tip.
Fossa: • There are two major fossae and two minor fossae.
• The major fossa is the central fossa which is roughly triangular and mesial
to the oblique ridge and the distal fossa (cigar fossa) which is linear and
distal to and parallel to the oblique ridge (OR).
• The central fossa has connecting sulci within its boundaries with develop-
mental grooves at the deepest portion of these sulci (sulcate grooves).
• The two minor fossae are the mesial triangular fossa (MTF) and the distal
triangular fossa (DTF) which are located distal to and mesial to the MMR
and the DMR.
(Contd.)
88 DADH Made Easy
Occlusal aspect (Contd.)

Ridges: • The mesiopalatal cusp has two triangular ridges (TR).
• The distopalatal cusp has a straight single triangular ridge.
• The groove between the two triangular ridges of the mesiopalatal cusp is
the “Stuart groove” (SG).
• The distal triangular ridge of mesiopalatal cusp (DTRMP) and the triangular
ridge of distobuccal cusp (TRDB) join to form a diagonal or oblique
transverse ridge called “Oblique ridge” (OR).
• Other texts refer to DTRMP by another name the distal cusp ridge of mesio-
palatal cusp (DCRMP): Subsequently the OR is formed by union of
triangular ridge of distobuccal cusp and distal cusp ridge of mesiopalatal
cusp (Refer page 399 Fig. 25.132).
• The oblique ridge is reduced in height in the centre of the occlusal surface
being about on the level of the marginal ridges of the occlusal surface
sometimes it is crossed by a developmental groove that partially joins the
two major fossa by means of a shallow sulcate groove.
• The mesial triangular ridge of mesiopalatal cusp (MTRMP) joins the
triangular ridge of the mesiobuccal (TRMB) cusp to form a transverse ridge.
• The MMR and the DMR are irregular ridges confluent with the mesial and
distal cusp ridges of the mesial and distal major cusps.
Pits: • The central pit (C) is located at the centre of the central fossa.
• Mesial (M) and distal pits (D) are located at the bottom of the mesial and
distal fossa.
Grooves: • There are 5 major developmental grooves. CG the central groove, the buccal
groove BG, DOG the distal oblique groove, PG the palatal groove, and
sometimes the transverse groove of the oblique ridge and the fifth cusp
developmental groove.
• Central groove (CG) extends in mesial direction at an obtuse angle to buccal
groove from the central pit (over the mesial transverse ridge) and ends in
the mesial triangular fossa.
A short developmental groove radiates from the central pit, extend disto-
palatally where it other crosses the oblique ridge and ends in the distal
fossa or fades out before reaching the OR.
This part of the CG which extends over the oblique ridge is called the
transverse groove of the oblique ridge, it is a shallow developmental groove.
• Buccal groove (BG) extends from the central pit in buccal direction on to
the buccal surface.
• Distal oblique groove (DOG) or linear groove or distopalatal groove
extends obliquely and traverses the distal linear fossa to join the palatal
developmental groove between the mesiopalatal and distopalatal cusps. It
shows several supplemental grooves. At distal pit it terminates into two
branches (TG) which form the two sides of the distal triangular fossa (DTF).
• Palatal developmental groove (PG) separates the MP and DP cusps and
extends on the palatal surface to terminate at the centre of the crown palatally
below the palatal root.
• Fifth cusp groove outlines the fifth cusp (cusp of carabelli) it joins the palatal
groove near its terminus.
The other grooves are :
• Distal marginal groove (DMG).
• Distobuccal triangular groove and distopalatal triangular groove.
• Mesial marginal groove.
• Mesiobuccal triangular groove and mesiopalatal triangular groove.
Q 6. Describe the occlusal surface of mandibular first molar. (Nov. 2009, May 2015)
Ans.
Occlusal aspect
Fig. 5.19A Fig. 5.19B

Shape and size: • Occlusal surface is quadrilateral in form but due to the presence of buccal
bulge of the distobuccal cusp and small distal cusp, it has a pentagon shape.
• Mesiodistal dimension is 1 mm more than the buccolingual dimension.
• Crown tapers from mesial to distal therefore the crown is wider bucco-
lingually on mesial half than on the distal half.
• Widest buccolingual dimension is in the middle third of the distobuccal
cusp.
• The crown narrows from buccal to lingual.
• Outline of the crown is convex on buccal, lingual, mesial, distal.
• The occlusal surface includes the cusps, the ridges, the fossae and the grooves.
• There are five triangular ridges, three fossae, three pits and four
developmental grooves.
Cusps: • Mesiobuccal cusp is larger than mesiolingual and distolingual cusps which
are almost equal in size, distobuccal cusp is smaller than the mesiobuccal,
mesiolingual, distolingual and distal cusps is the smallest.
Ridges: (Fig. 5.19B) • Some texts refer that the occlusal surface of mandibular first molar has no
transverse ridge.
• The triangular ridge of the mesiobuccal cusp (TRMB) extends lingually to
end at the mesial portion of the central groove.
• The triangular ridge of the distobuccal cusp (TRDB) extends mesiolingual
to the area of the central pit.
• The triangular ridge of the distal cusp (TRD) extends mesiolingual to the
distal pit area.
• The triangular ridge of the mesiolingual cusp (TRML) extends distobuccal
to end at the mesial portion of the central groove.
• The triangular ridge of the distolingual cusp (TRDL) extends mesiobuccally
to end in the area of the junction of the distobuccal groove (DBG) and the
distal portion of the central groove.
Ridges: (Fig. 5.19A) • Other texts refer that the occlusal surface of mandibular first molar has two
transverse ridges.
• The triangular ridges (TR) of the mesiobuccal and mesiolingual cusps (TRMB
and TRML) meet to form a transverse ridge.
(Contd.)
90 DADH Made Easy
Occlusal aspect (Contd.)

• The triangular ridges of distobuccal and distolingual cusps (TRDB and
TRDL) form a second transverse ridge.
• Since the lingual cusps are higher, TR of lingual cusps of first molars are
longer than the TR of buccal cusps.
Fossa: • There is one major fossa and two minor fossae.
• The major fossa is the central fossa. It is roughly circular, and it is centrally
placed on the occlusal surface between the buccal and palatal cusp ridges.
• All of the developmental grooves converge in the centre of the central fossa
at the central pit.
• Mesial triangular fossa is smaller and distal triangular fosa is smallest.
Grooves: • There are four developmental grooves. Central developmental groove (CG),
mesiobuccal developmental groove (MBG), the distobuccal developmental
groove (DBG) and the lingual developmental groove (LG).
• Central groove (CG) extends from mesial pit to distal pit and has a zigzag
course mesiodistally.
• Mesial portion of the central groove extends from central pit mesiobuccally
for short distance via mesiobuccal groove, then separates and continues
mesially to the mesial pit.
• Distal portion of the central groove extends from distal pit passes mesio-
buccally to becomes confluent with the distobuccal groove (DBG).
• MBG extends mesiobuccally from the central pit for short distance to traverse
on to the buccal surface passing between the MB and DB cusps.
• LG extends lingually from the central pit between the mesiolingual and
distolingual cusps but rarely extends on to the lingual surface.
Q 7. What is endodontic anatomy of maxillary first molar? (Nov. 2009)

Ans. Endodontic Anatomy of Maxillary First Molar
Pulp Chamber (PC)

• It has large pulp chamber with four pulp horns mesiobuccal, distobuccal, mesiopalatal and
distopalatal.
• Roof of the pulp chamber is rhomboid in cross-section whereas the floor of the PC is
triangular in cross-section.
• The three orifices of the root canals are present at triangles of the floor.
• It an accessory mesiobuccal canal is present the 4th canal orifice may be present at its palatal
end.
• Mesiobuccal orifice under the mesiobuccal cusp is long buccopalatally.
• Distobuccal orifice is slightly mesial and palatal to the mesiobuccal orifice.
• Palatal orifice is largest, is round or oval and is centered
palatally.
Root and Root Canals
• It usually has three roots and three canals. Mesiobuccal
root usually possesses an accessory canal.
• The mesiobuccal canal is often very small and curved but
some may be wide.
• The palatal root canal is the largest. Fig. 5.20: Maxillary first molar
• The distobuccal root canal is straighter and smaller and centred.

• The entire removal of pulp is an impossibility in many maxillary first molars because of the
compleixities of the root canal system.
Q 8. What is cusp of Carabelli?

Ans. Cusp of Carabelli
• It is a supplemental cusp palatal to mesiopalatal cusp which is largest of the well-developed
cusps of the deciduous and permanent maxillary first molar.
• Usually a developmental groove is found.
• This morphological trait can take the form of a well-developed fifth cusp, or it can grade
down to a series of grooves, depressions or pits on the mesial portion of the palatal surface.
• This trait has been used to distinguish populations.
• Fifth cusp or a developmental trace at its usual site serves to identify the maxillary first
molar.
92 DADH Made Easy
1. The molar having the crown, wider bucco- 8. The oblique ridge is formed by the union
palatally than mesiodistally is of triangular ridge of
a. Maxillary molars a. Distobuccal cusp and distal ridge of
b. Mandibular molars mesiopalatal cusp
c. Both b. Mesiobuccal cusp and distopalatal cusp
d. None c. Mesiopalatal and mesiobuccal cusp
2. The cusp or tubercle of Carabelli is found d. Distobuccal and distopalatal
in 9. The developmental groove traversing
a. Mandibular second molar from the linear distal fossa which connects
b. Maxillary second molar with the palatal development groove is
called the
c. Maxillary first molar
a. Distal developmental groove
d. Mandibualr first molar
b. Distopalatal groove
3. The largest cusp on the maxillary molars is c. Distal oblique groove
a. Mesiopalatal d. Mesial development groove
b. Mesiobuccal
10. The crown with more extreme rhomboid
c. Distobuccal
outline, having buccal roots that are more
d. Distopalatal nearly parallel is the characteristic of
4. The three roots in maxillary molars are a. Maxillary first molar
a. Mesiopalatal, distopalatal, and buccal b. Maxillary second molar
b. Mesiobuccal, mesiopalatal, and distal c. Maxillary third molar
c. Mesiobuccal, distobuccal, and palatal d. Mandibular first molar
d. None of the above 11. The poor development of distopalatal
5. The longest root in maxillary first molar is cusp and heart shape form is common to
a. Mesiobuccal a. Maxillary first molar
b. Distobuccal b. Maxillary second molar
c. Palatal c. Maxillary second and third molar
d. None of the above d. Mandibular second molar
6. In maxillary first molar, bifurcation is seen 12. The apex of the palatal root of maxillary
from second molar is
a. Buccal aspect b. Proximal aspect a. In line with the palatal groove
c. Both a and b d. Palatal aspect b. In line with the distopalatal cusp tip
7. From the occlusal aspect the crown is c. In line with mesiopalatal cusp tip
rhomboid in shape, wider bucco- d. In line with root axis
palatally than mesiodistally, is the 13. The apex of palatal root of maxillary first
characteristic of molar is
a. Maxillary molars a. In line with the palatal groove
b. Mandibular molars b. In line with the distopalatal cusp tip
c. Maxillary and mandibular molars c. In line with mesiopalatal cusp tip
d. Maxillary premolars d. In line with root axis
1-a, 2-c, 3-a, 4-c, 5-c, 6-c, 7-a, 8-a, 9-c, 10-b, 11-c, 12-b, 13-a
14. Crowns are wider mesiodistally than 21. Flattened buccal cusps are typical of all
buccopalatally in a. Maxillary first molars
a. Maxillary molars b. Mandibular molars
b. Mandibular molars c. All mandibular premolars
c. Both a and b d. Maxillary second molar
22. The distal cusp of mandibular first molar
15. Taper of crown from B to L is more in is located
a. Maxillary first a. On distal surface of the teeth
b. Maxillary second b. Part of it on palatal surface and part
c. Maxillary third of it on distal surface
d. None of the above c. Small portion on buccal and major
16. From proximal view the crown is tilted portion on distal surface.
palatally at cervix in d. On buccal surface
a. Maxillary molars 23. In mandibular first molar the mesiobuccal
b. Mandibular molars developmental groove is shorter of the
c. Mandibular premolars two grooves and is situated
d. Both b and c a. Mesial to the root bifurcation
17. The longest pulpal horn in mandibular b. In line with the root bifurcation
permanent first molar is c. Distal to the root bifurcation
a. Distobuccal d. None of the above
b. Mesiobuccal 24. The mesial root and canal show consi-
c. Distopalatal derable curvature, distal root is straighter
d. Mesiopalatal and shorter than the curved mesial root
is common to
18. In maxillary first molar the root which is
more often curved is a. Mandibular first molar
a. Mesiobuccal b. Distobuccal b. Mandiular second molar
c. Palatal d. Mesiopalatal c. Mandibular third molar
d. Maxillary first molar
19. Molars having short root trunk and two
roots M and D are 25. No transverse ridge, zigzag groove
a. Maxillary molars pattern, two buccal grooves, is the
b. Mandibular molars characteristic of permanent
c. Both a. Maxillary first molar
d. None b. Mandibular first molar
c. Mandibular second molar
20. The most common feature to differentiate
between maxillary first, second, and third d. Maxillary second molar
molars is 26. The widest mesiodistal dimension is
a. Position of distopalatal groove and found on permanent
size of DL cusp a. Maxillary first molars
b. Number of roots b. Maxillary central incisors
c. Cusp of Carabelli c. Mandibular first molars
d. All the above d. None of the above
14-b, 15-c, 16-d, 17-b, 18-a, 19-b, 20-a, 21-b, 22-c, 23-a, 24-a, 25-b, 26-c
94 DADH Made Easy
27. The size of the cusps from largest to 32. The cusp of Carabelli is located on the
smallest in mandibular first molar is a. Maxillary permanent third molar
a. Mesiopalatal, mesiobuccal, disto- b. Maxillary permanent first molar
buccal, distopalatal, distal c. Maxillary permanent CI
b. Mesiopalatal, distopalatal, mesio- d. Maxillary permanent second molar
buccal, distobuccal, distal 33. Oblique ridge connects
c. Mesiopalatal, mesiobuccal, disto- a. Mesiobuccal cusp to distopalatal cusp
palatal, distobuccal, distal b. Mesiobuccal cusp to distobuccal cusp
d. Distopalatal, distal, mesiopalatal, c. Mesiopalatal cusp to distopalatal cusp
mesiobuccal, distobuccal d. None of the above
28. The size of the cusps in maxillary first 34. The occlusal surface of permanent
molar from largest to smallest maxillary first molar is
a. Mesiopalatal, distopalatal, mesio- a. Oval in shape
buccal, distobuccal, cusp of Carabelli b. Trapezoid in shape
b. Mesiopalatal, mesiobuccal, disto- c. Rectangular in shape
buccal, distopalatal, fifth cusp. d. Rhomboid in shape
c. Mesiopalatal, mesiobuccal, disto- 35. Fourth canal in maxillary first molar is
palatal, distobuccal, fifth cusp commonly located in
d. Distopalatal, distobuccal, mesio- a. Mesiobuccal root
buccal, mesiopalatal b. Distobuccal root
c. Palatal root
29. Irregular groove pattern, numerous
supplemental groove bulbous (B and L
convex) and short crown, distal tilt is 36. Wrinkled occlusal surface is found in
characteristic of a. Mandibular third molars
a. Mandibular third molars b. Mandibular second molars
b. Mandibular second molars c. Maxillary third molars
c. Maxillary third molars d. Maxillary second molars
d. Maxillary second molars 37. The mandibular first molars having sixth
cusp located on the distal marginal ridge
30. The largest tooth in the maxillary arch is between the distal cusp and distopalatal
a. Maxillary first molar cusp is named
b. Mandibular second molar a. Tubercle of carabelli
c. Mandibular first molar b. Tuberculum sextum
d. Maxillary second molar c. Tuberculum intermedium
d. Tubercle genial
31. Using occlusal morphology as a guide,
the mandibular third molar is most similar 38. Sixth cusp on mandibular first molar when
to the located between two palatal cusps is
named
a. Permanent maxillary first molar
a. Cusp of Carabelli
b. Permanent mandibular first molar b. Genial tubercle
c. Permanent mandibular second molar c. Tuberculum sextum
d. Deciduous mandibular second molar d. Tuberculum intermedium
27-b, 28-b, 29-a, 30-a, 31-c, 32-b, 33-d, 34-d, 35-a, 36-a, 37-b, 38-d
39. Primary feature that distinguishes maxillary 45. Pits in the occlusal surface of molars and
molars from mandibular molars is premolars are at the junction of
a. Number of roots a. Marginal ridge and inclined planes
b. Number of cusps b. Inclined planes and cusp tips
c. Number of Surfaces c. Development grooves
d. All of the above d. Facial and mesial surfaces
40. A developmental groove that partially 46. In persmanent maxillary first molar, the
joins the two major fossae of maxillary level of the oblique ridge on the occlusal
first molar is surface near the center is at a level with
a. Stuart groove a. Marginal ridges
b. Sulcate groove/transverse groove b. Cusp of Carabelli
c. Central groove c. Tips of ML and DB cusps
d. Buccal groove d. Depth of cental and distal fossa
41. The most symmetrical permanent molar 47. In maxillary first M from which aspect
is bifurcation is closer to cervical line
a. Maxillary first molar a. Buccal b. Mesial
b. Maxillary second molar c. Distal d. Palatal
c. Mandibular first molar 48. Pulp horn most likely to be exposed acci-
d. Mandibular second molar dentally during class II cavity preparation
in a maxillary first molar are
42. Occlusocervically, the height of the distal
marginal ridge of a permanent maxillary a. ML and DL b. MB and ML
first molar is the same height as the c. ML and DB d. MB and DB
following: 49. Primates have conical cusps and are
a. Mesial marginal ridge of maxillary called
second molar a. Bunodont
b. MMR of mandibular first molar b. Haplodont
c. MMR of mandibular second molar c. Diphyodont
d. DMR of maxillary second molar d. Bilophodont
43. A fissured groove is most frequently found 50. Human teeth like incisors, canines pre-
on molars, molars can be described as
a. Facial of maxillary molar a. Monophyodont
b. Palatal of maxillary molar b. Homodont
c. Facial of mandibular molar c. Heterodont
d. Palatal of mandibular molar d. None of the above
44. The tooth most often restored, extracted 51. Simplest form of tooth with single cone
or replaced is is called as
a. Maxillary first molar a. Haplodont
b. Maxillary third molar b. Triconodont
c. Mandibular first molar c. Tritubercular
d. Mandibular first premolar d. Quadritubercular
39-a, 40-b, 41-d, 42-a, 43-b, 44-c, 45-c, 46-a, 47-b, 48-b, 49-a, 50-c, 51-a
96 DADH Made Easy
52. A transverse ridge in maxillary first molar 58. Which of the following is most likely to show
is formed by an anomaly in radicular morphology?
a. Triangular ridge of mesiobuccal cusp a. Maxillary canine
and the mesial triangular ridge of the b. Maxillary third molar
mesiopalatal cusp c. Maxillary first molar
b. Triangular ridge of distobuccal cusp d. Mandibular first molar
and triangular ridge of mesiopalatal
59. The occlusal outline of a permanent
cusp mandibular first molar is usually
c. Triangular ridge of mesiobuccal cusp a. Square b. Parallelogram
and triangular ridge of distopalatal
c. Circle d. Trapezoid
cusp
d. None of the above 60. The maxillary molar crown of early pri-
mates has trigon of three cusps namely
53. A deep concavity on the mesial surface
a. Mesiobuccal, mesiopalatal, disto-
of the crown in cervical area is present
buccal
in maxillary
b. Mesiobuccal, mesiopalatal, disto-
a. First premolar
palatal
b. First molar
c. Distobuccal, distopalatal, mesio-
c. Second premolar palatal
d. Second molar d. None of the above
54. A deep concavity on the distal surface 61. The crown formation of all permanent teeth
of the crown in the cervical area is except third molars is completed between
present in the maxillary
a. 2–3 years
a. First molar b. Canine b. Birth to 6 years
c. Incisors d. First PM c. Birth to 8 years
55. The two major fossa of permanent maxillary d. Birth to 12 years
first M as
62. In carving an occlusal amalgam restora-
a. M and D triangular fossa tion in a permanent mandibular second
b. Central fossa and distal fossa molar, the shape of the groove pattern is
c. Central fossa and mesial fossa a. H b.
d. Mesial fossa and mesial triangular c. U d. Y
fossa
63. In a molar, the root canals usually join
56. Which furcation of roots in permanent the pulp chamber
maxillary first molar is closer to cervical a. At the level of the furcation
line? b. At varying levels, depending on age
a. Mesial b. Distal c. Within the cervical third of the crown
c. Buccal d. Palatal d. Apical to the cementoenamel junction
57. The tooth which has longest root trunk 64. The root of permanent maxillary first
from buccal view is molar that is flattened mesiodistally and
a. Maxillary 1st molar has depressions on both its mesial and
b. Maxillary 2nd molar distal surfaces is the
c. Mandibular 1st molar a. Palatal b. Distobuccal
d. Mandibular 2nd molar c. Mesiobuccal d. Distopalatal
52-a, 53-a, 54-b, 55-b, 56-a, 57-c, 58-b, 59-d, 60-a, 61-c, 62-b, 63-d, 64-c
65. From occlusal aspect, the greatest bucco- 72. The three root canals of mandibular first
palatal dimension of a permanent molars are
mandibular second molar crown is a. MB, ML, and distal
located in the b. Mesial, distal, and palatal
a. Mesial half b. Distal half c. MB, DB, and palatal
c. Middle d. None d. DL, ML, and buccal
66. Cross-section of the floor of the pulp 73. The occlusal outlines of the permanent
chamber is triangular in posterior teeth is correctly matched in
a. Permmanent maxillary molars the following:
b. Permanent mandibular first molar a. Mandibular second premolar—square
c. Permanent mandibular second molar b. Mandibular first molar—trapezoid
d. None c. Maxillary first molar—rhomboidal
67. When a fourth root canal is present in a d. All of the above
maxillary first molar it is most likely 74. The statement not true about the molars is
located in the a. Mandibular molar crowns are tilted
a. Palatal root palatally
b. Mesiobuccal root b. Palatal cusp on mandibular molars are
c. Distobuccal root almost equal in size.
d. Distopalatal root c. Mandibular molars are wider mesio-
68. The smallest pulp horn in permanent distally
mandibular first molar is d. Maxillary molar crowns are titled
a. Distal b. Mesiobuccal palatally.
c. Distobuccal d. Distopalatal 75. The most constant feature that differen-
69. The statement which is correct regarding tiates maxillary first, second, and third
permanent mandibular first molar is molars is
a. It has four root canals a. The size of the DL cusp
b. Mesial root has concavities on both b. Number of roots
mesial and distal surfaces c. Cusp of Carabelli
c. Distal root has concavities on both d. The shape of the crown
buccal and palatal sides 76. Maxillary molar can be differentiated
d. No concavities seen on any root. from mandibular molar by all of the
70. The pulp horn most commonly exposed following except
in cavity preparation on newly erupted a. Number of roots
permanent molar is b. Number of cusps
a. ML and MB b. DL and DB c. Arrangement of roots
c. DL and ML d. None of the above d. All of the above
71. The tooth having five pulp horns and 77. The statement not true about the occlusal
three root canals is most likely to be morphology of mandibular first molars is
a. Maxillary first molar a. Buccal cusps are functional
b. Mandibular first molar b. Palatal cusps are non-functional
c. Mandibular second molar c. MB cusp is the widest
d. Maxillary second molar d. Presence of oblique ridge
65-a, 66-a, 67-b, 68-a, 69-b, 70-a, 71-b, 72-a, 73-d, 74-d, 75-a, 76-d, 77-d
98 DADH Made Easy
78. The permanent molar having similar 81. The permanent tooth with occlusal surface
occlusal morphology to mandibular third characterized by five cusps, one major
molar is and two minor fossa and five triangular
a. Mandibular first ridges is
b. Maxillary first a. Mandibular first molar
c. Mandibular second b. Mandibular second molar
d. Maxillary second c. Maxillary first molar
79. The two major fossa, of maxillary first d. Maxillary second molar
molar are
a. M and D triangular fossa 82. The furcation in permanent maxillary first
molar is closest to cervical line on
b. Central and distal fossa
c. Central and mesial fossa a. Mesial
d. Mesial and mesial triangular fossa b. Distal
80. The permanent tooth with occlusal sur- c. Buccal
face characterized by five cusps, three d. Palatal
primary and two secondary; two major 83. The longest root trunk from buccal aspect
and two minor fossa, four triangular ridges is seen in
and one oblique ridge is
a. Maxillary first molar
b. Maxillary second molar b. Maxillary second molar
c. Mandibular second c. Mandibular first molar
d. Mandibular second d. Mandibular second molar
78-c, 79-b, 80-a, 81-a, 82-a, 83-a

6
Differences between
Deciduous and Permanent
Dentition
LAQs (10 Marks)
Q 1. Differences between deciduous and permanent dentition. (Oct. 2003, June 2010)
Ans. Differences are macroscopic and microscopic or histological:
Macroscopic (SAQ 2000, 2001, Nov. 2014)

Deciduous dentition Permanent dentition
I. General features
1. Number and size of teeth • The jaws are smaller in size and • The jaws are larger. The number
number of teeth are less. A total of teeth are 32 with 16 teeth in
of 20 teeth, 10 in each jaw. each jaw.
• Teeth are smaller in size. • Teeth are larger in size than the
deciduous teeth.
• Crown of second molar is larger • Crown of first molar is larger
than crown of first molar. than that of the second and third
molar.
2. Classes of teeth and • There are 3 classes of teeth. • There are 4 classes of teeth.
dental formula Incisors, canines and molars. Incisors, canines, premolars, and
Premolars and third molars are molars.
not present.
• Molars are distal to canines. • Molars are distal to premolars.
Dental formula is: Dental formula is:
2 1 2 2 1 2 3
I , C , M I , C , P , M
2 1 2 2 1 2 3
• Total of 10 teeth, 5 in upper and • Total of 16 teeth, 8 in upper and 8 in
5 in lower jaw. Dental Formula is lower jaw. Dental formula is written
written for one side of the mouth. for one side of the mouth only.
(Contd.)
99
100 DADH Made Easy
Macroscopic (SAQ 2000, 2001, Nov. 2014) (Contd.)

3. Colour • Teeth are lighter in colour. They • Teeth are darker in colour. They
appear bluish white (milky white) appear yellowish white or grayish
and are also called as milk-teeth. white. Enamel is highly minera-
Their refractive index is compar- lized and translucent therefore
able to that of milk. The enamel reflects the yellowish white
is opaque and less mineralized. colour of the underlying dentin.
4. Placement in the jaw • Teeth are arranged perpendicular • Teeth are not perpendicular to
to the jaw. the jaw, but are labially inclined
which allows to accommodate
the larger permanent teeth.
5. Interdental spacing • Interdental spacing is present • No spacing present. If present it

which is physiological or develop- is due to decay or loss of tooth.
mental spacing.
6. Duration of dentition and • Deciduous dentition period lasts • Permanent dentition period is
period of eruption from 6 months to 6 years. Six years from 12 years onwards.
to 12 years is mixed dentition
period.
• Total period of eruption is from • Period of eruption is between
6 months to 2.5–3 years. 6 years to 12 years except for third
molars which erupt between
18–25 years.
• Root completion is 1 year after • Root completion is 2–3 years after
eruption. eruption.
7. Development time • Development time for deciduous • Development time for permanent
teeth is shorter. teeth is longer.
8. Sequence of eruption • The first tooth to erupt is • The first tooth to erupt is first
mandibular central incisor. molar.
• Deciduous teeth erupt from • Permanent teeth erupt from
anterior to posterior except first posterior to anterior.
molar which erupts before
canine.
ABDCE 61245378
• •
ABDCE 61234578
9. Shedding • Shedding is physiological. • Shedding or loss of teeth is due

• Teeth start exfoliating from to some pathology.
about 7–10 years due to physio-
logic resorption of roots.
10. Mineralization • The teeth are less mineralized • Teeth are highly mineralized.
therefore, wear out faster.
(Contd.)
Differences between Deciduous and Permanent Dentition 101

II. Crown morphology • Incisors • The length of the crown is more
11. Shape and cervical constriction – Width of the crown is more than the width.
than the length.
– More constriction at the cervix. • Less constriction at the cervix.
• Molar
Molars have more bulbous shape • Do not have bulbous shape.
due to more constriction at the
cervix.
Clinical significance • Cervical constriction has to be • Crowns of permanent teeth are

kept in mind while forming not so constricted at the cervix.
gingival floor during class II
cavity preparation.
12. Surface and cingulum and Incisors

cervical ridge • In incisors the surface is flat • In incisors, the surface above the
above the cervical ridge. height of contour is slightly
convex.
• There are no developmental • Transient developmental grooves
depressions on the labial surface. separating the mamelons are
present on the labial surface.
• Cervical ridge on labial surface of • No prominent cervical ridge
anterior teeth is very prominent.
• Cingulum is more prominent. • Comparatively cingulum is less
prominent.
Molars
• In molars also the surface is flat • In molars the surfaces are convex
above the cervical ridge up to the above the cervical ridge up to the
occlusal. occlusal.
• Cervical ridge on the buccal sur- • Cervical ridges are not prominent
face of molar is very prominent, except in mandibular second
especially on buccal surface of molars.
first molars. If overdeveloped, it
is referred to as “tubercle of
zuckerkandl” or buccal cingulum.
13. Mamelons • No mamelons in newly erupted • Mamelons are present on the

incisors. incisal ridge of the newly
erupted incisors.
14. Cervical line • Cervical line is less curved. • It is more curved.
(Contd.)
102 DADH Made Easy

15. Contact areas • Contacts areas between teeth are • Contact areas between permanent
Clinical significance flatter, broader and situated teeth are narrower and situated
gingivally. either in the middle third or at
• While preparing class II cavity, the junction of incisal and middle
buccal and lingual walls should third.
be made divergent.
16. Molar
• Upper first molar has 3–4 cusps, • Upper first molar has four cusps
it resembles a premolar. and accessory cusp the cusp of
Carabelli.
• Upper second molar has four • Upper second molar has four
cusps and one accessory cusp, cusps or three cusps.
the cusp of Carabelli. It resembles
permanent upper first molar.
• Lower first molar has four cusps • Lower first molar has five cusps.
(it does not resemble any permanent
tooth).
• Lower second molar has five- • Lower second molar has four
cusps (it resembles permanent cusps.
lower first molar.)
Relation between distal planes • Mesiodistal relation between
of last molars distal surfaces of upper and
lower second molars is called the
terminal plane.
• Distal surfaces of upper and • There is no such distal plane relation
lower second molars are in one in permanent molar.
vertical plane due to a greater
mesiodistal width of lower
second molar and is called
Flush-terminal plane or end-on-
occlusion which is necessary for
normal eruption and occlusion
of permanent first molar.
Cusps • The cusps are short and sharp • The cusps are less sharp.
but may become flat due to wear.
Occlusal surface • Since the cusps are short and the • Due to longer cusps and more
fossae and ridges are less prominent fossae and ridges the
prominent the occlusal surface is occlusal surface is deeper and
shallow. has curved contour.
Grooves • More supplemental grooves due • Fewer supplemental grooves.
to which more prone to caries. To
prevent caries, pit and fissure
sealants are advisable.
(Contd.)

Occlusal table area • Buccal and lingual surfaces • There is less convergence of
converge sharply occlusally, buccal and lingual surface
thus forming a narrow occlusal towards occlusal thus occlusal
table area buccolingually. table appears wider bucco-
• Deciduous molars are functio- lingually.
nally adapted to withstand less
occlusal load.
Clinical significance • Occlusal cavity preparation

should be kept narrow bucco-
lingually.
III. Root morphology

17. Length and width • Roots of deciduous teeth are • Roots are longer and stronger
shorter and slender and they are and they are broader mesio-
narrower mesiodistally. distally.
18. Crown root ratio • In deciduous teeth, the roots are • Roots are not as long in proportion
longer in proportion to the crown to the crown size.
size.
19. Inclination of the root • The roots of the anterior teeth • The roots do not show any labial
have a slight labial inclination of inclination.
about 10o in the apical third to
accommodate the developing
permanent anterior teeth.
20. Root trunk and furcation • The furcation of the roots of • The furcation of the root is more
molars is near the cervical line so apically placed, thus the root
that the root trunk is almost trunk is longer.
absent.
(Contd.)
104 DADH Made Easy

21. Flaring of roots in molars • Roots of deciduous molars flare • Roots of permanent molars do
out markedly to accommodate not flare markedly.
the developing premolars.
Clinical significance • Thin, slender and flared roots

with absence of root trunk may
cause fracture during extraction.
22. Apical foramen and resorption • The apical foramen is larger. • It is narrower.
• Roots undergo physiologic • Physiologic resorption is absent.
resorption. Pathoogical resorp- Pathological resorption is
tion is less common. commonly seen.
IV. Pulp morphology

23. Pulp chamber • Pulp chamber is larger as compared • Pulp chamber is smaller as com-
to the crown size. pared to the crown size.
24. Pulp horns • Pulp horns of molars (especially, • Pulp horns are lower and away
mesial horns) are higher and from the outer surface.
close to the outer surface than
that of permanent molars.
Clinical significance • Pulp horns more longer and

pointed than cusps would
indicate.
• Care should be taken during
cavity preparation to prevent
pulp exposure.
25. Pulp canals • Root canals are flat, ribbon shaped, • Root canals are well-defined and
more tortuous and branching less branching.
which makes complete debride-
ment impossible.
26. Accessory canals • Accessory pulp canals are more • Accessory canals are found near
in number and found in furcation the apex of the root.
area.
• Floor of the pulp chamber is

more porous due to which the
inflammation can directly reach
periodontium.
Q 2. Explain histologic/microscopic differences. (Nov. 2004)

Ans.

1. Enamel
Thickness • Enamel is thinner but of uniform • Enamel is thick (2–3 mm) and not
thickness. (1 mm) decay progresses uniform in thickness.
faster to the pulp.
Clinical significance • Depth of the cavity should be less
and less pressure required during
cavity preparation.
Mineralization • Enamel is less mineralized thus • Enamel is more mineralized.
wears out faster. It is more
permeable.
Clinical significance • Greater permeability facilitates
better uptake of fluoride in caries
preventive measures.
Direction of enamel rods • In the cervical region the enamel • In the cervical region the enamel
rods are directed occlusally from rods are directed gingivally.
DEJ to the enamel surface.
Incremental lines • Incremental lines of Retzius are • Lines of Retzius are more common.
less common.
Neonatal line • Neonatal line is present in all • Neonatal line is present in first
deciduous teeth. molar only.
2. Dentin
Thickness • Dentin is thin and of variable • Dentin is thick and is of more
thickness, increased thickness uniform thickness.
near occlusal fossa area.
Dentinal tubules • Dentinal tubules are less regular. • Dentinal tubules more regular.
Secondary dentin • Less deposition of secondary • Greater deposition of secondary
dentin. dentin.
Interglobular dentin • Interglobular dentin is absent. • Interglobular dentin is present
beneath the well-calcified mantle
dentin.
Neonatal line • Neonatal line is present in all • Neonatal line present only in
deciduous teeth. first molar.
Mineralization • It is less mineralized and softer. • It is more mineralized and harder.
DEJ • Dentinoenamel junction is not • Dentinoenamel junction is
scalloped. scalloped.
3. Cementum
Thickness • Cementum is relatively thin and • Cementum is relatively thick. Both
made-up of only primary cementum. cellular and acellular cementum
Anchorage is less firm. present. Cellular cementum being
thicker in the apical region.
(Contd.)
106 DADH Made Easy
Deciduous dentition Permanent dentition (Contd.)
CDJ • Cementodentinal junction is • Cementodentinal junction is

scalloped. not scalloped.
4. Pulp
Pulp chamber • Pulp chamber is proportionately • Pulp chamber is smaller in propor-
larger. tion to the crown size.
Pulp horns • Pulp horns are pointed and at a • Pulp horns are lower and not as
higher level especially the mesial pointed.
pulp horns.
• Hence care should be taken during
cavity preparation to prevent pulp
exposure.
Accessory canals • Accessory canals are present in • Accessory canals are more near
furcation area. the apex of the root.
Apical foramen • Apical foramen larger, thus abun- • Apical foramen is narrower.
dant blood supply and exhibit a
more typical inflammatory response.
• Poor localization of infection and
inflammation.
Root canals • Root canals flatter. • Root canals are round or oval or
triangular.
Nerves • Pulp is less innervated thus • Pulp is densely innervated.
primary teeth are less sensitive
to operative procedure.
5. PDL • Periodontal space is wider. • Periodontal space is narrower.
SAQs (3 Marks)
Q 1. Describe functions of deciduous teeth. (July 2008)

Ans.
1. The deciduous teeth are useful for mechanical preparation of child’s food for digestion and
assimilation during one of the most active periods of growth and development.
2. They maintain space in the dental arch for the permanent teeth to erupt.
3. They stimulate the growth of jaws through mastication especially in the development of
the height of the dental arches.
4. They function in the development of speech.
Ability to use the teeth for pronunciation is acquired entirely with the aid of primary teeth.
Early and accidental loss of primary anterior teeth may lead to difficulty in pronouncing
the sounds f, v, s, z, th.
5. The normal facial appearance and smile of the child is maintained due to support provided
by the teeth to cheeks and lips.
Q 2. Differentiate type traits of deciduous maxillary molars. (Nov. 2004)

Ans.
Maxillary first molar Maxillary second molar

• It is most atypical of all molars. • It resembles the permanent first molar that erupts
distal to it.
• It resembles the maxillary first premolar that
replaces it.
• It is mesial to the deciduous second molar.
• It is the smallest deciduous molar • It is larger than the first molar.
• Occlusal outline is relatively flat with no definite • Occlusal outline is formed by the tips of MB and
cusp form. DB cusps.
• Two buccal cusps are unequal in size and MB • Two buccal cusps are more equal in size.
cusp is wider, longer and less sharp.
• There is no cusp of Carabelli. • Cusp of Carabelli is present.
• Distolingual cusp is inconspicious. • DL cusp is smallest but well-developed.
From occlusal aspect
• It generally has four cusp giving it quadrilateral • It generally has four major cusps and one minor
occlusal form. cusp of Carabelli.
• Two larger cusps MB and ML show premolar • Occlusal form is rhomboidal.
like form.
• Two smaller cusps DB and DL which may be
absent giving triangular occlusal form.
• Oblique ridge is less prominent. • Oblique ridge is well-defined prominent and
straighter.
• There are three fossae. • There are four fossae.
• The central fossa, the mesial fossa is larger and • The central fossa, the mesial triangular fossa.
smaller distal triangular fossa. • The distal fossa located distal to oblique ridge and
less distinct distal triangular fossa.
• The central groove runs mesiodistally from • The central groove runs from mesial pit to the
mesial pit to distal pit. central pit.
• The buccal developmental groove separates MB • The buccal developmental groove separates MB
and DB cusps and may extend onto buccal surface. and DB cusps and may extend onto buccal surface.
• The distal developmental groove separates the • The distal developmental groove separates the two
two lingual cusps and may or may not extend lingual cusps and extends onto the lingual surface
onto lingual surface. as the lingual developmental groove.
• Three roots are thin, slender, divergenent, and • Three roots are thin, slender and divergenent and
visible from both buccal and lingual aspects. visible from both buccal and lingual aspects.
Q 3. Describe importance of primary teeth. (Nov. 2010, June 2011)

Ans.
• Care of primary dentition is very much essential for the normal growth and development
of the jaws and establishment of the normal occlusion of permanent dentition.
• Neuromuscular coordination required for masticatory process is established at primary
dentition stage.
• With the establishment of primary occlusion, child learns to masticate food efficiently.
• Functional occlusion of primary teeth helps to maintain a proper diet and good nutrition.
• A well-cared set of primary teeth helps to maintain normal facial appearance which in turn
helps normal psychological development of the child.
108 DADH Made Easy
• The primary teeth, especially the anteriors are necessary for normal pronunciation of
consonants and for development of clear speech.
• The proper care of primary teeth is important to avoid infection and spread of infection.
• The primary teeth maintain the normal eruption schedule of permanent successors.
• The primary teeth help in maintaining the space for eruption of permanent successor.
• The premature loss of primary teeth due to caries or trauma causes migration of adjacent
teeth into the available space leading to decrease in arch length. This causes lack of space
for the erupting permanent tooth resulting in development of malocclusion.
Q 4. What is buccal cingulum/tuberculum of Zukerkandl? (Dec. 2005, May 2007)

Ans.
• The cervical ridge running mesiodistally in the cervical third of the buccal surface of the
primary first molars is sometimes called buccal cingulum. It is present in both maxillary
and mandibular first molars.
• It is more prominent in the cervical third of the mesiobuccal cusp of the primary maxillary
first molar and is referred to as Tuberculum of Zukerkandl. When viewed from mesial
aspect, the buccal outline of the molar shows pronounced convexity of the cervical enamel
ridge in the cervical third and then the buccal outline is straight line converging in an occlusal
direction. This makes the occlusal table narrower buccolingually compared to that of the
permanent molars.
1. Divergent roots with very short root trunk 9. Man has two sets of dentition, one
is present in primary, the other permanent, this can
a. Permanent maxillary molars be correctly described as
b. Permanent mandibular molars a. Polyphyodont
c. Primary molars b. Monophyodont
d. All posterior teeth c. Diphyodont
2. The teeth not included in primary set are d. Homodont
a. Canines b. Third molars 10. Which tooth does not exist in primary
c. Premolars d. Both b and c dentition?
a. Incisors b. Canines
3. The predecessor of permanent molars
are
c. Premolars d. Molars
a. Primary first molar 11. Primary first molars are
b. Primary second molar a. Larger in size than primary second
c. Primary canine molars
d. None of the above b. Much smaller in size than primary
second molars
4. Mixed dentition is present from
c. Same as primary second molars
a. 1–5 years b. 3–8 years
c. 6–12 years d. 8–16 years
12. The primary teeth having strange and
5. The number of teeth present in the oral primitive appearance is
cavity at the age of 8 years are
a. Maxillary 1st molar
a. 20 b. 32
b. Maxillary 2nd molar
c. 24 d. 48
c. Mandibular 1st molar
6. Primary maxillary second molars most d. Mandibular 2nd molar
closely resemble
13. Primary teeth when in occlusion, each
a. Primary maxillary first molar
teeth occludes with two teeth of the
b. Permanent maxillary first molar opposing jaw except
c. Permanent maxillary second molar a. Mandibular central incisors
d. Primary maxillary second molar b. Maxillary central incisors
7. The highest and sharpest cusp on a c. Maxillary second molar
primary mandibular first molar is d. Both a and c
a. Mesiolingual b. Distolingual
14. Primary teeth are worn off rapidly on
c. Mesiobuccal d. Distobuccal incisal edges and occlusal surfaces
8. Primar y mandibular second molars because
resemble a. Of food habits
a. Primary mandibular first molar b. Of brittle teeth
b. Permanent mandibular second molar c. Teeth do not hold their relative positions
c. Permanent mandibular first molar for long-time
d. None of the above d. All the above
1-c, 2-d, 3-d, 4-c, 5-c, 6-b, 7-a, 8-c, 9-c, 10-c, 11-b, 12-c, 13-d, 14-c
110 DADH Made Easy
15. The human dentition is referred to as b. Distal surface relationship between

a. Omnivorous dentition upper and lower second deciduous
b. Carnivorous dentition molars
c. Herbivorous dentition c. Both a and b
d. All the above d. None of the above
16. The groove that separates the gumpads 21. Leeway space of Nance is the difference
from the palate and floor of the mouth between the combined MD width of
is a. C, D, E and 3, 4, 5
a. Gingival groove b. C, D, E and 4, 5, 6
b. Dental groove c. A, B, C and 1, 2, 3
c. Transverse groove d. C, D, E and 5, 6, 7
d. Mesiogingival groove 22. The Leeway space on each side of the
17. Even though upper and lower gumpads maxillary and mandibular arch is
are almost similar to each other the upper a. 1.8 mm and 3.4 mm
gum pad is b. 0.9 mm and 1.7 mm
a. Wider and longer than the lower c. 0.5 mm and 0.9 mm
b. Narrower and shorter than the lower d. 0.2 mm and 0.5 mm
c. Wider and shorter than the mandi- 23. When thickness of dentin in primary teeth
bular gum pad is compared with that of permanent
d. Narrower and longer than lower teeth the dentin in primary teeth is about
18. When upper and lower gum pads are a. One-fourth of the thickness of per-
approximated manent teeth
a. There is complete over jet all around b. Half of the thickness of the permanent
b. Contact occurs only at first molar teeth
region c. Two-thirds of the thickness of the
c. Space exists between them in anterior permanent teeth
region d. One-sixth of the thickness of the
d. Infantile open bite is normal and helps permanent teeth
suckling 24. The pulp horn which is more likely to be
e. All of above exposed during cavity preparation on
19. The spaces between the deciduous teeth deciduous molars is
are called a. Mesiobuccal of first molar
a. Normal and physiological spaces or b. Distobuccal of first molar
developmental spaces c. Mesiobuccal of second molar
b. Abnormal spaces d. Distobuccal of second molar
c. Diastema 25. In general, first deciduous tooth to erupt
d. Leeway space in oral cavity is
20. The location and relationship of the first a. Mandibular central incisor
permanent molar depends much upon b. Maxillary central incisor
a. Mesial surface relationship between c. Mandibular first molar
upper and lower first deciduous molars d. Maxillary second molar
15-a, 16-a, 17-a, 18-e, 19-a, 20-b, 21-a, 22-b, 23-b, 24-a, 25-???
26. Mixed dentition period in an average 33. The general order of eruption of primary
child is between dentition is
a. 10 years to 15 years of age a. A – B – C – D – E
b. 6 years to 13 years of age b. D – A – B – C – E
c. 4 years to 13 years of age c. A – B – D – C – E
d. 15 years to 17 years of age d. B – A – C – D – E
27. Generally the sequence of eruption of 34. The process of exfoliation of the primary
permanent teeth in maxilla is teeth takes place during
a. 1 – 6 – 2 – 3 – 4 – 7 – 5 – 8 a. 5th and 10th year
b. 6 – 1 – 2 – 4 – 3 – 5 – 7 – 8 b. 6th and 14th year
c. 6 – 1 – 2 – 3 – 4 – 5 – 7 – 8 c. 7th and 12th year
d. 1 – 2 – 3 – 4 – 5 – 6 – 7 – 8 d. 8th and 11th year
28. In deciduous dentition, the tooth which 35. The primary teeth remain in normal
is more wider mesiodistally is alignment and occlusion for
a. Maxillary first molar a. 6 years b. 5 years
b. Mandibular first molar c. 4 years d. 3 years
c. Maxillary second molar 36. In primary dentition, the canine which
d. Mandibular second molar has its mesial cusp slope longer than the
29. Generally the sequence of eruption of distal cusp slope is
permanent teeth in lower jaw is a. Primary maxillary canine
a. 1 – 6 – 2 – 3 – 5 – 4 – 7 – 8 b. Primary mandibular canine
b. 6 – 1 – 2 – 4 – 5 – 3 – 7 – 8 c. Both the above
c. 6 – 1 – 2 – 3 – 4 – 5 – 7 – 8 d. None of the above
d. 1 – 7 – 6 – 5 – 4 – 3 – 2 – 8 37. Which of the following is not a succeda-
30. The permanent tooth which succeeds neous tooth
the deciduous first molar is a. Permanent first molar
a. First premolar b. Permanent third molar
b. First molar c. Permanent second molar
c. Second premolar d. All of the above
d. Second molar 38. Zukerkandl tubercle is present on
31. Abscess from a primary tooth can cause a. Deciduous first molar
dark spot on the underneath permanent b. Deciduous second molar
developing tooth is called c. Deciduous canine
a. White spot b. Black spot d. Deciduous incisors
c. Turner’s spot d. None of the above 39. The primary molar having a prominent
32. Calcification of the primary teeth begins transverse ridge that unites the mesio-
in utero facial and mesiolingual cusps is
a. 18–20 weeks a. First mandibular molar
b. 15–18 weeks b. Second mandibular molar
c. 13 and 16 weeks c. First maxillary molar
d. 6–10 weeks d. Second maxillary molar
26-b, 27-b, 28-d, 29-c, 30-a, 31-c, 32-c, 33-c, 34-c, 35-c, 36-a, 37-d, 38-a, 39-a
112 DADH Made Easy
40. Primary maxillary canine exfoliates at the 47. Calcification of the roots of primary teeth
age of is normally completed between
a. 6–7 years b. 7–8 years a. 1–2 years b. 3–4 years
c. 9–10 years d. 10–11 years c. 5–6 years d. 7–8 years
41. Resorption of roots of primary molars 48. The primary molar in which the mesial
begins at the age of portion of the occlusal table is separated
a. 5 years b. 4 years from the remainder by a transverse ridge
c. 3 years d. 2 years is
42. The last succedaneous tooth to erupt in
b. Mandibular first molar
mouth is
c. Mandibular second molar
a. Maxillary second molar
d. None
b. Maxillary first molar
c. Maxillary canine 49. The dentition of a normally developed
6½-year old child usually consists of
d. Maxillary first premolar
a. 8 primary and 8 permanent teeth
43. Generally permanent maxillary central
b. 10 primary and 10 permanent teeth
incisors has
c. 18 primary and 6 permanent teeth
a. Three mamelons and two develop-
mental lobes d. 20 primary teeth
b. Two mamelons and two developmental 50. A one-year old child is expected to have
lobes the following maxillary and mandibular
c. Three mamelons and four develop- teeth
mental lobes a. Incisors and canines
d. Three mamelons and three develop- b. Incisors and first molars
mental lobes c. Central incisors and canines
44. An approximation of the curvature of the d. Mandibular central and lateral incisors
circles of a 4-inch equilateral triangle 51. The highest and sharpest cusp on the
was given by deciduous mandibular first molar
a. Von Spee b. Monson a. Mesiobuccal b. Distobuccal
c. Bolton d. Bonwill c. Mesiolingual d. Distolingual
45. Under normal condition the presence 52. The primary teeth that present the most
of mamelons in a 14-year-old patient is outstanding morphological deviation
indicative of from permanent teeth are
a. Malnutrition b. Flurosis a. Central incisors
c. Malocclusion d. Malformation b. Lateral incisors
46. A transverse ridge is prominently present c. Canines
on the following primary molar d. First molars
a. Maxillary first molar 53. The primary mandibular second molars
b. Maxillary second molar have
c. Mandibular first molar a. 2 cusps b. 3 cusps
d. Mandibular second molar c. 4 cusps d. 5 cusps
40-d, 41-b, 42-c, 43-c, 44-d, 45-c, 46-c, 47-b, 48-b, 49-c, 50-b, 51-c, 52-d, 53-d
54. The lingual surface of primary maxillary 61. The outline of the labial surface of
central incisors closely resembles that of deciduous maxillary canine
a. Mandibular lateral incisor a. Diamond shaped
b. Maxillary canine b. Rhomboidal
c. Mandibular lateral incisor c. Angular
d. Mandibular central incisor d. Both a and c
55. Initial calcification of primary teeth 62. Occlusal outline seen in deciduous
occurs before birth in the following maxillary first molar
a. Incisors
a. Two-cusp type
b. Canines
b. Three-cusp type
c. Molars
c. Four-cusp type
d. All of the above
d. Both b and c
56. Hypoplasia of primary teeth limited to
incisal or occlusal one-third indicates 63. The primary mandibular left canine
a. Flouridated water according to universal numbering
system is written as
b. Tetracycline medication
c. Metabolic disturbance a. R b. M
d. Dentinogenesis imperfecta c. 73 d. 83
57. The deciduous molar which has greatest 64. Cusp of Carebelli is seen in the
resemblance to a premolar is a. Deciduous maxillary first molar
a. Maxillary first molar b. Deciduous maxillary second molar
b. Maxillary second molar c. Permanent maxillary first molar
c. Mandibular first molar d. Both b and c
d. Mandibular second molar
65. The number of teeth in deciduous denti-
58. The developmental space or primate tion and permanent dentition are
space in mandibular arch is present a. 31 and 20
between
b. 20 and 32
a. Canine and first molar
c. 52 and 20
b. First and second molar
d. 20 and 52
c. Lateral incisor and canine
d. Central and lateral incisor 66. The deciduous teeth are white in colour
because
59. The occlusal outline of the primary
mandibular first molar a. Enamel is less mineralized
a. Rhomboidal b. Enamel does not reflect the colour of
b. Trapezoidal the underlying dentin
c. Diamond shaped c. Enamel is opaque
d. Rectangular d. All of the above
60. Number of grooves present on the 67. The degree of labial bend in the apical
occlusal surface of primary mandibular third of the roots of the deciduous anterior
first molar are teeth is
a. 4 b. 6 a. 20° b. 12°
c. 3 d. 8 c. 10° d. 8°
54-b, 55-d, 56-c, 57-a, 58-a, 59-a, 60-a, 61-d, 62-d, 63-b, 64-d, 65-b, 66-d, 67-c
114 DADH Made Easy
68. The level of furcation of the roots of the 72. The crown formation of all the permanent
deciduous teeth is teeth except third molars is completed
a. 4 mm from cervix between
b. 3 mm from cervix a. 2–3 years
c. Near the cervix b. Birth to 6 years
d. Both a and c c. Birth to 8 years
69. In deciduous teeth the accessory pulp d. Birth to 12 years
canals are situated at the 73. Root development of permanent dentition
a. Apical region except third molar is completed by
b. Furcation a. 12 years
c. Middle third b. 14 years
d. All c. 16 years
70. Initial calcification of which of the primary d. 18 years
teeth occurs before birth
74. The lingual surface of primary maxillary
a. Incisors b. Canines
CI closely resembles that of
c. Molars d. All of the above
a. Maxillary lateral incisor
71. In the sequence of eruption of perma- b. Maxillary canines
nent dentition, the maxillary canine
c. Mandibular LI
usually follows
a. Maxillary LI d. Mandibular CI
b. Mandibular 1st PM 75. The primary second molars have
c. Mandibular 2nd PM a. 2 cusps b. 3 cusps
d. Mandibular canine c. 4 cusps d. 5 cusps
68-c, 69-b, 70-d, 71-c, 72-c, 73-c, 74-b, 75-d

7
Occlusion
LAQ (10 Marks)
Q 1. Define occlusion. Describe factors governing occlusion. (Nov. 2004, 2014, June 2016)
Ans. Occlusion is derived from the Latin word Occlude meaning “to close”.
Definition
• It is defined as the contact relationship of the teeth in function and parafunction.
• In addition to the contact at an occlusal interface, occlusion is also concerned with other
factors associated with the development and stability of the masticatory system and with
the use of teeth in oral motor behavior.
Factors influencing occlusion
1. Development of the dentition.
2. Dental arch form.
3. Curvatures of occlusal planes.
4. Inclination and angulation of the roots of the teeth.
5. Functional form of the teeth at incisal and occlusal thirds.
6. Facial and lingual relations of each tooth in one arch to its antagonists in the opposing arch
in centric occlusion (overlap of the teeth).
7. Occlusal contacts and intercuspal relations between arches.
8. Occlusal contact relations and intercuspal relations of the teeth.
9. Neurobehavioral aspects of occlusion.
1. DEVELOPMENT OF THE DENTITION

The different periods of dentition are pre-dentition period, deciduous dentition period, mixed
dentition period, and permanent dentition.
Pre-dentition Period (Figs 7.1 and 7.2)

• This period is the time from birth to 6 months (till the first deciduous tooth erupts).
• The dental arches during this period are referred to as gum pads. These are pink, firm and
covered by a dense layer of fibrous periosteum.
115
116 DADH Made Easy
Figs 7.1A and B: (A) Upper gum pad; (B) Lower gum pad Fig. 7.2: Gum pads in occlusion
• The upper gum pads are wider than the lower gum pads.
• Upper and the lower gum pads are U-shaped.
• The contact between the gum pads occur in the first molar region with absence of contact at
the anterior region of the jaws. This spacing is physiologic and aids the infant in suckling.
• This period ends when first deciduous tooth erupts and period of deciduous dentition begins.
Clinical Implications
Natal and neonatal teeth: These refer to the teeth that erupt prematurely before their normal
eruption time. Natal teeth are those which erupt before 30 days of birth and neonatal teeth are
referred to those teeth that erupt between 30 days to 6 months. The natal and neonatal teeth
are usually present in the mandibular region and interfere with suckling and hence have to be
managed appropriately.
Deciduous Primary Dentition

• This period extends from 6 months of age when the deciduous mandibular incisors erupt
till 6 years of age when permanent first molar erupts.
• The primary teeth are arranged in the form of two arches; maxillary and mandibular and
outline is roughly elliptical when following the labial and buccal surface which is wider in
the maxillary arch than the mandibular arch.
• Time taken for eruption of deciduous teeth: 6 months to 2 and half-year and root formation
is completed by 3 years of age.
• Sequence of eruption: A B D C E.
• Interdental spacing: (Fig. 7.3)
– After the deciduous teeth are fully formed and occupy their respective position, rapid
development of the jaws results in interdental spacing between the teeth. These spaces
between the teeth are referred to as physiological spaces or developmental spaces and
Occlusion 117
are necessary to accommodate the

permanent teeth which have a larger mesio-
distal dimension than the primary teeth.
– Simian space or primate space or anthr-
opoid space: The physiological spaces
occurring mesial to maxillary canine or
distal to mandibular canine are referred to
as primate spaces. Fig. 7.3: Primate space
– The absence or presence of these spaces serves as an indicator of future sufficiency of
space in the dental arches for the permanent teeth.
• Primary molar relationships: (Fig. 7.4)
– Described in three ways: Flush terminal plane, mesial step and distal step based on the
relationship of the distal surface of second primary molar.
– Flush terminal plane: Distal surface of primary mandibular second molar and maxillary
second molar are in the same plane. This is also referred to as end to end molar relationship.
– Mesial step: The distal surface of primary mandibular second molar is mesially located to
the distal surface of the primary maxillary second molar.
– Distal step: Distal surface of the primary mandibular second molar is distally located to
the distal surface of the primary maxillary second molar.
• Effects of terminal plane relationship: The effects of these relationships have a bearing on
the relationship of permanent molars.
– It is considered that a flush terminal plane in deciduous dentition may lead to either an
end on molar relation, a class I or a class II molar relation in permanent dentition.
– Distal step in primary dentition may lead to class II permanent molar relation.
– Mesial step in primary dentition may lead to either a class I relation or class III molar
relation.
Fig. 7.4: Primary molar relationship

118 DADH Made Easy
– Other factors which have an influence on molar relationships include differential growth
of the jaws, forward growth of the mandible and sufficient Leeway space to accommodate
a mesial drift of the permanent molars.
• The deciduous dentition period ends with the eruption of the permanent first molars and
the mixed dentition or transition period starts from then.
Mixed (Transitional) Dentition
• This period which indicates the transition from primary to permanent dentition begins
about 6 years of age with the emergence of permanent molars.
• As the permanent teeth in general have a greater mesiodistal dimension than the primary
teeth, they are accommodated by the space provided by the growth of the jaws. In addition,
the erupting permanent teeth utilize the physiological spaces available in the deciduous
dentition.
• Leeway space of Nance: (Fig. 7.5)
– This space is defined as the difference in the
combined mesiodistal width of C, D, and E
(deciduous canine, first molar, and second molar)
and mesiodistal width of 3, 4, and 5 (permanent
canine, first premolar, and second premolar).
– The space is 1.8 mm in maxilla (0.9 mm in each
quadrant) and 3.4 mm in mandible (1.7 mm in
each quadrant).
– Significance: This space allows the mesial
movement of mandibular molar thereby guiding
them into proper occlusion.
• Permanent molars are initially in an end-on
relationship. Later this is converted into a class I
molar relationship by the following factors:
– Mesial drifting of mandibular molar utilising the
physiological space and Leeway space of Nance.
Fig. 7.5: Leeway space of Nance
– Differential forward growth of the mandible.
• Incisal liability: Because of the discrepancy in mesiodistal crown dimensions between the
primary and permanent incisors, some degree of transient crowding may occur at around
8 to 9 years of age until the emergence of canine when the space for the teeth may again be
adequate. This is referred to as incisal liability.
• Ugly duckling stage: Around 8–10 years of age, while the permanent maxillary canines are
erupting; they exert pressure on the roots of the maxillary lateral incisors. This causes flaring
of the crowns of permanent maxillary central and lateral incisors in distal direction resulting
in spacing between the teeth. This is known as ugly duckling stage and disappears as soon
as the canines erupt. They do not possess much clinical significance except for the appearance
(Fig. 7.6).
• The permanent molar relationship is categorized as follows:
– Class I: When the mesiobuccal cusp of the maxillary first molar aligns with the buccal
groove of the mandibular first molar.
– Class II: When the buccal groove of the mandibular first molar is distally positioned
when in occlusion with the mesiobuccal cusp of the maxillary molar.
Occlusion 119
Fig. 7.6: Ugly duckling stage
– Class III: When the buccal groove of mandibular first molar is mesially placed in relation
to the mesiobuccal cusp of the maxillary first molar when the teeth are in occlusion.
Permanent Dentition
Sequence of eruption:
• Maxilla: 6-1-2-4-3-5-7-8 or 6-1-2-4-5-3-7-8
• Mandible: 6-1-2-3-4-5-7-8
2. DENTAL ARCH FORM

a. The teeth are positioned on the maxilla and mandible in such a way to produce a curved
arch when viewed from the occlusal aspect. This arch form is largely determined by the
shape of the underlying basal bone.
b. In general, the alignment of the teeth in both the arches follows a parabolic curve. Variations
of the arch form are U-shaped (square form), ellipsoid, rotund or tapered. The tapered arch
form (V-shaped) generally occurs in the maxillary arch where there is narrowing of the
anterior maxilla secondary to thumb sucking habit.
120 DADH Made Easy
c. The tooth alignment in the arches is divided into three segments—anterior, middle, and
posterior. The anterior segment is described by a curved line and includes anterior teeth up
to the labial ridge of canine. The middle segment is described by a straight line which
includes distal portion of canine, premolars, and mesiobuccal cusp of first molar. The
posterior segment is again a straight line from distobuccal cusp of first molar and includes
the buccal surface of second and third molar.
d. Under resting conditions, the teeth, and the dental arches are in space referred to as Neutral
space which is balanced by two set of forces. The lips and cheeks generate muscular forces
externally which are balanced by the internal muscular forces arising from the tongue thereby
maintaining the dental arches and the teeth in normal alignment. Any imbalance of these
forces may result in malocclusion or abnormal alignment of arches. Examples of such forces
are tongue thrusting which generates greater outward forces from the tongue against the
teeth leading to its protrusion. In mouth breathing, pressure of the lips on the teeth is more
than the outward pressure of the tongue.
3. CURVATURES OF OCCLUSAL PLANES

a. The occlusal surfaces of the dental arches do not generally conform to a flat plane. The
mandibular arch conforms generally to one or more curved planes which appear concave
while the curvature at the opposing maxillary arch appears convex.
b. Some of the curves are:
i. Curve of Spee (anteroposterior curve of occlusal plane).
ii. Curve of Wilson (side to side curve)
iii. Curve of Monson
• Curve of Spee: (Fig. 7.7)
– This is an anteroposterior curve of the
occlusal surfaces and is viewed from buccal
surface.
– The curve of Spee begins at the tip of the
lower cuspid and touches the buccal cusp
tips of all the mandibular posterior teeth
and continues to the anterior border of the
ramus. An ideal curve of Spee is aligned so
that a continuation of this arc would extend
through the condyles. The curvature of this
arc would relate, on average, to part of a Fig. 7.7: Curve of Spee
circle with a 4-inch radius.
– Function: Allows for the normal functional protrusive movements of the mandible.
• Curve of Wilson: (Fig. 7.8)
– This is a mediolateral curve and is viewed from the anterior aspect with the mouth slightly
open.
– The curve of Wilson contacts the buccal and lingual cusp tips of each side of the arch. It
results from the inward inclination of the lower posterior teeth, making the lingual cusps
lower than the buccal cups on the mandibular arch; the buccal cusps are higher than the
lingual cusps on the maxillary arch because of the outward inclination of the upper
posterior teeth.
Occlusion 121
– Functions: Allows for those requisite movements

that are used in chewing functions. The lingual
inclination of the lower posterior teeth positions
the lingual cusps lower than the buccal cusps. This
design permits easy access to the occlusal table. As
the tongue lays the food on the occlusal surfaces, it
is stopped from going past the chewing position
by the taller buccal cusps.
• Curve of Monson: Is an extension of curve of Spee
Fig. 7.8: Curve of Wilson
wherein a spherical curvature is visualized involving
both the right and left bicuspid and molar cusps and the right and left condyles. It was
supposed that the centre of a sphere with an eight inch diameter was the vector for
converging lines of masticatory forces passing through the center of the teeth and that the
occlusal surfaces of the molar teeth were congruent with the surface of the sphere of some
dimension.
• Bennett movement: The movement of the mandible to the right or left during mastication is
referred to as Bennett movement.
Relationship of teeth:
Centric relation: It is the most posterior position of the mandible relative to the maxilla at a
given vertical dimension.
Centric occlusion: Refers to the relationship of the mandible to the maxilla when the teeth
are in maximum occlusal contact, irrespective of the position or alignment of the condyle-
disk assemblies.
4. INCLINATION AND ANGULATION OF THE ROOTS OF THE TEETH

The inclination of axes of the maxillary and mandibular teeth to each other varies with each
tooth group. The importance of the relative root angles helps relate the direction of occlusal
forces in restorations along the long axis of teeth, guides the control of orthodontic forces
for proper tooth angulation, aids in using templates for implant placement and also in
visualization how the X-ray beam must be directed. The angle at which the tooth is placed
depends on its function and lines of forces brought about during function. The mesiodistal
and faciolingual inclincations are described in terms of angle between the long axis of a
tooth and a line drawn perpendicular to a horizontal or median plane. The maximum
faciolingual inclination of teeth is seen with maxillary central incisors which has an inclination
of 28° while the least is with maxillary premolars at 4–5°. The mesiodistal angulation of the
mandibular molars is highest between 10–14° while mandibular lateral incisors do not show
any angulation.
5. FUNCTIONAL FORM OF THE TEETH AT INCISAL AND OCCLUSAL THIRDS

The incisal or occlusal thirds of the tooth crowns present convex or concave tooth surface at
all contacting tooth areas. When the teeth of one jaw comes in contact with the occlusal surface
of the antagonist teeth, these curved surfaces come in contact with each other. The lingual
surface of maxillary incisors present some concave surfaces which come in contact with the
convex portions present in the incisal ridges of mandibular incisors. In the posterior teeth, the
depressions in the depth of sulci and developmental grooves contact with the curved portion
of the cusp and marginal ridges.
122 DADH Made Easy
Escapement Spaces/Spillway Spaces (Fig. 7.9)

Although the teeth in centric occlusion seem to intercuspate closely, escapement spaces have
been provided between the teeth which are needed for efficient occlusion during mastication.
Escapement space is provided in the teeth by the form of cusp and ridges, the sulci and
development grooves and the interdental spaces or embrasures when the teeth come together
in occlusion. The escapement spaces are reduced with increase in occlusal contact and vice-
versa.
Fig. 7.9: Escapement spaces/spillway spaces
6. FACIAL AND LINGUAL RELATIONS OF EACH TOOTH IN ONE ARCH TO ITS ANTAGONISTS IN
THE OPPOSING ARCH IN CENTRIC OCCLUSION (OVERLAP OF THE TEETH)
a. The arch form of the maxilla tends to be larger than that of the mandible. This results in the
maxillary teeth overhanging the mandibular teeth when the teeth are in centric occlusion.
b. Under normal circumstances of maximal intercuspation the maxillary anterior teeth overlap
the mandibular teeth. The overlap could be horizontal (overjet) or vertical (overbite).
c. Overbite (Fig. 7.10): Overbite is defined as
the vertical overlap of the maxillary and
mandibular anterior teeth, where the
maxillary anterior teeth extend below the
incisal edges of the mandibular anterior
teeth.
d. Overjet (Fig. 7.11): Overjet is defined as the
horizontal overlap of the maxillary and
mandibular anterior teeth, where the
maxillary anterior teeth are labial to incisal
edges of the mandibular anterior teeth. Fig. 7.10: Overbite Fig. 7.11: Overjet
Occlusion 123
e. Ideally overjet and overbite is in the range of 2–4 mm.

f. Clinical significance:
i. Overlapping of the maxillary teeth over the mandibular teeth protects the cheeks, lips
and tongue during the opening and closing movements of the jaws. Insufficient horizontal
overlap of the molars may result in cheek biting.
ii. There should be sufficient vertical overlap to enable the disocclusion of the posterior
teeth in function.
g. Excessive vertical overlap of the anterior teeth may result in tissue impingement and is
referred to as impinging overbite.
h. Incisal guidance: Is a measure of the amount of movement and angle at which the lower
incisors and mandible must move from the overlapping position (centric occlusion) to an
edge to edge relationship with maxillary incisor.
7. OCCLUSAL CONTACT RELATIONS AND INTERCUSPAL RELATIONS BETWEEN THE ARCHES

• Supporting cusps: The lingual cusps of the maxillary posterior teeth and the buccal cusps of
the mandibular posterior teeth that make contact with the opposing teeth are referred to as
supporting cusps.
• Centric stops: The areas of occlusal contact that a supporting cusp makes contact with
opposing teeth in centric occlusion are centric stops. These contribute to occlusal stability.
• Guiding cusps: The upper buccal cusps and the lower lingual cusps make contact on their
occlusal sides only when the mandible makes gliding movements. Since these cusps provide
guidance for the mandibular movement, they are known as guiding cusps.
8. OCCLUSAL CONTACT RELATIONS AND INTERCUSPAL RELATIONS OF THE TEETH

• Eccentric movements: Occlusal contact relations away from the intercuspal position involve
all possible movements of the mandible within the envelope of border movements. These
movements are referred to as lateral, protrusive and retrusive movements. Lateral
movements may be either to the right or left.
• Lateral movements: When the mandibular teeth make their initial contact with the maxillary
teeth in right or left lateral occlusion, they bear a right or left lateral position to centric
occlusion. During the right lateral movement, the mandible is depressed and the dental
arches are separated, the jaw moves to the right and brings the teeth together at points right
of the intercuspal position in right working position. On the left side, the teeth may or may
not make contact. In respect to lateral movements, the side towards which the mandible
moves is the working side and the opposite side is the non-working side (known as balancing
side in complete dentures).
– Working side/working occlusion: During lateral movements, when the teeth are brought
together with the mandible to one side, the condyle of the same side (working side)
remains in the posterior position and the condyle of the opposing side (non-working
side) have been moved forward in the glenoid fossa. This type of closure is referred to as
working position and the sliding action of the mandible from working position back to
centric occlusion is working occlusion.
– Balancing side/Balanced occlusion: The opposite side of working side in lateral movements
is referred to as non-working side or balancing side. The teeth on this side may or may
not make contact. The function of this side during all types of mandibular movement is
124 DADH Made Easy
to balance the mandible against the maxilla. When all the teeth in both the arches occlude
perfectly in all positions and excursions of the mandible, they are said to be in balanced
occlusion. Balanced occlusion is seen only in complete dentures and is rarely seen in
natural dentition.
• Protrusive occlusion: When the teeth are closed with the protruded mandible so that both
the condyles are equally forward in the glenoid fossa and the incisors are edge to edge,
while at the same time the mandibular posterior teeth contact the maxillary posterior teeth,
the closure is called protrusive position. As the mandible is retracted from the protrusive
position to centric occlusion, the relationship of upper and lower teeth changes in such a
manner that the incisal edges of the mandibular anterior teeth slide along the sulci and
cross the marginal ridge of the opposing teeth at the same time. This sliding action is called
as protrusive occlusion and is used mostly in the act of cutting of food when it is too large
to be taken wholly into the mouth.
• Retrusive movements: A retrusive movement normally follows a protrusive movement back
to the intercuspal position (centric occlusion). Retrusive movement from centric occlusion
to the retruded contact position where the condyles are in the rearmost, uppermost position
seems to occur in bruxism but infrequently in mastication and swallowing.
9. NEUROBEHAVIORAL ASPECTS OF OCCLUSION

The neurobehavioral aspect of occlusion relates to the function and parafunction action of
stomatognathic system. Functions include a variety of actions such as chewing, sucking,
swallowing, speech and respiration while parafunctional habits refer to habits like bruxism.
The stability of the occlusion and the maintainance of tooth position are dependent on all the
forces that act on the teeth. Occlusal forces, eruptive forces, lip, and cheek pressure, periodontal
support and tongue pressure are all involved in maintaining the position of teeth. This requires
a very intricate control system involving a number of guiding influences from teeth and their
supporting structures along with the involvement of higher centers in the central nervous
system.
SAQs (3 Marks)
Q 1. What are curvatures of occlusal planes?

(Dec. 2005, June 2006, May 2007, 2011, Nov. 2010, 2011)
Ans. The occlusal surfaces of the dental arches do not generally conform to a flat plane. The
mandibular arch conforms generally to one or more curved planes which appear concave
while the curvature of the opposing maxillary arch appears convex.
Some of the curves are:
1 Curve of Spee
2. Curve of Wilson
3. Curve of Monson
4. Bonwill’s equilateral triangle.
1. CURVE OF SPEE (May 2011)

• Concept of this curve was introduced by F. Graf Von Spee in 1890.
• This is an anteroposterior curve of the occlusal surface and is viewed from buccal surface.
Occlusion 125
• This curvature is within sagittal plane only.

• The curve of Spee begins at the tip of the lower cuspid and touches the buccal cusps of all
the mandibular teeth and continues to the anterior border of the ramus.
• An ideal curve of Spee is aligned so that a continuation of this arc would extent through the
condyles.
The curvature of this arc would relate, on an average, to part of a circle with 4-inch radius.
Significance
• It has clinical significance in relation to tooth guidance—that is canine and/or incisal
guidance as applied in orthodontics and restorative dentistry.
• Curve of Spee allows for the normal functional protrusive movements of the mandible.
2. CURVE OF WILSON
• This is a mediolateral curve viewed from anterior aspect with the mouth slightly open.
• The cusp tips of posterior teeth follow a gradual curve from left side to right side. This is
curve of Wilson.
• The curve of maxillary arch is convex and the curve of mandibular arch is concave.
• Thus, the lingual cusps of the posterior teeth are aligned at a lower level than the buccal
cusps on both sides and in both the arches.
Significance
It allows for those requisite movements that are used in chewing functions.
3. CURVE OF MONSON
• It is a three-dimensional combination of curves of Spee and Wilson.
• The concept was introduced by G. S. Monson in 1920.
• According to Monson, all cusps and incisal edges in a natural dentition are tangent to a
surface of a sphere, approximately 4-inches in radius with center in the area of glabella.
4. BONWILL’S EQUILATERAL TRIANGLE (May 2007) (Fig. 7.12)

Taking the point between two mandibular central incisors and mid-point of condyles, an
equilateral triangle is formed with the sides approximately 4-inches in measurement known
as Bonwill’s equilateral triangle.
Fig. 7.12: Bonwill’s triangle

126 DADH Made Easy
Q 2. Describe compensating curvatures. (June 2005, Nov. 2015)

Ans. Compensating curvatures
• All surfaces of dental arch conform to the curvatures.
• When viewed from occlusal aspect each dental arch is U-shaped.
• The buccal cusp tips follow a curved line around the outer edge of the dental arch.
• The lingual cusp tips follow a curved line nearly parallel to the buccal cusp tip curved
line.
• Between the buccal and lingual cusps is the sulcular groove which runs anteroposteriorly
throughout the length of the posterior teeth. The curvature of the mandibular arch is concave
and the maxillary arch is convex. As mandibular teeth appear in advance of maxillary teeth,
the mandibular teeth are the ones which establish compensating curvatures. The maxillary
teeth have to adapt themselves to the mandibular teeth. The curve of one arch is compensated
by another arch hence they are called ‘compensating curvatures’.
Importance of compensating curvatures: Compensatory curves are developed to compensate
for the paths of the condyle as the mandible moves from centric to eccentric position.
Although the maxillary and mandibular curvatures are opposite, they are complimentary
and thereby may help achieve occlusal balance during mastication by encouraging
simultaneous contact in more than one area of the dental arches.
Q 3. Define overjet. (May 2002, 2012, Nov. 2010)

Overjet and overbite
Ans. Overjet
• The arch form of the maxilla tends to be larger than that of the mandible. As a result the
maxillary teeth overhang the mandibular teeth when the teeth are in centric occlusion (the
position of maximal intercuspation).
The lateral or anteroposterior aspect of this overhang is called ‘overjet’.
• Overjet is defined as the horizontal overlap of the maxillary and mandibular anterior teeth
where the maxillary anterior teeth are labial to incisal edges of the mandibular anterior
teeth.
• Ideally overjet is in the range of 2–4 mm.
Significance
• Overjet protects the cheeks, lips and tongue during the opening and closing movements of
the jaws.
• Insufficient horizontal overlap of the molars may result in cheek biting.
Overbite
It is defined as the vertical overlap of the maxillary and mandibular anterior teeth, where the
maxillary anterior teeth extend below the incisal edges of the mandibular anterior teeth.
Ideally, the overbite is in the range of 2–4 mm.
Significance
• There should be sufficient overlap to enable the disocclusion of the posterior teeth in function.
• Excessive vertical overlap of the anterior teeth may result in tissue impingement and is
referred to as “impinging overbite.”
Occlusion 127
Q 4. Define freeway space. (Oct. 2003)

Ans.
• Free wayspace is 2–6 mm between occluding surfaces of the maxillary and mandibular
teeth when mandible is in physiologic resting position or
• The amount of separation between the occlusal surfaces of maxillary and mandibular teeth
when mandible is in its rest position.
• Synonyms: Interocclusal clearance, interocclusal distance, interocclusal gap interocclusal
rest space.
Q 5. Describe Bennett shift (movement). (Oct. 2003)

Ans.
• The movement of the mandible to the right or left during mastication is referred to as ‘Bennett
movement’. It is the lateral movement of mandible produced when the mandibular condyles
slide along mandibular fossae during sideway jaw movement.
• It is the bodily side shift of the mandible toward the side in function and occurs to some
extent in most patients during lateral functional movements.
• It may significantly influence the movement of the mandibular cusp tips, thereby determining
the proper inclination, direction and contour of the facial and lingual grooves in posterior
teeth.
Q 6. What is ugly duckling stage? (July 2005)

Ans.
• The ugly duckling stage was first described by B H Broadbent in 1937.
• It is a mixed dentition stage also called as ‘Broadbent phenomenon’.
• It is a transient or self-correcting malocclusion seen in the maxillary incisor region between
the age of 8–10 years during the eruption of permanent maxillary canines.
• It is a stage of dental development preceding the eruption of permanent canines which
exert pressure on the roots of maxillary lateral incisors causing flaring of crowns of maxillary
central and lateral incisors in distal direction resulting in spacing between the teeth.
It is called ugly duckling stage because dentition in children at this stage looks ugly due to
spacing between the teeth. It disappears as soon as canines erupt (around 11–12 years).
Q 7. What is dental arch form? (Nov. 2010)

Ans. Dental Arch Form
• The teeth are positioned on the maxilla and mandible in such a way as to produce a curved
arch when viewed from the occlusal aspect. This arch form is largely determined by the
shape of the underlying basal bone.
• In general, the alignment of the teeth in both the arches follows a parabolic curve. Variations
of the arch form are U-shaped (square form), ellipsoid, round or tapered. The tapered arch
form (V-shaped) generally occurs in the maxillary arch where there is narrowing of the
anterior maxilla secondary to thumb-sucking habit.
• The tooth alignment in the arches is divided into three segments, anterior, middle, and
posterior. The anterior segment is described by a curved line and includes anterior teeth up
to the labial ridge of canine. The middle segment is described by a straight line which
includes distal portion of canine, premolars and mesiobuccal cusp of first molar. The
posterior segment is again a straight line from distobuccal cusp of first molar and includes
128 DADH Made Easy
the buccal surface of second and third molars. The concept of arch segment allows the
arches to overlap slightly so that canines and first molars are cooperating in more than one
segment indicating that canines and molars function as anchor supports for both arches.
• Under resting conditions, the teeth and the dental arches are in space referred to as Neutral
space which is balanced by two set of forces. The lips and cheeks generate muscular forces
externally which are balanced by the internal muscular forces arising from the tongue thereby
maintaining the dental arches and the teeth in normal alignment. Any imbalance of these
forces may result in malocclusion or abnormal alignment of arches. Examples of such forces
are tongue thrusting which generates greater outward forces from the tongue against the
teeth leading to its protrusion.
• In mouth breathing, pressure of the lips on the teeth is more than the outward pressure of
the tongue.
Overlap of the Teeth

• The maxillary arch form of the maxilla tends to be larger than that of the mandible. This
results in the maxillary teeth overhanging the mandibular teeth when the teeth are in centric
occlusion.
• The mandibular arch is narrower in width than the maxillary arch. This relation is caused
by the difference in MD width between mandibular and maxillary anterior teeth and by the
lingual projection of the crowns of the mandibular posterior teeth. This relationship is
reflected by the overjet and overbite characteristics of teeth.
• Mandibular arch is smaller compared to maxillary arch hence all the teeth of this arch are
forwarded to midline.
• Under normal circumstances of maximal intercuspation the maxillary anterior teeth overlaps
the mandibular teeth. The overlap could be horizontal (overjet) or vertical (overbite).
• Overbite: It is defined as the vertical overlap of the maxillary and mandibular anterior
teeth where the maxillary anterior teeth extend below the incisal edges of the mandibular
anterior teeth.
• Overjet: It is defined as the horizontal overlap of the maxillary and mandibular anterior teeth
where the maxillary anterior teeth are labial to incisal edges of the mandibular anterior teeth.
• Ideally overjet and overbite is in the range of 2–4 mm.
Clinical Significance
• Overlapping of the maxillary teeth over the mandibular teeth protects the cheeks, lips, and
tongue during the opening and closing movements of the jaws. Insufficient horizontal
overlap of the molars may result in cheek biting.
• There should be sufficient vertical overlap enable the disocclusion of the posterior teeth in
function.
• Excessive vertical overlap of the anterior teeth may result in tissue impingement and is
referred to as impinging overbite.
Q 8. What is leeway space of Nance?

Ans. Leeway Space of Nance
• Leeway Space of Nance is defined as the difference between combined mesiodistal width
of primary canine and molars, i.e. deciduous canine, first molar, second molar, and mesio-
distal width of permanent canine and both premolars.
Occlusion 129
• Usually, the sum of mesiodistal width of C, D, E, is larger than the sum of mesiodistal
width of 3, 4, 5.
This difference, i.e. the Leeway Space in maxilla is 1.8 mm (0.9 mm in each quadrant) and in
mandible it is 3.4 mm (1.7 mm in each quadrant).
Significance
It is partly used for alignment of permanent incisors and partly for normal permanent molar
relationship.
Q 9. Define occlusion in deciduous dentition. (May 2013)

Ans.
• Deciduous dentition stage starts with eruption of mandibular central incisors at around
6 months of age and ends with the eruption of first permanent molar at around 6 years of
age.
• The eruption of all primary teeth is completed by the age of 2½–3 years of age. With the
eruption of second primary molar.
• Each tooth in the arch occludes with two teeth in the opposing jaw except for mandibular
central incisor and the maxillary second molar.
• Features of normal primary dentition:
1. Spaced anteriors
2. Primate spaces
3. Deep overbite and increased overjet
4. Straight terminal plane
5. Sallow cuspal interdigitation
6. Almost vertical inclination of anterior teeth
7. Ovoid arch form
8. Flat occlusal plane or almost no curve of Spee.
• Sequence of eruption:
AB D C E
A B D C E
• Characteristics of occlusion in deciduous dentition:
1. Interdental spacing
2. Incisor relationship
3. Molar relationship
1. Interdental spacing: Generalized spacing is very common in deciduous dentition. These
spaces are called physiological or developmental spaces.
These spaces are necessary to accommodate the permanent teeth which have a larger
mesiodistal dimension than the primary teeth.
This space is about 4 mm in the maxillary arch and 3 mm in mandibular arch.
Primate/Simian/Anthropoid/Baume space.
The physiological space seen mesial to maxillary canine and distal to mandibular canine
is called ‘primate space’. These spaces are similar to the dentition of the primates.
These spaces are utilized during early mesial shift of molars from end-on to Class I
relation.
130 DADH Made Easy
2. Incisor relationship: There is increased overbite and overjet in the initial phase of
deciduous dentition.
Gradually, it gets corrected due to attrition of anteriors, eruption of posterior teeth and
due to growth of mandible.
3. Primary molar relationship: In deciduous dentition the mesiodistal relation between
the upper and lower second molar is called ‘terminal plane’.
• In flush terminal plane distal surface of deciduous lower second molar and upper
second molar are in the same vertical plane. It is also referred to as end-on molar
relationship 37%.
• In mesial step, the distal surface of deciduous lower second molar is mesial to the
distal surface of deciduous upper second molar 49%.
• In distal step, the distal surface of deciduous lower second molar is distal to the distal
surface of upper second molar.
Q 10. What are escapement spaces/spillway spaces?

Ans.
• Although the teeth in centric occlusion seem to intercuspate closely, escapement spaces
have been provided between the teeth which are needed for efficient occlusion during
mastication.
• Escapement space is provided in the teeth by the form of cusp and ridges, the sulci and
developmental groove and the interdental spaces or embrasures. When the teeth come
together in occlusion.
• The escapement spaces are reduced with increased in occlusal contact or vice-versa.
• When two adjacent teeth in the same arch are in contact with each other there are four
triangular continuous spaces adjacent to the contact areas. These are embrasures.
• They are named according to their location which depends on the aspect from which the
teeth are viewed.
• From facial and lingual aspect—incisal and cervical embrasures are seen.
• From occlusal aspect—facial and lingual embrasures are seen.
• It is significance that it provides a Spillway for food during mastication and makes teeth
self-cleansing, prevents food from impinging on gingiva.
Q 11. Explain theories of occlusion. (Oct. 2002)

Ans.
1. Theory of equilateral triangle: This theory was proposed by Bonwill which states that an
equilateral triangle is formed with the three corners of the triangle being right condyle, left
condyle, and a point between the two mandibular central incisors. The distance between
the two points (or one side of he triangle) is 4 inches or 10 cm. The theory postulates that
the teeth move in relation to each other as guided by the condyle control and the incisal
point.
2. Conical theory of occlusion: This theory postullates that lower teeth move over the surface
of the upper teeth as over the surface of a cone with a generating angle of 45°. The central
axis of the cone is tipped at an angle of 45° to the occlusal plane. In case of posterior teeth,
the cusps of teeth have 45° and each cusp behaves like a separate cone. The cusps of the
lower posterior teeth incline over the cusps of the maxillary teeth similar to that of the
anterior teeth.
Occlusion 131
3. Spherical theory of occlusion: This theory was proposed by G.S. Monson in 1918. According
to the theory, the lower teeth move over the surface of the upper teeth as over the surface of
a sphere. This sphere has a diameter of 8 inches or 20 cm with its center near the glabella.
The surface of the sphere passes through the glemoid fossa along the articular eminence.
This theory postulated that teeth are positioned in such a way that the anteroposterior and
mesiodistal inclinations of the teeth are in harmony with the spherical surface.
4. Theory of organic occlusion: The theory was proposed by Stuart and Stallard in 1947. They
proposed that teeth are in harmony with muscles and joints in function; the latter determining
the mandibular position of occlusion throughout tooth guidance. Organic occlusion has
the following features teeth are passive to the paths of mandibular movements, cusp fossa
contact relationship are developed when jaws are in centric relation, posterior teeth protect
anteriors during centric occlusion, separation of posterior teeth on both sides of the arch
when jaw moves away from the centric occlusion, vertical overlap of maxillary central
incisors is sufficient to provide separation of posterior teeth when the incisor are at an end
to end relation and during lateral movement of the mandible, the canines cause disclusion
of all the other teeth.
132 DADH Made Easy
1. All teeth have two antagonists in the 6. Usually the canine erupts before pre-
opposing jaw except molar in
a. Mandibular central incisor a. Maxillary arch
b. Maxillary third molar b. Mandibular arch
c. Both a and b c. Both a and b
d. Mandibular third molar d. None of the above
2. In centric occlusion, the massive and 7. Dentition in girls erupts earlier than in
pointed mesiolingual cusp portion of boys by about
maxillary first molar fits into a. 5 months
a. Distal fossa of lower first molars b. 3 months
b. Mesial fossa of lower first molars c. 2 months
c. Major/central fossa of lower first d. 1 months
molars
8. In Angle’s class I molar relationship
d. Mesial fossa of upper first molar mesiolingual cusp of maxillary first molar
3. The distolingual cusp of maxillary first occludes into the
molars are in apposition a. Mesial triangular fossa
a. To the distal triangular fossa and b. Distal triangular fossa
marginal ridge of mandibular first c. Central fossa
molars d. None of the above
b. To the mesial marginal ridge of the
molar distal to the mandibular first 9. In normal occlusion, the buccal cusps
of maxillary teeth occlude
molar
a. With the lingual surface of mandibular
c. Both a and b
teeth
b. With the buccal surface of mandibular
4. In centric occlusion, lingual cusp of teeth
mandibular first premolar c. In the central sulci of mandibular teeth
a. Contacts with distal marginal ridge of d. Distal surface of permanent mandibular
maxillary canine first molar
b. Contacts with cingulum of maxillary
canine 10. In normal occlusion mesiobuccal cusp
of permanent maxillar y first molar
c. Does not contact with any teeth
occludes with
d. Contacts with mesial marginal ridge
a. Mesiobuccal groove of permanent
of maxillary canine
mandibular first molar
5. In physiologic rest position of mandible b. Distobuccal groove of permanent
a. There is slight contact mandibular first molar
b. There is maximum contact c. Mesial surface of permanent mandi-
c. There is no contact bular first molar
d. The contact depends on the size of the d. Distal surface of permanent mandibular
cusp first molar.
1-c, 2-c, 3-c, 4-c, 5-c, 6-b, 7-a, 8-c, 9-b, 10-a
Occlusion 133
11. If a permanent first molar is lost, the 17. In the unworn dental arch all the following
permanent second molar drifts to the occlusal contacts are there except
a. Distal side a. Point to point b. Point to area
b. Mesial side c. Edge to edge d. Edge to area
c. Buccal side e. Area to area
d. Lingual side 18. The cusp of the maxillary molar that serves
12. ‘Leeway space’ is as a reference point in identifying Angle’s
Class I, Class II, Class III occlusion is
a. Physiologic spacing between deciduous
teeth a. Distobuccal cusp
b. The difference in labiolingual width b. Mesiobuccal
between deciduous molars and pre- c. Mesiolingual
molars d. Distolingual
c. The difference in mesiodistal width of 19. When the mandible is in its physiologic
deciduous molars and permanent rest or postural position, contact of teeth is
molars a. Maximum b. Premature
d. The difference in combined mesiodistal c. Slight d. Not present
width of deciduous canine and molars 20. When posterior teeth are in normal ideal
and of permanent canines and pre- relationship, the following cusps are
molars considered supporting cusps
13. The interocclusal freeway space in a. Maxillary lingual
normal circumstances should be b. Maxillary facial
a. 0–1 mm b. 1–2 mm c. Mandibular lingual
c. 2–4 mm d. 3–5 mm d. Mandibular facial
14. In Primary dentition the physiologic e. Both a and d
space mesial to maxillary canine and 21. The following cusps are referred to as
distal to mandibular canine is called ‘stamp cusps’
a. Primate/Simian space a. Maxillary lingual cusps
b. Leeway space b. Maxillary buccal
c. Freeway space c. Mandibular buccal
d. Diastema d. Mandibular lingual
e. Both a and c
15. Curve which runs in anteroposterior
direction is 22. In the intercuspal position distobuccal
a. Curve of Spee cusp of permanent mandibular first
b. Curve of Wilson molar occludes into
a. The interproximal marginal ridge area
c. Monson’s curve
between maxillary second premolar
and first molar
16. Freeway space is maximum at b. Central fossa of maxillary first molar
a. Incisor region c. Central fossa of maxillary second molar
b. Canine region d. Interproximal marginal ridge area
c. Premolar region between maxillary first molar and
d. Molar region second molar
11-b, 12-d, 13-c, 14-a, 15-a, 16-a, 17-e, 18-b, 19-d, 20-e, 21-e, 22-b
134 DADH Made Easy
23. Cusptip articulating with a marginal 29. The position of the jaw that is exclu-sively
ridge area is called as determined by the behavior of the
a. Normal cusp mandibular musculature is
b. Plunger cusp a. Postural b. Terminal
c. Non-working cusp c. Intercuspal d. None of the above
d. Deflected cusps 30. During nonmasticatory swallowing teeth
are usually
24. Forces of occlusion are mainly sustained
by a. Protruded
a. Tough enamel b. In a working arrangement
b. Resilience of dentin c. In contact in intercuspal position
c. Supporting cancellous bone d. None of the above
d. PDL 31. Spacing between anterior teeth in the
primary dentition is most frequently
25. Maximum mesiodistal inclination with
caused by
respect to mid-sagittal plane is found in
a. Thumb sucking
a. Maxillary canine
b. Tongue thrusting
b. Mandibular lateral incisor
c. The growth of the dental arches
c. Mandibular canines
d. The pressure from the succedaneous
d. Maxillary molar
teeth
26. From proximal view, the tooth which has
32. The lingual cusps of the mandibular first
least labiolingual inclination is
molar must be restored to accomodate
a. Maxillary canine
a. Centric relation
b. Maxillary central incisor
b. Working movement
c. Maxillary lateral incisor c. Non-working movement
d. Mandibular central incisor d. Maximum intercuspation
27. The teeth which have only one antagonist 33. The smallest vertical dimenson measure-
in the opposite arch are ment will be present in one of the following
a. Mandibular third molar and maxillary position
lateral incisor a. Edge-to-edge
b. Mandibular central incisors and b. Retruded contact
maxillary third molars
c. Maximum intercuspation
c. Maxillary and mandibular third
d. Retruded contact
molars
d. Maxillary and mandibular central 34. When the mandible slides in a protrusive
incisor contacting movement, the mandibular
teeth that make contact with maxillary
28. Opening of mandible is initiated by lateral incisors are
a. Cortical center a. Central and lateral incisors
b. Bulbay center b. Central incisors and canines
c. Pre-central gyrus c. Lateral incisors and canines
d. Post-central gyrus d. All of the above
23-b, 24-d, 25-a, 26-a, 27-b, 28-c, 29-a, 30-c, 31-c, 32-b, 33-c, 34-c
Occlusion 135
35. Moving the mandible from a maximum 40. In canine guided occlusion contact
intercuspal position to a retruded contact between posterior teeth occurs in
position usually results in a. Centric occlusion only
a. Increased occlusal vertical dimension b. Eccentric movement only
b. Decreased vertical overlap c. Protrusive movement only
c. Increased horizontal overlap d. Retrusive movement only
d. All of the above
41. In protrusion mandibular right central
36. In an ideal permanent tooth relationship, incisor occludes with maxillary
the tip of a mandibular canine in lateral a. Right lateral incisor only
excursion passes
b. Right central incisor only
a. Distal to the tip of maxillary canine
cusp c. Right and left central incisors only
b. Mesial to the tip of maxillary canine d. Right central and lateral incisor
cusp 42. In protrusion maxillary right central incisor
c. Directly in line with the maxillary contacts with mandibular
canine cusp tip a. Right and left mandibular central
d. Through the embrasure between the incisors
maxillary canine and first premolar b. Right central and lateral incisors
37. The wear facets on the incisal edges of c. Right central incisors only
the mandibular lateral incisors are d. Left central incisor only
caused by occlusion with the
43. In centric occlusion the cusp tip of
a. Maxillary central incisors only maxillary canine opposes
b. Maxillary central and lateral incisors a. Distal marginal ridge of mandibular
c. Maxillary lateral incisors and canines canine
d. None of the above b. Facial embrasure between lower
38. The non-working pathway of the maxillary canine and premolar
cusps on the mandibular posterior teeth c. Mesial marginal ridge of lower lateral
is towards the incisors
a. Distobuccal d. Interproximal space between lower
b. Mesiobuccal lateral and canine
c. Distolingual 44. The teeth in occlusion have
d. Mesiolingual a. Surface contact
39. The Bennett movement is best described b. Cusp to cusp contact
as the c. Cusp to fossa contact
a. Medial shift of the working condyle d. Marginal contact
b. Lateral movement of the non-working
45. Wilson curve in mandibular arch is
condyle
c. Bodily shift of the mandible in the a. Concave
direction of the working condyle b. Convex
d. Bodily shift of the mandible in the c. Concavoconvex
direction of the non-working condyle d. Convexoconcave
35-d, 36-b, 37-b, 38-a, 39-c, 40-a, 41-b, 42-b, 43-a, 44-d, 45-a
136 DADH Made Easy
46. In ideal occlusion with class I molar and 51. Direct lateral shift of condyle occurs
canine relationship, mesial cusp ridge of a. On working side
mandibular canine opposes maxillary b. On balancing side
a. Lateral incisor on distal side c. Both on working side and non-working
b. Canine on mesial side side
c. Lateral incisor on mesial slide d. Laterla shift never occurs
d. Canine on distal side 52. During lateral movements the balancing
side of condyle moves
47. In an ideal occlusion mesial marginal
a. Forward, downwards, mesially
ridge of maxillary canine
b. Forward, downwards, laterally
a. Opposes mesiobuccal cuspal ridge of
c. Forward, upwards, mesially
mandibular first premolar
d. Backwards, downwards and mesially
b. Opposes distal marginal ridge of
mandibular canine 53. The effect of benett shift will be on mesio-
distal positioning of
c. Is in line with mesial marginal ridge
of mandibular canine a. Lingual cusps of all teeth
b. Buccal cusps of all teeth
d. Opposes mandibular lateral incisor
c. Both buccal and lingual cusps
48. In centric occlusion, cusp of mandibular d. No effect on cusps
canine will oppose
54. Which is the active component in
a. Marginal ridge of upper canine and
masticatory apparatus
first premolar
a. TMJ
b. Marginal ridge of upper canine and
b. Muscles of mastication
lateral incisors
c. Molar teeth
c. Cingulum of maxillary canine
d. All of the above
d. Distal ridge of maxillary first premolar
55. Free way space is maximum at
49. In physiologic rest position of mandible a. Incisor region
there is
b. Canine region
a. Slight contact c. Premolar region
b. No contacts d. Molar region
c. Maximum contacts 56. Longest stage of deglutition is
d. None of the above a. Stage I b. Stage II
50. The movements of mandible during c. Stage III d. All stages are equal
chewing can be described as 57. The smallest permanent tooth in the
a. Being vertical and tear-drop in shape mouth is
b. Being horizontal and rhomboidal in a. Maxillary central incisor
shape b. Mandibular canine
c. Occurring only on working side c. Mandibular central incisor
d. Occurring only on non-working side d. Maxillary lateral incisor
46-a, 47-b, 48-b, 49-b, 50-a, 51-b, 52-a, 53-b, 54-a, 55-d, 56-c, 57-c
8
Blood and Nerve Supply to

Teeth and Tongue
SAQs (3 Marks)
Q 1. Describe blood and nerve supply to tongue. (May 2007)

Ans. Blood and Nerve Supply to Tongue
• The tongue and floor of the mouth are supplied by lingual artery.
• The lingual artery is a branch of external carotid artery.
• Its dorsal lingual branch supplies the base of the tongue.
• The deep lingual branch supplies the body and apex of the tongue.
• One of its terminal branches communicates with the deep lingual artery of the opposite
side and is called the ‘arcus raninus’.
• Venous drainage of tongue is quite peculiar and is from two different routes for two different
parts of tongue. The dorsal surface and side of the tongue drains into lingual vein, ventral
surface drains into deep lingual veins.
• Venous blood from lingual vein drains into facial vein and later into internal jugular
veins.
Nerve Supply
• The tongue is developed from the contribution of different arches which is reflected in the
nerve supply.
• Mucous membrane of anterior two-thirds of the tongue is supplied by mandibular branch
of trigeminal nerve.
• Posterior one-third of the tongue is supplied by glossopharyngeal nerve, the ninth cranial
nerve which carries the taste sensation from the posterior part.
• The hypoglossal nerve, the 12th cranial nerve supplies the voluntary muscles.
• Lingual branch of the mandibular branch of trigeminal nerve supplies the anterior two-
thirds of the tongue for general sensation of pain, temperature, touch, etc.
• Chorda tympanic branch of the 7th cranial nerve supplies the anterior two-thirds for special
sensation of taste.
• Posterior one-third is supplied by 9th cranial nerve, the glossopharyngeal nerve.
137
138 DADH Made Easy
Q 2. Write about blood and nerve supply to teeth.

Ans. Blood Supply
• Mandibular teeth and supporting structures are supplied by inferior alveolar artery which
is a branch of maxillary artery.
• Interior alveolar artery passes through the mandibular foramen to enter into the mandibular
canal and terminate as mental and incisive arteries.
• Maxillary teeth receive arterial supply from two different sources: Posterior superior alveolar
artery supplies the molars and premolars while anterior superior alveolar artery supplies
the anterior teeth.
• The veins drain into either facial vein or pterygoid plexus of veins.
• The lymph vessels from teeth run directly into the submandibular nodes on the same side.
Lymph from lower incisors may drain into submental nodes. Sometimes molars may drain
directly into jugulodigastric gray of nodes.
Nerve Supply
The pulp and periodontal membrane have the same nerve supply which is different from that
of the overlying gingiva.
• Mandibular incisors are innervated by incisive nerve premolar and molars are innervated
by inferior alveolar nerve.
• Maxillary anterior teeth are innervated by anterior superior alveolar nerve.
Premolars and mesiobuccal root of first molar are innervated by middle superior alveolar
nerve. Molars are innervated by posterior superior alveolar nerve.
Blood and Nerve Supply to Teeth and Tongue 139
1. The mental foramen on each side lies 8. Lymph from mandibular posterior teeth
near the apex of the is drained into
a. Mandibular canine a. Submental lymph nodes
b. Mandibular first premolar b. Submandibular lymph nodes
c. Mandibular second premolar c. Submental and submandibular lymph
d. In between mandibular first and nodes
second premolar d. Cervical lymph nodes
2. The mental foramen in most humans is 9. Branches of maxillary artery that supply
located superior to the inferior border of the temporomandibular Joint are
the mandible at a distance of a. Anterior tympanic
a. 10–12 mm b. 8–10 mm b. Masseteric
c. 13–15 mm d. 6–8 mm c. Middle meningeal
3. The single, bilaterally symmetrical, d. All the above
movable, bone of the skull is
10. The facial nerve is
a. Maxilla b. Temporal
a. Sensory nerve
c. Mandible d. Occipital
b. Motor nerve
4. The carotid artery that supplies the mouth c. Mixed nerve
a. External carotid d. None of the above
b. Internal carotid
11. Mandibular torus is found on the
c. Both a and b
a. Labial side of the mandible
d. Middle carotid
b. Lingual side of the mandible
5. The blood supply to maxillar y and c. Angle of the mandible
mandibular teeth is by
d. Lower border of the mandible.
a. Mandibular part of maxillary artery
12. Mandible is a following type of bone
b. Anterior tympanic
a. Intracartilagenous
c. Middle meningeal
d. Laryngeal b. Intracartilagenous and intramem-
branous
6. The inferior alveolar artery supplies c. Intramembranous
a. Maxillary molars d. None of the above
b. Mandibular molars and premolars
13. The sections of the teeth clearly seen on
c. Both a and b
standard radiographs are
d. Maxillary central incisor
a. The labial and buccal longitudinal
7. The symphyseal cartilage ossifies sections
a. Before birth b. The mesial and distal aspect of
b. At birth longitudinal sections
c. One year after birth c. Both
d. At 21 years of age d. None of the above
1-c, 2-c, 3-c, 4-a, 5-a, 6-b, 7-c, 8-b, 9-d, 10-c, 11-b, 12-b, 13-a
140 DADH Made Easy
14. The lingual plate is paper thin over the 21. The bone buccal to last two molars in
lingual alveolus of the mandible is
a. Maxillary first molar a. Very heavy and thick
b. Maxillary premolar b. Very thin
c. Maxillary second and third molars c. Moderately thick
d. Mandibular molars d. Moderately thin
22. Mandible is formed by
15. Mandibular anterior teeth have sensory
a. Endochondral ossification method only
nerve supply from
b. Intramembranous ossification
a. Superior alveolar nerve
c. Both endochondral and intramem-
b. Inferior alveolar nerve branous ossification
c. Lingual nerve d. None of the above
d. Buccal nerve 23. The sutural junction where frontal and
16. Lower lip gets sensory nerve supply from parietal bones unite is termed
a. Buccal branch of facial nerve a. Nasion b. Bregma
b. Mandibular branch of facial nerve c. Lamboid d. Frontion
c. Buccal branch of mandibular nerve 24. Lingula is the projection of bone on the
d. Mental nerve following part of the mandible
a. Medial aspect of vertical ramus of
17. Buccinator muscle receives its motor mandible
nerve supply from b. Inner aspect of mandible at midline
a. Zygomatic branch of facial nerve c. Outer aspect of mandible near mental
b. Buccal branch of trigeminal nerve foramen
c. Buccal branch of facial nerve d. None of the above
d. Mandibular branch of facial nerve. 25. Genial tubercles are the tiny projections
18. Hypoglossal nerve is motor nerve for all of the bone present in
the muscles of tongue except a. Inner aspect of mandible near mylohyoid
ridge
a. Superior longitudinal muscle
b. External surface of mandible near
b. Inferior longitudinal muscle symphysis menti
c. Genioglossus c. Inner aspect of mandible at midline
d. Palatoglossus d. The lingula
19. The line of posterior alveoli of mandibular 26. Lingual foramen is present on
teeth are inclined a. Inner aspect of vertical ramus
a. Labially b. Outer aspect of mandible near pre-
b. Lingually molar region
c. Not inclined, are straight c. Inner aspect of mandible near midline
d. The symphysis menti
d. Mesially
27. Lymph drainage from all the following
20. The mandibular anterior teeth have structures go to submandibular lymph
alveoli tipped nodes, except
a. Labially a. Mandibular teeth
b. Lingually b. Occipital part
c. Not tipped c. Tongue
d. Mesially d. Maxillary teeth
14-a, 15-b, 16-d, 17-c, 18-d, 19-b, 20-a, 21-a, 22-c, 23-b, 24-a, 25-c, 26-c, 27-b
9
Muscles of Mastication
SAQs (3 Marks)
Q 1. Enumerate and describe muscles of mastication (Oct. 2002, 2003, June 2005, 2006)
Ans. Muscles of Mastication
• The masticatory muscles surrounding the joint are group of muscles that contract and relax
in harmony so that the jaws function properly.
• There are four pairs of muscles of mastication, masseter, temporalis, medial pterygoid, and
lateral pterygoid.
Masseter
• It is the principal and strongest muscle of mastication, which stems from the temporal bone
and extends down the outside of the mandible to its lower angle. It consists of two
overlapping heads:
• Origin: Zygomatic arch.
• Insertion: Lateral surface of ramus, angle and border of mandible.
• Nerve supply: Masseter nerve.
• Function: To close the jaw and apply power in crushing food.
Temporalis Muscle
• It is a fan-shaped muscle and the largest masticatory muscle that fills the temporal fossa.
• Origin: Temporal fossa and the overlying temporal fascia.
• Insertion: Coronoid process of mandible, anterior border of ramus and temporal crest of
mandible via one common tendon.
• Nerve supply: Temporal branch of mandibular nerve.
• Function: Its anterior fibers help in elevation of mandible. Its posterior fibers help in retracting
the protruded mandible.
Medial Pterygoid Muscle

• It runs parallel to the masseter muscle but on the inside of the jaw.
• Origin: From the medial surface of the lateral pterygoid plate.
• Insertion: On the medial surface of mandible in the triangular region just above the angle.
141
142 DADH Made Easy
• Nerve supply: The nerve to the medial pterygoid, a branch of main trunk of mandibular
teeth.
• Function: Elevation and protrusion of mandible.
Lateral Pterygoid Muscle

• It is a short conical muscle and has upper and lower heads.
• Origin: Sphenoid bone.
• Insertion: Into the neck of condyle.
• Nerve supply: Branch of anterior division of mandibular nerve.
• Function: In opening of the jaw, in protrusion and lateral movements of mandible.
Q 2. What is Mastication? (July 2005)

Ans. Mastication
• It is a complex rhythmical activity that requires coordination of the neuromusculature. It
is the cutting down of food substances in small particles and grinding them into a small
bolus.
• Mastication is a repititive sequence of jaw opening and closing with a profile in the vertical
plane called the ‘chewing cycle’.
• Mastication consists of number of chewing cycles opening phase, closing phase, occlusal or
intercuspal phase.
• Each chewing cycle lasts approximately for .8 to 1.0 sec.
• During normal function 7 to 15 kg force occurs during swallowing and chewing.
• The act of mastication begins with “setting the system” by sight, tactile sense and smell to
receive the food.
• When food is taken into mouth, the lips, tongue and periodontium function to estimate
size, hardness, etc. of food.
• This information sets the chewing program in pattern.
• Chewing is highly complex.
• The duration of chewing cycle varies between 1 to 6 sec, depending on the type of food.
• Speed, duration and form of the chewing cycle vary with the type of occlusion, kind of
food, and presence of dysfunction.
Muscles of Mastication 143
1. Retraction results from the bilateral 7. Contraction of posterior fibres of temporalis

contraction of the muscle results in
a. Medial pterygoid a. Retrusion b. Protrusion
b. Lateral pterygoid c. Opening d. Closing
c. Posterior fibers of the temporalis 8. The position in which there is relative
muscle muscular equilibrium is
d. Masseter a. Retruded contact position
2. Protraction results from the simultaneous b. Postural position
contraction of c. Protruded contact position
a. Right and left medial pterygoid d. None of the above
b. Right and left lateral pterygoid 9. Except one pair all the following are jaw
c. Temporalis elevators
d. Buccinator a. Masseter
3. Sideway movement of mandible results b. Temporalis
from the contraction of c. Medial pterygoid
a. One lateral pterygoid muscle on d. Lateral pterygoid
opposite side 10. All the following muscles are elevators
b. One medial pterygoid muscle on of mandible except
opposite side a. Masseter b. Digastric
c. Pterygoid muscle c. Temporalis d. Medial pterygoid
d. Temporalis
11. Medial pterygoid takes its origin on
4. In the opening of the mouth, all of the a. Medial surface of lateral pterygoid
following muscles take part, except plate (sphenoid bone)
a. Temporalis b. External pterygoid plate
b. Platysma c. Styloid process
c. Digastric d. Zygoma
d. Lateral pterygoid
12. Buccinator muscle receives its motor
5. Muscle attached to articular disc is nerve supply from
a. Lateral pterygoid a. Zygomatic branch of facial nerve
b. Medial pterygoid b. Buccal branch of trigeminal nerve
c. Masseter c. Buccal branch of facial nerve
d. Temporalis d. Mandibular branch of facial nerve
6. The muscle which moves the disc of the 13. The following muscles take their origin on
TMJ forward is medial surface of mandible except
a. Lateral pterygoid a. Medial pterygoid muscle
b. Medial pterygoid b. Mylohyoid muscle
c. Temporalis c. Genioglossus muscle
d. Masseter d. Superior constrictor
1-c, 2-b, 3-a, 4-a, 5-a, 6-a, 7-a, 8-b, 9-d, 10-b, 11-a, 12-c, 13-d
144 DADH Made Easy
14. The combined pull of two lateral ptery- 18. Opening of mouth (depression) results
goid muscles along with the anterior from the bilateral contraction of
bellies of the two digastric and the other a. Both lateral pterygoid
suprahyoid muscles will result in b. Masseter
a. Protrusion c. Medial pterygoid
b. Retrusion d. Buccinator
c. Closing 19. During the opening of mouth there is
d. Opening of mandible a. Only translation movement
b. Only hinge movement
15. The fan shaped large and flat muscle is
c. First hinge and then translation move-
a. Buccinator
ment
b. Temporalis d. Sliding movement
c. Masseter 20. Temporalis muscle performs the function
d. Medial pterygoid of
16. Out of the four pairs of muscles of a. Elevation b. Retraction
mastication the only pair of muscle c. Clenching d. All of the above
which is oriented horizontally is 21. The most superficial bulky and powerful
a. Medial pterygoid muscle of mastication is
b. Lateral pterygoid a. Temporalis
c. Masseter b. Masseter
d. Temporalis c. Medial pterygoid
d. Lateral pterygoid
17. Closing of the mouth (elevation) results
22. The muscle which is not antigravity
from the bilateral contraction of
muscle is
a. Right and left temporalis a. Masseter
b. R and L masseter b. Temporalis
c. R and L medial pterygoid c. Medial pterygoid
d. All of the above d. Lateral peterygoid
14-d, 15-b, 16-b, 17-d, 18-a, 19-c, 20-d, 21-b, 22-d

10
Deglutition
SAQs (3 Marks)
Q 1. Define deglutition. (Oct. 2004, July 2005, June 2007, May 2009, 2013)
Ans. Swallowing of food is known as deglutition:
Deglutition occurs in 3 stages, namely.
1. Oral stage—when food enters from mouth into pharynx.
2. Pharyngeal stage—when food enters esophagus from pharynx.
3. Esophageal stage—when food enters stomach from esophagus.
• Oral stage: It is preceded by mastication. The passage of food through oral cavity into the
pharynx occurs in this stage. This is a voluntary stage.
• Pharyngeal or second stage: In this stage, the bolus is pushed from pharynx into the
esophagus. It is an involuntary stage.
The pharynx is a common passage for food and air.
It divides into larynx and esophagus.
Larynx lies anteriorly and continues as respiratory passage. Esophagus lies behind the larynx
and continues as GIT.
During this stage of swallowing, the bolus can enter 4 ways into the pharnyx, which are:
a. Back into mouth
b. Upward into nasopharynx
c. Forward into larynx
d. Downward into the esophagus.
The various movements are coordinated so that the bolus enters only the esophagus.
The entrance of bolus through other outlets is prevented as follows:
a. Back into mouth is prevented by position of the tongue and the high intraoral pressure
created by the movement of the tongue.
b. Upward into nasopharynx is prevented by elevation of soft palate.
c. Forward into larynx is prevented by:
• Approximation of vocal cords.
• Forward and upward movement of larynx.
145
146 DADH Made Easy
• Backward movement of epiglottis to close the larynx and by temporary arrest of

breathing.
• This occurs during second stage of swallowing and apnea during deglutition is called
“deglutition apnea, or “swallowing apnea”.
d. Entrance of bolus into esophagus.
As the other three paths are closed for the Bolus, it has to only pass through the esophagus.
This occurs by the combined effects of various factors:
• Upward movement of the larynx.
• Relaxation of upper 3–4 cm of esophagus.
• Peristaltic contraction in the pharynx.
• Lifting away of glottis from the food passage due to elevation of larynx.
The whole process takes place within 1–2 sec and this process is purely involuntary.
• Esophageal or third stage: This is also an involuntary stage.
The function of esophagus is to transport the food from pharynx to the stomach.
The movements of esophagus are specifically organized for this function and these
movements are called “peristaltic waves”, which propel the bolus into the stomach.
Q 2. What is speech regulatory center? (June 2007)

Ans. Speech Regulatory Center
• Speech is one of the functions of the upper aerodigestive tract and is an activity that involves
nerves, muscles, and mechanical factors such as movement of air and hearing.
• Speech is produced and modified in the vocal tracts.
• The term language center refers to the area of the brain which serves a particular function
for speech processing and production. For example, Broca’s area and Wernicke’s area.
• Most areas of speech processing develop in second year of life in the dominant half
(hemisphere) of the brain, which corresponds to the opposite of dominant hand. Nenety
eight percent of right handed people are left hemisphere dominant and majority of left
hand people as well.
• Broca’s area is located in left inferior frontal cortex (left cerebral hemisphere in the inferior
frontal gyrus of the frontal lobe).
• Wernicke’s area is located in the superior temporal gyrus of the temporal lobe.
• Broca’s area is an speech production center with motor functions.
• Wernicke’s area is a language center with motor comprehension center which is next to
primary auditory cortex. It controls meaningful or logical speech.
• The cranial nerves involved in speech production are V, VII, X, XII.
Deglutition 147
1. The process of preventing entry of food 4. The stage of deglutition which is voluntary
bolus into the respiratory tract in the is
pharyngeal stage is known as a. Pharyngeal b. Esophageal
a. Respiration of swallowing c. Oral d. Both a and b
b. Deglutition apnea
5. Respiration stops for a while in the following
c. Both
phase of swallowing
d. None
a. Esophageal b. Oral
2. Muscle that closes nasopharynx during c. Pharyngeal d. Both b and c
deglutition is
a. Levator palate 6. Newborn and infants feed by a process
b. Tensor palate called
c. both a and b a. Suckling b. Sucking
d. Palato glossus c. Mastication d. All of the above
3. The number of times swallowing takes 7. Irritation or noxious stimulation of the
place per day in an individual is approxi- posterior of the oral cavity results in the
mately following reflex
a. 600 times b. 60 times a. Swallowing b. Masticatory
c. 6000 times d. 1600 times c. Suckling d. Vomiting
1-b, 2-c, 3-a, 4-c, 5-d, 6-a, 7-d

11
Temporomandibular Joint
SAQs (3 Marks)
Q 1. Describe ligaments of temporomandibular joint.

(June 2004, Nov. 2010, 2014, 2015, May 2012, Oct. 2015)
Ans. Ligaments of Temporomandibular Joint
• The TMJ has one major and three minor ligaments.
• The temporomandibular ligament is the major ligament.
• The sphenomandibular ligament, the stylomandibular ligament and pterygomandibular
raphae are minor ligaments.
• The temporomandibular ligament (lateral ligament) strengthens the joint capsule. It is
infact the thickened lateral portion of the capsule.
• The function of this ligament is to provide the main support to the joint and to resist
dislocation during functional movements.
• Sphenomandibular ligament is a flat, thin band which is attached to the spine of the
sphenoid above and to the lingula of the mandible below.
The function of this ligament is to limit distension of the mandible in an inferior direction.
• Stylomandibular ligament: This ligament is a specialized band or the free border of the cervical
fascia which extends from the apex of the styloid process of the temporal bone to the posterior
border of the angle of the mandible, between the masseter and internal pterygoid.
This ligament along with the sphenomandibular ligament, limits excessive opening of the
mandible.
• Pterygomandibular raphae: It is a tendinous band of the buccopharyngeal fascia attached
by one extremity to the hamulus of the medial pterygoid plate and by the other extremity
to the posterior end of the mylohyoid line of the mandible.
Q 2. What is synovial membrane? (Oct. 2004)
Ans. Synovial Membrane
• The synovial membrane is a thin and flexible layer lining the inner surface of the capsule.
It covers all the intraarticular surfaces except pressure-bearing fibrocartilage.
• The synovial membrane consists of two layers.
The cellular intima layer and the vascular sub-intima layer.
• Function of synovial membrane is to produce fluid which helps in lubricating the joint,
repairing the wear.
148
Temporomandibular Joint 149
1. During the opening of mouth there is 8. Meniscus of TMJ in older person is

a. Only translation movement a. Synovial
b. Only hinge movement b. Cartilagenous
c. First hinge and then translation move- c. Fibrocartilagenous
ment d. Fibrous
d. Sliding movement 9. Muscle attached to articular disc is
2. Temporomandibular joint is found in a. Lateral pterygoid
b. Medial pterygoid
a. Only mammals
c. Massetor
b. Reptiles
d. Temporalis
c. Amphibians
10. The muscle which moves the disc of TMJ
d. Mammals and reptiles
forward is
3. Synovial membrane is present in a. Lateral pterygoid
a. Temporomandibular joint b. Medial pterygoid
b. Knee joint c. Temporalis
c. Wrist joint d. Masseter
d. All of the above 11. The articulation between the movable
4. Capsule of TMJ is weakest mandible and the stationary skull is
known as
a. Anteriorly
a. Temporomandibular joint
b. Laterally
b. Craniomandibular joint
c. Medially
c. Both a and b
d. Posteriorly d. Gomiohosis
5. The only ligament that gives direct 12. The mandible functions as which type of
support to the capsule of the TMJ is lever
a. Sphenomandibular ligament a. Class I b. Class II
b. Stylomandibular ligament c. Class III d. Class IV
c. Temporomandibular ligament 13. Medially and laterally, the articular disc
d. None of the above is attached to
6. The amount of synovial fluid a. Lateral pterygoid
a. Increases with age b. Squamotympanic fissure
b. Decreases with age c. Condylar neck
d. Joint capsule
c. Does not depend on age
d. None of the above 14. Glenoid fossa is
a. Central fossa of mandibular first molar
7. The articular surface of TMJ in made-up of
b. Articulating surface of mandibular
a. Vascular fibrous tissue condyle
b. Calcific tissue c. Depression in maxilla distal to canine
c. Hyaline tissue fossa
d. None of the above d. None of the above
1-c, 2-a, 3-d, 4-c, 5-c, 6-b, 7-c, 8-d, 9-a, 10-a, 11-c, 12-c, 13-d, 14-b
150 DADH Made Easy
15. TMJ is capable of performing full opening c. Forwards and downwards

movements and slight gliding movements d. Forwards and upward.
and this type of joint can be described as
19. The movement that occurs during open-
a. Ball and socket joint ing of mandible from retruded contact
b. Hinge joint position is
c. Pivot joint a. Hinge movement only
d. Condylar joint b. Sliding movement
16. Contraction of lateral ptyerygoid causes c. Hinge followed by sliding
meniscus to move forwards and this d. Sliding followed by hinge
results
20. The stylomandibular ligament of TMJ is
a. Posterior movement of condyles in the attached
glenoid fossa
a. Above to the lateral surface of the
b. Forward and downward movement of styloid process
the condyles
b. Below to the angle and posterior
c. Forceful closure of the mandible border of the ramus of the mandible
d. None of the above c. Both a and b
17. Which of the following protects TMJ in d. None of the above
function?
21. TMJ gets its blood supply from
a. Synovial fluid
a. Branches from superficial temporal
b. Ligaments of the capsule
and maxillary arteries
c. Muscles of mastication
b. Branches from mandibular arteries
d. All of the above
c. External carotid artery
18. When mandible is brought forward to d. Mental artery
make edge to edge contacts there is
both hinge and gliding movements. The 22. TMJ gets its nerve supply/TMJ is innervated
condyles contacts there is both hinge by
and gliding movements. The condyles in a. Auriculotemporal nerve
the glenoid fossa moves. b. Masseter nerve
a. Forward only c. Both a and b
b. Backward only d. None of the above
15-b, 16-b, 17-d, 18-c, 19-c, 20-c, 21-a, 22-c

12
Maxillary Sinus
SAQ (3 Marks)
Q 1. Describe maxillary sinus. (June 2008)

Ans.
• It is also called “maxillary antrum”, and the “antrum of Highmore”.
• It is the pneumatic space that is lodged inside the body of the maxilla and it communicates
with the environment by way of the middle nasal meatus and the nasal vestibule.
• It is large, four-sided, pyramid-shaped cavity. Its size is 25 × 30 × 30 mm. Capacity of 15 ml
or about 1 tablespoon.
• The sinus cavity floor extends inferiorly into the base or top of the alveolar process where
many projections of the apical ends of the molar roots and sometimes, premolar roots are
found.
• Histology of maxillary sinus:
– Microscopically three layers surround the maxillary sinus space—the epithelial layer,
basal lamina, and subepithelial layer including periosteum.
– The epithelium is pseudostratified, columnar and ciliated. The most numerous cellular
type is columnar ciliated epithelial cell.
– In addition basal cells, columnar nonciliated cells, and Goblet cells are also seen.
– A ciliated cell has nucleus and cytoplasm with numerous mitochondria and enzyme
containing organelles. The cilia are typically composed of 9+1 pairs of microtubules and
they provide the motile apparatus to the sinus epithelium. By way of ciliary beating the
mucous blanket lining the epithelial surface moves from sinus toward nasal cavity.
– The Goblet cell displays all of the characteristic features of a secretary cell. In the basal
segment of the cell is the nucleus, rough, and smooth endoplasmic reticulum and golgi
apparatus. All of which are involved in the synthesis of secretory mucosubstances. From
the golgi apparatus the zymogenic granules transport the mucopolysaccharides toward
the cellular apex and finally release this material onto the epithelial surface by exocytosis.
– In addition to the epithelial secretion, the surface of the sinus is provided with a mixed
secretory product from the subepithelial glands. These are located in the subepithelial
layer of the sinus and reach the sinus lumen by way of excretory ducts. Acini of
subepithelial glands has varying proportions of serous and mucous cells.
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• Functions:
– Lighten the skull, give resonance to voice, warm the air we breathe, moisten the nasal
cavity.
– It enhances faciocranial resistance to mechanical shock.
• Clinical considerations:
– Agenesis, aplasia or hypoplasia of the maxillary sinus occurs either alone or in association
with other anomalies, e.g. cleft palate, high palate, and septal deformity.
– Since upper first molar is very close to the floor of maxillary sinus, surgical manipulation
on this tooth breaks the bony lamina and creates an oroantral fistula.
Fig. 12.1: Maxillary sinus

Maxillary Sinus 153
1. Opening of maxillary sinus is situated in 6. The maxillary sinus communicates with

a. Superior meatus the environment by
b. Middle concha a. Superior nasal meatus
c. Inferior meatus b. Middle nasal meatus
d. Hiatus semilunaris c. Middle nasal meatus and nasal vestibule
2. Maxillary sinus is lined with d. Inferior nasal meatus
a. Squamous cell epithelium 7. The secretary cells present in the sub-
b. Columnar epithelium epithelial glands of maxillary sinus are
c. Pseudostratified ciliated columnar a. Mucous cells
epithelium b. Serous cells
d. Stratified squamous epithelium c. Both of the above
3. The largest sinus is d. None of the above
a. Maxillary 8. The functions of maxillary sinus are
b. Frontal a. Protect the internal structures against
c. Ethmoid exposure to cold air
d. Sphenoid b. Contribute resonance to voice
4. The first formed sinus is c. Mastication
a. Maxillary b. Frontal d. Both a and b
c. Ethmoid d. Sphenoid 9. The maxillary sinus is also called as
5. The paranasal sinus which is not paired a. Antrum of maxilla
is b. Antrum of mandible
a. Maxillary b. Frontal c. Antrum of highmore
c. Ethmoid d. Sphenoid d. Antrum of lowmore
1-d, 2-c, 3-a, 4-a, 5-d, 6-c, 7-c, 8-d, 9-c

Section II
Dental Histology
13. Development of Tooth and Face
14. Enamel
15. Dentin
16. Pulp
17. Cementum
18. Periodontal Ligament
19. Bone
20. Oral Mucous Membrane
21. Salivary Glands
22. Tooth Eruption
23. Shedding of Deciduous Teeth
24. Preparation of Specimen for Histologic Study
13
Development of
Tooth and Face
LAQs (10 Marks)
Q 1. Enumerate various stages of tooth development. Describe in detail early bell stage.
(Nov. 2000, May 2015)
Ans. Introduction
• The primitive oral cavity, stomodeum is lined by ectoderm. Deep to oral epithelium is the
ectomesenchyme which is thought to instruct the overlying ectoderm to start tooth
development.
• Oral epithelium gives rise to two horseshoe-shaped bands of tissues at the surface of
stomodeum, one for each jaw. These are called as primary epithelial bands.
• At about 7th week, primary epithelial band divides into dental lamina and vestibular lamina.
• At certain points along the dental lamina, little outgrowths from the dental lamina grow
into the underlying mesenchyme, these are known as enamel organs.
• As cell proliferation continues, each enamel organ increases in size and changes its shape.
Based on the shape of enamel organ, morphologic stages of tooth development are described
as:
1. Bud stage 3a. Early bell stage
2. Cap stage 3b. Advanced bell stage
On the basis of histophysiological process, development of tooth can be described as:
1. Initiation
2. Proliferation
3. Histodifferentiation
4. Morphodifferentiation
5. Apposition
Early Bell Stage (Fig. 13.1)
Features of tooth germ at early bell stage are:
• By the 14th week, further proliferation of the tooth germ leads to bell stage. As the under
surface of the cap deepens, the enamel organ takes the shape of a bell.
• In this stage, the crown of the tooth gets its final shape (morphodifferentiation) and cells
that form the hard tissues of the crown (the ameloblasts that form the enamel and
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Fig. 13.1: Early bell stage of tooth development
odontoblasts that form the dentin) acquire histodifferentiation. The inner enamel epithelial
cells at the future cusp tip or incisal region, stop dividing and begin to differentiate. Cell
differentiation proceeds gradually cervically.
• During this stage, dental lamina joining the enamel organ to the oral epithelium, breaks up
into discrete islands of cell rests of Serres.
• At this stage, developing tooth germ shows enamel organ, dental papilla and denta
sac.
Enamel Organ
At bell stage, four different layers of cells can be distinguished in enamel organ, outer enamel
epithelium, inner enamel epithelium, stellate reticulum, and stratum intermedium.
1. Inner Enamel Epithelium (IEE)

• IEE consists of a single layer of cells that differentiate prior to amelogenesis into tall columnar
cells called ameloblasts. These cells are 4–5 nm in diameter and 40 nm high.
• The cells of IEE are separated from dental papilla by a basement membrane. They are attached
to one another by junctional complexes laterally and to the cells of the stratum intermedium
by desmosomes.
• At the regions associated with the future cusp tips or incisal regions the IEE cells become
elongated and this differentiation gradually reaches cervically.
• The basement membrane that separates the enamel organ and dental papilla just prior to
dentin formation is called the membrana preformativa.
• The folding of inner enamel epithelium causes different crown shapes due to difference in
the rate of mitosis and differences in cell differentiation time.
• Inner enamel epithelium meets the outer enamel epithelium at the rim of the enamel organ.
This junctional zone is known as cervical loop.
• Functions: Cells differentiate prior to amelogenesis into tall columnar cells called
preameloblasts which later form enamel. These cells exert an organizing influence on
peripheral cells of dental papilla so that they differentiate into odontoblasts.
The folding of IEE causes different crown shapes.
Development of Tooth and Face 159
2. Stratum Intermedium
• It first appears at early bell stage and consists of 2–3 layers of squamous cells lying between
inner enamel epithelium and the stellate reticulum.
• It is absent in the root portion of the tooth germ.
• The cells are connected to one another and to the cells of inner enamel epithelium and
stellate reticulum by desmosomes and gap junctions.
• These cells contain alkaline phosphatase and are rich in glycogen.
• Function: It is concerned with the synthesis of enamel proteins and transport of nutrients to
the ameloblasts. It is essential for enamel formation.
3. Stellate Reticulum (SR)
• SR is most fully developed at bell stage. It expands further mainly by increase in the amount
of intercellular fluid. The cells are star shaped with bodies containing conspicuous nucleus
and many branching processes.
• Desmosomal junctions are observed between the cells of stellate reticulum, stratum
intermedium and outer enamel epithelium.
• Functions: These serve to protect the delicate enamel forming cells, inner enamel epithelial
cells, by acting as a shock absorber.
Before enamel formation begins, the stellate reticulum collapses reducing the distance
between the ameloblasts and the nutrient capillaries near the outer enamel epithelium.
4. Outer Enamel Epithelium
• Cells are flat to low cuboidal in shape, separated from the surrounding ectomesenchyme
cells by a basement membrane.
• The cytoplasm consists of few organelles, free ribosomes, few rough endoplasmic reticulum,
some mitochondria, and scattered tonofilaments. Adjacent cells are joined by junctional
complexes.
• At the end of the bell stage, the smooth surface of the OEE is laid in folds. Between the
folds, the adjacent mesenchyme of the dental sac forms papillae that contain capillary loops,
thus providing nutritional supply to the enamel organ.
• Functions: It maintains shape of the enamel organ.
It helps in exchange of nutrients between the enamel organ and the dental sac.
Dental Papilla (DP)

• It is enclosed in the invaginated portion of the enamel organ. It consists of closely packed
mesenchymal cells with only a few delicate extracellular fibrils.
• Function: Before the cells of inner enamel epithelium begin to produce enamel, the peripheral
cells of dental papilla differentiate into odontoblasts under the organizing influence of inner
enamel epithelium and form dentin. The dental papilla ultimately gives rise to dental pulp
once dentin formation starts.
• The basement membrane that separates the enamel organ and dental papilla just prior to
dentin formation is called the membrana preformativa.
Dental Sac (DS)

• Before formation of dental tissues begins, dental sac shows a circular arrangement of its
fibers and resembles a capsular structure.
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• Function: It serves as a primordium for formation of cementum, alveolar bone, and

periodontal ligament.
Q 2. Name the stages of tooth development. Describe in detail the advanced bell stage.
(SAQ, July 2005, May 2009, 2015)
Ans. Introduction
• The primitive oral cavity or stomodeum is lined by ectoderm. Deep to oral epithelium is the
ectomesenchyme which is thought to instruct the overlying ectoderm to start tooth development.
• Oral epithelium gives rise to two horseshoe-shaped bands of tissues at the surface of
stomodeum, one for each jaw. These are called as primary epithelial bands.
• At about 7th week, primary epithelial band divides into dental lamina and vestibular lamina.
• At certain points along the dental lamina, little outgrowths from the dental lamina grow
into the underlying mesenchyme, these are known as Enamel organs.
• As cell proliferation continues, each enamel organ increases in size and changes its shape.
Based on the shape of enamel organ, morphologic stages of tooth development are described
as:
1. Bud stage
2. Cap stage
3a. Early bell
3b. Advanced bell stage
• On the basis of histophysiological process, development of tooth can be described as:
1. Initiation
2. Proliferation
5. Apposition
ADVANCED BELL STAGE/LATE BELL STAGE (Hard tissue formation stage/crown stage/appositional
stage) (Fig. 13.2)
• This stage commences at about 18th week.
Fig. 13.2: Advanced bell stage of tooth development

Features of tooth germ at advanced bell stage are:
Enamel Organ
• It is characterized by formation of two principal hard tissues, enamel and dentin, and root
formation. Formation of dentin always precedes enamel formation.
• Four different types of epithelial cells can be distinguished in enamel organ at advanced
bell stage.
1. Inner Enamel Epithelium (IEE)

• At the site of future cusp tips and incisal areas where dentin will first be formed, the cells
of inner enamel epithelium become tall columnar and their nuclei become aligned at
the proximal end of the cells adjacent to the stratum intermedium. This is reversal of
polarity.
• There is migration of cellular organelles responsible for enamel protein formation from
proximal end to the distal end of the ameloblast.
• This reversal of polarity is in preparation to formation of enamel matrix.
• The cells of IEE exert an organizing influence on the underlying mesenchymal cells of dental
papilla, which later differentiate into odontoblasts.
• After the first layer of dentin is formed only then the cells of the inner enamel epithelium
differentiate further, assuming a secretory function and producing an organic matrix against
the newly formed dentin surface. It immediately gets partially mineralized and becomes
the enamel of the crown.
• Before the formation of first dentin, enamel organ and in particular the cells of the inner
enamel epithelium receive nutrition from blood vessels located in the dental papilla and
those situated along the periphery of the outer enamel epithelium.
• After the first layer of dentin is formed, blood supply from dental papilla to the enamel
organ is cut-off. Enamel organ then gets nutrition from dental sac.
• The enamel formation then proceeds coronally and cervically, in all regions from the
dentinoenamel junction towards the surface.
2. Stratum Intermedium
• It first appears at early bell stage and consists of 2–3 layers of squamous cells lying over
inner enamel epithelium.
• The cells are connected to one another and to the cells of inner enamel epithelium and
stellate reticulum by desmosomes and gap junctions.
• These cells contain alkaline phosphatase.
• Function: It has been suggested that stratum intermedium is concerned with the synthesis
of enamel proteins and transport of nutrients to the ameloblasts. It is essential for enamel
formation.
• It is absent in the part of the tooth germ that outlines the root portion of the tooth which
does not form enamel.
3. Stellate Reticulum
• At early bell stage, stellate reticulum collapses so that the ameloblasts are approximated to
the blood vessels lying outside the outer enamel epithelium and their demand of nutrition
is satisfied.
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4. Outer Enamel Epithelium

• In the late bell stage, preparatory to and during the formation of enamel, the formerly
smooth surface of outer enamel epithelium is laid in folds. Between the folds, the adjacent
mesenchyme of the dental sac forms papillae that contain capillary loops and thus provide
a rich nutritional supply for the intense metabolic activity of the avascular enamel organ.
Dental Papilla
• The undifferentiated mesenchymal cells of dental papilla increase rapidly in size and
ultimately differentiate into odontoblasts, the dentin forming cells. This differentiation is
initiated by an organizing influence of inner enamel epithelium on dental papilla.
• The increase in size of the papillary cells to become odontoblasts eliminates the acellular
zone between dental papilla and inner enamel epithelium.
• Odontoblasts contain increasing amount of rough endoplasmic reticulum and golgi complexes.
They have highly polarized nuclei which are positioned away from inner enamel epithelium.
• Enamel formation cannot begin until some dentin has been formed. This interdependency
between the two tissues is an example of epithelial-mesenchymal interaction.
• Odontoblasts as they differentiate, begin to elaborate organic matrix of the dentin, which
gets ultimately mineralized.
• Formation of dentin occurs first as a layer along the future dentinoenamel junction in the
region of future cusps and proceeds pulpally and apically. After the first layer of dentin is
formed, the newly differentiated ameloblasts lay down enamel over the dentin.
• Cervical portion of the enamel organ gives rise to the epithelial root sheath of Hertwig.
Hertwig’s epithelial root sheath outlines the future root and is responsible for the shape, length,
size, and number of roots.
Dental Sac
• Before the formation of dental tissues begins, dental sac shows a circular arrangement of its
fibers and resembles a capsular structure.
• Function: It serves as a primordium for formation of cementum, alveolar bone, and
• With the development of the root, fibers of the dental sac differentiate into periodontal
fibers that become embedded in the developing cementum and alveolar bone.
Q 3. Enumerate various stages of tooth development. Describe in detail bell stage.

(July 2006, May 2008)
Ans. Describe early and advance bell stage from Q 1 and Q 2.
SAQs (3 Marks)
Q 1. Describe cap stage. (June 2011, 2013)

Ans.
• Based on the shape of enamel organ, morphologic stages of tooth development are described
as bud stage, cap stage, early bell, and advanced bell stage.
• During tooth development, the enamel organ grows into cap shape due to unequal growth
in different parts of tooth bud which leads to a shallow invagination on the deep surface of
the bud.
1. Enamel Organ
• As the tooth bud continues to proliferate, it does not expand uniformly into a larger sphere.
Unequal growth in different parts of the enamel organ into the underlying ectomesenchyme
leads to cap stage (Fig. 13.3).
• The ectomesenchyme adjacent to the cap shaped enamel organ gets condensed. The
condensed ectomesenchyme near the shallow invaginated (concave) portion of the enamel
organ is called dental papilla. The ectomesenchyme surrounding the enamel organ and
dental papilla is dental sac.
• The enamel organ at this stage has distinct cell layers, the outer enamel epithelium, the
inner enamel epithelium and stellate reticulum.
Outer Enamel Epithelium (OEE)
• These are peripheral cuboidal cells that cover the convexity of the cap and are separated
from dental sac by a delicate basement membrane and is anchored to it by hemidesmosomes.
• The cells contain a large centrally placed nucleus and small amount of cytoplasmic organelles.
• Function: Outer enamel epithelium cells are involved in maintaining the shape of enamel
organ and in the exchange of substances between the enamel organ and the surrounding
tissue.
Inner Enamel Epithelium (IEE)

• These are columnar cells that lie on the concavity (invagination) of the cap and are separated
from the dental papilla by a delicate basement membrane and are anchored to it by
hemidesmosomes.
• During bell stage, IEE cells differentiate into ameloblasts, enamel forming cells.
Stellate Reticulum
• These are polygonal cells located in the center of the enamel organ, between the OEE and
IEE. They begin to separate due to water being drawn into the enamel organ from the
surrounding dental papilla as a result of osmotic force exerted by glycosaminoglycans
contained in the ground substance.
• As a result the polygonal cells begin to separate and become star shaped but maintain
contact with each other by their cytoplasmic processes.
• As these star shaped cells form a cellular network, they are called the stellate reticulum.
This gives the stellate reticulum a cushion-like consistency and acts as a shock absorber
that may support and protect the delicate enamel forming cells.
• Transient structures: In enamel organ at cap stage, some transient structures appear which
act as a reservoir of dividing cells for the growing enamel organ. These are Enamel knot,
enamel cord and enamel septum. Enamel knot also plays an important role in determining
the shape of the tooth.
2. Dental Papilla
• Under the organizing influence of the proliferating epithelium of the enamel organ, the
ectomesenchyme (neural crest cells), that is partially enclosed by the invaginated portion of
the IEE, proliferates.
• It condenses to form the dental papilla, which is the formative organ of the dentin and the
primordium of the pulp.
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• Dental pupilla shows active budding of capillaries and its peripheral cells adjacent to IEE
later differentiate into odontoblasts.
3. Dental Sac/Dental Follicle

• Concomitant with the development of enamel organ and dental papilla, there is a
marginal condensation in the ectomesenchyme surrounding the enamel organ to form
dental sac.
• Dental sac gives rise to the supporting tissues of tooth, i.e. cementum, periodontal ligament
and alveolar bone.
Fig. 13.3: Cap stage of tooth development
Q 2. Define transient structures.

Ans. In enamel organ during cap stage and early bell stage, before enamel formation begins,
some transient structures appear which act as a reservoir of dividing cells for the growing
enamel organ. These are enamel knot, enamel cord and enamel septum. These are temporary
structures that disappear before enamel formation begins.
1. Enamel Knot
• It is a localized mass of cells in the center of the enamel organ which are densely packed.
Characteristically it forms a bulge into the dental papilla at the center of the enamel organ,
which is bordered by the labial and lingual enamel grooves.
• Function: It acts as a reservoir of dividing cells for the growing enamel organ. It may represent
an important signalling center during tooth development and play an important role in
determining the shape of the tooth. It plays prime role in controlling the growth as well as
designing of tooth cusps.
2. Enamel Cord and Septum

• Enamel cord is vertical extension of the enamel knot. It is a strand of cells running from the
knot towards outer enamel epithelium (OEE).
• When the enamel cord extends to meet the outer enamel epithelium, it is termed as enamel
septum, as it divides the stellate reticulum into two parts.
• The point on OEE, where the enamel cord meets OEE, shows a small depression which is
termed enamel navel, as it resembles the umbilicus.
Significance
Transient structures act as reservoir of dividing cells for the growing enamel organ.
Q 3. Write about stellate reticulum/enamel pulp. (June 2002, 2004)

Ans. Introduction
Stellate reticulum is a layer of cells present beween outer and inner enamel epithelia in enamel
organ during development of tooth.
Structure (Refer Fig. 13.3)

• Stellate reticulum, also called enamel pulp, consists of the polygonal cells in the center of
enamel organ.
• These cells begin to separate due to water being drawn into the enamel organ from the
surrounding dental papilla as a result of osmotic force exerted by glycosaminoglycans
contained in the ground substance.
• As a result, the polygonal cells become star shaped but maintain contact with each other by
their cytoplasmic processes.
• These cells are star shaped with bodies containing conspicuous nucleus and many branching
processes. As these star shaped cells form a cellular network, they are called as stellate reticulum.
• Stellate reticulum is fully developed at bell stage.
• Desmosomal junctions are observed between the cells of stellate reticulum, stratum
intermedium, and outer enamel epithelium.
Functions
• Stellate reticulum has cushion like consistancy.
• It acts as a shock absorber that may support and protect the delicate enamel forming cells.
• In late bell stage just before enamel formation begins, stellate reticulum collapses reducing
the distance between ameloblasts and the nutrient capillaries near the OEE.
• Its cells are then hardly distinguished from those of the stratum intermedium. This change
begins at the height of the cusp and progresses cervically. This collapsed enamel organ
along with stellate reticulum is called as reduced enamel epithelium and it serves to protect
the newly formed enamel till eruption.
Q 4. Write about outer enamel epithelium. (Oct. 2002)

Ans.
• Enamel organ during development of tooth has distinct cell layers, outer enamel epithelium,
inner enamel epithelium, stellate reticulum and stratum intermedium.
• Outer enamel epithelium (OEE) has cuboidal cells that cover the convexity of the enamel
organ and are separated from the dental sac by a delicate basement membrane and are
anchored to it by hemidesmosomes.
• The cells contain a large, centrally placed nucleus and the cytoplasm consists of few
organelles, free ribosomes, few rough endoplasmic reticulum, some mitochondria and
scattered tonofilaments. Adjacent cells are joined by junctional complexes.
• At bell stage the cells of OEE flatten to a low cuboidal form.
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• Functions:
1. OEE cells are involved in maintaining the shape of enamel organ and in the exchange of
substances between enamel organ and surrounding tissue/dental follicle.
2. In the late bell stage preparatory to and during formation of enamel, formerly smooth
surface of outer enamel epithelium is laid in folds. Between the folds adjacent mesenchyme
of the dental sac forms papillae that contain capillary loops which provide a rich nutritional
supply for the intense metabolic activity of the avascular enamel organ.
Q 5. Explain root formation. Or write about Hertwing’s Epithelia Root Sheath (HERS).
Ans.
• Development of root begins after enamel and dentin formation has reached the future
cementoenamel junction. Enamel organ plays an important role in the formation of root by
forming Hertwig’s Epithelial Root Sheath (HERS) from the cervical loop.
• Cervical portion of the enamel organ at bell stage gives rise to HERS. It consists of inner
enamel epithelium and outer enamel epithelium. It does not include stratum intermedium
and stellate reticulum.
• HERS plays an important role in the determination of the shape, length, size, and number
of roots. In addition, it initiates radicular dentin formation.
• The inner cells of the HERS induce differentiation of radicular dental papilla cells into
odontoblasts. After the first layer of root dentin is laid down by these cells, HERS lose its
structural continuity and breaks its remnants persist as epithelial network of strands which
are found in PDL of erupted teeth and are called cell rests of Malassez.
• The cells of dental follicle surrounding the HERS, proliferate and come in contact with the
outer surface of newly laid dentin and differentiate into cementoblasts that deposit a layer
of cementum onto the surface of root dentin.
• At the proliferating end HERS bend into a horizontal plane. This area is termed as epithelial
diaphragm. The epithelial diaphragm encircles the apical opening of the dental papilla.
• As the odontoblasts differentiate along the pulpal boundary, root dentinogenesis proceeds and
the root lengthens. Dentinogenesis and cementogenesis continues until the appropriate root
length is developed. The root then thickens till the apical opening is 1–3 mm which is sufficient
to allow vascular and neural communication between the pulp and periodontal ligament.
• With the increase in root length, the tooth begins its eruptive movement which provides
further space for further lengthening of the root. This is how a single root is formed.
• Root formation in multirooted teeth: Differential growth of the epithelial diaphragm causes
the root trunk of multirooted tooth to divide into 2–3 roots. During the general growth of
the enamel organ in a multirooted tooth, the expansion of its cervical opening occurs in
such a way that long tongue like epithelial extensions of the horizontal diaphragm develop.
Two or three such extensions can be present in multirooted teeth, depending on the number
of roots to be formed.
• The single cervical opening of the coronal enamel organ is then divided into 2–3 openings
by the horizontal extensions. On the pulpal surface of these horizontal bridges, dentin
formation starts after the induction of odontoblasts. Root development then proceeds in
the same way as single root formation.
• Significance: If cells of HERS remain adherent to the dentin surface, they may differentiate
into ameloblasts and produce enamel. Such droplets of enamel, called enamel pearls are
found in furcation area of roots of permanent molars.
If continuity of HERS is broken or is not established prior to dentin formation a defect in
dentinal wall of pulp ensures which accounts for the development of accessory root canals.
Q 6. Write about cell rests of Malassez. (2000, Oct. 2003, May 2007)
Ans.
• During development of tooth, root development begins after enamel and dentin formation
has reached the future cementoenamel junction. Enamel organ plays an important role in the
formation of root by forming Hertwig’s Epithelial Root Sheath (HERS) from its cervical portion.
• The inner cells of the HERS induce differentiation of radicular dental papilla cells into odonto-
blasts. After the first layer of root dentin is laid down by these cells, HERS loses its structural
continuity and breaks. Its remnants persist as epithelial network of strands which are found
in periodontal ligament of erupted teeth and are called cell rests of Malassez (Figs 13.4A and B).
• Significance: They are inactive but can become active, proliferate to form odontogenic cysts,
and tumors or may also undergo calcification to become cementicles.
Fig. 13.4A: Root formation/Hertwig’s epithelial root sheath
Fig. 13.4A: Root formation/Cell rests of Malassez

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Q 7. Write about dental lamina and its fate. (2000, 2001, Nov. 2010)
Ans. Dental Lamina (Fig. 13.5)
• The primitive oral cavity, or stomodeum, is lined by oral ectoderm.
• At around 7th week of intrauterine life, due to proliferation of basal cells of the oral ectoderm
there is formation of a continuous band of epithelium called as Primary epithelial band. It
invades the underlying ectomesenchyme along each of the horseshoe-shaped future dental
arches. At about 7th week the primary epithelial band devides into two subdivisions, vestibular
lamina and dental lamina.
• Within dental lamina, continued localized proliferation leads to formation of a series of
epithelial ingrowths into ectomesenchyme at sites corresponding to the position of future
deciduous teeth.
• Functions:
1. Dental lamina serves as the primordium for the ectodermal portion of deciduous teeth.
2. Later during development of the jaws, permanent molars arise directly from a distal
extension of the dental lamina.
3. The lingual extension of the free end of the dental lamina, called as successional lamina
gives rise to succedenous teeth.
• Fate of dental lamina:
– It is evident that total activity of dental lamina extends over a period of at least
5 years.
– As the teeth continue to develop, they lose their connection with the dental lamina. It
then breaks up by the mesenchymal invasion.
• Significance: Remnants of the dental lamina persist as epithelial pearls or islands within the
jaws as well as in the gingiva. These are referred to as cell rests of Serres. However, dental
lamina may remain active in the third molar region. It may give rise to odontogenic cysts
and tumors.
Fig. 13.5: Bud stage/Dental lamina

Q 8. Enumerate histophysiological stages of tooth development.

(Dec. 2005, July 2006)
Ans. Various physiologic growth processes participate in the progressive development of the
teeth. On the basis of these histophysiological processes, the development of tooth can be
studied under following headings:
1. Initiation
2. Proliferation
5. Apposition
1. Initiation
• Initiation of tooth development depends on the epithelial-ectomesenchymal interaction.
Dental lamina, a part of oral epithelium, has the ability to form enamel organs of the
deciduous and permanent teeth, when instructed by underlying ectomesenchyme.
2. Proliferation
• Enamel organ formed due to initiation, undergoes proliferation to give the crown of the
tooth its final size shape, and results successively in the bud, cap, and bell stage.
• Proliferative growth causes changes in the size and proportions of the growing tooth germ.
• As the cells continue to proliferate, they undergo definite morphologic and functional
changes and give up their capacity to multiply and prepare themselves to carry out their
specific function, for example deposition of organic matrix. This is termed histo-
differentiation.
• In the bell stage, the inner enamel epithelium influences adjacent cells of the dental papilla
to differentiate into odontoblasts which form the dentin matrix. This constitutes
histodifferentiation of odontoblasts. With the formation of dentin, the inner enamel epithelial
cells differentiate into ameloblasts which form the enamel matrix. This constitutes
histodifferentiation of the ameloblasts.
• Dentin formation precedes and is essential to enamel formation.
• The morphologic pattern, or basic form and relative size of the tooth, is determined by
morphodifferentiation or differential growth.
• The dentinoenamel and dentinocemental junctions, which are different in characteristic for
each type of tooth, acts as a blue print pattern and determines the form and size of the
tooth.
5. Apposition
• It is the deposition of the matrix of the hard dental structures.
• Appositional growth of enamel and dentin is the layer like deposition of the extracellular
matrix of dental hard tissues, characterized by alternate periods of activity and rest. It is
this regular and rhythmic appositional growth that gives the tooth its final shape.
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• Lack of initiation results in absence of teeth, known as anodontia.
• Abnormal initiation can result in development of supernumerary teeth.
• Improper histodifferentiation can result in failure of ameloblasts to differentiate as can occur
in vitamin A deficiency.
• Disturbance in morphodifferentiation can result in peg shaped permanent incisors.
• Enamel hypoplasia is disturbed synthesis and secretion of organic matrix of enamel.
• Enamel hypocalcification is defective mineralization of enamel.
Q 9. Explain histo and morphodifferentiation. (Nov. 2009)

Ans. On the basis of various physiologic growth processes taking place, the development of
tooth can be studied under following headings:
1. Initiation
2. Proliferation
5. Apposition
Histodifferentiation
As the cells continue to proliferate, they undergo definite morphologic and functional changes,
and prepare themselves to carry out their function, for example, deposition of organic matrix.
This is termed histodifferentiation.
• In the bell stage, the inner enamel epithelium influences the adjacent cells of the dental
papilla to differentiate into odontoblasts which form the dentin matrix. This constitutes the
histodifferentiation of odontoblasts.
• With the formation of dentin, the inner enamel epithelial cells differentiate into ameloblasts
which form the enamel matrix. This constitutes histodifferentiation of the ameloblasts.
• Dentin formation precedes and is essential to enamel formation. While, differentiation of
the epithelial cells precedes and is essential to the differentiation of the odontoblasts and
the initiation of dentin formation.
• Thus, formation of enamel and dentin are dependent on one another, and this forms the
basis of reciprocal induction.
• In vitamin A deficiency, ameloblasts fail to differentiate properly and hence their organising
influence on the adjacent cells of dental papilla is disturbed. As a result, odontoblasts fail to
differentiate properly and the dentin formed by these odontoblasts will be atypical and
known as osteodentin.
Morphodifferentiation
• The dentinoenamel junction and the dentinocemental junction are established before
formation of the hard tissues. These junctions are different and characteristic for each type
of tooth and acts as a blue print pattern which determines the form and size of the tooth.
• In accordance with their shape, the formative cells deposit enamel, dentin and cementum,
giving the tooth their characteristic form and size.
• Disturbances occuring during the morphodifferentiation can affect the morphology of the
crown or root without impairing the function of the ameloblast or odontoblasts.
• Examples of morphodifferentiation disturbances involving the crown are formation of
supernumerary cusp, loss of cusp, and peg shaped teeth. Formation of supernumerary root
and dilaceration (abnormal curvature in the root caused due to trauma) are some examples
of disturbances involving the morphology of root with enamel and dentin which may be
normal in structure.
• An abnormality in shape may result in peg or malformed tooth. Peg shaped teeth (screw-
driver shaped) with the permanent upper central incisor showing a notched incisal edge
may be seen in individuals born with congenital syphilis. This condition is known as
Hutchinson’s incisor.
Q 10. Describe bud stage.

Ans.
• By the 8th to 10th week in utero, continued and localized proliferative activity
within dental lamina leads to the formation of epithelial downgrowths into the
underlying ectomesenchyme. These are the primordia of the enamel organ, the tooth
buds.
• These round or ovoid epithelial downgrowths into the underlying ectomesenchyme form
at the sites corresponding to the position of 10 maxillary and 10 mandibular deciduous
teeth.
• Since main function of certain epithelial cells of these epithelial downgrowths is formation
of tooth enamel, these epithelial swellings are called as enamel organs.
• The epithelium of the enamel organ is separated from the underlying ectomesenchyme by
a basement membrane.
• As cell proliferation continues, each enamel organ increases in size, sinks deeper into
the ectomesenchyme and due to differential growth changes its shape from bud to cap to
bell.
• At bell stage, proliferation of tissues of enamel organ occurs. No structural changes occur
in the cells of the enamel organ or ectomesenchyme as later occurs during differentiation
and morphogenesis.
• In the bud stage, the enamel organ consists of peripherally located low columnar cells and
centrally located polygonal cells (Refer Fig. 13.5).
• Many cells of the tooth bud and the surrounding ectomesenchyme undergo mitosis. As a
result of increased mitotic activity and migration of neural crest cells into the area, the
ectomesenchymal cells surrounding the tooth bud condense.
• The area of ectomesenchyme condensation immediately subjacent to the enamel organ is
the dental papilla.
• The condensed ectomesenchyme cells surrounding the tooth bud and the dental papilla is
the dental sac or dental follicle.
• Both the dental papilla and dental sac become more well-defined as the enamel organ grows
into cap and bell shape.
172 DADH Made Easy
Q 11. What is enamel pearl?

Ans.
• The cells of the Hertwig’s epithelial root sheath may differentiate into fully functional
ameloblasts and form enamel if they remain adherent to the radicular dentin without
becoming removed by the invading cells of dental follicle.
• This may appear as a globule of enamel called enamel pearl and is sometimes seen at the
furcation area of roots of permanent molars.
Q 12. Describe development of tongue.

Ans.
• Tongue develops in relation to the pharyngeal arches in the floor of the developing mouth.
• Pharyngeal arch arises as a mesodermal thickening in the lateral wall of the foregut and it
grows ventrally to become continuous with the corresponding arch of the opposite side.
• During 4th week of intrauterine life, the medial-most parts of the first (mandibular) arches
proliferate to form two lingual swellings. The lingual swellings are partially separated from
each other by a median swelling, tuberculum impar, which appears in the midline.
• Anterior two-thirds of the tongue is formed by fusion of the tunberculum impar and the two
lingual swellings. Thus, anterior two-thirds of the tongue is derived from the mandibular arch.
• Immediately behind the tuberculum impar, the epithelium proliferates to form a
downgrowth, thyroglossal duct, from which the thyroid gland develops.
• The site of this epithelial downgrowth is marked by a depression called foramen caecum.
• Posterior one-third of the tongue is formed by third arch mesoderm. The posterior-most
part of tongue is derived from the fourth arch.
• Formation of posterior third of tongue is indicated by a midline swelling, hypobranchial
eminence which is seen in relation to the medial ends of the second, third, and fourth
pharyngeal arches. This eminence shows a subdivision into a cranial part (copula), and a
caudal part.
• The posterior one-third of the tongue is formed from the cranial part of the hypobranchial
eminence (copula).
• Anterior two-thirds of the tongue is covered by ectoderm and posterior one-third by
endoderm.
• The connective tissue components of the anterior two-thirds of the tongue are derived from
first arch mesenchyme while that of posteior one-third from third arch mesenchyme.
• The intrinsic musculature of the tongue is derived from the pharyngeal arch mesenchyme
while the extrinsic muscles arise from the occipital myotomes and are supplied by the
hypoglossal nerve.
• Formation of taste buds and papillae of the tongue: Epithelium of the tongue is at first
made-up of a single layer of cells. Later it becomes stratified and papillae become evident.
• The most common lingual papillae, filiform papillae, develop at around 10th to 11th weeks.
The vallate and foliate papillae appear close to terminal branches of the glossopharyngeal
nerve. The fungiform papillae appear later near the termination of the chorda tympani,
branch of the facial nerve.
• Taste buds are formed in relation to the terminal branches of the innervating nerve fibers
during 11th to 13th weeks by inductive interaction between the epithelial cells of the tongue
and gustatory nerve cells from the chorda tympani, glossopharyungeal and vagus nerve.
Anomalies of Tongue
1. Macroglossia—too large tongue, or aglossia—tongue may be absent, bifid tongue due to
non-function of the two lingual swellings, fissured tongue, are the developmental anomalies
of tongue.
2. Ankyloglossia is tongue tie.
3. Remnants of thyroglossal duct may form cysts at the base of the tongue.
Q 13. Decribe development of maxilla/palate.

Ans.
• The face is developed by the fusion and merging of frontonasal process, a pair of maxillary
process and a pair of mandibular processes.
• Palate consists of two parts, primitive (premaxilla) and permanent (secondary) palate. The
primitive palate is formed from the frontonasal process while the secondary palate develops
from the fusion of the palatine processes of maxillary prominences.
• The frontonasal process gets divided into a median nasal process and two lateral nasal
processes by the ingrowth of a pair of olfactory pits. The primitive palate is formed
by the fusion of the maxillary processes and the globular part of the median nasal
processs.
• During the 6th week of intrauterine life a shelf like projection, the palatine process grows
medially from the inner surface of each maxillary process.
• During 7th week, the mandibular arches grow more ventrally and caudally producing the
prominence of the chin which causes necessary depression and ventral shifting of the tongue.
As a result the palatine process assumes horizontal position, meet and fuse with each other,
and form the permanent palate.
• The definitive palate is formed by the fusion of three parts as:
a. The two palatal processes fuse with each other in the midline. Their fusion begins
anteriorly and proceeds backwards.
b. Each palatal process fuses with the posterior margin of the primitive palate in a “y”
shaped manner. Each limb of “y” passes between the lateral incisor and canine.
• The primitive palate (premaxilla) is wedge shaped and carries four incisor teeth.
• Later, the mesoderm in the ventral three-fourths of the permanent palate undergoes
ossification to form the hard palate.
• Ossification of the palate starts at 8th week of intrauterine life by intramembranous
ossification of mesoderm.
• However, ossification does not extend into the most posterior portion which remains as the
soft palate.
• The fusion of the palatine process with each other and with the primitive palate is completed
at about ninth week of intrauterine life. Median palatine raphe indicates the line of fusion
of the lateral palatine processes.
Clinical Considerations
• Defective fusion of the various compartments of the palate gives rise to clefts in the palate
which results in communications between the mouth and the nose which can be unilateral
or bilateral.
174 DADH Made Easy
Q 14. Describe development of mandible.

Ans.
• A part of the mandibular arches forms the lower lip, lower jaw, and the integument covering
the mandible.
• First or mandibular arch has a dorsal maxillary process, and a ventral mandibular part.
• The cartilaginous bar of the mandibular part is known as the Meckel’s cartilage which extends
dorsally up to the cartilaginous ear capsule. The dorsal part of the cartilage gets ossified to
form the malleus and the incus, which are the two ossicles of the middle ear.
• The succeeding part of the cartilage regresses but its fibrous envelop persists as the anterior
ligament of the malleus and the sphenomandibular ligament. The fibrous membrane of the
ventral part of the Meckle’s cartilage gets ossified to form the body of the mandible. This
occurs at around 6th week of intrauterine life. The cartilage cells then disappear.
• The lingula of the mandibular foramen and the mental ossicles of the symphysis mentis
are the ossified remnants of the cartilage and are incorporated with the body of the
mandible.
• Between 10th and 14th week of intrauterine life, secondary cartilage develops which
include the condylar cartilage, the coronoid and the symphyseal secondary cartilage. The
condylar cartilage gives rise to condyle while secondary cartilage of coronoid forms
coronoid.
• The two halves of mandible get united at midline by 4th–12th months postnatally.
• Major part of the mandible is formed by intramembranous ossification.
• Mandibulofacial dysostosis—entire first arch may remain underdeveloped resulting in
retrognathic mandible.
1. The basement membrane that separates 8. The cells of dental follicle differentiate
the enamel organ and the dental papilla to form
just prior to dentin formation is called the a. Dentin and pulp
a. Nasmyth’s membrane b. Pulp and cementum
b. Enamel cuticle c. PDL and cementum
c. Membrana preformativa d. Enamel
d. Dentinoenamel membrane 9. Initiation of tooth formation occurs at
2. Enamel formation is influenced by a. First week of intrauterine life
a. Stratum intermedium b. Second week of intrauterine life
b. Stratum reticulum c. Sixth week of intrauterine life
c. Membrane preformativa d. Sixth month of intrauterine life
d. All of the above 10. The cells of dental papilla differentiate
3. Stratum intermedium is present in to form
a. Bud stage a. Enamel
b. Bell stage b. Dentin and pulp
c. Cap stage c. Pulp and cementum
d. All of the above d. Cementum and PDL
4. The nucleus of the preameloblasts in the 11. The buccophar yngeal membrane
advanced bell stage is ruptures at approximately
a. In the basal region of the cell a. 20th day of gestation
b. In the distal end of the cell b. 25th day of gestation
c. In the middle of the cell c. 26th day of gestation
d. In the mesial region of the cell d. 27th day of gestation
5. The total activity of dental lamina extends 12. The shape of the cells of stratum inter-
over a period of medium is
a. 2 years b. 4 years a. Squamous b. Columnar
c. 5 years d. 8 years c. Star shaped d. Cuboidal
6. The dental lamina forms when the 13. The densely packed stellate reticulum
embryo is cells in the center of the enamel organ
a. 3 weeks old b. 4 weeks old in the cap stage is called
c. 6 weeks old d. 7 weeks old a. Enamel niche b. Enamel cord
7. Hertwig’s epithelial root sheath consists c. Enamel knot d. Enamel tuft
of 14. The advanced bell stage marks the stage
a. Outer enamel epithelium (OEE) and of
inner enamel epithelium (IEE) a. Histodifferentiation
b. OEE, stellate reticulum and IEE b. Morphodifferentiation
c. OEE, stratum intermedium and IEE c. Proliferation
d. OEE and stratum intermedium only d. Both a and b
1-c, 2-a, 3-b, 4-b, 5-c, 6-c, 7-a, 8-c, 9-c, 10-b, 11-d, 12-a, 13-c, 14-d
176 DADH Made Easy
15. The following structures have influence 21. Stomodeum is lined by

in the initiation of enamel formation a. Ectoderm b. Endoderm
a. Stratum intermedium c. Mesoderm d. Ectomesenchyme
b. Membrana preformativa 22. The stellatet reticulum collapses
c. Cervical loop a. To facilitate the enamel formation
d. Stellate reticulum b. To facilitate the supply of nutrients to
16. If the organic matrix is normal but its the IEE cells
mineralization is defective the condition c. To facilitate the supply of nutrients to
is called the OEE cells
a. Hypoplasia d. To facilitate the supply of nutrients to
b. Hypocalcification or hypominera- odontoblasts
lization 23. The cells of stratum intermedium are
c. Both a and b closely attached by
d. None of the above a. Desmosomal junctions
b. Tight junctions
17. Both hypoplasia and hypocalcification
can occur due to disturbance (insult) to c. Gap junctions
the cells during d. Desmosomal and gap junctions
a. Proliferative stage 24. The time of initiation of first permanent
b. Histodifferentiation stage molar is
c. Morphodifferentiation stage a. Fourth month of intrauterine life
d. Apposition stage b. Sixth month of intrauterine life
c. Ninth month of intrauterine life
18. Disturbance in morphodifferentiation
d. Sixth month after birth
affects the
a. Form and size of the tooth 25. The first evidence of calcification of the
permanent first molars occurs approxi-
b. Matrix formation
mately at
c. Mineralization a. Six weeks of intrauterine life
d. All of the above b. At birth
19. In vitamin A deficiency ameloblasts fail c. Three years
to differentiate properly due to which of d. Six years
the formation
26. The anatomical form of the roots of teeth
a. Atypical enamel is determined by
b. Osteodentin a. Dental lamina
c. Hypoplastic dentin b. Periodontal ligament
d. Both a and b c. Epithelial attachment
20. All of the following structures are essential d. Hertwig’s epithelial root sheath
for tooth formation, except 27. Stratum intermedium first appears during
a. Dental lamina a. Bud stage
b. Membrana performativa b. Cap stage
c. Dental papilla c. Bell stage
d. Vestibular lamina d. None of the above
15-a, 16-b, 17-d, 18-a, 19-b, 20-d, 21-a, 22-b, 23-d, 24-a, 25-b, 26-d, 27-c
28. The permanent teeth are initiated by 35. Remnants of dental lamina persist as
a. Dental lamina a. Enamel pearls
b. New tooth bud b. Epithelial pearls
c. Successional lamina c. Enamel cord
d. Enamel organ d. Cell rests of Malassez
29. The disturbance in the normal synthesis 36. The name for the lingual extension of
and secretion of the organic matrix leads dental lamina is
to a condition called
a. Vestibular lamina
a. Hypoplasia
b. Distal lamina
b. Hypocalcification
c. Successional lamina
c. Both a and b
d. All of the above
37. Tooth germ is made-up of
30. Morphologic outline of crown of tooth is
determined by a. Dental organ
a. Dentinoenamel membrane b. Dental papilla
b. Membrana preformativa c. Dental follicle
c. Dental papilla d. All of the above
d. Cervical loop 38. Tomes’ processes are
31. Lip furrow band is the a. Conical processes of odontoblasts
a. Dental lamina proper b. Conical processes of ameloblasts
b. Lateral dental lamina c. Conical processes of cementoblasts
c. Vestibular lamina d. Processes of osteoblast
d. None of the above 39. Mulberry molars and peg laterals are
32. The first hard tissue that is formed in the formed as a result of disturbances in
tooth is a. Initiation
a. Enamel b. Histodifferentiation
b. Dentin c. Morphodifferentiation
c. Cementum d. Mineralisation
d. Alveolar bone
40. Hertwig’s epithelial root sheath is formed
33. The successors of deciduous teeth develop by
from the
a. Enamel organ
a. Distal extension of dental lamina
b. Dental lamina
b. Lingual extension of dental lamina
c. Vestibular extension c. Oral epithelium
d. None of the above d. None of the above
34. A cell active in secretory function usually 41. An enzyme present in stratum inter-
shows medium is
a. Decreased number of mitochondria a. Acid phosphatase
b. Increased rough endoplasmic reticulum b. Alkaline phosphatase
c. Increased number of lysosomes c. Esterase
d. Increase in size of nucleus d. Lysosomal sulfatase
28-c, 29-a, 30-b, 31-c, 32-b, 33-b, 34-b, 35-b, 36-c, 37-d, 38-b, 39-c, 40-a, 41-b
178 DADH Made Easy
42. Enamel pulp is same as 49. The number of visceral arches in humans
a. Dental papilla are
b. Stellate reticulum a. 2 b. 4
c. Outer enamel epithelium c. 5 d. 6
d. Inner enamel epithelium 50. The name of the first visceral arch is
a. Hyoid b. Maxillary
43. Dental papilla becomes the pulp when
c. Mandibular d. None of the above
a. Cementum is laid down around dentin
51. The second visceral arch is
b. Dentin is laid down around pulp
a. Hyoid b. Mandibular
c. First layer of enamel is formed over it
c. Maxillary d. None of the above
d. None of the above.
52. Which of the following statement is true?
44. The following is not a part of tooth bud a. Foramen caecum is present at the junc-
a. Dental papilla tion of anterior two-thirds and
b. Dental follicle posterior one-third of the tongue
c. Vestibular lamina b. Anterior two-third of the tongue is
d. Enamel organ covered by ectoderm and posterior
45. The permanent molars arise from the one-thirds is covered by endoderm
following extension of dental lamina c. The epithelial components of the
a. Lingual salivary glands are derived from oral
ectoderm
b. Buccal
d. All of the above
c. Distal
53. Median rhomboid glossitis is
d. Mesial
a. Caused by persistence of tuberculum
46. The space between the jaws into which the impar
teeth erupt is provided by growth at the b. Red and rhomboidal smooth zone of
a. Alveolar process the tongue
b. Mandibular condyles c. Found in midline in front of the
c. Intermaxillary sutures and mental foramen caecum
symphysis d. All of the above
d. None of the above 54. Membrane preformativa is seen during
47. A narrow developmental pit is most likely a. Bell stage
to be found on the lingual surface of b. Cap stage
a. Maxillary canine c. Bud stage
b. Maxillary central incisor d. Advanced bell stage
c. Maxillary lateral incisor 55. Life of successional lamina is from the
d. Mandibular central incisor a. 5th month in utero to the 10th month
of age
48. In a developing tooth, alkaline phosphate
b. Third month in utero to the 10th month
in present in
of age
a. OEE c. 5th month in utero to the 10th month
b. IEE in utero
c. Stellate reticulum d. 6 weeks of embryo to the 10th month
d. Stratum intermedium in utero
42-b, 43-b, 44-c, 45-c, 46-b, 47-c, 48-d, 49-d, 50-c, 51-a, 52-d, 53-a, 54-a, 55-a
56. Epithelial pearls are found 63. In the bell stage, the cells in the center
a. Within the jaw of enamel organ continue to synthesize
b. In the gingiva and secrete
c. None of the above a. Glycogen
d. Both a and b b. Glycosaminoglycans
57. Retarded eruption of teeth occurs in c. Alkaline phosphatase
persons with d. Proteins
a. Hypopituitarism and hypothyroidism
64. The branchial arches are separated from
b. Hyperpituitarism each other by
c. Hyperthyroidism
a. The stomodeum
b. Prosencephalon
58. The layer of enamel organ which has
c. The neural groove
Cushioning effect is
a. Inner enamel epithelium d. Ectodermal to endodermal groove
b. Stellate reticulum 65. The process which does not play any role
c. Stratum intermedium in the development of face is
d. Outer enamel epithelium a. Maxillary process
59. The component that is absent in enamel b. Mandibular
organ is c. Frontonasal
a. Dental sac d. Ethmoidal
b. Stellate reticulum
66. Each maxillary process forms a horizontal
c. Stratum intermedium
extension termed as
d. Outer enamel epithelium
a. The lateral nasal process
60. One of the following is not true about
b. The internal nares
dental lamina
a. The total activity lasts for approximately c. The median nasal septum
5 years d. The palatal process
b. It persists as epithelial pearls 67. The anterior two-thirds of the tongue
c. It is derived from ectoderm develops from the
d. Derived from mesoderm a. The first arch mesenchyme
61. The calcified tissue which has the largest b. The copula
hydroxyapatite crystals is c. The hypobranchial eminence
a. Enamel
d. The tuberculum impar and adjacent
b. Dentin
tissue
c. Cementum
d. Bone 68. The salivary glands develop from
62. Periodontal ligament develops from a. Ectodermal germ layer
a. Enamel organ b. Endodermal germ layer
b. Dental papilla c. Ectodermal and endodermal germ
c. Perifollicular mesenchyme layers
d. None of the above d. Oral mesenchyme
56-d, 57-a, 58-b, 59-a, 60-d, 61-a, 62-c, 63-a, 64-d, 65-d, 66-a, 67-a, 68-a
180 DADH Made Easy
69. The developing mandible grows back (not 73. The cell rests of Malassez in the perio-
surrounding Meckel’s Cartilage) to form dontal ligament are derived from
a. The malleus a. Dental pulp
b. Otic capsule b. Lamina propria
c. The hyoid cartilage c. Odontogenic epithelium
d. Vestibular lamina
d. The coronoid process
74. The precise expression of growth and
70. When a tooth erupts, the percentage of transcription factors associated with
root formation completed is future cusp formation takes place in the
a. 20% a. Enamel cord
b. 30% b. Enamel knot
c. 50% c. Inner enamel epithelium
d. 80% d. None of the above
71. The embryonic connective tissue under 75. Reciprocal induction is seen between the
the oral ectoderm is termed ecto- a. Cementoblast and odontoblast
mesenchyme because b. Cementoblast and osteoblast
a. It has both ectodermal and mesen- c. Ameloblast and odontoblast
chymal cells d. None of the above
b. It has migrated neural crest cells in it 76. Hypoplasia is
c. It has characteristics similar to ecto- a. Disturbance in matrix formation
dermal cells b. Disturbance in calcification
d. None of the above c. Disturbance in maturation
d. All of the above
72. The primary epithelial band is
77. The correct sequence of dental tissues
a. Same as dental lamina from softest to hardest is
b. It is the structure that gives rise to a. Dentin, cementum, enamel
dental lamina and vestibular lamina b. Cementum, dentin, enamel
c. Same as lip furrow band c. Dentin, enamel, cementum
d. None of the above d. Cementum, enamel dentin
69-a, 70-c, 71-b, 72-b, 73-c, 74-b, 75-c, 76-a, 77-b

14
Enamel
LAQ (10 Marks)
Q 1. Describe different stages in the life cycle of ameloblasts in detail.

(June 2006, 2009, 2011, 2014, Nov. 2015)
Ans. LIFE CYCLE OF AMELOBLASTS
Introduction
• During development of tooth, the inner enamel epithelial (IEE) cells of enamel organ
differentiate into ameloblasts which produce enamel matrix and help in its mineralization.
• According to their function, the life cycle of ameloblasts can be divided into 6 stages.
1. Morphogenic stage
pre-secretory stage
2. Organizing stage
3. Formative stage/secretory stage
4. Maturative stage/transitional or maturation proper
5. Protective stage
post-maturation stage
6. Desmolytic stage
• Differentiation of ameloblasts is most advanced in the region of incisal edge or cusp tip.
1. Morphogenic Stage
• During the bell stage of tooth development, the cells of
the IEE interact with adjacent mesenchymal cells,
determining the shape of the dentinoenamel junction and
the crown.
• At this stage, the cells of the IEE are short and columnar
with large oval nucleus that almost fills the cell body
(Fig. 14.1A).
• The golgi apparatus are near the proximal (basal) portion
of the cells (near the stratum intermedium) whereas the
mitochondria and other cytoplasmic components, are Fig. 14.1A: Morphogenic stage of
scattered throughout the cytoplasm. ameloblast
181
182 DADH Made Easy
• During ameloblast differentiation, terminal bars appear between the adjacent cells
concomitantly along with migration of mitochondria to the basal region of the cells. Terminal
bars represent areas of close contact between the cells.
• IEE is separated from the connective tissue of dental papilla by a delicate basal lamina.
• The adjacent pulpal layer is a cell-free zone.
2. Organizing Stage
• This stage is characterized by a change in the
appearance of the IEE cells. They become elongated
and the nucleus-free zone at the distal end becomes
almost as long as the proximal part containing the
nucleus.
• Majority of the cell organelles migrate from the
proximal end of the cell to the distal end. This is called
as “reversal of functional polarity” (Fig. 14.1B). Thus,
ameloblast becomes a highly polarized cell for the
functional need to secrete the enamel matrix from Fig. 14.1B: Organizing stage of ameloblast:
the distal end. Reversal of functional polarity
• Clear cell-free zone between IEE and dental papilla disappears as elongation of the cells of
IEE occurs. This causes the epithelial cells to come in contact with the connective tissue cells
of the dental papilla which differentiate into odontoblasts. This is a part of epithelial-
mesenchymal interaction during tooth development.
• During the terminal phase of this stage, formation of dentin by odontoblasts begins.
• The first appearance of dentin seems to be a critical phase in the life cycle of the cells of IEE.
As long as the IEE cells are in contact with the connective tissue cells of the dental papilla
they receive nutrients from the blood vessels of the dental papilla. However, after deposition
of first layer of dentin, the IEE cells are cut-off from their original source of nourishment
and from then on they are supplied by the capillaries that surround outer enamel epithelium
(OEE).
• This reversal of nutritional source is characterized by proliferation of capillaries of the dental
sac and by reduction and gradual collapse of the stellate reticulum. Thus, the distance
between the capillaries and stratum intermedium and ameloblasts is reduced.
3. Formative/Secretory Stage
• Ameloblasts enter the formative stage after the first layer of dentin is laid down
(Fig. 14.1C).
• Presence of dentin seems to be necessary for the beginning of enamel matrix formation.
• Morphology of ameloblasts at this stage reveals their intense synthetic and secretory activity,
so as to form enamel matrix.
• The earliest apparent change is the development of a blunt process on the ameloblast surface
called the Tomes’ process.
• Synthesis of enamel proteins occurs in the rough endoplasmic reticulum from where it is
passed to golgi complex in which it is condensed and packaged into membrane bound
secretory granules (Fig. 14.1D).
• Contents of secretory granules are released as enamel matrix against the newly formed
mantle dentin.
Enamel 183
Fig. 14.1C: Formative/secretor y stage of Fig. 14.1D: Synthesis of enamel proteins by Tomes’
ameloblast process
4. Maturative Stage
• Enamel maturation (full mineralization) occurs
after most of the thickness of the enamel matrix has
been formed in the occlusal or incisal area.
• During this stage there is reduction in the height
of the ameloblasts and decrease in its volume and
organelle content.
• Ameloblasts display microvilli at their distal
extremities which indicate an absorptive function
of these cells (Fig. 14.1E).
• This morphology alternates with that of smooth Fig. 14.1E: Maturative stage of ameloblast
ended ameloblasts (Fig. 14.1E).
• Ameloblasts with microvilli promote the calcium influx into the maturing enamel and
smooth bordered ameloblasts promote the removal of proteins and water.
• Process of maturation starts from the height of the crown and progresses cervically.
5. Protective Stage/Post-maturation
• When the enamel has completely developed and has fully calcified, ameloblasts cease to be
arranged in a well-defined layer.
• They are no longer differentiated from the cells of the stratum intermedium and outer enamel
epithelium.
• These cell layers then form a stratified epithelial covering of the enamel which is known as
reduced enamel epithelium (REE).
• Function of REE is to protect the mature enamel
by separating it from the connective tissue until
the tooth erupts (Fig. 14.1F).
• During this stage if the connective tissue comes in
contact with the enamel, anomalies may develop.
Under such conditions enamel may be either
resorbed or covered by a layer of cementum. Fig. 14.1F: Protective stage of ameloblast
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6. Desmolytic Stage
• REE proliferates and seems to induce atrophy of the connective tissue, which
separates it from the oral epithelium, so that fusion of REE with oral epithelium can
occur.
• The epithelial cells elaborate enzymes that are able to destroy connective tissue fibers by
desmolysis.
• Premature degeneration of the REE may prevent eruption of tooth.
1. Ameloblasts are very sensitive cells. Infections, trauma, chemicals and metabolic changes
involving calcium or phosphorus affect ameloblasts. As a result, they produce decreased
thickness of enamel, called enamel hypoplasia or decreased mineralization, called enamel
hypomineralization.
2. Fluorosis affects enamel. It is chemical intoxication of ameloblasts when drinking water
has fluoride in excess of 1.5 parts per million.
SAQs (3 Marks)
Q 1. Describe physical and chemical properties of enamel. (May 2002, Nov. 2009, 2010)
Ans. PHYSICAL AND CHEMICAL PROPERTIES OF ENAMEL
Introduction
• Enamel is the hard mineralized tissue covering the anatomic crown of tooth. It is acellular
and avascular.
• Highest content of mineral salts along with crystalline arrangement makes it hardest calcified
tissue in the human body.
Physical Properties
• Thickness: Enamel forms a protective covering of variable thickness over different parts of
the crown with a maximum of 2.5 mm at the cusp tips to less than 100 at the neck of the
tooth.
• Density and hardness: High mineral content and crystalline arrangement of mineral
salts makes enamel the hardest tissue in the human body. This hardness enables it
to withstand the heavy masticatory forces. Density of enamel is 2.8–3. Knoop hardness
number is 343.
• Brittleness: Enamel is brittle, having a low tensile strength due to its structure and the
hardness.
• Colour: Enamel is translucent. Its colour varies from light yellow to grayish white. Colour
is determined by difference in the translucency of enamel, which is influenced by the
thickness of enamel. Thinner areas appear more yellowish as the underlying dentin is seen
through the thin translucent enamel.
• Permeability: It is semipermeable.
• Temperature resistance: Enamel is an insulator at room temperature. It is a non-electrical
conducive material.
Enamel 185
Chemical Properties
• Enamel consists mainly of inorganic (96%) and only a small amount of organic substance (4%).
• Organic content: Organic part is present between and around the crystals. It consists of
protein and water. It has two groups of proteins, amelogenins and nonamelogenins
Amelogenins account for 90% of the enamel proteins, are hydrophobic and are of low
molecular weight. Nonamelogenins (enamelin, ameloblastin and tuftelin) account for 10%
of enamel matrix proteins and are high molecular weight proteins. Enamel proteins do not
contribute to structuring of enamel.
• Inorganic content: The inorganic material of enamel is hydroxyapatite [Ca10 (PO4)6 (OH4)2]
and various ions such as strontium, magnesium, lead, and fluoride. The crystals of hydroxy-
apatite are hexagonal in cross-section and are arranged to form enamel rods or prisms. The
hydroxyapatite crystal has a central core or C axis of hydroxyl ion around which calcium
and phosphorus ions are arranged in the form of triangles.
• Water is present as a part of hydroxyapatite crystal, between crystals and between rods and
surrounding the rods.
Q 2. Describe hypocalcified structures of enamel. (June 2006, Nov. 2009)

Ans. HYPOCALCIFIED STRUCTURES OF ENAMEL
• Enamel is the hardest calcified tissue of body, forming the outermost covering of tooth crown.
• Hypocalcified structures in enamel are those which have higher organic content than enamel
tissue as a whole. These occur due to less removal of organic matrix and water during
development. They contribute to the microporosity of enamel.
• These structures are:
1. Enamel lamellae 4. Neonatal line
2. Enamel tufts 5. Lines of Retzius
3. Enamel spindles 6. Cross striations
1. Enamel Lamellae (SAQ, May 2009, 2010, 2013)

• They are hypocalcified thin, leaf-like structures that extend from the enamel surface towards
the dentinoenamel junction (DEJ) (Fig. 14.2).
Fig. 14.2: Enamel lamellae

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• They consist of organic material but with little mineral content.

• They may extend to and sometimes penetrate into the dentin.
• In ground section, these structures maybe confused with cracks caused by the grinding of
the specimen. Crack can be distinguished from lamella by careful decalcification of ground
section of the tooth which will cause disappearance of the cracks but lamella will persist.
• Lamellae may develop in planes of tension. When rods cross such a plane, a short segment
of rod may not fully calcify. If the disturbance is more severe and occurs in unerupted
tooth, a crack may develop that is filled by surrounding cells. If the crack develops after
eruption it gets filled by organic substances from the oral cavity.
Types of Lamellae
Three types of lamellae are present:
In type A, lamella is composed of poorly calcified rod segments.
In type B, it consists of degenerated cells.
In type C, the lamellae in erupted teeth are the cracks filled with organic matter from saliva,
this type is more common.
Type A and B are produced during enamel formation and type C is produced after eruption.
Lamellae of type A are restricted to the enamel, while those of types B and C may reach into
the dentin.
Significance
It may be a site of weakness in a tooth and may act as pathways for caries producing bacteria.
2. Enamel Tufts
• Are hypocalcified structures that originate at the DEJ and extend into enamel for about one-
third of its thickness.
• Tufts form between groups of enamel rods, which are oriented in slightly different directions
at the DEJ which is scalloped. Tufts arise from these scalloped peaks.
• They resemble tufts of grass. They do not spring out from a single small area but are narrow,
ribbon-like structures. The impression of a tuft of grass is created by examining such
structures in thick sections (Fig. 14.3).
Fig. 14.3: Enamel tufts

Enamel 187
• Tufts consist of hypocalcified enamel rods and interprismatic substance. These are areas
where young enamel proteins are not completely transformed during maturation.
• Enamel tufts are tubular structures with cross striations as shown by scanning electron
microscope.
• They are well-appreciated in cross-sections.
• Developmentally, they are formed due to abrupt changes in the rod direction which leads
to different ratio of inter-rod enamel. Their development is a consequence of an adaptation
to the spatial conditions in the enamel.
Significance
• At tufts the caries spreads laterally.
3. Enamel Spindles
• They arise at DEJ and extend into enamel. Enamel spindles are the odontoblastic processes
that extend into the enamel across DEJ before hard tissue formation (Fig. 14.4).
• They are the only hypocalcified structures of enamel that are not derived ectodermally but
are derived from dentin.
• Enamel spindles are channels of about 2 microns in diameter and contain small needle-like
crystals or granular and/or amorphosus material, as shown by transmission electron
microscope.
• As they are thickened at their ends they are named as enamel spindle. They are found
mainly in the cusp tip regions.
• The direction of the spindles corresponds to the original direction of the ameloblast, that is
right angles to the surface of dentin. Since the enamel rods are formed at an angle to the
axis of the ameloblast, the direction of rod and spindle is divergent.
• Enamel spindles are shorter than the tufts. Enamel spindles, tufts and lamellae contain less
calcium and phosphorus than enamel prisms.
• In ground sections of teeth, the organic content of spindle disintegrates and is replaced by
air and the spaces appear dark in transmitted light.
Fig. 14.4: Enamel spindles

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4. Lines of Retzius/Incremental Lines (SAQ, Dec. 2005)

• They represent the incremental pattern of the enamel.
• They appear as brownish bands in ground section of the enamel.
• They mark the successive apposition of layers of enamel during formation of crown. The
mean daily rate of enamel formation is about 3.5 microns. In longitudinal section, incremental
lines surround the tip of dentin. In transverse sections of tooth, they appear as concentric
circles.
• They have been attributed to periodic bending of the enamel rods, to variations in the basic
organic structure or to a physiological calcification rhythm.
• The occurrence of few striae is considered normal but when they are present in great numbers
or as a broad band, it indicates periods of metabolic disturbances.
• Perikymata are transverse wave-like grooves which are believed to be the external
manifestations of lines of Retzius (Fig. 14.5).
5. Neonatal Line
• An accentuated striae which represents the disturbances at birth is the neonatal line or
neonatal ring.
• The enamel of deciduous teeth develops partly before and partly after birth. The boundary
between the prenatal and postnatal enamel is marked by the neonatal line or neonatal ring.
• It appears to be the result of the abrupt change in the environment and nutrition of the
newborn infant.
• Prenatal enamel is better developed than the postnatal. This is explained by the fact that the
fetus is developed in a well-protected environment with an adequate supply of all the
essential materials, even at the expense of the mother.
• Postnatal enamel has more defects and it is darker.
• Neonatal lines are found more frequently in primary teeth and permanent first molars
(Fig. 14.5).
Fig. 14.5: Incremental lines of Retzius and neonatal line

Enamel 189
6. Perikymata
• Perikymata are transverse wavelike grooves present on outer surface of newly erupted
teeth.
• They are external manifestations of the striae of Retzius.
• Because of the undisturbed and even development of the enamel prior to birth, perikymata
are absent in the occlusal parts of deciduous teeth. They are present in the postnatal cervical
parts.
7. Cross Striations
• Each enamel rod is build-up of segments separated by dark lines that gives it a striated
appearance.
• The rods are segmented because the enamel matrix is laid in a rhythmic manner.
• Cross striations are the structures that mark the daily growth increment in human enamel
and are 4 μm apart.
• They run at right angles to the enamel rods.
• They are more pronounced in enamel that is insufficiently calcified.
• In these areas rods show varicosities and variation in composition.
Q 3. What is Nasmyth’s membrane? (May 2008)

Ans. DEVELOPMENTAL ENAMEL CUTICLE/NASMYTH’S MEMBRANE/DENTAL CUTICLE/PRIMARY
ENAMEL CUTICLE
• It is a delicate membrane that covers the entire crown of the newly erupted tooth but is
probably soon removed by mastication.
• It is about 0.5 to 1.5 mm thick. It is acellular. It is formed as the final secretory product of
ameloblasts. It is basal lamina secreted by ameloblasts.
• This cuticle is apparently secreted by ameloblasts when enamel formation is completed. It
is formed after the epithelial enamel organ retracts from the cervical region during tooth
development.
• Function is to protect the enamel from the resorptive activity of the adjacent vascular tissue
prior to the eruption of the teeth.
Q 4. What is Tomes’ process?

Ans. TOMES’ PROCESS
• The surface of ameloblasts facing the developing enamel is not smooth but has a projection
penetrating into the enamel matrix, named as Tomes’ process.
• At first ameloblasts form a structureless enamel layer. Once this structureless enamel layer
is formed, ameloblasts migrate away from the dentin surface and each ameloblast develops
a short conical projection known as Tomes’ process. All enamel matrix secretions from
then occurs through the Tomes’ process.
• Although the cytoplasm of the ameloblasts continues into the Tomes’ process, distinction
between the process and the cell body is clearly marked by distal terminal bar, which is a
distal junctional complex.
• Tomes’ process contain secretory granules, rough endoplasmic reticulum and mitochondria.
• Junctional complexes encircle the ameloblast at their distal and proximal ends which serve
to control the substances that pass between ameloblast and enamel.
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• Secretions from areas close to junctional complexes and from adjacent ameloblasts form the
inter-rod enamel. They serve to outline the pit into which secretions from Tomes’ process
occur later to form the enamel rod.
• This mechanism of enamel formation creates the rod-like structure of enamel.
• Tomes’ process persists until the formation of the final few increments of enamel, when it is
lost. As a result, the final few increments of enamel are also structureless.
Q 5. Write about Hunter-Schreger bands. (July 2005)

Ans. HUNTER-SCHREGER BANDS
Introduction
• These are alternating dark and light strips of varying width that can be seen in longitudinal
ground section under oblique reflected light.
• They originate at dentinoenamel junction and pass outward, ending at some distance from
the outer enamel surface (Fig. 14.6).
Reason for Appearance

• The change in the direction of rods is responsible for the appearance of the Hunter-Schreger
bands.
• The prisms which are cut longitudinally to produce dark bands are called diazones, while
the prisms which are cut transversely to produce light bands, are called parazones. The angle
between the parazones and diazones is 40 degrees.
• In the outer third of enamel, the prisms do not bend, hence these bands are absent.
• These structures may not be the sole result of an optical phenomenon but they are actually
composed of alternate zones having different permeability and different content of organic
material.
• The more or less regular change in the direction of the rod may be regarded as functional
adaptation, minimizing the risk of cleavage in the axial direction under the influence of
occlusal masticatory forces.
Fig. 14.6: Hunter-Schreger bands

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Q 6. Describe surface structures of enamel. (Oct. 2004)

Ans. Introduction
Surface Structures of Enamel
Structures seen on the outer surface of enamel are:
1. Aprismatic enamel/structureless layer of enamel
2. Perikymata
3. Enamel rod ends
4. Cracks
5. Cuticle
1. Aprismatic Enamel/Structureless Layer of Enamel/Prismless Enamel

• It is hypermineralized and rodless layer of enamel near the dentinoenamel junction (DEJ),
approximately 30 μm thick.
• It is present in almost 70% of permanent teeth and all deciduous teeth.
• It is found commonly towards cervical areas of enamel.
• It is deposited by ameloblasts before formation of Tomes’ process.
• All the apatite crystals in it are parallel to one another and perpendicular to the striae of
Retzius.
2. Perikymata/Imbrication Lines (June 2004)

• They are transverse wavelike grooves believed to be the external manifestation of the striae
of Retzius in enamel.
• They are continuous around a tooth and usually lie parallel to each other and the
cementoenamel junction (CEJ).
• There are about 30 perikymata per milliimeter in the region of the CEJ, gradually decrease
to 10 per millimeter near the incisal or occlusal surface.
• They are not found in the occlusal third of the deciduous teeth as they are formed prenatally
during which time the enamel formation occurs in an undisturbed and even manner.
3. Enamel Rod Ends

• They are concave and vary in depth and shape. They are shallow in cervical region and
deepest in occlusal region.
4. Cracks
• Are narrow, fissure like structures. They are the outer edges of the lamellae.
• They extend for varying lengths along the surface at right angles to the DEJ.
• Ultrastructurally, the surface of the enamel appears very uneven. Pits of about 1–1.5 μm in
diameter and small elevations of about 10–15 μm called enamel caps are seen. The surface
pits are said to represent the ends of ameloblast and the caps are due to enamel deposition
on nonmineralizable debris. Larger enamel elevations are enamel brochs.
5. Enamel Cuticle
A. Developmental
B. Acquired
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A. Developmental enamel cuticle/Nasmyth’s membrane/Dental cuticle/Primary enamel cuticle:

• It is a delicate membrane that covers the entire crown of the newly erupted tooth but is
probably soon removed by mastication.
• It is about 0.5 to 1.5 mm thick. It is acellular. It is formed as the final secretory product of
ameloblasts. It is basal lamina secreted by ameloblasts.
• This cuticle is secreted after the epithelial organ retracts from the cervical region during
tooth development.
B. Acquired:
• It is the pellicle that covers erupted enamel which is apparently a precipitate of salivary
proteins.
• This pellicle reforms within hours after an enamel surface is mechanically cleaned.
• It becomes colonized by microorganisms to form a bacterial plaque.
Q 7. Write about gnarled enamel. (June 2001)

Ans. Gnarled Enamel
• Generally, the enamel rods are oriented at right angles to the dentin surface. The rods are
rarely straight, they have a wavy course from dentin to the enamel surface.
• The enamel rods below the cusps and incisal region appear irregularly twisted and
interwined. This optical appearance of enamel is called gnarled enamel (Fig. 14.7).
• Unlike the Hunter-Schreger bands, gnarled enamel extends throughout the thickness of
enamel at the cusp tips and incisal edges.
• It resists the high masticatory loads that the cusps or incisal edges have to bear.
Fig. 14.7: Gnarled enamel
Q 8. What is reduced enamel epithelium (REE)? (May 2014)

Ans. Reduced Enamel Epithelium
• During the protective stage in the life cycle of ameloblast, when the enamel is completely
developed and has fully calcified, ameloblasts cease to be arranged in a well-defined layer.
• They are no longer differentiated from the cells of the stratum intermedium and outer enamel
epithelium.
• These cell layers then form a stratified epithelial covering of the enamel which is known as
reduced enamel epithelium (REE).
Enamel 193
Functions
• The function of REE is to protect the mature enamel by separating it from the connective
tissue until the tooth erupts.
• The epithelial cells elaborate enzymes that are able to destroy connective tissue fibers by
desmolysis. This causes fusion of REE with oral epithelium. This helps in eruption of teeth.
Significance
• If reduced enamel epithelium is delayed in its separation from dentin, cementum and dentin
do not meet and this result in formation of gap type of cementoenamel junction.
• If REE degenerates prematurely, the connective tissue comes in contact with the enamel
and anomalies may develop. Under such conditions, enamel may be either resorbed or
covered by a layer of cementum.
• Premature degeneration of the REE may also prevent the eruption of tooth.
Q 9. Describe age changes in enamel.

Ans. AGE CHANGES IN ENAMEL
• Enamel is a non-vital tissue and is incapable of replacement.
• Attrition is the most apparent age change in enamel. It is wearing off of the occlusal surface
and proximal contact points as a result of mastication. This is evident by a loss of vertical
dimension of the crown and by flattening of the proximal contour. The earliest clinical
change is the loss of mamelons. Loss of enamel could also be due to mechanical wear
(abrasion) and chemical wear (erosion).
• The surfaces of unerupted and recently erupted teeth are covered with pronounced rod
ends and perikymata. With age there is generalised loss of rod ends and flattening of
perikymata.
• Teeth darken with age which could be due to addition of organic material from environment
or due to deepening of dentin color seen through the progressive thinning of translucent
enamel.
• Enamel becomes less permeable to fluids with age which could be due to the increase in the
size of the crystals which decrease the pores between the crystals. Intake of ions such as
nitrogen, fluorine, from oral fluids, accumulates at the surface layers which causes the crystals
to become bigger, reducing the pores between them.
• Resistance to decay increases with age.
• Enamel becomes harder with age. However, it tends to become more brittle. Increased
hardness is attributable to the uptake of fluoride by the surface layers of enamel.
Q 10. Explain amelogenesis.

Ans. AMELOGENESIS
Amelogenesis is the formation of enamel which occurs during advanced stage of tooth
development after the first layer of dentin has been laid down.
Enamel formation comprises two stages:
1. Secretion/formation of enamel matrix
2. Mineralisation
Enamel formation differs from other hard tissues like dentin, cementum and bone which
are all derived from connective tissue. Enamel is derived from ectoderm and has a unique
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organic matrix. Noncollagenous proteins are involved in mineralization of enamel whereas

collagen plays an important role in mineralization of dentin and bone. Matrix of enamel does
not contain collagen while it is present in bone, dentin and cementum. The matrix of enamel is
partially mineralized while in other hard tissues matrix is nonmineralized. Enamel lacks a
distinct organic phase.
1. Secretion or Formation of Enamel Matrix

• Ameloblasts begin their secretory activity after a layer of dentin has been laid down.
• During tooth development, the low columnar cells of the inner enamel epithelium (IEE)
supported by a basement membrane are separated from the acellular zone of the dental
papilla.
• When dental papilla cells differentiate into odontoblasts, the IEE cells become tall and
columnar and their nuclei become aligned at the proximal end of the cells adjacent to the
stratum intermedium. This is reversal of polarity.
• Message is sent by preameloblasts to newly differentiated odontoblasts, which lay down
predentin. This, in turn, causes the differentiation of secretory ameloblasts which secrete
enamel matrix over the newly formed dentin. This is reciprocal epithelial-mesenchymal
interaction.
• This matrix immediately becomes partially mineralized. Secretion and partial mineralization
continues until almost all of the entire thickness of enamel has been formed.
• As the first increment of enamel is formed, the ameloblasts begin to move away from the
dentin surface and soon each cell forms a short conical projection called Tomes’ process
which penetrates into the newly formed enamel.
• There is an interdigitation of the cells and the enamel rod that they produce. This is because
the long axes of the ameloblasts are not parallel to the long axes of the rods.
• Four ameloblasts are required for synthesis of one enamel rod.
• Head of each enamel rod is formed by one ameloblast whereas three other ameloblasts
contribute to the tail of each rod. Thus, each enamel rod is formed by four ameloblasts and
each ameloblast contributes to four different rods.
• When secretion of full thickness of enamel is completed, the ameloblasts shorten, lose their
Tomes’ processes and become involved in the maturation of the enamel.
2. Enamel Mineralization and Maturation
Mineralization of enamel matrix takes place in two stages:
• In the first stage immediate partial mineralization occurs in the matrix segments and the
interprismatic substance. Nucleation for mineralization in enamel is initiated by the apatite
crystallites of dentin on which enamel is laid. Matrix vesicles are not involved in enamel
formation. There is no unmineralized matrix like that of predentin or osteoid during enamel
formation. This first formed enamel consists of approximately 65% water, 20% organic
material and 15% inorganic material.
• The second stage or maturation is characterized by the gradual completion of mineralization,
i.e. growth of mineral crystals and withdrawal of substantial amount of protein and water.
The original ribbon-shaped crystals increase in thickness than in width. Crystals increase in
size from 15 to 25 μm during maturation.
• Maturation begins before the matrix has reached its full thickness.
Enamel 195
• Pattern of mineralization/maturation progresses from DEJ towards enamel surface.

• Each rod matures from the depth to the surface of enamel and the sequence of the maturing
rods is from cusps or incisal edge toward the cervical line.
• This means incisal and occlusal region reach maturity ahead of the cervical region.
• Maturation is characterized by growth of the crystals. It involves selective removal of
proteinaceous material so as to make space for growing mineral crystals.
• Ameloblasts alternate cyclically in developing smooth and ruffled borders in the apical
cytoplasm during maturation stage in a cervioocclusal direction. This is modulation. The
ruffled ended ameloblasts have their villous surface, packed with mitochondria. They show
numerous lysosomes and possess endocyte activity. They also promote calcium entry into
the forming enamel. The smooth ended ameloblasts leak small proteins and water into
forming enamel.
• In enamel 90% of secreted matrix is absorbed while in other hard tissues there is no absorption
of secreted matrix.
• The rate of formation of enamel is 4 μm/day. The rate of formation is more in permanent
teeth than in deciduous teeth.
• As the enamel formation continues cells of the outer enamel epithelium, stellate reticulum,
and stratum intermedium gradually lose their discrete identities and form a stratified
epithelial layer adjacent to the ameloblasts.
• Once the maturation is completed, the ameloblast layer, together with the adjacent stratified
layer constitutes the reduced enamel epithelium (REE).
• Though it is no longer involved in the secretion and maturation of enamel, REE continues
to cover enamel till tooth eruption and has a protective function.
1. During amelogenesis if matrix formation is affected, enamel hypoplasia results. If maturation
is lacking or incomplete, hypocalcification of the enamel results.
2. Systemic hypocalcification of enamel due to high fluoride content in water is called as mottled
enamel.
3. After formation of enamel, ameloblasts undergo apoptosis, hence there is no formation of
enamel later in life unlike in other hard tissues.
Q 11. Write about dentinoenamel junction.

Ans. DENTINOENAMEL JUNCTION
• The junction between enamel and dentin is not straight but appears as a scolloped line.
(Refer Fig. 14.6)
• The surface of the dentin at the dentinoenamel junction (DEJ) is pitted. Into the shallow
depressions of the dentin, fit rounded projections of the enamel. This relation assures the
firm hold of the enamel on the dentin.
• The convexities of the scallops of DEJ are directed towards the dentin.
• The pitted dentinoenamel junction is preformed even before the development of hard tissues.
• In the DEJ, the crystals of dentin and enamel mix with each other.
• DEJ is more pronounced in the occlusal area, where masticatory stresses are greater.
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Q 12. Describe structure of enamel or ultrastructure of enamel.

Ans. ULTRASTRUCTURE OF ENAMEL
• Enamel is the hardest calcified tissue of body, which forms the outermost covering of the
tooth crown.
• It is composed of enamel rods or prisms, rod sheaths, and a cementing interprismatic substance.
• Enamel rods are cylindrical in shape. Their number ranges from 5 million in lower lateral
incisors to 12 million in the upper first molars.
• Enamel rods run in oblique direction from dentinoenamel junction (DEJ) to the outer surface
of enamel. They have wavy course. Rods located in the cusps are longer than those at the
cervical areas of teeth.
• Average diameter of enamel rod is 4 microns but it varies. At the outer surface of the enamel,
it is greater than the dentinal surface. The ratio of diameter of rods from the DEJ towards
the surface of the enamel is 1:2.
• Rods have a clear crystalline appearance, permitting light to pass through them.
• In cross-section of human enamel, many rods resemble fish scales. Rods have arcade outlines
near DEJ and keyhole-shaped outlines at the enamel surface.
Ultrastructure
• Human enamel contains rods or prisms surrounded by rod sheaths and separated by inter-
rod substance.
• The enamel prisms appear as segmental rods in longitudinal section and in cross-section
they appear as oval, fish scale or keyhole shaped.
• When cut longitudinally, sections pass through the ‘heads’ or ‘bodies’ of one row of rods
and the tails of an adjacent row.
• Rods are 5 microns in breadth and 9 microns in length.
• Enamel rods have apatite crystals arranged parallel to their long axes in their bodies or
heads and deviate about 65 degrees as they fan out into tails of the prims.
• The apatite crystals of human enamel rods are irregular in shape and are about 30 nm in
thickness and 90 nm in width.
• Direction of enamel rods: rods are oriented at right angle to the dentin surface. In the cervical
and central parts of the crown of a deciduous tooth, they are horizontal while near the
incisal edge or cup tips they are almost vertical. In permanent teeth, in cervical region, the
rods deviate from horizontal to apical direction.
• Each enamel rod is built-up of segments and are more pronounced in enamel that is
insufficiently calcified. The rods are segmented because the enamel matrix is formed in
rhythmic manner. In humans these segments are of 4 microns in length.
• The cross striations are due to diurnal rhythm in enamel formation and in these areas rods
show variations in composition.
• Ultrastucturally enamel shows certain hypocalcified structures as incremental lines of
Retzius, neonatal lines, enamel lamellae, enamel tufts, and spindles.
Course of enamel rods is important in cavity preparation. Close to the cementoenamel junction
the rods run in a more horizontal direction. In preparing cavities it is important to remove
unsupported enamel rods as they can break and produce leakage.
Enamel 197
1. The only hard calcified dental tissue 9. The only high organic containing micro-
derived from ectoderm is scopic structure of enamel that is not
a. Bone b. Dentin derived from enamel is
c. Enamel d. Cementum a. Enamel tuft
b. Enamel spindle
2. The only dental tissue that is totally
acellular c. Enamel lamellae
a. Cementum b. Enamel d. Cross striations
c. Dentin d. Bone 10. The microscopic structures of enamel
that are not lined up as rows are (They
3. The maximum thickness of enamel is do not follow the direction of rods)
a. 1.3 mm b. 2.4 mm a. Lamellae b. Tufts
c. 2.5 mm d. 3.8 mm c. Spindles d. All of the above
4. The density of enamel is 11. The hardest tissue in human body is
a. 2.8–3.0 gm/ml a. Bone b. Dentin
b. 2.5–3.5 gm/ml c. Enamel d. Cementum
c. 1.5–2.0 gm/ml 12. The color of enamel is
d. 1.0–0.7 gm/ml a. Light yellow
5. The knoop hardness number of enamel is b. Dark yellow
a. 643 b. 343 c. Light yellow to greyish white
c. 243 d. 143 d. Chalky white
6. The average length of enamel rod at 13. Mature human enamel is made-up of
midcrown region is a. 96% inorganic and 4% organic material
a. 0.2 mm b. 0.05 mm b. 65% inorganic and 35% organic material
c. 0.04 mm d. 0.02 mm c. 45% inorganic and 55% organic material
7. The proteins of enamel are unique d. 30% inorganic and 70% organic
among mineralized tissues as they are 14. The basic structural unit of enamel is
a. Type I collagen a. Cell b. Fiber
b. Fibrous collagen c. Rod/prism d. Tubule
c. Amelogenins and enamelins 15. The average thickness of enamel rod is
d. Type II collagen a. 20 mm b. 30 mm
8. Enamel lamellae may be confused with c. 45 mm d. 60 mm
cracks caused by grinding of the speci- 16. From the dentinoenamel junction (DEJ)
men, decalcification of ground section towards the surface of the enamel, the
will cause diameter of the rod
a. Disappearance of cracks a. Decreases
b. Disappearance of lamellae b. Increases
c. No change c. Remains same
d. Both a and b d. Alternate increase and decrease
1-c, 2-b, 3-c, 4-a, 5-b, 6-a, 7-c, 8-a, 9-b, 10-c, 11-c, 12-c, 13-a, 14-c, 15-c, 16-b
198 DADH Made Easy
17. The number of enamel rods in upper first 25. The shape to the crown is given by
molar are a. Outer enamel epithelium
a. 15 million b. 12 million b. Inner enamel epithelium
c. 2–3 million d. 5000–90,000 c. Stellate reticulum
18. Incremental lines of enamel are d. Stratum intermedium
a. Incremental lines of von Ebner 26. The diameter and height of ameloblasts is
b. Incremental lines of Salter a. 6–7 mm in diameter and 60 mm high
c. Incremental lines of Retzius b. 4–5 mm in diameter and 40 mm high
d. Line of Owen c. 3–4 mm in diameter and 20 mm high
19. Surface manifestations of lines of Retzius d. 2–3 mm in diameter and 20 mm high
are known as 27. All are hypocalcified structures except
a. Perikymata and imbrication lines a. Enamel tufts
b. Enamel lamellae b. Enamel lamellae
c. Cracks c. Enamel rods
d. Mamelons d. Inter-rod substances
20. Microscopic structures that do not appear 28. The part of the tooth germ that outlines the
to originate at DEJ are root portion does not have the presence of
a. Hunter-Schreger bands a. Outer enamel epithelium
b. Enamel tufts b. Inner enamel epithelium
c. Enamel lamellae c. Stratum intermedium
d. Spindles d. Stellate reticulum
21. The enamel forming cells are e. Both c and d
a. Odontoblasts b. Ameloblasts 29. The functional unit responsible for the
c. Cementoblasts d. Osteoblasts production of enamel
22. Ameloblasts are derived from a part of a. Ameloblasts and stratum intermedium
dental organ called b. Ameloblasts and OEE
a. Outer enamel epithelium c. Ameloblasts and stellate reticulum
b. Inner enamel epithelium d. OEE and IEE
c. Stratum intermedium 30. On completion of enamel formation, the
d. Stellate reticulum shor tened ameloblasts secrete an
23. The differentiation of ameloblasts require organic structureless membrane on the
the presence of surface of the enamel called
a. Enamel b. Pulp a. Primary cuticle
c. Dentin d. Cementum b. Pellicle
c. Perikymata
24. During dentinogenesis, odontoblasts
retreat centrally leaving behind formed d. Membrane preformativa
dentin whereas ameloblasts retreat in 31. Each enamel rod is formed by
a. Central direction a. One ameloblast
b. Peripheral direction b. Two ameloblasts
c. Mesial direction c. Three ameloblasts
d. Distal direction d. Four ameloblasts
17-b, 18-c, 19-a, 20-c, 21-b, 22-b, 23-c, 24-b, 25-b, 26-b, 27-c, 28-e, 29-a, 30-a, 31-d
Enamel 199
32. All of the following are the surface struc- 39. Enamel is almost as hard as
tures of enamel except a. Granite b. Gold
a. Hunter-Schreger bands c. Diamond d. Iron
b. Rod ends 40. Amount of collagen present in enamel is
c. Enamel crack a. 2% b. 1%
d. Perikymata c. 0.5% d. Nil
33. Mesenchymal cells in dental papilla 41. The successional lamina develops from
differentiate into odontoblasts under the a. 6th month in utero to 12th month of
organizing influence of cells of age
a. Outer enamel epithelium b. 5th month in utero to 10th month of
b. Stratum intermedium age
c. Inner enamel epithelium c. 4th month in utero to one year
d. All the above d. 3rd month in utero to one year
34. The protective covering of the enamel 42. The development of root begins after the
of teeth before its eruption is enamel and dentin formation has
a. Enamel cuticle reached the future
b. Reduced enamel epithelium a. Dentinoenamel junction
c. Outer enamel epithelium b. Cementoenamel junction
d. Inner enamel epithelium c. Dentinocemental junction
35. The largest hydroxyapatite crystals are
d. Dentinopredentin junction
found in 43. The direction of the enamel rods in the
a. Enamel b. Dentin permanent teeth is
c. Cementum d. Bone a. Same as in deciduous
b. Inclined in an apical direction in the
36. The cells of dental organ/enamel organ
cervical third of the crown
differentiate to form
c. Inclined in an occlusal direction in the
a. Dentin
cervical third of the crown
b. Enamel
d. Horizontal direction
c. Cementum
44. The cell rests of Serre represent
d. Periodontal ligament (PDL)
a. Remnants of dental lamina
37. Cells of dental follicle differentiate to b. Remnants of successional lamina
form
c. Remnants of Hertwig’s epithelial root
a. Cementum and PDL sheath
b. Enamel and pulp d. Remnants of dental follicle
c. Dentin and cementum
45. The hypocalcified structure of enamel
d. Pulp and cementum that extends from enamel surface towards
38. Remnants of dental lamina persist as dentinoenamel junction (DEJ) is
a. Enamel pearls a. Enamel spindle
b. Epithelial pearls/cell rests of Serres b. Enamel tufts
c. Cell rests of malassez c. Enamel lamellae
d. None of the above d. All of the above
32-a, 33-c, 34-b, 35-a, 36-b, 37-a, 38-b, 39-c, 40-d, 41-b, 42-b, 43-b, 44-a, 45-c
200 DADH Made Easy
46. The convexities of the scallops of the 53. Enamel tufts are
dentinoenamel junction are directed a. Hypercalcified enamel rods
towards b. Hypocalcified enamel rods
a. Enamel c. Hypocalcified enamel rods and inter-
b. Dentin prismatic substance
c. Both enamel and dentin d. Accentuated incremental line
d. Incisal surface 54. Under the electron microscope the cut
section of enamel rods are seen as
47. Aprismatic enamel is found at
a. Key holes
a. Surface layer only
b. Staggered arches
b. DEJ only c. Stacked arches
c. Surface layer and DEJ d. All of the above
d. None of the above 55. The dentinal end of ameloblast is also
48. External manifestation of enamel lamellae called
running longitudinally and in a direction a. Mesial end b. Distal end
perpendicular to DEJ represents c. Proximal end d. None of the above
a. Perikymata 56. The neonatal line is seen in enamel of
b. Crack a. Deciduous teeth
c. Imbrication lines of pickerill b. Deciduous and permanent first molar
d. Enamel hypoplasia c. Permanent central incisor
49. Diameter of enamel rod increase from d. Permanent maxillary first molar
DEJ towards the surface of the enamel 57. The neonatal line is seen in dentin of
at a ratio of a. Permanent maxillary first molar
a. 2:4 b. 2:3 b. Deciduous teeth and permanent first
c. 1:4 d. 1:2 molar
c. Permanent maxillary central incisor
50. Permeability of enamel
d. Deciduous teeth
a. Increases with age
58. The enamel spindles are
b. Decreases with age
a. The terminal branches of odontoblasts
c. Remains same
b. The terminal branches of odontoblastic
d. Does not depend on age processes
51. Enamel can be studied by using c. The terminal branches of odontoblastic
a. Decalcified section process in enamel
b. Ground section d. None of the above
c. Frozen section 59. The maximum thickness of enamel is
d. All of the above a. At the cusp of molars and premolars
b. At the incisal edge of the newly
52. Primary enamel cuticle is also called
erupted anterior teeth
a. Nasmyth’s membrane c. Cingulum portion of maxillary central
b. Reduced enamel epithelium incisor
c. Preameloblastic layer d. At the tip of the crown of maxillary
d. Pellicle canine
46-b, 47-c, 48-b, 49-d, 50-b, 51-b, 52-a, 53-c, 54-d, 55-b, 56-a, 57-b, 58-c, 59-a
Enamel 201
60. Which of the following features does not 68. The formula of the unit cell of hydroxy-
come under the surface structure of apatite crystal is
enamel? a. 3Ca3 (PO4)2, : Ca(OH)2
a. Perikymata b. 2Ca3 (PO4)2, : Ca(OH)2
b. Enamel crack c. Ca3 (PO4)2, : Ca(OH)2
c. Rod ends d. Ca3 (PO4)2, : 3Ca(OH)2
d. Hunter-Schreger bands
69. The other name for inner enamel epi-
61. Process of rhythmic laying down of enamel thelium in bell stage is
is called
a. Ameloblastic layer
a. Apposition b. Secretion
b. Odontoblastic layer
c. Deposition d. Calcification
c. Cementoblastic layer
62. The structures of the enamel which are
d. Osteoblastic layer
most resistant to the actions of acids are
a. Enamel cuticles 70. On the cusp of human molars and pre-
b. Enamel lamellae molars maximum thickness of enamel is
about
c. Enamel spindles
a. 0 to 1 mm
d. Enamel tufts
b. 2 to 3 mm
63. “Seeding” process of mineralization of
c. 4 to 5 mm
enamel and dentin is known as
a. Calcification b. Epitaxy d. 4 to 6 mm
c. Epistaxis d. Phosphorylation 71. Enamel tufts which arise at the dentino-
enamel junction and reach in enamel
64. All the submicroscopic structures of the
to about 1/5th to 1/3rd of its thickness are
enamel are hypocalcified except
a. Enamel spindles a. Hypocalcified enamel rods and inter-
prismatic substance
b. Enamel lamellae
c. Enamel prisms b. Hypocalcified enamel rods only
d. Enamel tufts c. Hypomineralised enamel rods only
d. Similar to surface structures
65. All the submicroscopic parts of enamel
are of ectodermal in origin except 72. In the life cycle of an ameloblast, the
a. Enamel lamellae Tomes’ process develops during the
b. Enamel tufts following stage
c. Enamel spindles a. Morphogenic stage
d. Enamel rod sheath b. Organizing stage
66. Specific gravity of enamel is c. Secretary (formative) stage
a. 2.8 b. 4.3 d. Maturative stage
c. 6.4 d. 8.2 73. Each of the following terms is used to
67. Appositional growth is describe an enamel structure except
a. Additive growth a. Prisms
b. Linear growth b. Perikymata
c. Circumferential growth c. Striae of Retzius
d. None of the above d. Contour lines of Owen
60-d, 61-a, 62-a, 63-b, 64-c, 65-c, 66-a, 67-a, 68-a, 69-a, 70-b, 71-a, 72-c, 73-d
202 DADH Made Easy
74. Maturation of enamel is characterized 82. The cells leading to differentiation of

by addition of inorganic content and dentin forming cells are
a. Addition of water a. Ameloblasts b. Odontoblasts
b. Addition of organic content c. Cementoblasts d. Osteoblasts
c. Removal of water and organic content 83. Hardness of enamel from surface to inside
d. Removal of water and addition of a. Increases
organic content. b. Decreases
75. Gnarled enamel is most frequently found c. Does root changes
in d. First increases than decreases
a. Cusps
84. All of the following are true regarding
b. Near the cervical line incremental lines of Retzius except
c. Around pits and fissures a. Brownish band in ground section
d. Adjacent to contact areas b. Concentric in transverse section
76. Perikymata are the result of c. Represents successive apposition of
a. Enamel hyperplasia enamel
b. Enamel hypoplasia d. Are present in dentin
c. Interstitial growth 85. In protective stage of life cycle of amelo-
d. Normal enamel apposition blast, it protects the
77. Direction of enamel rods in deciduous a. Osteoblast b. Odontoblast
teeth in the cervical third region is inclined c. Cementoblast d. Enamel
a. Horizontally b. Occlusally 86. Striations in human enamel appear at a
c. Apically d. Vertically distance of
78. One of the following is the optical pheno- a. 4 microns b. 5 microns
menon of enamel c. 6 microns d. 7 microns
a. Enamel crack 87. All are age changes in enamel except
b. Perikymata a. Permeability decreases
c. Hunter-Schregar band b. Resistance to caries decreases
d. Enamel spindle c. Fluoride content at surface increases
79. Mineralization of enamel takes place in d. Enamel becomes harder and darker
a. One stage b. Two stages 88. One of the following is not true regarding
c. Three stages d. Four stages Nasmyth’s membrane
80. The percentage of protein found in the a. Is also known as primary enamel
enamel of mature teeth is cuticle
a. 0.1% b. 0.2% b. It covers the newly formed enamel
c. 0.3% d. 0.4% c. It disappears with the eruption of
81. In histological staining reaction, enamel tooth due to removal by mastication
matrix behaves like d. It forms after tooth eruption
a. Keratinized epidermis 89. The tissue which is lost maximum during
b. Non-keratinized mucosa decalcification is
c. Keratinized mucosa a. Bone b. Cementum
d. Parakeratinized mucosa c. Dentin d. Enamel
74-c, 75-a, 76-d, 77-a, 78-c, 79-b, 80-a, 81-a, 82-a, 83-b, 84-d, 85-d, 86-a, 87-b, 88-d, 89-d
Enamel 203
90. The cell which cannot regenerate is 92. In organizing stage of amelogenesis,
a. Ameloblast b. Odontoblast ameloblast resemble
c. Cementoblast d. Fibroblast a. Squamous cell
91. Which of the following is not true b. Cuboidal cell
regarding the dentinoenamel junction? c. Flat cell
a. Scalloped with convexities towards d. Tall columnar cell
the dentin
b. Preformed even before the develop- 93. The dentinal end of ameloblast can be
ment of hard tissues regarded as
c. Hypermineralized zone present at DEJ a. Proximal end b. Distal end
d. Hypomineralized zone present at DEJ c. Mesial end d. Lateral end
90-a, 91-d, 92-d, 93-b

204 DADH Made Easy
15
Dentin
LAQ (10 Marks)
Q 1. Enumerate and describe the hypocalcified structures of dentin. (May 2002)

Ans. Dentin provides the bulk and general form of the tooth and is characterized as a hard
tissue with tubules throughout its thickness.
Hypocalcified structures present in dentin are:
1. Incremental lines of von Ebner and contour lines of Owen.
2. Neonatal line
3. Interglobular dentin
4. Tomes’ granular layer
1. Incremental Lines of von Ebner and Contour Lines of Owen

• Dentin formation proceeds rhythmically with alternate phases of activity and quiescence.
These phases are represented in formed dentin as incremental lines of von Ebner or imbrication
lines. They appear as fine lines or striations in dentin (Fig. 15.1).
Fig. 15.1: Incremental lines in dentin
204
Dentin 205
• These lines reflect the daily rhythmic recurrent deposition of dentin matrix as well as a
hesitation in the daily formative process.
• These are best seen in longitudinal ground section of tooth.
• These incremental lines run at right angles to the dentinal tubules and generally mark the
normal rhythmic linear pattern of dentin deposition in an inward and rootward direction.
The course of the lines indicates the growth pattern of the dentin.
• The distance between lines varies from 4 to 8 μm in the crown and much less in root.
• Occasionally some of the lines are accentuated because of the disturbance in the matrix and
mineralization process. Such lines are readily demonstrated in longitudinal ground section
and are known as contour lines of Owen. These lines represent hypocalcified bands.
2. Neonatal Line
• This is a hypocalcified structure present in dentin in deciduous teeth and in the first
permanent molars, where dentin is formed partly before and partly after birth.
• The prenatal and postnatal dentin in these teeth are separated by an accentuated contour
line, a zone of hypocalcification. This is termed as neonatal line and is seen in enamel as well
as in dentin.
• This line reflects the abrupt change in environment that occurs at birth.
• The dentin matrix formed prior to birth is usually better in quality than that formed after birth.
3. Interglobular Dentin
• This is unmineralized or hypomineralized dentin where in small globular areas of dentin
fail to coalesce into a homogenous mass.
• During the mineralization of dentin matrix, the minerals are deposited as globules or
calcospherites. In most of the areas, these globules fuse to form a uniformly calcified tissue.
• When some of these globules fail to fuse into a homogenous mass, zones of hypomineralization
form between the globules. These zones are known as globular dentin or interglobular spaces
(Fig. 15.2).
• Most often it forms in the crown in the circumpulpal dentin just below the mantle dentin,
where the pattern of mineralization is mainly globular.
Fig. 15.2: Interglobular dentin

206 DADH Made Easy
• In areas of interglobular dentin, the architectural pattern of the tubules does not change
and the tubules pass through interglobular areas without deviation. This confirms that the
formation of interglobular dentin is because of a defect in mineralization and not in matrix
formation.
• When ground sections are viewed in transmitted light, interglobular areas appear as dark
rounded masses with concave edges.
• Vitamin D deficiency or exposure to high levels of fluoride during dentin formation is
thought to be responsible for the failure of fusion of the globules and formation of
interglobular dentin.
4. Tomes’ Granular Layer

• When dry ground sections of the root dentin are visualized in transmitted light, a zone
adjacent to cementum appears granular. This is known as Tomes’ granular layer (Fig. 15.3).
• This appearance is seen in the root but not in the crown as there is difference in the rate of
formation of coronal and radicular dentin.
• It is a hypomineralized region and is found only in root dentin.
• This zone increases in amount from cementoenamel junction to the apex of the root.
• The dentinal tubules in this area branch more profusely leading to coalescing and looping
of the terminal branches. This occurs because odontoblasts turn on themselves during early
dentin formation. These areas remain unmineralized.
• The air spaces thus created appear dark and granular in ground sections because of internal
reflection of transmitted light.
• An alternative explanation for the granular appearance is that it is due to incomplete fusion
of calcospherites.
• Recent studies have shown that Tomes’ granular layer has a special arrangement of collagen
and non-collagenous matrix proteins at the interface between dentin and cementum.
• Among hypomineralized areas, Tomes’ granular layer shows highest concentrations of
calcium and phosphorus.
Fig. 15.3: Tomes’ granular layer

Dentin 207
SAQs (3 Marks)
Q 1. Describe about physical and chemical properties of dentin. (Oct. 2002, 2004)
Ans. PHYSICAL PROPERTIES OF DENTIN
• Dentin is a hard tissue of tooth with tubules throughout its thickness. It provides the bulk
and general form of the tooth.
• It is sensitive and forms throughout life at the expense of the pulp.
• Even though it resembles bone physically and chemically, morphologically they differ. Bone
forming cells (osteoblasts) become entrapped in the matrix to form osteocytes whereas the
dentin forming cells remain external to the dentin matrix and only their processes are
enclosed in the dentinal tubules.
Colour
Dentin is light yellowish in colour in young individuals. It becomes darker with age.
Permeability
It is a hard tissue with tubules throughout its thickness which makes it more permeable. The
permeability decreases with age. Dentinal tubules are filled with tissue fluid.
Hardness
• Dentin hardness varies slightly between tooth types and between crown and root dentin.
Dentin is harder in its central part than near the pulp or on its periphery. Dentin of primary
teeth is slightly less hard than that of permenant teeth.
• Dentin is viscoelastic and is harder than bone and cementum but softer than enamel.
Compared to enamel it has higher compressive strength but lower tensile strength.
• In radiographs, dentin appears more radiolucent (darker) than enamel and more radio-
opaque than pulp (lighter).
CHEMICAL PROPERTIES OF DENTIN

Dentin is composed of 65% inorganic material and 35% organic matter and water.
Organic matter: Consists of collagenous fibrils (Type I collagen) embedded in ground
substance. Important constituents of ground substane are:
• Proteoglycans: Chondroitin sulphates, decorin and biglycan.
• Glycoproteins: Dentin sialoprotein, osteonectin, osteopontin.
• Phosphoproteins: Dentin phosphoprotein.
In addition, matrix contains growth factors.
The matrix components play an important role in mineralisation of dentin.
Inorganic material: Consists of hydroxyapatite.
• Each hydroxyapatite crystal is composed of several thousand unit cells. The unit cell have a
formula of 3Ca3(PO4)2, Ca(OH)2.
• The crystals are plate shaped and much smaller than the hydroxyapatite crystals in enamel.
• Dentin also contains small amount of phosphates, carbonates and sulphates.
• Organic and inorganic substances can be separated by either decalcification or incineration.
In the process of decalcification the organic constituents of dentin can be retained and they
maintain the shape of dentin.
208 DADH Made Easy
• Whereas enamel has 95% minerals and therefore, after decalcification enamel is lost. Hence,
its histologic visualization is not possible after decalcification. Therefore, enamel can be
studied only by ground sections.
Q 2. Describe contents of dentinal tubules. (Dec. 2005)

Ans. CONTENTS OF DENTINAL TUBULES
• Dentinal tubules are the structural units of dentin. They make the dentin permeable. They
are small canal like spaces within the dentin.
• Dentinal tabule contains the odontostastic process surrounded by dentinal fluid.
• The inner wall of dentinal tabule is formed by the highly mineralized intratubular dentin.
The space between the odontoblastic process and the intratubular dentin contains the
dentinal fluid (tissue fluid), the movement of which forms the basis of dentin sensitivity.
• Dentin producing cell, odontoblast, resides in the peripheral pulp while its process extend
into the dentinal tubules. The processes are largest in diameter near the pulp (3–4 μm) and
taper to 1 μm into the dentin. The odontoblastic process is composed of microtubules and
small filaments and occasionally mitochondria, lysosomes and microvesicles.
• The odontoblastic processes divide near the dentinoenamel junction and may extend into
enamel as enamel spindles.
• A thin organic membrane (lining) rich in glycosaminoglycans called the lamina limitans is
seen on the inner aspect of the intratubular (peritubular) dentin.
• Nerve fibers also accompany the odontoblastic process within dentinal tubules. The fluid
movement stimulates the pain mechanism in the tubules by mechanical disturbance of the
nerves, thus playing role in pain transmission.
Q 3. What is peritubular dentin/Intratubular dentin? (May 2015)

Ans. INTRATUBULAR/PERITUBULAR DENTIN (Fig. 15.4)
• The dentin that immediately surrounds the dentinal tubules is termed peritubular dentin.
Since the deposition of the minerals here occurs in the inner wall of the tubule rather than
on the outer walls, the term intratubular is more appropriate.
• It is more highly mineralized (about 9%) than intertubular dentin (Fig. 15.4).
Fig. 15.4: Peritubular and Intertubular dentin

Dentin 209
• It is twice as thick in outer dentin than in inner dentin.

• It is absent where the tubules run through the interglobular areas and that portion of dentin
which is close to the pulp.
• A very delicate organic matrix has been demonstrated in this dentin that along with the
mineral is lost after decalcification. Therefore, after decalcification the odontoblast process
appears to be surrounded by an empty space.
• A thin organic membrane (lining) rich in glycosaminoglycans called the lamina limitans, is
seen on the inner aspect of the peritubular dentin.
• The space between the odontoblastic process and the peritubular dentin contains the dentinal
fluid, the movement of which forms the basis of dentin sensitivity.
Q 4. Write about primary and secondary dentin. (May 2007, 2009, June 2010, 2012)
Ans. DENTIN
• Dentin is a hard mineralized tissue which provides the bulk and general form to the tooth.
• Based on time of formation physiological types of dentin are: Primary and Secondary dentin.
Primary Dentin
• Primary dentin is the dentin which is formed before root completion (Fig. 15.5).
• It forms most of the tooth and outlines the pulp chamber of the fully formed tooth.
• Primary dentin is of two types: Mantle dentin and Circumpulpal dentin.
Mantle Dentin
• The outer layer of primary dentin in the crown is called mantle dentin.
• It is about 20 mm thick.
• It is the first formed dentin in the crown underlying the dentinoenamel junction and
underlying it is the circumpulpal dentin. It is deposited by the odontoblasts that have just
begun to differentiate and have not yet reached their full size.
• This dentin is soft and thus provides cushioning effect to the tooth.
• The organic matrix of mantle dentin is composed of larger collagen fibrils than are present in
the rest of the primary dentin. These fibres are oriented perpendicular to the dentinoenamel junction.
• These fibers are argyrophilic (silver stained) and are known as von Korff’s fibers.
They contain mainly type III collagen.
• Compared to circumpulpal dentin it is less mineralized. Mantle dentin has fewer defects
than circumpulpal dentin.
• Matrix vesicles are involved in the mineralization of mantle dentin. Mantle dentin undergoes
globular mineralization whereas circumpulpal dentin mineralizes either by globular or linear
pattern.
• Dentinal tubules branch profusely in the mantle dentin.
• It extends into the root as 5–10 mm thick hyaline layer of Hopewell-Smith. It is the first
formed dentin in the root underlying the cementum.
• In the root mantle dentin, the collagen fibres are arranged parallel to the basal lamina.
Circumpulpal Dentin
• The primary dentin that surrounds the pulp is called circumpulpal dentin.
• It represents all of the dentin formed before root completion.
210 DADH Made Easy
• It forms the remaining primary dentin or bulk of the tooth, apart from mantle dentin.
• The circumpulpal dentin before mineralization is termed predentin.
• Collagen fibrils in circumpulpal dentin are smaller in diameter and are closely packed
together as compared to the mantle dentin and parallel to the dentinoenamel junction.
• It is slightly more mineralized compared to mantle dentin.
• It is further divided into intertubular and peritubular dentin.
• Intertubular dentin forms the main body of dentin. It is located between the zones of
peritubular dentin. Peritubular dentin forms the walls of the dentinal tubules.
Secondary Dentin
• It forms internal to the primary dentin of crown and root. It is a narrow band of dentin
bordering the pulp.
• It represents the dentin which is formed after root completion. It develops after the crown
has come into clinical occlusal function and the roots are nearly completed.
• It is the most important age-associated change in dentin.
• It represents the continuing, but much slower deposition of dentin by odontoblasts after
root formation has been completed.
• It contains fewer tubules than the primary dentin. There is usually a bend in the tubules
where primary and secondary dentin interface.
• It is deposited regularly but not uniformly. There is regular arrangement of dentinal tubules.
Hence, this dentin is also known as regular secondary dentin (Fig. 15.5).
• There is greater deposition of secondary dentin on the roof and floor of pulp chamber,
where it protects the pulp from exposure in older teeth.
• The secondary dentin formed is not in response to any external stimuli and it appears very
much like primary dentin, but contains fewer tubules.
• The apical dentin shows irregularity in the dentinal tubules of both primary and secondary dentin.
• Secondary dentin scleroses more readily than primary dentin. This tends to reduce the
permeability, thereby protecting the pulp.
• It is a physiologic type of dentin whereas tertiary or reparative dentin is formed in reaction
to trauma.
Fig. 15.5: Primary and secondary dentin

Dentin 211
Q 5. What is Reparative or Tertiary dentin? (Oct. 2003, June 2006, Nov. 2010)
Ans. REPARATIVE OR TERTIARY DENTIN
• Tertiary dentin is reactive, response or reparative dentin.
• It is localized formation of dentin on the pulp-dentin border, formed in reaction to trauma
such as caries or restorative procedures, abrasion or erosion.
• Due to trauma depending on the intensity of injury the odontoblasts die or survive.
• If after injury the odontoblasts survive, the dentin that is produced is known as reactionary
or regenerated dentin.
• If after injury the odontoblasts are killed, they get replaced by the migration of
undifferentiated mesenchymal cells which differentiate into odontoblasts and form dentin.
This dentin is known as reparative dentin or tertiary dentin (Fig. 15.6).
• It is believed that the origin of the new odontoblasts from cells in the cell-rich zone or from
undifferentiated perivascular cells deeper in the pulp.
• Bacteria, living or dead, or their toxic products as well as chemical substances from restorative
materials, migrate down the tubules to the pulp and stimulate pulpal response, leading to
reparative dentin formation.
• This action to seal off the zone of injury occurs as a healing process initiated by the pulp,
resulting in resolution of the inflammatory process and removal of dead cells. The hard
tissue then formed is termed reparative dentin.
• This reparative dentin has fewer and more twisted dentinal tubules than normal dentin. It
is due to irregular nature of the dentinal tubules, this type of dentin is also referred to as
irregular secondary dentin.
• The quality and quantity of tertiary dentin produced is related to the intensity and duration
of the stimulus.
• In rapidly progressing caries, where there is extensive destruction of dentin and considerable
pulp damage, tertiary dentin is deposited rapidly and displays a sparse, irregular tubule
pattern with frequent cellular inclusions. Tertiary dentin with such cellular inclusions is
sometimes called osteodentin. In other instances a combination of osteodentin and tubular
dentin is seen.
Fig. 15.6: Dead tracts and Tertiary/Reparative dentin

212 DADH Made Easy
Q 6. Write about dead tracts? (Nov. 2010)

Ans. DEAD TRACTS
• In dried ground sections of normal dentin, the odontoblast processes disintegrate and get
filled with air. These empty, air-filled tubules appear dark in transmitted light and white in
reflected light because of internal reflection.
• Loss of odontoblast processes may also occur in teeth containing vital pulp. Stimuli such as
caries, attrition or erosion result in dentin areas characterized by degenerated odontoblastic
processes. The dentinal tubules become empty following the retraction of the odontoblastic
process or death of odontoblast. These empty dentinal tubules are then sealed by reparative
dentin at their pulpal ends.
• These empty dentinal tubules get filled with fluid or gaseous substances. In ground sections,
such groups of tubules may entrap air and appear black in transmitted and white in reflected
light. Thus, dentin areas characterised by degenerated odontoblast processes give rise to
dead tracts (Refer Fig. 15.6).
• Dead tracts are seen more commonly in older teeth and demonstrate reduced sensitivity.
• Dead tracts are considered to be the initial step in the formation of sclerotic dentin.
Q 7. Write about sclerotic/transparent dentin. (2001)

Ans. SCLEROTIC/TRANSPARENT DENTIN (Fig. 15.7)
• It refers to the filling up of the dentinal tubules calcified material in response to external
stimuli such as slowly progressing caries, attrition or erosion.
• This condition is prevalent in older individuals. It is seen especially in the roots. This may
be regarded as an age change.
• Sclerotic dentin formation is a protective change in the existing dentin. It is considered as a
defensive reaction because it reduces the permeability of dentin and keeps the pulp vital
for a prolonged period.
• In cases of caries, attrition, abrasion, erosion or cavity preparation, sufficient stimuli are
generated to cause collagen fibers and apatite crystals to begin appearing in the dentinal
tubules. This results in blocking of the tubules which is considered a defensive reaction of
dentin.
Fig. 15.7: Transparent dentin

Dentin 213
• Gradually, the tubule lumen is obliterated with minerals, which appears very much like
the peritubular dentin. The refractive indices of dentin in which the tubules are occluded
are equalized and such areas become transparent.
• It is observed in the teeth of elderly people, especially in roots.
• The deposited mineral is different from that in peritubular dentin. Though the mineral
concentration is higher, the size of the crystals in sclerotic dentin is smaller than that in
normal dentin.
• Sclerotic dentin is harder, has reduced fracture toughness but same elastic properties as
normal dentin.
Significance
• Permeability of dentin becomes reduced while hardness increases in the region of sclerotic
dentin.
• It may also be found under slowly progressing caries. Sclerosis reduces permeability of the
dentin and may help to prolong pulp vitality.
• It may block the tubules against entry of bacteria.
• Breakage of apical thirds of roots during extraction of teeth of elderly is due to the brittle
nature of sclerotic dentin.
Q 8. Describe dentin sensitivity or theories of pain transmission through dentin.

(June 2005)
Ans. DENTIN SENSITIVITY OR THEORIES OF PAIN TRANSMISSION THROUGH DENTIN
Innervation of Dentin
• Dentin is highly sensitive tissue. Pulp has numerous myelinated and unmyelinated nerve
fibers.
• The unmyelinated nerve fibers end on blood vessels and the myelinated nerve fibers can be
followed up to subodontoblastic layer.
• They loose their myelin sheath and go up to odontoblastic layer and form a plexus. Most of
the fibers end in contact with odontoblasts in dentinal tubules. These nerve fibers are referred
to as intratubular nerves. The nerve endings are packed with small vesicles. Synapse like
relation exist between the odontoblast process and nerve fibers.
• The stimulation of dentin by any agent causes a pain like sensation called hypersensitivity.
• There are three basic theories of pain conduction or sensitivity through dentin.
1. Direct neural stimulation: According to this theory nerves in the dentin get stimulated.
Stimulation in some manner reach the nerve endings in the inner dentin.
But this theory is not accepted as it is demonstrated that there are no fibres which reach
dentinoenamel junction (DEJ). Topical application of local anaesthetics do not abolish
sensitivity. Hence this theory is not accepted.
2. Fluid or hydrodynamic theory: Dentinal tubules contain odontoblastic processes
surrounded by dentinal fluid. Various stimuli such as heat, cold, air blast desiccation or
mechanical or osmotic pressure affect fluid movement in the dentinal tubules. This fluid
movement either inward or outward, stimulates the pain mechanism in the tubules by
mechanical disturbance of the nerve closely associated with the odontoblasts and its
process. Thus, nerve endings may act as mechanoreceptors as they are affected by
mechanical displacement of the tubular fluid. This is the most accepted theory.
214 DADH Made Easy
Sensitivity of the dentin is explained by the hydrodynamic theory. This theory explains
pain throughout dentin since fluid moment will occur at the DEJ as well as near the pulp.
3. Transduction theory: This theory presumes that the odontoblast process is the primary
structure excited by the stimulus and that the impulse is transmitted to the nerve endings
in the inner dentin. This is not a popular theory since there are no neurotransmitter
vesicles in the odontoblast process to facilitate the synapse.
Treatment of hypersensitivity is done either by blocking the patent tubules or modifying or
blocking pulpal nerve response.
Q 9. Describe age and functional changes in dentin. (Nov. 2009)

Ans. AGE AND FUNCTIONAL CHANGES IN DENTIN
• Age changes take place in dentin to ensure the function of protection.
• Dentin is able to react to physiological and pathological stimuli because it is a vital tissue
due to presence of odontoblastic processes.
• The two most important changes seen in dentin with advancing age are:
a. Increase in thickness of dentin due to continuous gradual deposition of secondary dentin.
b. Increased sclerosis or obliteration of dentinal tubules resulting in reduced sensitivity
and permeability.
• Dentin is laid down throughout life, although after the teeth have erupted and have been
functioning for a short-time, further dentin formation is slow and is called secondary dentin.
The laying down of dentin is either related to age (secondary dentin formation) or as a
response to a stimulus applied to the tooth as in case of tertiary dentin formation.
• Pathological effects of caries, abrasion, attrition or cutting of dentin during operative
procedures causes changes in dentin which leads to development of dead tracts, sclerosis,
and reparative dentin (Refer to Figs 15.6 and 15.7). Secondary dentin and translucent dentin
occur due to physiologic age changes.
• Describe dead tracts, sclerotic dentin and reparative dentin as described earlier.
Q 10. Write about dentinogenesis.

Ans. DENTINOGENESIS
• Formation of dentin during development of tooth is dentinogenesis.
• Dentin formation begins when the tooth germ has reached the bell stage of development.
• Dentinogenesis begins at cusp tips after the odontoblasts have differentiated and begin
collagen production.
• Initially, the outermost ectomesenchymal cells of the dental papilla are small,
undifferentiated and have few organelles and are separated from the inner enamel epithelium
by an acellular zone.
• Later, under the organizing influence of the inner enamel epithelium these cells differentiate
into odontoblasts. As they differentiate they change from ovoid to columnar shape, nucleus
becomes oriented towards the base and there is increased amount of protein-synthesizing
organelles.
• Dentinogenesis occurs in a two-phase sequence. Collagen matrix is formed first and then
gets calcified. Odontoblasts secrete both collagen and other components of the extracellular
matrix.
Dentin 215
1. Matrix Formation
• Proteins (proline) appear in the rough surface endoplasmic reticulum and golgi apparatus
of odontoblasts. Proline then migrates into the cell process in dense granules and is emptied
into the extracellular collagen matrix of the predentin.
• As the matrix formation continues, the odontoblast process lengthens as does the dentinal
tubule.
• Initially daily increments of approximately 4 μm of dentin are formed. This continues till
the crown is formed and the tooth erupts and moves into occlusion. After which dentin
production slows down to 1 μm/day.
• As each increment of predentin is formed along the pulp border, it remains, a day before it
is calcified and the next increment of predentin forms.
2. Mineralization
• The mineralization of dentin occurs in relation to collagen fibers as linear deposits (linear
mineralization) or by fusion of globules (globular mineralization).
• Matrix vesicles are involved in the mineralization of the mantle dentin.
• These vesicles contain the enzyme alkaline phosphatase, which increases the concentration
of phosphates. The phosphate combines with calcium (taken up from the tissue fluid) to
form apatite.
• These apatite crystals grow and rupture from the confines of the vesicles to form a cluster
of crystallites, which fuse with adjacent clusters to form a continuous layer of mineralized
matrix.
• Initially, the apatite crystals are deposited on the surface of collagen fibrils and in the ground
substance. Later, the crystals are laid down within the fibrils with their long axis parallel to
the long axis of the fibrils.
• In circumpulpal dentin the mineralization is either of globular pattern, if the rate of deposition
is fast or the linear pattern, if the rate of deposition is slow.
• The radicular dentin formation compared to coronal dentin, is slower, less mineralised
with collagen fibers laid parallel to cementodentinal junction.
• Incomplete fusion of globules leads to the formation of interglobular dentin.
• Dentin formation, unlike bone, is not affected by vitamin D deficiency state.
Q 12. Describe predentin.

Ans. PREDENTIN
• Predentin is a band of newly formed unmineralized dentin matrix at the pulpal border of
dentin.
• It is the innermost layer of dentin, located adjacent to the pulp tissue and is 2 to 6 μm wide
depending on the extent of activity of the odontoblast.
• As the collagen fibres undergo mineralization at the predentin-dentin front, the
predentin then becomes dentin and a new layer of predentin forms circumpulpally
(Fig. 15.8).
• Predentin is similar to osteoid in bone and is easy to identify in hematoxyline and eosin
stained section because it stains less intensely than mineralized dentin.
216 DADH Made Easy
Fig. 15.8: Predentin
• It is thickest cementum layer where active dentinogenesis is occurring.

• Its presence is important in maintaining the integrity of dentin since its absence appears to
leave the mineralized dentin vulnerable to resorption by odontoclasts.
Q 13. What is layer of Hopewell and Smith/Intermediate cementum layer?

Ans. HOPEWELL AND SMITH/INTERMEDIATE CEMENTUM LAYER
• Between the Tomes’ granular layer and cementum, is found a structureless hyaline layer of
10 μm width; it is called layer of Hopewell and Smith or intermediate cementum layer. It does not
exhibit features of dentin or cementum. It has been suggested that it plays a role in sealing
the sensitive root dentin. It is seen in apical two-thirds of roots of molars and premolars. It
is considered to be of dentinal origin. It contains no tubules but wide spaces which are
thought to be enlarged terminals of dentinal tubules.
• This hyaline layer represents areas where cells of HERS become entrapped in a rapidly
deposited dentin or cementum matrix.
Dentin 217
1. The inorganic component of dentin is 7. The rate of coronal dentin deposition is

studied by approximately
a. Decalcification a. 1 mm/day b. 2 mm/day
b. Electron microscope c. 3 mm/day d. 4 mm/day
c. Roentgen X-ray defraction 8. Dentin consists of
d. Scanning electron microscope a. 35% organic and 65% inorganic
b. 25% organic and 75% inorganic
2. The most popular theory that explains
c. 10% organic and 90% inorganic
dentin sensitivity is
d. 4% organic and 96% inorganic
a. Direct neural stimulation
9. The ratio between the outer and inner
b. Hydrodynamic theory
surface of dentin is about
c. Transduction theory a. 2:1 b. 4:1
d. None of the above c. 5:1 d. 6:1
3. The main histological difference between 10. Intertubular dentin is
bone and dentin is a. Dentin in tubules
a. Only odontoblasts are entrapped in b. Dentin present between the odonto-
the matrix blastic processes
b. Odontoblasts with processes are c. Dentinal tubules which crossover to
entrapped in the matrix enamel
c. Only the processes of odontoblasts are d. Dentin between the zones of peri-
entrapped in the matrix tubular dentin
d. None of the above 11. Root dentin is distinguished from crown
4. The mineral content is highest in dentin by presence of
a. Mantle dentin
a. Peritubular/intratubular dentin
b. Tomes’ granular layer
b. Intertubular dentin
c. Reparative dentin
c. Interglobular dentin d. Contour lines of Owen
d. Predentin
12. Crown dentin formation begins at
5. The calcified dentin includes a. Cap stage
a. Both odontoblasts and processes b. Early bell stage
b. Only processes of the odontoblasts c. Late bell stage
c. Only odontoblasts d. Bud stage
d. None of the above 13. Mineralization of dentin matrix takes
place by
6. The color of the dentin is
a. Immediate mineralization and later
a. Yellowish white maturation
b. Grayish white b. Calcospherite calcification
c. Pale light yellow c. Alternate deposition and mineralization
d. White d. None of the above
1-c, 2-b, 3-c, 4-a, 5-b, 6-c, 7-d, 8-a, 9-c, 10-d, 11-b, 12-c, 13-b
218 DADH Made Easy
14. Completion of root dentin in deciduous 22. Transparent dentin is same as

teeth takes place a. Secondary dentin
a. 12 months after the tooth erupts b. Sclerotic dentin
b. 15 months after the tooth erupts c. Mantle dentin
c. 18 months after the tooth erupts d. Predentin
d. 3 years after the tooth erupts 23. The apatite crystal size of dentin is
15. The hypocalcified structures of dentin are a. 4 mm thickness and 120 mm length
a. Mantle dentin and predentin b. 3 mm thickness and 100 mm length
b. Incremental lines and neonatal line c. 2 mm thickness and 80 mm length
c. Interglobular dentin and Tomes’ d. 1 mm thickness and 60 mm length
granular layer 24. The hard tissue that forms the bulk of the
d. All of above tooth
16. Among two submicroscopic structures a. Enamel
seen in dentinal tubules one is odonto- b. Dentin
blastic process and the other is c. Cementum
a. Nerve ending d. Both enamel and dentin
b. Collagen fiber 25. The ratio of number of tubules per unit
c. Enamel lamellae area on the pulpal and outer surface is
d. Fat droplets about
17. The first formed hard tissue of the tooth a. 4:1 b. 3:1
and the vital tissue of the tooth is c. 2:4 d. 2:1
a. Pulp b. Enamel 26. The dentin retained after decalcification
c. Dentin d. Cementum is
18. Junction between primary and secondary a. Intratubular
dentin is characterized by b. Intertubular
a. Sharp reduction in number of dentinal c. Transparent
tubules d. None of the above
b. Sharp change in direction of dentinal 27. The dentin which is similar to osteoid in
tubules bone and stains light with H and E
c. Reversal line compared to other dentin is
d. Resting line a. Primary dentin
b. Secondary dentin
19. The fibrillar component of mature dentin is
c. Predentin
a. Keratin b. Collagen
d. Reparative dentin
c. Reticulin d. Elastin
28. The mineralized dentin is vulnerable
20. Knoop hardness number of dentin is
to resorption by odontoclasts in the
a. 109 b. 100 absence of
c. 68 d. 54 a. Inner enamel epithelium
21. The hypercalcified structures of dentin are b. Odontoblasts
a. Intratubular b. Sclerotic dentin c. Predentin
c. Intertubular d. All of the above d. Ectomesenchymal cells
14-c, 15-d, 16-a, 17-c, 18-b, 19-b, 20-c, 21-d, 22-b, 23-b, 24-b, 25-a, 26-b, 27-c, 28-c
Dentin 219
29. The outer layer of primary dentin and the 35. The vitality of dentin is dependent upon
first formed dentin, bounded above by the
DEJ and below by interglobular dentin is a. Dentinal tubules
a. Mantle dentin b. Nerve supply of the pulp
b. Circumpulpal dentin c. Odontoblasts
c. Layer of Hopewell Smith d. Cementoblasts
d. Secondary dentin 36. The cells that form secondary dentin are
30. The first few layers of dentin in the root the
which are structure less is called as a. Mast cells b. Odontoblasts
a. Tomes’ granular layer c. Osteoblasts d. Cementoblats
b. Hyaline layer 37. Among the different areas of dentin the
area which contains more mineral
c. Intertubular dentin
component is
d. Interglobular dentin
a. Dentinal tubule
31. The rhythmic dentin formation with alter- b. Peritubular dentin
nate phases of activity and quiescence c. Intertubular dentin
is represented as d. Mantle dentin
a. Incremental lines
38. Osteodentin is a part of dentin in which
b. Von Ebner lines one of the following are entrapped
c. Imbrication line a. Osteoid tissue
d. All the above b. Osteoblasts
32. The accentuated incremental lines in c. Odontoblasts
dentin, because of the disturbance in the d. Cementoblasts
matrix and mineralization process, are 39. Among two submicroscopic structures
called seen in the dentinal tubules, one is odonto-
a. Neonatal lines blastic process and other is
b. Von Ebner lines a. Nerve endings
c. Contour lines of Owen b. Collagen fibers
d. Lines of salter c. Sharpey’s fibers
d. Enamel lamellae
33. Dentin areas characterized by degene-
rated odontoblastic processes give rise to 40. Odontoblastic processes are absent in
a. Sclerotic dentin a. Mantle dentin b. Sclerotic
b. Reparative dentin c. Circumpulpal d. Secondary dentin
c. Dead tracts 41. Dentinoenamel junction at occlusal or
d. Secondary dentin incisal third of a tooth is
a. Straight line
34. Tomes’ granular layer is present in
b. Scalloped with its convexities towards
a. Dentin enamel
b. Cementum c. Scalloped with its convexities towards
c. Enamel dentin
d. Pulp d. Irregular
29-a, 30-b, 31-d, 32-c, 33-c, 34-a, 35-c, 36-b, 37-b, 38-c, 39-a, 40-b, 41-c
220 DADH Made Easy
42. The statement not true about dentin is 48. Transparent dentin is best demonstrated
a. Dead tracts appear black in transmitted by
light a. Scanning electron microscope
b. Sclerotic dentin appears white in b. Electron microscope
transmitted light c. Dark field microscope
c. Sclerotic dentin appears black in d. Polarized microscope
reflected light 49. There is decreased permeability in the
d. Dead tracts appear black in reflected following types of dentin
light a. Reparative
43. The organic and inorganic substance in b. Secondary
dentin is separated by c. Sclerotic dentin
a. Decalcification d. All of the above
b. Incineration 50. The calcified tubule wall of dentin has
c. Both of the above an inner organic lining termed as
d. Frozen section a. Lamina dura
44. The first convexity of the dentinal tubules b. Lamina limitans
is directed towards c. Lamina lucida
a. The apex of the tooth from enamel d. Lamina densa
surface 51. Circumpulpal dentin matrix consists of
b. The apex of the tooth from the pulpal a. Dentinal matrix
surface b. Dentinal fibers
c. The coronal part from pulpal surface c. Beta fibers
d. The coronal part from enamel surface d. Beta and alfa fibers
45. Mantle dentin is the 52. The type of collagen absent in normal
a. Most peripheral part of primary dentin adult dentin is
b. First formed dentin a. Type I
c. Contains numerous coarse fibers b. Type II
d. All of the above are correct c. Type III
46. Tomes’ granular layer is formed d. All of the above
a. By the deposition of the granules by 53. The main body of dentin is
the odontoblasts a. Peritubular dentine
b. By looping of the terminal portion of b. Intertubular dentin
dentinal tubules c. Predentin
c. Due to hypomineralization of the d. Tomes’ fibers
globular dentin 54. The cytoplasmic extension of the odonto-
d. None of the above blasts into dentinal tubules is called as
47. The predominant inorganic element of a. Odontoblastic process
dentin is b. Tomes’ fiber
a. Fluorine b. Calcium c. Both a and b
c. Phosphorous d. Sodium d. None of the above
42-d, 43-c, 44-b, 45-d, 46-b, 47-b, 48-a, 49-d, 50-b, 51-d, 52-b, 53-b, 54-c
Dentin 221
55. The first event of dentinogenesis is forma- 62. Structures present in dentinal tubules are
tion of a. Odontoblastic processes
a. Enamel b. Nerve fiber terminals
b. Membrana preformativa c. Collagen fibers and fat droplets
c. Mantle dentin d. All of the above
d. Circumpulpal dentin 63. Tomes’ granular layer is found in
56. Interglobular dentin is a. Root dentin
a. Dentin surrounding the tubules b. On pulpal surface
b. The dentin present between the c. In coronal dentin
odontoblastic processes d. Near cusp tips
c. Dentinal tubules which crossover the 64. One of the following is not correct about
enamel the dentinal tubule
d. None of the above a. There are more tubules per unit area
in the crown than root
57. Incremental lines of dentin are called
b. They richly branched in root dentin
a. Lines of Retzius
c. Tubules are more in number near the
b. Lines of Salter pulpal surface than at periphery
c. Lines of von Ebner d. They don’t arise from odontoblast
65. Circumpulpal and mantle dentin have
58. The type of mineralization seen in dentin following facts except one
is a. Both are formed before root completion
a. Globular b. Circumpulpal is more mineralized
b. Linear than mantle dentin
c. Both a and b c. Mantle dentin contains Korff’s fibers
d. None of the above d. Tertiary dentin is part of mantle dentin
59. The cells that form secondary dentin are 66. The following fact is true about secondary
a. Cementoblasts dentin
b. Fibroblasts a. It is found only in permanent dentition
c. Odontoblasts b. It is the first formed dentin below the
d. Osteoblast DEJ
c. It is formed before root completion
60. The type of dentin that is formed prior to
d. It represents dentin formed after root
root completion is
completion
a. Intertubular
67. The following structural changes are
b. Peritubular
found from primary to secondary dentin
c. Circumpulpal
except
d. Secondary a. Changes in direction of dentinal
61. The pair of calcified tissues that can be tubules
considered vital is b. Reduction in number of dentinal
a. Dentin and cementum tubules
b. Cementum and bone c. Progressive crowding of odontoblasts
c. Enamel and cementum in the pulp
d. Dentin and bone d. Increased diameter of odontoblasts
55-c, 56-b, 57-c, 58-c, 59-c, 60-c, 61-d, 62-d, 63-a, 64-d, 65-d, 66-d, 67-d
222 DADH Made Easy
16
Pulp
LAQ (10 Marks)
Q 1. Write structural elements of pulp. Write the functions and clinical considerations.
(May 2008)
Ans. Pulp is delicate, soft, richly vascularised and innervated connective tissue which is present
at the center of the tooth and is bounded by dentin. It reflects the tooth vitality.
Various structural elements of pulp are (Flowchart 16.1):
1. Cells such as odontoblasts, undifferentiated mesenchymal cells, fibroblasts, various
defense cells, and pulpal stem cells
2. Intercellular/extracellular substance
3. Fibers
4. Blood vessels, lymph vessels, and nerves
Flowchart 16.1: Structural elements of dental pulp
When viewed under microscope pulp shows two regions.

1. The pulp at periphery which is composed of three zones.
a. Odontoblastic zone: The outermost zone, adjacent to the pulp-dentin border.
b. Cell-free zone: The middle cell-free zone, Weil’s zone, is the space that is seen between
the odontoblastic zone and the cell rich zone.
c. Cell-rich zone: It is restricted to the coronal regions.
222
Pulp 223
2. The pulp at center : The central region of both the coronal and the radicular pulp contains
large nerve trunks and blood vessels (Flowchart 16.2).
Flowchart 16.2: Pulp at center and periphery
1. Pulp at Periphery (Fig. 16.1)

a. Odontoblastic Zone
• As the name suggests, this zone shows the presence of odontoblasts, the dentin forming
cells arranged in a palisading manner. These cells are seen at the periphery of the pulp,
adjacent to unmineralized dentin called predentin.
• Odontoblasts are the second most prominent cells in the pulp with cell bodies in the pulp
and cell processes in the dentinal tubules.
• They are 5–7 µm in diameter and 25–40 µm in length.
• Though these cells are arranged in a single row, sometimes they crowd and appear pseudo-
stratified, as if arranged in two to three rows. The crowding of the odontoblasts is seen
because of the reduction in surface area when the odontoblasts move inward and produce
secondary dentin.
• The number of the odontoblasts may range from 59,000–76,000/mm2.
• There is some variation in the morphology, size, and number of odontoblasts in different
parts of the tooth. The number and size of the odontoblasts is greater in the coronal pulp as
compared with the root.
Fig. 16.1: Zones of pulp at periphery

224 DADH Made Easy
• The cells are columnar in the crown, cuboidal in the mid portion and spindle-shaped in the
apical part of the tooth.
• Cell junctions such as gap junction, tight junction, and junctional complexes are seen between
odontoblasts.
• The lifespan of the odontoblasts is till the tooth is viable.
• Odontoblasts synthesize collagen and some non-collagenous proteins.
• Odontoblast morphology and its organelles vary with the functional activity of the cell. Active
cell is elongated, nucleus is basally placed and the cytoplasm is basophilic. In this cell, Golgi
apparatus is prominent, rough endoplasmic reticulum is abundant and numerous mitochondria
are present throughout the cytoplasm. Numerous vesicles are also seen in the process.
• The resting cell is devoid of organelles. It has more basophilic nucleus than the active cell.
This cell contains lipid-filled vacuoles.
• In the transitional or intermediate stage, the cells are narrower, have fewer organelles and
contain autophagic vacuoles.
• Since the odontoblasts are highly differentiated cells, they do not divide. Thus, formation
of the reparative dentin happens by the differentiation of undifferentiated mesenchymal
cells into the odontoblasts.
Odontoblastic process:
• It is an extension of the odontoblast cell.
• The process measures about 3–4 µm in diameter at their pulpal end and is present inside
the dentinal tubule. Junctional complexes are present at this zone.
• Majority of the odontoblastic processes extend to about two-thirds of the lengths of the
dentinal tubules.
• The odontoblastic process is devoid of major cell organelles. There are numerous micro-
tubules and filaments arranged along the length of the process.
• The space between the odontoblastic process and the dentinal tubule contains fluid called
as dentinal fluid. This fluid movement stimulates the pain mechanism in the tubules by
mechanical disturbance of the nerves closely associated with the odontoblast and its process.
b. Cell-free Zone of Weil
• This zone appears as a space between the odontoblastic zone and the cell-rich zone. In this
space, odontoblasts move more pulpward during tooth development and to a limited extent
in functioning teeth.
• There are no cells in this zone. However, there are a few fibres which run through this zone.
• Peripheral axons of myelinated and somatic nerves form a network of nerves within cell-
free zone, termed as parietal layer of nerves, also known as plexus of Raschkow.
c. Cell-rich Zone
• This zone is composed principally of fibroblasts and undifferentiated mesenchymal cells
and is restricted to the coronal pulp.
• During early dentinogenesis there are many young collagen fibers in this zone.
1. Fibroblast:
• Fibroblasts are the most numerous cell type in pulp.
• They function in collagen fiber formation throughout the pulp during the life of the tooth.
• They are stellate-shaped and have extensive cytoplasmic processes which contact and
are joined by intercellular junctions to the processes of other fibroblasts.
Pulp 225
• In young pulp, they divide and are active in protein synthesis, but in older pulp they
appear rounded or spindle-shaped with short processes and exhibit fewer organelles
and are termed fibrocytes.
• They synthesise and degrade collagen.
• They also play role in inflammation and healing.
• The size of these cells decreases as age advances, while fibrous components predominate.
2. Undifferentiated mesenchymal cells:
• Undifferentiated mesenchymal cells are the primary cells in very young pulp.
• These are totipotent cells which can differentiate into odontoblasts, fibroblasts or
macrophages when the need arises.
• They are larger than fibroblasts and are polyhedral in shape with peripheral processes
and large oval nuclei.
• Apart from cell rich-zone, they are also found along pulp vessels and throughout the
central pulp.
• Number of these cells decreases with age.
• Other cells of pulp are:
– Pulp shows a variety of defence cells such as histiocytes, macrophages, dendritic cells,
mast cells, and plasma cells.
– In addition, there are blood vascular elements such as neutrophils (PMNs), eosinophils,
basophils, lymphocytes, and monocytes. These migrate from pulpal blood vessels and
develop in response to inflammation.
Defence cells:
• Histiocyte or macrophage is an irregularly shaped cell with short blunt process and has function
of phagocytosis in inflammation. It has small, round, dark staining nucleus and granular
cytoplasm. It can be stained by toluidine blue stain.
• Plasma cells have eccentrically placed nucleus and abundant cytoplasm and they have
function of antibody production. Chromatin of their nucleus is adherent to the nuclear
membrane and gives the cell a cartwheel appearance. The cytoplasm is basophilic with
light stained Golgi zone adjacent to the nucleus.
Dendritic cells:
• They are found in close relation to the endothelial cell.
• They present the antigen to the T-cells.
• They play an important role in immunosurveillance and their number is increased in areas
affected by caries, attrition or restorative procedures.
Lymphocytes, eosinophils and mast cells:
• Lymphocytes and eosinophils are found extravascularly in the normal pulp.
• Their number increases during inflammation.
• Most of the lymphocytes present in pulp are T-lymphocytes.
• Mast cells are seen along the vessels in inflamed pulp. They have a round nucleus and
contain many dark staining granules in the cytoplasm.
Pulpal stem cells:
• These are pluripotent cells present in pulp.
• They undergo proliferation and migrate to the site of injured odontoblasts and produce dentin.
226 DADH Made Easy
• Clinical significance: The pulp tissue of the third molars may serve as a suitable source of
stem cells for future stem cell based therapies as they are viable after cryopreservation.
2. The Pulp at Centre
Central region of pulp contains large nerve trunks and blood vessels.
Blood Vessels
• Pulp organ is extensively vascularised and vitality of the tooth is due its blood supply.
• The circulation in pulp facilitates rapid transport of metabolites.
• Blood vessels of the pulp and the periodontium arise from the inferior or superior alveolar
artery and also drain by the same veins.
• There is communication of the vessels of the pulp with the periodontium through apical
foramen and accessory canals due to which the infection has a potential to spread.
• When the vessels enter the pulp, they become thinner walled. Small arteries and arterioles enter
the apical canal and along their course to the coronal pulp they give off numerous branches
in the radicular pulp. These pass peripherally to form a plexus in the odontogenic region.
• Pulpal blood flow is more rapid than in most areas of the body. Pulpal pressure is among
the highest of body tissues.
• Arteries possess three layers, the tunica intima consisting of squamous or cuboidal
endothelial cells, tunica media consisting of one to three layers of smooth muscle cells and
the third and the outer layer, the tunica adventitia made-up of collagen fibers.
• Arterioles are present throughout the coronal pulp and the terminal arterioles are present
peripherally in the pulp.
• Veins and venules are larger than the arteries and appear in the central region of the root
pulp. They exhibit much thinner walls in relation to the size of the lumen with much flatter
endothelial cells.
• Blood capillaries, endothelium-lined tubes, form a network in the coronal pulp. They are
involved in rapid transport of metabolites during dentinogenesis.
Lymph Vessels
• The lymphatic vessels are endothelium-lined tubes that join thin-walled lymph venules or
veins and are more numerous in the central part of the pulp.
• Lymph vessels draining the pulp and periodontal ligament of the anterior teeth pass to the
submental lymph nodes while those of the posterior teeth pass to the submandibular and
deep cervical lymph nodes.
Nerves
• Abundant nerve supply in the pulp follows the distribution of the blood vessels. Blood
vessels and nerves enter and leave through apical foramen.
• Majority of them are unmyelinated and many are sympathetic. They have role in vasoconstriction.
• The large myelinated fibers mediate the sensation of pain.
• The peripheral axons of the myelinated and somatic nerves form a network of nerves adjacent to
the cell-rich zone. This is termed the parietal layer of nerves, also known as plexus of Raschkow.
• Nerve axons from the parietal zone pass through the cell-rich and cell-free zones and
terminate adjacent to the odontoblast processes in the dentinal tubules. These are sensory
receptors. They play important role in pain transmission.
• Since, pulp contains only free nerve endings all forms of sensory stimuli result in pain sensation.
Pulp 227
Intercellular Substance
• It is composed of acid mucopolysaccharides, protein polysaccharides, and glycoproteins.
• The ground substance lends support to the cells of the pulp. It also transports nutrients
from the blood vessels to the cells as well as transport metabolites from cells to blood vessels.
Fibers
• Main type of collagen in pulp is type I. Type III is also present.
• They exhibit typical cross striations at 64 nm and range in length from 10–100 nm.
• They are diffuse or in bundles.
• Bundles of collagen fibers increase as the pulp matures.
• They are prevalent in root-canals, especially at apex.
Functions
Functions of the pulp are inductive, formative, nutritive, protective and reparative.
1. Inductive:
• Primary role of pulp anlage is to interact with the oral epithelial cells, which leads to differen-
tiation of the dental lamina and enamel organ formation, leading to formation of enamel.
• The pulp anlage also interacts with the developing enamel organ as it determines a particular
type of tooth.
2. Formative: Pulp contains dentin forming cells, the odontoblasts. They secrete organic matrix
of dentin and also take part in its calcification.
3. Nutritive: Pulp is richly vascular. It nourishes dentin through the odontoblasts and their
processes and by means of the blood vascular system of the pulp.
4. Protective: The pulp is supplied by sensory nerves. These respond to various thermal,
chemical, and physical stimuli in the form of pain and protect the tooth from injury.
5. Defensive or reparative:
• Pulp has capacity to repair injury.
• It responds to irritation, whether mechanical, thermal, chemical or bacterial by producing
reparative dentin and mineralizing any affected dentinal tubule (sclerotic dentin formation).
• After injury to the mature tooth, the fate of odontoblast varies according to the intensity of
the injury. Milder injury can result in functional activity leading to focal secretion of
reactionary dentin called Regeneration. If the injury is greater, death of odontoblasts can
result. Differentiation of the totipotent cells from subodontoblastic zone then takes place
resulting in formation of new odontoblasts which then form Reparative dentin.
• Both, the reparative dentin formed in the pulp and the sclerosis in the dentinal tubules are
attempt to wall off the pulp from its source of irritation.
• Pulp has macrophages, lymphocytes, neutrophils, monocytes and plasma and mast cells,
which aid in the process of repair of the pulp.
SAQs (3 Marks)
Q 1. Write about age changes in pulp or regressive changes in pulp.

Pulp stones/denticles or diffuse/linear calcifications.
Ans. Introduction
Pulp is the soft connective tissue present at the center of the tooth and is surrounded by dentin.
With age, size of pulp reduces due to continuous deposition of dentin.
228 DADH Made Easy
In aging pulp the changes are seen in both cellular and extracellular components as:
1. Cellular changes
2. Fibrosis
3. Vascular changes
4. Pulp stones (denticles)
5. Diffuse calcification
1. Cellular Changes
Ageing pulp shows decrease in the number of cells with decrease in their size and number of
cytoplasmic organelles.
2. Fibrosis
• In the ageing pulp accumulation of diffuse fibrillar components and bundles of collagen
fibers appear (Fig. 16.3).
• In radicular pulp, fiber bundles are arranged longitudinally while in coronal pulp they are
more diffuse.
• Any external trauma such as dental caries or deep restorations usually cause a localized fibrosis.
• Collagen gets deposited in medial and adventitial layers of blood vessels.
3. Vascular Changes
• Atherosclerotic plaques may appear in pulpal vessels.
• Calcifications are found in the walls of blood vessels and surrounding the vessels.
• Blood flow decreases with age.
4. Pulp Stones (Denticles)
• Pulp stones or denticles are nodular, calcified masses appearing in either or both the coronal
and root portions of the aging pulp (Figs 16.2A and B).
• Tooth with pulp stones appears normal and is asymptomatic unless they impinge on nerves
or blood vessels.
• They are seen in functional or embedded unerupted teeth as well.
• Types according to their structure are: (a) True denticles, (b) False denticles.
• Depending on the relation with dentin, pulp stones can be grouped as: (i) Free, (ii) Attached,
(iii) Embedded.
True denticles (Fig. 16.2A) False denticles (Fig. 16.2B)

1. Structure: These are similar in structure to dentin 1. Do not exhibit dentinal tubules but appear as
as they have dentinal tubules and contain processes concentric layers of calcified tissue in the centre
of odontoblasts. of which there appear remnants of necrotic and
calcified cells.
2. Location: These are rare and located close to the 2. Appear within bundle of collagen fibers or arise
apical foramen. around vessels or necrotic tissue.
3. Formation: True pulp stones are formed because 3. Remnants of necrotic and calcified cells or
of the inclusion of remnants of Hertwig’s epithelial calcification of thrombi in blood vessels,
root sheath into the pulp. These cells induce phleboliths, serve as nidi for false denticles.
differentiation of pulpal cells into odontoblasts and
further lead to deposition of dentin.
Pulp 229
Free, attached or embedded pulp stones:

• Depending on the relationship of denticles to the dentin, they can be free, attached on
embedded. The free denticles are entirely surrounded by pulp tissue, attached denticles
are partly fused with the dentin and embedded denticles are entirely surrounded by
dentin.
• All are formed free in the pulp and later they become attached or embedded as dentin
formation progresses.
1. Pulp stones lying at the opening of the root canal can cause difficulty in locating the canals
during root canal treatment.
2. A statistically significant relationship has been found between patients with cardiovascular
disease (CVS) and presence of pulp stones. This suggests the usefulness of dental radiograph
to identify patients with CVS disease for further evaluation.
Figs 16.2A and B: Types of pulp stones/Denticles—true and false

230 DADH Made Easy
5. Diffuse or Linear Calcifications

• These appear as irregular calcific deposits in the pulp tissue.
• Usually seen around collagenous fiber bundles or blood vessels.
• Are found in the root canals while denticles are commonly found in the coronal pulp.
• These are dystrophic type of calcifications (Fig. 16.3).
• With increasing age the volume of pulp and reparative capabilities of pulp decreases. The
blood flow is reduced. There is increase in the number of calcified tissues in pulp.
• All these changes contribute to a decrease in pulp resilience and its ability to sense and
react to insult.
Fig. 16.3: Pulp fibrosis and calcification
Q 2. Write about vitality of pulp.

Ans. VITALITY OF PULP
• Pulp organ is extensively vascularized and the vitality of the pulp depends on its blood
supply.
• In clinical practice, instruments called vitalometers, which test the reaction of the pulp to
electrical stimuli or thermal stimuli (heat or cold) are often used to test the vitality of the
pulp.
• However, these methods provide information about the status of the nerves supplying the
pulp tissue and therefore check the “sensitivity” and not the “vitality” of pulp.
• The vitality of the pulp depends on its blood supply.
• In traumatized teeth, there can be damage to the nerves but the blood supply can be
normal. Such pulps do not respond to electrical or thermal stimuli but are completely
viable.
Q 3. Write clinical considerations of pulp.

Ans. CLINICAL CONSIDERATIONS
• Pulpitis, inflammation of pulp, is a response of the traumatized pulp, due to dental
caries or physical trauma to the tooth structure. Mild pulpal inflammation, focal
Pulp 231
reversal pulpitis, if left untreated may progress to acute or chronic pulpitis. Pulp polyp
or chronic hyperplastic pulpitis, a type of chronic pulpitis is seen with well-
vascularized pulpal apex. This requires endodontic theraphy or open extraction of
tooth.
• Internal resorption or pink tooth, is the outward resorption of dentinal walls
which results in the pulpal tissue appearing pink through thin, transulent
enamel.
• For all operative procedures the shape of the pulp chamber and its extension into the pulpal
horns is important. Wide pulp chamber and higher pulp horns in the tooth of a young
person will make a deep cavity preparation hazardous, and it should be avoided. X-ray
will help to determine the size of the pulp cavity.
• Since dehydration causes pulpal damage, operative procedures producing this condition
should be avoided. An appropriate cavity liner should be used below deep restorations.
Pulp has to be protected from damage due to heat transmission by metallic restorations by
the use of bases.
• In older person, due to excessive deposition of dentin at the roof and floor of the pulp
chamber, it is difficult to locate the root canals. In such cases it is advisable to advance
toward the distal root in the lower molar and toward the palatal root in the upper molar to
avoid perforation of the floor of the pulp chamber.
• In the anterior teeth, the coronal part of the pulp chamber may be filled with secondary
dentin and pulp stones lying at the opening of the root canal make location of the root canal
difficult.
• The shape and location of apical foramen may play an important role in the treatment of
root canal.
• When accessory canals are located near the coronal part of root or in the bifurcation are, a
deep periodental pocket may cause inflammation of dental pulp. Conversely, a necrotic
pulp can cause spread of disease to periodontium.
• Pulpal and periodontal disease may spread by their common blood supply. Pulpal infection
can spread into periodontal ligament causing abssesses and cysts.
• Most of the compounds containing Ca(OH) readily induce reparative dentin underlying a
cavity. Enamel matrix derivative is also shown to be promoting reparative process in the
wounded pulp. Mineral trioxide aggregate (MTA) is shown to be with effective as pulp
capping agent.
• In clinical practice, instrument called vitalometer is used to test the vitality of the pulp. It
tests the reaction of pulp to electrical or thermal stimuli. These methods provide information
about the status of the nerves supplying the pulpal tissue and therefore check the sensitivity
of the pulp and not its vitality.
• The vitality of pulp depends on its blood supply. The thickness of remaining dentin
is shown to be an import factor in maintaining the vitality of pulp. A minimum thickness of
5 mm or greater has a powerful influence on pulp vitality.
• Since the pulp contains only free nerve endings all forms of sensory stimuli like touch,
pressure or temperature to the pulp result in pain sensation only. Pain is the only symptom
of pulpitis.
232 DADH Made Easy
1. The total number of pulp organs in every 9. Close to the apex of the adult tooth, the
person is odontoblasts appear like osteoblasts,
a. 20 b. 28 they can be recognized as odontoblasts
c. 32 d. 52 a. Due to their ovoid shape
2. The total volume of all the permanent b. Due to their spindle shape
teeth pulp organs is c. Due to their processes extending into
a. 0.50 cc b. 0.42 cc the dentin
c. 0.38 cc d. 0.28 cc d. Due to their large nucleus
3. As the age advances the pulp becomes 10. Compared to the pressure in other body
a. Smaller tissue the pressure in the pulp is
b. Larger a. Higher
c. Remains of same size b. Lower
d. None of the above c. Moderate
d. Same as in other tissues
4. The average size of the apical foramen
of the maxillary teeth in the adult is 11. The capillary associated fibroblasts are
a. 0.2 mm b. 0.3 mm a. Fibrocytes b. Pericytes
c. 0.4 mm d. 0.5 mm c. Mast cells d. Lymphocytes
5. In the mandibular teeth the average size 12. The change that occurs in pulp due to
of the apical foramen is aging is
a. 0.4 mm b. 0.3 mm a. Increase in vascularity
c. 0.2 mm d. 0.1 mm b. Increase in number of collagen
6. The cells occurring in the greatest c. Increase in size of pulp chamber
number in the pulp are d. Calcification and vascularity decreases
a. Plasma cells 13. The sensation felt by pulpal nerves is that
b. Odontoblasts of
c. Fibroblasts a. Temperature b. Pressure
d. Macrophages c. Pain d. Proprioception
7. The pulp is the only specialized connec- 14. Rich nerve plexus in the subodontogenic
tive tissue which lacks cell-free zone is known as
a. Precollagenous fibers a. Parietal plexus
b. Collagenous fibers b. Plexus of Rashkow
c. Elastic fibers c. Circum odontoblastic plexus
d. All of the above d. All of the above
8. As the pulp matures, the number of 15. The pulp responds to irritation because
bundles of collagen fibers of its remarkable reparative ability by
a. Increases a. Producing reparative dentin in the pulp
b. Decreases b. Calcification of dentinal tubules
c. Remains same c. Both a and b
d. Disappear d. None of the above
1-d, 2-c, 3-a, 4-c, 5-b, 6-c, 7-c, 8-a, 9-c, 10-a, 11-b, 12-b, 13-c, 14-d, 15-c
Pulp 233
16. The cells of the pulp which aid in the 23. In pulp, the cells which are believed to
process of repair of the pulp are be totipotent are
a. Macrophages and mast cells a. Pericytes
b. Lymphocytes and monocytes b. Odontoblasts
c. Neutrophils and plasma cells c. Undifferentiated mesenchymal
d. All of the above d. Fibroblasts
17. As each tooth matures, the number of 24. As age advances pulp becomes smaller
odontoblasts because of
a. Decreases a. Continuous deposition of collagen fibers
b. Increases b. Continuous deposition of dentin
c. Remains the same c. Increase in the cells of the pulp
d. Degenerates d. Calcification
18. The collagen fibers in the pulp are 25. The location and shape of apical foramen
secreted (produced) by may undergo changes as a result of
a. Fibroblasts b. Odontoblasts a. Functional influence on the teeth
c. Both a and b d. Osteoblasts b. Continuous deposition of dentin
19. Degradation of fibers in pulp takes place c. Continuous deposition of cementum
by d. Continuous deposition of bone
a. Odontoblasts b. Fibroblasts
26. Fibers which are found in pulp are
c. Both a and b d. Osteoblasts
a. Collagen and oxytalan
20. Plexus of Rashkow is the name given to b. Collagen and elastic
plexus of
c. Collagen
a. Nerve fibers around blood vessels in
d. Collagen and reticulin
periodontal ligament (PDL)
b. Periodontal fibers in PDL 27. The cart wheel appearance of nuclear
c. Nerve fibers in peripheral pulp chromatin is seen in
d. Gingival fibers around the cervix of a a. Mast cells b. Macrophages
tooth c. Basophils d. Plasma cells
21. True pulp stones exhibit structure of 28. All of the following cells are present in
a. Concentric layers of calcification pulp except
b. Tubular arrangement like in dentin a. Fibroblast
c. Homogeneous mass of calcification b. Fat cells
d. Cells of remnants of Hertwig’s epithelial c. Odontoblasts
root sheath d. Undifferentiated mesenchymal cells
22. Diffuse, minute foci of calcification in the 29. Histologically the dental pulp at centre
pulp are termed most closely resembles
a. Pulp stones a. Nerve tissue
b. Diffuse calcification b. Vascular tissue
c. Pulp polyps c. Granulation tissue
d. False denticles d. Loose connective tissue
16-d, 17-a, 18-c, 19-b, 20-c, 21-b, 22-b, 23-c, 24-b, 25-a, 26-c, 27-d, 28-b, 29-d
234 DADH Made Easy
30. Which one of the following structures is 38. Nerve supply of pulp is
not found in a living pulp? a. Sympathetic afferent
a. Collagen fibers b. Sympathetic efferent
b. Haversian canals c. Parasympathetic afferent
c. Nonmyelinated nerves d. Parasympathetic efferent
d. Odontoblasts
39. Pulp formation starts at
31. All the following fibers are seen in the a. 6th week b. 8th week
dental pulp except
c. 10th week d. 14th week
a. Elastic fibers
b. Collagen fibers 40. Space occupied by dental pulp is called
c. Argyrophilic fibers a. Pulp chamber b. Pulp cavity
d. Nerve fibers c. Pulp canal d. Any of above
32. Total volume of pulp tissue combined in 41. The total volume of pulp organ of maxillary
all permanent teeth is first molars is
a. 0.38 cc b. 0.68 cc a. 0.006 cc b. 0.007 cc
c. 0.95 cc d. 2.23 cc c. 0.068 cc d. 0.38 cc
33. Histiocytes in the pulp are also called 42. The total volume of pulp organ of mandi-
a. Fibroblasts bular central incisor is
b. Resting wandering cells a. 0.006 cc b. 0.007 cc
c. Undifferentiated mesenchymal cells c. 0.012 cc d. 0.014 cc
d. Mast cells 43. Weil’s zone of pulp is a
34. Perivascular granulocyte found in inflamed a. Cell-rich zone
pulp is b. Cell-free zone
a. Histiocyte c. Fibroblast zone
b. Lymphocyte d. Mesenchymal cell zone
c. Plasma cell 44. In young pulp the cells which divide and
d. None of the above are active in protein synthesis are known
35. True denticles are present as
a. Near apical foramen a. Fibroblasts b. Fibrocytes
b. In pulp chamber c. Odontoblasts d. Histiocytes
c. In coronal third of the root 45. The anastomosis which occurs in pulp is
d. In apical third of the root a. Venous-venous
36. Accessory canals result from b. Arteriole-venous
a. Defects in cementogenesis c. Both a and b
b. Dividing epithelial bridges d. None of the above
c. Break in Hertwig’s root sheath 46. The second most prominent cell in pulp is
d. Adherent epithelial rests a. Fibroblast
37. The principal cell of pulp tissue is b. Cementoblast
a. Fibroblast b. Odontoblast c. Odontoblast
c. Defence cell d. Histiocyte d. Neutrophil
30-b, 31-a, 32-a, 33-b, 34-a, 35-a, 36-c, 37-a, 38-a, 39-b, 40-b, 41-c, 42-a, 43-b, 44-a, 45-c, 46-c
Pulp 235
47. Sensation of pain in pulp is mediated by 54. Protein secreted by odontoblast is

a. Large myelinated fibers a. Chitin b. Keratin
b. Large unmyelinated fibers c. Collagen d. Elastin
c. Small unmyelinated fibers 55. Dystrophic calcification is seen most
d. None of the above commonly in
48. The peripheral axons form a network of a. Enamel b. Pulp
nerves located adjacent to the cell-rich c. Dentin d. PDL
zone in pulp is known as 56. In a developing tooth, the junction of the
a. Parietal layer of nerves dental papilla and the inner enamel
b. Plexus of Rashkow epithelium becomes the
c. Zone of Weil a. Zone of Weil
d. Both a and b b. Dentinoenamel junction
49. In which week of intrauterine life nerve c. Cementoenamel junction
fibers in dental follicles are first seen d. Primitive epithelial layer
a. Sixth week 57. Pulp chamber is that part of pulp cavity
b. Eleventh week where the external surface of dentin is
c. Eighteenth week covered by
d. Twenty fourth week a. Cementum
50. In which week of intrauterine life nerve b. Enamel
fibers in dental papillae are first seen c. Both cementum and enamel
a. Sixth week d. None of the above
b. Twelfth week 58. Pulp canal or root canal space is that
c. Eighteenth week part where the external surface of dentin
d. Twenty fourth week is covered by
51. Wandering cells of pulp are a. Cementum
a. Lymphoid wandering cells b. Enamel
b. Histiocytes c. Both a and b
c. Fibroblasts d. None of the above
d. Undifferentiated mesenchymal cells 59. The cellularity of pulp within the pulp
52. Calcification in the walls of blood vessels chamber is
in aging pulp is found most often in the a. More than the pulp in the canal
region near the b. Less than the pulp in the canal
a. Coronal portion of root c. Same as in the canal
b. Cementoenamel junction of root d. None
c. Apical foramen 60. The odontoblasts are cuboidal in pulp
d. Pulp chamber chamber but as the apex is approached
53. The tooth pulp is initially called the they are
a. Predentine a. Still cuboidal
b. Dental papilla b. Columnar
c. Subpulpal dentin c. Flatter
d. Pulp polyp d. Hexagonal
47-a, 48-d, 49-b, 50-c, 51-b, 52-c, 53-b, 54-c, 55-b, 56-b, 57-b, 58-a, 59-a, 60-c
236 DADH Made Easy
61. Lateral root canals in anterior teeth are 66. The term fibrocytes is applied to
most commonly found in a. Fibroblasts active in protein synthesis
a. Apical third of the root b. Fibroblasts with fewer intracellular
b. Middle third of the root organelles
c. At cervical line c. The undifferentiated mesenchymal
d. Cervical third of the root cells
62. In a tooth the entire space occupied by d. Fibroblasts undergoing calcification
pulp organ is 67. The average length of time a primary
a. Pulp cavity pulp functions in the oral cavity is
b. Pulp chamber a. 8.3 years b. 9.3 years
c. Pulp canal c. 7.3 years d. 6.3 years
d. None of the above 68. All the following are true regarding blood
63. Pulp stones are usually seen in supply to the pulp except
a. Young pulp organ a. Blood flow is more rapid and highest
b. Aged pulp organ amongst body tissues
c. Traumatized pulp b. Blood capillaries form dead ends in
the pulp
d. Infected pulp
c. Blood vessels form rich anastomosing
64. Pulp communicates with peripheral network in the odontogenic region
tissues through
d. Blood supply increases as the age
a. Apical foramen increases
b. Pulp canals
69. All the facts are true regarding nerve
c. Mental foramen supply except
d. Dentinoenamel junction a. Supplied by branches of trigeminal
65. The pulp cavities of deciduous teeth are nerve
a. Proportionately smaller than in perma- b. A nerve plexus of Rashkow near cell-
nent teeth rich zone
b. Proportionately larger than in perma- c. Nerve fibers are sympathetic and
nent teeth nonmyelinated
c. Have long pulp horns d. Nerve fibers are parasympathetic and
d. Are same as that of permanent teeth myelinated
61-a, 62-a, 63-b, 64-a, 65-c, 66-b, 67-a, 68-d, 69-d

17
Cementum
LAQs (10 Marks)
Q. 1. Define cementum. Give functions and its properties. Add a note on cementogenesis.
(Nov. 2010)
Ans. Introduction
• Cementum is a mineralized, avascular connective tissue covering the anatomic roots of the
human teeth.
• It furnishes the medium for the attachment of collagen fibers that bind the tooth to the
surrounding structures.
Physical Properties
• Colour: Cementum is light-yellow in colour and can be distinguished from enamel by its
lack of luster and its darker hue.
• Hardness: Its hardness is less than that of dentin.
• Permeability: It is permeable to a variety of materials. It is more permeable than dentin.
• Thickness: It varies in thickness. It is thinnest at cementoenamel junction (20 to 50 μm) and
thickest at apex (150 to 200 μm).
Chemical Properties
• Chemical composition: It contains 45 to 50% inorganic substance and 50 to 55% organic
substance and water.
• Inorganic portion consists mainly of calcium and phosphate in the form of hydroxyapatite.
• Organic portion consists of type I collagen and protein polysaccharides. The noncollagenous
proteins in cementum have role in matrix deposition, initiation, and control of mineralization
and matrix remodeling. These proteins are bone sialoprotein and osteopontin.
• Proteoglycans present in cementum are chondroitin sulfate, heparan sulfate, etc.
• Cementum has the highest fluoride content of all the mineralized tissues.
Cementogenesis (SAQ, Oct. 2002, Nov. 2010)
• The process of formation of cementum is known as cementogenesis and the cells which
form cementum are cementoblasts (Fig. 13.4B).
237
238 DADH Made Easy
• Cementum formation in developing tooth is preceded by the deposition of dentin along the
inner aspect of Hertwig’s epithelial root sheath (HERS). HERS induces cells of dental papilla
to differentiate into odontoblasts, which form root dentin.
Cementoblasts
• Once dentin formation is underway, HERS breaks, allowing the newly formed dentin to
come in direct contact with the connective tissue of dental follicle.
• Cells derived from dental follicle then differentiate into cementoblasts which form cellular
intrinsic fiber cementum (CIFC). Cementoblasts derived from dental follicle have a similar
phenotype to osteoblasts.
• One more source of cementoblasts is HERS. Cementoblasts derived from HERS are involved
in the formation of acellular extrinsic fiber cementum.
• Cementoblasts have numerous mitochondria, a well-formed golgi apparatus and large
amount of granular rough endoplasmic reticulum.
• Cementoblast synthesize collagen and protein polysaccharides, which make-up the organic
matrix of cementum.
Formation of Acellular Cementum

• Acellular cementum formation is preceded by mineralization of first formed dentin after
which the root sheath breaks.
• Cementoblasts derived from HERS come in contact with dentin and lay down ground
substance and collagen fibrils forming acellular cementum.
• Acellular cementum extends from cervical margin to apical one-third.
Formation of Cellular Cementum

• Celluar cementum is deposited over acellular cementum. It is less mineralized than acellular
cementum.
• The cementoblasts derived from dental follicle secrete the collagen fibers and ground
substance which form the intrinsic fibers of cellular cementum.
• Matrix secretion occurs from different regions of these cementoblasts (multipolar) and the
rate of deposition of matrix is fast. Uncalcified matrix of cementum is cementoid.
• This results in entrapment of cementoblasts in its own matrix resulting in formation of
cellular cementum.
• Incremental lines called lines of Salter are seen in cementum during cementogenesis as
there are periods of rest and activity. These lines are closer in acellular cementum.
FUNCTIONS OF CEMENTUM (SAQ, MAY 13)

• Cementum is a mineralized, avascular connective tissue covering the anatomic roots of the
human teeth.
• Though different functions have been attributed to the different types of cementum,
cementum functions as a single unit.
1. Anchorage
• Primary function of cementum is to furnish a medium for the attachment of the collagen
fibers that bind the tooth to the alveolar bone.
Cementum 239
• Connective tissue fibers from periodontal ligament (PDL) pass between the cementoblasts
into the cementum. These fibers, known as Sharpey’s fibers are embedded in the cementum
and they serve to attach the tooth to surrounding bone providing anchorage to teeth.
• In hypophosphatasia, which is characterized by absence of cementum, there is loosening
and premature loss of teeth.
• Continuous formation of cementum helps to maintian the width of periodontal ligament.
2. Adaptation
• Cementum is a tissue that makes functional adaptation of teeth possible.
• Deposition of cementum in an apical area compensates for loss of tooth substance from
occlusal wear.
• Continuous deposition of cementum is of considerable importance. As the most superficial
layer of cementum ages a new layer of cementum is deposited to keep the attachment
apparatus intact.
3. Repair
• Cementum serves as a major reparative tissue for root surfaces.
• Damage to roots such as fractures and resorption can be repaired by deposition of new cementum.
• Cementum formed during repair is cellular cementum.
SAQs (3 Marks)
Q. 1. Describe formation of acellular cementum. (2000, June 2006)

Ans. Acellular cementum extends from cervical margin to apical one-third.
• Hertwig’s epithelial root sheath (HERS) shows close relationship with cementoblasts during
acellular cementum formation.
• Acellular cementum formation is preceded by mineralization of first layer of dentin and is
associated with secretion of cementum related proteins such as bone sialoprotein,
osteopontin and fibrillar collagen.
• Cementoblasts derived from HERS form a fibrous fringe over the layer of first formed dentin.
The periodontal ligament (PDL) fibers get attached to this fibrous fringe to form acellular
extrinsic fiber cementum (Fig. 17.1).
• Connective tissue fibers from PDL pass into cementum and they serve to attach the tooth to
the surrounding bone. These are called as Sharpey’s fibers. These are the extrinsic fibers seen
in acellular cementum. The main function of this type of cementum is anchorage especially
in single rooted teeth.
• In permanent teeth, this acellular extrinsic fiber cementum is formed after the tooth is
erupted, when two-thirds of the root would have been formed. Before this the acellular
cementum lining the root, is acellular intrinsic fiber cementum.
• Acellular aftrillar cementum is the one which is formed when there is premature loss of the
reduced enamel epithelium protecting the newly formed enamel at the cervical margin of
the tooth.
• Uncalcified cementum matrix is called cementoid tissue.
• Growth of cementum is rhythmic process and as new layer of cementoid is formed the old
one calcifies.
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• A thin layer of cementoid is usually observed on the cemental surface. It is lined by

cementoblasts.
• After cementoid is laid down, its mineralization begins. Calcium and phosphate ions present
in tissue fluids are deposited into the matrix and are arranged as unit cells of hydroxyapatite.
• Osteocalcin and osteonectin act as nucleators for mineralization and alkaline phosphatase
promotes mineralization while osteopontin regulates growth of apatite crystals.
• Incremental lines called as lines of Salter, are seen during cementogenesis as there are periods
of rest and activity. The periods of rests are associated with these lines. The lines are closer
in acellular cementum as it is formed slowly.
Fig. 17.1: Acellular cementum/Sharpey’s fibers
Q. 2. Describe types of cementum, acellular and cellular cementum.

(2000, June 2006, May 2007)
Ans. Introduction
• Cementum is a mineralized, avascular connective tissue covering the anatomic roots of
human teeth. It furnishes a medium for the attachment of collagen fibers that bind the tooth
to the alveolar bone.
• Cementum of different types differ from one another in their location, structure, function,
rate of formation, biochemical composition and degree of mineralization.
On the basis of presence of cementocytes cementum can be classified as:
1. Cellular
2. Acellular cementum.
On the basis of types of fibers, cementum can be classified as:
1. Intrinsic fiber cementum
2. Extrinsic fiber cementum
3. Afibrillar cementum.
• Intrinsic fibers are produced by cementoblasts, smaller, and are usually oriented parallel
to the surface.
Cementum 241
• The extrinsic fibers are produced by periodontal ligament (PDL) fibroblasts and are larger
bundles and are oriented perpendicular to the surface.
• Thus, by combining the types of fibers, extrinsic and intrinsic, presence or absence of
cementocytes, different types of cementum are described as:
1. Acellular extrinsic fiber cementum (AEFC)
2. Cellular intrinsic fiber cementum (CIFC)
3. Acellular afibrillar cementum (AAC).
In addition, acellular intrinsic fiber, cellular and acellular mixed fiber and cellular mixed
stratified cementum have also been described.
1. Acellular extrinsic fiber cementum (AEFC):
• It is regarded as primary cementum (Fig. 17.2) as it forms first.
• It extends from cervical margin to apical third.
• It is the only type of cementum seen in single rooted tooth.
• It is formed by cementoblasts which is derived from Hertwig’s epithelial root sheath.
• Cementocytes are not seen. The extrinsic collagen fibers are formed by fibroblasts of
PDL and they run perpendicular to the surface of cementum and are known as Sharpey’s
fibers. They are mineralized except for their inner cores.
• The noncollagenous proteins fill up the space between the extrinsic fibers.
• This type of cementum is formed slowly and regularly. Therefore, the incremental lines
(lines of Salter) run parallel to the surface and are closer together.
• Cementoid is not observed in AEFC.
• Main function of this type of cementum is anchorage especially in single rooted teeth.
2. Cellular cementum (Fig. 17.2):
• It is also known as secondary cementum as it is formed later than AEFC.
• It is found in apical third and furcation of roots of teeth.
• It is of two types:
a. Cellular mixed fiber cementum: It forms the bulk of the secondary cementum and occupies
the apical interradicular regions. It contains both types of fibers, that is derived from
PDL fibroblasts and the cementoblasts.
b. Cellular intrinsic fiber cementum (CIFC): It is present in the middle and apical third.
• These types are mainly involved in adaptation and repair.
• Cementocytes are present, which lie in lacunae.
• They have cell processes or canaliculi which anastomose with those of neighbouring cells.
• Most of the canaliculi are directed toward the PDL surface of the cementum.
• Cementoblasts forming this type of cementum are derived from dental follicle.
• Noncollagenous proteins and proteoglycans are present in matrix.
• Both cellular and acellular cementum are separated by incremental lines into layers which
indicate periodic formation.
• These incremental lines are highly mineralized with less collagen and more ground
substance.
• Incremental lines counted in ground sections are of value in age estimation.
• As cellular cementum is rapidly formed the incremental lines in it are placed further
apart than in AEFC.
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Fig. 17.2: Cellular cementum
3. Acellular afibrillar cementum:

• It is formed when there is premature loss of the reduced enamel epithelium protecting
the newly formed enamel at the cervical region. It is deposited as a thin layer on the
enamel at the cervical margin of the tooth.
• It is mineralized ground substance containing no cells and is devoid of extrinsic and
intrinsic collagen fibers.
Differences between AEFC and CIFC
Acellular extrinsic fiber cementum Cellular intrinsic fiber cementum
1. Location Cervical to apical third of root. Apical third and furcation.
2. Formation Formed earlier, hence primary Formed later and during repair, hence
cementum. named as secondary cementum.
3. Composition Noncollagenous proteins are absent. Noncollagenous proteins are present.
Growth factors are not seen. Growth factors are seen.
Proteoglycons are not identified Proteoglycans are present in the
in matrix. matrix.
4. Cementoid It is usually absent It is seen on the surface.
5. Fibers present Contain extrinsic fibers of the Contain intrinsic fibers produced by
PDL formed by fibroblast. cementoblasts.
6. Rate of formation Slow Rapid
7. Incremental These are regular and close together. These are irregular and far apart.
lines of Salter
8. Presence of Cementocytes are not seen. Cementocytes are present.
Cementocytes
9. Origin of Derived from HERS. Derived from inner cells of dental
cementoblasts follicle, cementoblasts are pheno-
typically similar to osteoblasts.
10. Expression of para- Cementoblasts do not express. Cementoblasts express.
tharmone receptor
11. Present in which teeth Single rooted teeth. Absent in single rooted teeth.
12. Function Anchorage Adaptation and repair
Cementum 243
Q. 3. Write about cementocytes. (2001)

Ans. CEMENTOCYTES
• Cementum is a mineralized dental tissue covering the anatomic roots of teeth.
• It furnishes a medium for attachment of collagen fibers of periodontal ligament (PDL) that
bind the tooth to alveolar bone.
• Cellular or secondary cementum, a type of cementum found in the apical third of the root,
is characterized by presence of cementocytes.
• Cementocytes are the cementoblasts which get incorporated into this type of cementum
during its formation.
• In cellular cementum, since the matrix secretion occurs from different regions of the
cementoblast and it forms fast, cementoblasts get entrapped in their own matrix. These
entrapped cells are cementocytes. They are phenotypically similar to osteocytes.
• They lie in spaces called lacunae.
• They have numerous cell processes called canaliculi. These processes branch and anastomose
with those of neighbouring cells.
• These processes are directed towards the PDL surface of cementum for nutrition as
cementum is avascular.
• Cytoplasm of cementocytes in deeper layer of cementum contains few organelles, dilated
endoplasmic reticulum and sparse mitochondria, suggesting that they are marginally active
cells.
• In deeper layers, lacunae appear empty suggesting their degeneration.
Function
They play role in cementum formation and repair.
Q. 4. Write about cementoenamel junction (CEJ). (July 2005, 2016)

Ans. CEMENTOENAMEL JUNCTION
• The relation between cementum and enamel at the cervical region of the tooth is
cementoenamel junction (CEJ) and is variable (Fig. 17.3).
• Three types of cementoenamel junctions are described :
1. Gap junction:
– In 10% of the teeth, enamel and cementum do not meet.
– This occurs when enamel epithelium in the cervical portion of the root is delayed in its
separation from dentin.
– There is no CEJ in such cases and therefore, a zone of root is devoid of cementum and is,
for a time, covered by reduced enamel epithelium.
2. Edge-to-edge junction:
– In 30% of the teeth, cementum meets the cervical end of the enamel in a sharp line.
3. Overlap type of junction:
– In 60% of the teeth, cementum overlaps the cervical end of enamel for a short distance.
– This occurs when the enamel epithelium degenerates at its cervical termination, permitting
connective tissue to come in direct contact with the enamel surface, which results in
formation of afibrillar cementum.
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Fig. 17.3: Types of cementoenamel junction

Cementum 245
– Afibrillar cementum is so named because it does not possess collagen fibrils with 64 nm
periodicity. If such afibrillar cementum remains in contact with connective tissue for
long-time, fibrillar cementum is deposited on its surface.
• Recently a fourth type of CEJ has been described in which enamel overlaps the cementum.
• CEJ may exhibit all of these patterns in teeth of an individual.
• In deciduous teeth, edge-to-edge junction is more common, followed by overlap junction.
Q. 5. Write about Sharpey’s fibers.

Ans. SHARPEY’S FIBERS
• Periodontium is a connective tissue organ, that attaches the tooth to the bone of the jaws.
• This function is furnished by collagen fibers of periodontal ligament (PDL) that are embedded
into cementum on one side of the periodontal space and into alveolar bone on the other
side. These embedded fibers are termed as Sharpey’s fibers (Fig. 17.1).
• Sharpey’s fibers are the terminal portions of the principal fibers of PDL embedded in
cementum and bone.
• They are more numerous but smaller at their attachment into cementum than alveolar bone.
• They are oriented perpendicular to the surface of cementum.
• Each Sharpey’s fiber is composed of numerous collagen fibrils that pass well into the cementum.
• Sharpey’s fibers in primary acellular cementum are fully mineralized, while those in cellular
cementum and bone are generally mineralized only partially at their periphery.
• They are associated with abundance of noncollagenous proteins.
• The mineralization is at right angles to long axis of fibers, indicating that in function the
fibers are subjected to tensional forces.
• Few Sharpey’s fibers pass uninterruptedly through the bone of the alveolar process, termed
transalveolar fibers, which may serve as a mechanism to connect adjacent teeth.
Q. 6. Write about intermediate cementum layer (Hyaline layer of Hopewell Smith).

Ans. INTERMEDIATE CEMENTUM LAYER
• At cementodentinal junction, sometimes dentin is separated from cementum by a zone
known as intermediate cementum layer.
• This does not exhibit characteristic features of either dentin or cementum.
• This is predominantly seen in the two-thirds of roots of permanent molars and premolars
and is rarely seen in permanent incisors or deciduous teeth.
• This layer represents areas where cells of Hertwig’s epithelial root sheath become trapped
in a rapidly deposited dentin or cementum matrix.
• It is considered to be of dentinal origin. It contains no tubules but wide spaces which are
thought to be enlarged terminals of dentinal tubules.
• Functions: It may act as permeability barrier and may be precursor for cementogenesis in
wound healing.
• Clinical significance: Relates to regeneration of the periodontium following periodontal surgery.
Q. 7. Write about hypercementosis. (May 2002, 2009)

Ans. HYPERCEMENTOSIS
• It is an abnormal thickening of cementum. It is excessive formation of cementum
(Fig. 17.4).
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Types
1. Generalised: When it affects all teeth of the dentition
or
2. Localised: When it is confined to a single tooth or even only parts of one tooth.
• Hypercementosis can be diffuse or circumscribed.
• There can be hypertrophy or hyperplasia. When excessive deposition of cementum
improves the function of a tooth, it is known as cementum hypertrophy. Excessive
deposition of cementum in non-functional teeth is known as cementum hyperplasia.
Reasons for Hypercementosis

• Excessive cementum formation can occur due to physiological causes like in accelerated
eruption of teeth or pathological causes like secondary to chronic periapical infection, Paget’s
disease.
• In localized hypertrophy tooth exposed to more stress may form a spur or prong-like
extension of cementum to provide firmer anchorage to the subjected tooth.
• Localized hypercementosis is sometimes seen in areas where enamel drops have been
developed on the dentin.
• Excementosis is knob-like projection of hyperplastic cementum which has developed around
degenerated epithelial rests.
• Extensive deposition of cementum associated with chronic periapical inflammation is
circumscribed and it surrounds the root like a cuff.
• Thickening of cementum is observed in non-functioning teeth which may extend around
the entire root or may be localized. Hypercementosis in non-functioning tooth has reduction
in the number of Sharpey’s fibers embedded in the root.
• Thickening of cementum around the apex of all teeth and in the furcation of multirooted
tooth may be found in embedded and in newly erupted teeth.
• Sometimes irregular overgrowth of cementum with spike like extensions and calcification
of Sharpey’s fibers accompanied by numerous cementicles may be observed as a sequela of
injuries to the cementum.
Fig. 17.4: Hypercementosis

Cementum 247
• With progressive age, cemental hyperplasia can reach almost three-fold of the normal
thickness of cementum.
• Hypercementosis can be seen in some of the neoplastic and non-neoplastic diseases.
• Generalized thickening of cementum is seen in Paget’s disease.
• Localized thickening is seen in benign cementoblastoma, florid cemento-osseous dysplasia,
acromegaly, calcinosis and some form of arthritis.
Hypercementosis results in anchoring the teeth tightly to the socket of jaw and therefore a
part of jaw may be fractured in an attempt to extract the tooth. Therefore, it is necessary to
take the radiographs of the tooth before extraction.
Q. 8. Write clinical considerations of cementum. (June 2004, Nov. 2014)

Ans. Introduction
• Cementum is a mineralized dental tissue covering the anatomic root of human teeth.
• It furnishes a medium for the attachment of collagen fibers that attaches the tooth to the
surrounding structure.
• Cementum is avascular and is therefore more resistant to resorption than bone. Because of
this property of cementum, the orthodontic tooth movement is possible. When the tooth is
moved by orthodontic appliance, bone is resorbed on the side of the pressure and the new
bone is formed on the side of tension while minimum cementum resorption is seen.
• Cementum resorption can occur after trauma or excessive occlusal forces and resorption
can continue into dentin. The damage is usually repaired either by formation of cellular or
acellular cementum or both. When the former outline of root surface is restored, repair is
called anatomic repair. When a thin layer of cementum is deposited, a bay-like recess
remains. In such cases the periodontal space is restored to normal width by formation of a
bony projection for proper functional relationship. This type of repair is known as Functional
repair.
• Transverse fractures of root may heal by formation of new cementum.
• Hypercementosis occurs secondary to periapical inflammation or extensive occlusal stress.
Extraction of such teeth may necessitate removal of bone.
• Extensive excementosis anchors the tooth tightly to socket because of which a part of jaw
can fracture during extraction of such teeth. Therefore, radiograph should be taken before
extraction.
• In periodontal pockets, plaque can cause alterations in pathologically exposed cementum.
In periodontal therapy, this altered cementum is intentionally removed so that periodontal
regeneration can occur. Commercially available enamel matrix proteins are coated on cleaned
and planed root surface for new cementum deposition.
• Cementum is found to be thick in type-2 diabetes.
• Abnormal deposition of cementum can lead to fusion of bone and cementum called as
ankylosis.
• Counting of the incremental lines in cementum can be useful in age determination in forensic
dentistry.
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1. The highest content of fluoride of all the 7. When compared to dentin, cementum
mineralized tissues is found in color is
a. Bone a. Lighter
b. Enamel b. Darker
c. Dentin c. Same as dentin
d. Cementum d. None of these
2. The cellular cementum can be best 8. The characteristic of cementum that is
differentiated from acellular cementum important clinically in the orthodontic
due to presence of treatment is
a. Embedded Sharpey’s fibers a. Its similarity with bone
b. Incremental growth pattern b. Its lusterless light yellow color
c. Separate and distinct functions c. Its function of attachment of
d. Lacunae periodontal ligament fibers
3. The percentage of inorganic and d. Its resistance to resorption
organic contents of cementum is 9. The thickness of cementum is least at
a. 50–55% inorganic and 45–50% organic a. Cementoenamel junction
b. 45–50% inorganic and 50–55% organic b. Cementodentinal junction
and water c. Middle of the root
c. 40% inorganic and 60% organic d. At the apex
d. 30–40% inorganic and 60–70% organic 10. The cementodentinal junction (CDJ) in
4. The hardness of fully mineralized cem- permanent teeth is
entum compared to dentin is a. Smooth
a. Less b. Scalloped
b. More c. Zigzag
c. Equal d. None of the above
d. Almost equal 11. The cementodentinal junction in deciduous
5. Color of cementum is teeth is
a. Dark yellow a. Smooth
b. Light yellow b. Scalloped
c. White c. Zigzag
d. Gray d. None of the above
6. The organic por tion of cementum 12. In decalcified and stained sections
consists of compared to dentin, cementum stains
a. Type I collagen and proteoglycans a. Darker
b. Type II collagen b. Lighter
c. Type III collagen c. Same as dentin
d. All of the above d. Does not take stain
1-d, 2-d, 3-b, 4-a, 5-b, 6-a, 7-a, 8-d, 9-a, 10-a, 11-b, 12-a
Cementum 249
13. The cementum and enamel meet edge 20. Cellular cementum is present along the
to edge in a. Coronal third of the root
a. 40% of teeth b. Middle third of the root
b. 30% of teeth c. Apical third of the root
c. 25% of teeth d. All the above
d. 20% of teeth 21. Accessory canals result from
14. Presence of gap between cementum a. Defect in cementogenesis
and enamel at cementoenamel junction b. Dividing epithelial bridges
is found in
c. Breaks in Hertwig’s epithelial root
a. 10% of teeth
sheath (HERS)
b. 15% of teeth
d. Adherent epithelial rests
c. 20% of teeth
d. 25% of teeth 22. Cementicles are the submicroscopic
structures present mostly in
15. Cementum overlaps enamel in a. Acellular cementum
a. 70% of teeth
b. Periodontal ligament
b. 60% of teeth
c. Cellular cementum
c. 40% of teeth
d. Tomes' granular layer
d. 20% of teeth
23. Epithelial cell rests of Hertwig’s epithelial
16. Human cementum is
root sheath may be present in
a. Highly vascular
a. Periodontal ligament
b. Less vascular
b. Pulp
c. Avascular
d. None of the above c. Cementum
d. None
17. Under normal conditions cementum
undergoes 24. The remnants of HERS are known as
a. Alternate resorption and formation a. Epithelial pearls
b. Resorption and no new formation b. Epithelial islands
c. No resorption c. Epithelial cell rests of Malassez
d. No change d. Epithelial knots
18. On the teeth that are not in function, it is 25. Incremental lines which indicate periodic
observed that cementum gets formation of cementum are
a. Thinner a. Less mineralized
b. Thicker b. Highly mineralized
c. Remains same c. Both a and b
d. None of the above d. Not mineralized
19. Cementum can replace resorbed 26. Sharpey’s fibers are seen in
a. Enamel only a. Ground section
b. Dentin only b. Decalcified section
c. Bone only c. Both
d. Dentin and cementum d. None of the above
13-b, 14-a, 15-b, 16-c, 17-c, 18-b, 19-d, 20-c, 21-c, 22-b, 23-a, 24-c, 25-b, 26-a
250 DADH Made Easy
27. If overgrowth of cementum inspires the 34. Transeptal fibers are present in
functional abilities of cementum it is a. Between cementum of two teeth
termed as: b. Septal area
a. Hyperplasia c. Inter-radicular area
b. Hypoplasia d. Apical area
c. Hypertrophy
35. Extrinsic fibers in cementum are secreted
d. Hypotrophy by
28. Absence of cementum is found in a. Periodontal ligament fibroblasts
a. Hypophosphatasia b. Cementoblasts
b. Hyperparathyroidism c. Osteoblasts
c. Hyperthyroidism d. Cementocytes
d. Mongolism 36. The commonest type of CEJ is the
29. Cementum formation is a. Knife edge junction
a. Not a continuous process b. Gap junction
b. Always results in cellular cementum c. Enamel overlapping cementum
c. A continuous process d. Cementum overlapping enamel
d. Present only during development of 37. Intermediate cementum is also known
tooth as
30. Cellular cementum is thickest a. Hyaline layer
a. Around the root apex b. Mixed fiber cementum
b. At cementoenamel junction c. Hyaline layer of Hopewell Smith
c. At middle one-third of the root d. None of the above
d. At coronal one-third of the root 38. The type of cementum predominantly
31. Cementum is thinnest at involved in the process of attachment
a. Apical third of root with the periodontal ligament
b. Middle third of root a. Cellular
c. Cementoenamel junction b. Acellular
d. Apical foramen c. Both a and b
32. Acellular cementum is thickest at
39. Functional repair of cementum is
a. Apical foramen
a. Repair without a defect restoring the
b. Coronal one-third of the root
normal anatomy
c. Middle one-third of the root
b. Repair with a bay-like defect
d. Apical one-third of the root
c. Formation of a bony projection by the
33. Cementum deposited on enamel of alveolar bone to establish the normal
tooth is physiologic width of the periodontal
a. Acellular b. Cellular attachment
c. Fibrillar d. Afibrillar d. Both b and c
27-c, 28-a, 29-c, 30-a, 31-c, 32-b, 33-d, 34-a, 35-a, 36-d, 37-c, 38-b, 39-c
18
Periodontal Ligament
LAQs (10 Marks)
Q. 1. Describe different fibers of periodontal ligament. Enumerate functions of periodontal

ligament. (May 2012)
Ans. Periodontal ligament (PDL) is a fibrous connective tissue which provides continuity
between cementum and alveolar bone and primarily serves to support the teeth in the bony
socket.
It is a soft, fibrous, vascular and cellular connective tissue that surrounds the roots of the
teeth and joins the root cementum with the socket wall. The extracellular substance of the
PDL comprises of fibers and ground substance (Table 18.1).
The connective tissue fibers are mainly collagenous but there are small amounts of oxytalan
and reticulin fibers, and in some species, elastin fibers.
Table 18.1: Extracellular substance of PDL

Fibers Ground substance
1. Collagen 1. Glycosaminoglycans
2. Elastic-oxytalan 2. Proteoglycans
3. Reticular 3. Glycoproteins
4. Secondary
5. Indifferent fiber plexus
I. COLLAGEN PRINCIPAL FIBERS OF PDL (SAQ, JUNE 2006)

The connective tissue fibers of PDL are mainly collagenous.
The collagen fibrils in PDL are of mean diameter 45–55 nm. They are gathered to form
bundles of 5 μm in diameter. The main types of collagen in PDL are type I and type III.
Bundles of collagen in PDL are termed principal fibers. The principal fiber group is the
alveodental ligament which consists of five fiber groups:
1. Alveolar crest group
2. Horizontal group
251
252 DADH Made Easy
3. Oblique group
4. Apical group
5. Interradicular group in multirooted teeth.
Principal group of fibers help the periodontal ligament to support the tooth in the bony
socket (Figs 18.1A and 18.1B).
1. Alveolar Crest Group

• Extend obliquely from the cementum just beneath the junctional epithelium to the alveolar
crest.
• These fibers resist tilting, intrusive, extrusive, and rotational forces.
2. Horizontal Group
• They are immediately apical to the alveolar crest fiber group and run at right angles to the
long axis of the tooth from cementum to bone.
Fig. 18.1A: Principal fibers of periodontal ligament
Fig. 18.1B: Principal fibers of periodontal ligament: Apical group of fibers

Periodontal Ligament 253
• They pass from their cemental attachment across the periodontal ligament space to become
inserted in the alveolar process as Sharpey’s fibers.
• These fibers resist horizontal and tipping forces.
3. Oblique Group
• These are the most numerous and occupy nearly two-thirds of the ligament.
• They run obliquely and coronally from cementum to alveolar bone.
• They resist vertical and intrusive forces.
4. Apical Group
• They traverse from the cementum at the root tip through the periodontal space to the fundus
of the bony socket.
• They resist forces of luxation, may prevent tooth tipping and protect delicate blood and
lymph vessels and nerves.
5. Interradicular Group
• They are inserted into the cementum from the crest of interradicular septum in multirooted
teeth.
• They resist tooth tipping, torquing and luxation.
• They are lost in age related gingival recession when the furcation area is exposed.
• In chronic inflammatory periodontal disease, there occurs total loss of these fibers.
Gingival Group of Fibers (Fig. 18.2) (SAQ, July 2005)

• These are found within lamina propria of the marginal gingiva, attaching the gingiva firmly
to the teeth.
• They support the marginal gingival tissues and maintain their relationship to the tooth.
• They are referred as gingival ligament and they serve to support the free gingiva, bind
attached gingiva to the alveolar bone, tooth, and link one tooth to another (Fig. 18.2). They
are divided into:
Fig. 18.2: Gingival fibers of periodontal ligament

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Gingival group of fibers

1. Dentogingival: Extend from the cervical cementum into the lamina propria of the gingiva.
They constitute the most numerous group of gingival fibers.
2. Alveologingival: They arise from the alveolar crest and extend into the lamina propria.
3. Circular: These are small group of fibers that encircle the tooth and interlace with other
fibers.
4. Dentoperiosteal: They traverse from the cementum into the periosteum of the alveolar
crest and of the vestibular and oral surfaces of the alveolar bone.
Transseptal fibers
• These are accessory fibers that extend interproximally between adjacent teeth and they
make-up the interdental ligament (Fig. 18.3).
• Apart from all these fibers, semicircular, vertical and transgingival fiber groups also exist.
Fig. 18.3: Transseptal fibers
Sharpey’s fibers
• These are the terminal portions of the principal fibers embedded into cementum on one
side of the periodontal space and into alveolar bone on the other.
• Few Sharpey’s fibers pass through the bone of the alveolar process to continue as principal
fibers of PDL and are termed as transalveolar fibers. They connect adjacent teeth.
II. ELASTIC FIBERS

• There are three types of elastic fibers elastin, elaunin, and oxytalan fibers.
• Elastin are the mature elastic fibers while elaunin and oxytalan are immature. These fibers
are present in the walls of afferent blood vessels.
• Elastin meshwork in PDL is composed of many elastin lamellae with peripheral oxytalan
fibers and elaunin fibers.
• Elaunin fibers are found within the fibers of the gingival ligament.
• Oxytalan fibers (SAQ, Oct. 2002, July 2005): These are a type of immature elastic fibers
associated with PDL. They are 0.5 mm to 2.5 mm in diameter. They consist of microfibrillar
component only. Light microscopic demonstration of oxytalan fibers is possible if the tissue
is oxidized prior to staining. In electron microscope, they resemble elastic fibers.
Orientation of these fibers is different from that of collagen fibers. They run in axial
direction, one end being embedded in cementum or bone and the other in the wall of a
blood vessel. At the apex of the tooth they form a complex network.
Functions: They play a part in supporting the blood vessels of the periodontal ligament.
They are thicker and more numerous in teeth subjected to high loads. Thus, they have a role in
tooth support.
III. RETICULAR FIBERS

They are fine immature collagen fibers with argyrophilic properties. They are related to
basement membrane of blood vessels and epithelial cells which lie within PDL.
Functions of PDL (SAQ, May 2008, Nov. 2010)

Periodontal ligament is a fibrous connective tissue which provides continuity
between cementum and alveolar bone, and primarily serves to support the teeth in the bony
socket.
It has following functions:
1. Supportive
2. Sensory
3. Nutritive
4. Homeostatic
5. Eruptive
1. Supportive
PDL collagen fibers, vasculature and its ground substance, all contribute to the tooth support.
When a tooth is moved in its socket as a result of forces acting on it as during mastication,
part of the periodontal space will be narrowed and the periodontal ligament contained in
these areas will be compressed. Other parts of periodontal space will be widened. The collagen
fibers in the compressed ligament, act as a cushion for the displaced tooth. The pressure of
blood in the vessels (vascular pressure) also provides a hydraulic cushion for the support
of the teeth. Biochemical analysis of the proteoglycans in the PDL has shown that the degree
of aggregation/disaggregation of the ground substance may have a role of tooth support.
Thus, PDL behaves as a suspensory ligament.
2. Sensory
PDL through its nerve supply provides a most efficient proprioceptive mechanism. PDL can
detect the application of the most delicate forces to the teeth and very slight displacement of
the teeth.
Mechanoprotection protects both supporting structures of the tooth and the crown from
excessive masticatory forces.
3. Nutritive
PDL contains blood vessels, which provide nutrition to its cells, cementocytes and superficial
osteocytes of alveolar bone.
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4. Homeostatic
PDL has the capacity to resorb and synthesize the extracellular substance of the connective
tissue of ligament, alveolar bone, and cementum. This results in maintaining the width of
PDL throughout life which functions under physical forces of mastication. This is done by
formation or resorption of bone, formation of cementum, formation and degradation of collagen
fibers, the ground substance, and detachment and reattachment of collagen fibers to their new
locations. Failure of homeostatic mechanism, that is if the balance between synthesis and
resorption is disturbed, it may lead to tooth ankylosis and/or tooth resorption and can result
in loss of function by the tooth.
5. Eruptive
The cells, vascular elements, and extracellular matrix proteins of the PDL function collectively
to enable eruption.
6. Physical
Physical function of PDL entails protection of vessels and nerves of PDL from mechanical
forces and also offers resistance to impact from occlusal forces. PDL transmits occlusal forces
to the bone by acting as shock absorber.
Q. 2. Describe cells of periodontal ligament.

Ans. CELLS OF PERIODONTAL LIGAMENT
• The periodontium is a connective tissue organ, covered by epithelium that attaches the
teeth to the bones of the jaws and provides a continually adapting apparatus for support of
the teeth during function. It comprises of cementum, periodontal ligament, bone lining the
tooth socket (alveolar bone) and that part of the gingiva facing the tooth (dentogingival
junction).
• Periodontal ligament is a fibrous connective tissue which provides continuity between
cementum and alveolar bone, and primarily serves to support the tooth in the bony socket.
CELLS OF PDL
• PDL is a fibrous connective tissue that is noticeably cellular.
• The principal cells of the healthy, functioning PDL are concerned with the synthesis and
resorption of alveolar bone and the fibrous connective tissue of the ligament and cementum.
Cells of PDL are

I. Synthetic cells
1. Fibroblasts
2. Osteoblasts
3. Cementoblasts
II. Resorptive cells
1. Fibroblasts
2. Osteoclasts
3. Cementoclasts
III. Progenitor cells
IV. Epithelial cell rests of Malassez
V. Defense cells
1. Mast cells
2. Macrophages
3. Eosinophils
I. Synthetic Cells
• These cells synthesize proteins for extracellular substance of connective tissue.
• In light microscope, these cells show a large, open faced or vesicular nucleus with prominent
nucleoli (due to increased transcription of RNA and production of ribosomes).
• These cells show cytoplasmic basophilia due to large quantities of rough endoplasmic
reticulum (RER) covered by ribosomes. Increased RER and golgi membrane is for translation
and transport of proteins.
• Such cells are:
1. Osteoblasts: Synthesizing cells present at the periodontal surface of the alveolar
bone.
2. Fibroblasts: Synthesizing cells lying in the body of the soft connective tissue.
3. Cementoblasts: Synthesizing cells found in cementum.
1. Osteoblasts
• Osteoblasts, the bone forming cells, cover the periodontal surface of the alveolar
bone or line the tooth socket.
• These cells are cuboidal in shape with prominent round nucleus present at their
basal end.
• These are active cells with abundant rough endoplasmic reticulum, mitochondria,
and vesicles.
• Cells contact one another and also with the underlying osteocytes through their
cytoplasmic processes.
2. Fibroblasts:
• Fibroblasts, the predominant cell in the PDL, are ectomesenchymal in origin. These
are different from the fibroblasts which are present in other connective tissues.
• The role of fibroblasts is to produce the structural connective tissue proteins, collagen
and elastin, as well as glycoproteins, and glycosaminoglycans that comprise the
PDL ground substance.
Fibroblasts of PDL are characterised by rapid turnover of extracellular matrix,
particularly collagen.
• These cells are responsible for the formation and remodelling of the PDL fibers, and
a signalling system to maintain the width of PDL by preventing encroachment of
bone and cementum into PDL space.
• They are fusiform with extensive cytoplasm and abundant organelles. They are
arranged parallel to collagen fibers.
• Presence of actin network endows PDL fibroblasts with a degree of contractility
with which it can exert tractional forces on extracellular matrix.
3. Cementoblasts:
• These cells line the surface of cementum.
• They lay down cementum which helps in attachment of tooth.
258 DADH Made Easy
• They are cuboidal with large vesicular nucleus and abundant cytoplasm.
Cementoblasts actively depositing cellular cementum exhibit abundant basophilic
cytoplasm and cytoplasmic processes and folded nuclei while those depositing
acellular cementum do not have prominent cytoplasmic processes.
II. Resorptive Cells

1. Osteoclasts:
• These are multinucleated giant cells, derived from blood monocytes.
• They resorb bone and have abundant eosinophilic cytoplasm and numerous
cytoplasmic organelles.
• They appear in Howship’s lacunae on the surface of the bone to be resorbed.
• They have ruffled plasma membrane which is separated from the rest of the plasma
membrane by clear zone.
• The area of bone to be resorbed is sealed by the ruffled border and is exposed to acidic
pH due to pumping of protons by osteoclasts which brings about resorption.
2. Fibroblasts:
• These cells show rapid degeneration of collagen by phagocytosis and that is the basis
for fast turnover of collagen in periodontal ligament.
• Degradation of collagen includes both intracellular and extracellular events.
• Collagen is degraded extracellularly by matrix metalloproteinases after which there
occurs intracellular digestion of collagen with the help of lysosomal cysteine
proteinases.
3. Cementoclasts:
• Resemble osteoclasts and are occasionally found in normal functioning PDL.
• Though cementum does not undergo resorption normally but under certain
circumstances its resorption can occur and in these instances cementoclasts located in
Howship’s lacunae are found on the surface of the cementum.
III. Progenitor Cells (SAQ)

• PDL being a connective tissue, contain progenitors for synthetic cells that have capacity to
undergo mitotic division.
• These progenitor cells replace differentiated cells dying at the end of their lifespan or as a
result of trauma.
• They are small in size, nucleus is close faced and have very little cytoplasm.
• These cells divide in response to normal biologic requirement or to wounding of PDL.
• They are located predominantly in the vicinity of blood vessels.
• Within this group, mesenchymal stem cells are present and are responsible for tissue
homeostasis. They can generate cementoblasts, osteoblasts, and fibroblasts.
IV. Epithelial Rests of Malassez (SAQ, 2000, Oct. 2003, May 2007)
Introduction
• These are the epithelial cells that are found close to the cementum in periodontal ligament.
• These were described by Malassez in 1884 and are the remnants of Hertwig’s epithelial root
sheath.
• At the time of cementum formation, the continuous layer of epithelium that covers the surface
of the newly formed dentin breaks into lace like strands which are epithelial rests of Malassez.
Location
• They are present near and parallel to the root surface lying about 25 μm from the cementum
surface in PDL.
• Their distribution varies as per the site and age. They are numerous in children. They are
commonly found in apical region up to the second decade and later are mainly located
cervically in the gingiva above alveolar rest.
Histological features
• The epithelial rests persist as a network, strands, islands or tubule like structures near and
parallel to the surface of the root.
• In cross-section they appear cluster like and are separated from the surrounding connective
tissue by a basal lamina.
• These are cuboidal cells with deeply stained nucleus and with scanty cytoplasm having
less number of cytoplasmic organelles, indicating lack of protein synthesis.
Function
• It is not clear but they could be involved in periodontal repair and regeneration.
Significance
• These cells may proliferate to form cysts and tumor.
• These cells may undergo calcification to become cementicles.
V. Defence Cells
1. Mast cells:
• Mast cells are seen occasionally in healthy PDL.
• They are small round cells often associated with blood vessels.
• Cells are characterised by numerous cytoplasmic granules which are dense, membrane
bound vesicles.
• These granules stain with basic dyes and are readily demonstrated by metachromatic
dye, Azure A. They are also stained by PAS stain.
• Function: These granules contain heparin and histamine. Histamine plays role in inflammatory
reaction and its release into extracellular environment causes proliferation of endothelial
cells and mesenchymal cells resulting in regulation of their population in PDL.
2. Macrophages:
• Are predominantly located adjacent to blood vessels in PDL.
• They phagocytose dead cells and secrete growth factors that regulate the proliferation
of adjacent fibroblasts and endothelial cells.
3. Eosinophils:
• They are occasionally seen in PDL and are capable of phagocytosis.
• Balance between the synthesis and resorption of tissues by synthetic and resorptive
cells in PDL helps to maintain tissue homeostasis in PDL and maintains its width
throughout life.
260 DADH Made Easy
SAQs (3 Marks)
Q. 1. Write about homeostatic function of PDL. (June 2004)

Ans. HOMEOSTATIC FUNCTION
• Homeostatic function is one of the important functions of PDL.
• PDL has the capacity to resorb and synthesize the extracellular substance of the connective
tissue of the ligament, alveolar bone, and cementum. This results in maintaining the width
of PDL throughout life which functions under physical forces of mastication.
• This is done by formation or resorption of bone, formation of cementum, formation, and
degradation of collagen fibers, the ground substance and detachment and reattachment of
collagen fibers to their new locations.
• The preservation of the PDL width throughout mammalian life-time is an important measure
of PDL homeostasis.
• The ability of the PDL cells to synthesize and secrete a wide range of regulatory molecules
is an essential component of tissue remodeling and PDL homeostasis. PDL cells can induce
mitogenic effect and can also downregulate osteoblastic activity and differentiation of PDL
cells. They can also regulate bone formation.
• Loss of balance between synthesis and resorption results in failure of homeostatic
mechanism.
• Failure of homeostatic mechanism may lead to tooth ankylosis and/or tooth resorption
and can result in loss of function by the tooth.
• Homeostatic function of PDL is also related to tooth function.
• In non-functional tooth much of the extracellular substance of the ligament is lost due to
diminished synthesis of substances required to replace structures resorbed during normal
turnover. This results in decreased width of the PDL. With this there occurs increased
deposition of cementum and decrease in alveolar bone. The process is irreversible if the
tooth is returned to function.
Q. 2. Enumerate the principal fibers of PDL and functions of PDL. (Dec. 2005)
Ans. Same as answer of LAQ 1.
Q. 3. Write about evolution of periodontal ligament. (May 2009)

Ans. EVOLUTION OF PERIODONTAL LIGAMENT
• There is a fundamental difference between the attachment of reptilian and mammalian
teeth.
• In the ancestral reptiles the teeth were ankylosed to the bone. In mammals they are suspended
in their socket by ligaments.
• The evolutionary step from reptile to mammal included a series of coordinated changes in
the jaws.
• In reptiles, the mandible consists of a series of bones united by sutures. The dentary, the
uppermost bone, carries the ankylosed teeth.
• During transition from advanced types of reptiles to the first mammals, dentary occupied
the large part and the other mandibular bones were reduced in size. Finally, only the dentary
formed the mammalian mandible.
• Other components are lost or changed into two ossicles of the middle ear.
• The evolutionary change replaces the ankylosis of teeth and bone to a ligamentous
suspension with tooth.
Q. 4. Write about development of periodontal ligament.

Ans. DEVELOPMENT OF PERIODONTAL LIGAMENT
• Development of periodontal ligament (PDL) begins with root formation, prior to tooth
eruption.
• It develops from dental follicle.
• Dental follicle cells located between the developing alveolar bone and the Hertwig’s epithelial
root sheath are composed of two subpopulation of cells, mesenchymal cells of dental follicle
proper and the perifollicular mesenchyme.
• As the tooth formation continues, mesenchymal cells in the perifollicular area actively
synthesize and deposit collagen fibrils and glycoproteins in the developing PDL.
• Developing PDL contain undifferentiated stem cells that retain the potential to differentiate
into osteoblasts, cementoblasts and fibroblasts.
• Development of principal fibers: Immediately before tooth eruption, active fibroblasts
adjacent to cementum of the coronal third of the root, align in an oblique direction and
the first collagen fiber bundles of the ligament appear, alveolar crest fiber bundle. By the
time of first occlusal contact of the tooth with its antagonist, the horizontal group are
developed. As eruption continues and definite occlusion is established, oblique fiber
bundles mature.
With the formation of the apical fiber group, the definitive PDL architecture is established.
• Development of cells: With the onset of root formation, the cells of the follicle show
increasing number of cell organelles. Collagen and ground substance formation begins and
fills the extracellular spaces. Stem cells, which give rise to cementoblasts, osteoblasts, and
fibroblasts are seen in a perivascular location.
Q. 5. Write about cementicles.

Ans. CEMENTICLES:
• These are calcified bodies found in periodontal ligament.
• They are seen in older individuals, and they may remain free in the connective tissue, they
may fuse into large calcified masses, or they may be joined with the cementum.
• As the cementum thickens with advancing age, it may develop these bodies.
• When they are adherent to the cementum they form excementoses.
• Degenerated epithelial cells form the nidus for calcification and these bodies may form.
Q. 6. Write about Sharpey’s fibers?

Ans. SHARPEY’S FIBERS (Refer fig. 17.1):
• Collagen fibers of PDL are embedded into cementum on one side and into alveolar bone on
the other. These terminal portions of the principal fibers embedded in cementum and bone
are termed Sharpey’s fibers.
• Sharpey’s fibers are more numerous but smaller at their attachment into cementum than
alveolar bone.
• Once embedded in either the wall of the alveolus or the tooth, Sharpey’s fibers calcify to a
certain degree.
• Each Sharpey’s fiber is composed of numerous collagen fibrils.
262 DADH Made Easy
• Sharpey’s fibers in primary cellular cementum are mineralized fully while those in cellular
cementum and bone are mineralised partially at their periphery.
• Bundles of Sharpey’s fibers are anchored in the bundle bone of alveolar bone proper.
• Few Sharpey’s fibers pass uninterruptedly through the bone of the alveolar process and are
termed as transalveolar fibers. They can continue as principal fibers of the adjacent PDL or
they may mingle buccally and lingually with fibers of the periosteum that cover the outer
cortical plates of the alveolar process.
• Transalveolar fibers may serve as a mechanism to connect adjacent teeth.
• Function of Sharpey’s fibers: They serve to attach the tooth to surrounding bone.
1. Periodontal ligament (PDL) is found in 9. Intermediate plexus of PDL is a distinct

a. Reptiles b. Mammals zone of
c. Amphibians d. Both a and b a. Fibers from bone to cementum
2. PDL consists of the following synthetic b. Site of rapid remodeling
cells except c. Site allowing small movement of teeth
a. Osteoblast b. Osteoclast d. An artifact due to tissue sectioning
c. Cementoblast d. Fibroblast 10. Oxytalan is a type of fiber largely restricted
3. PDL is to the walls of blood vessels in humans.
It is a type of
a. Thickest at cervical third of root
a. Elastic fibers
b. Thinnest at middle third of root
b. Collagen fibers
c. Thickest at apical third of root
c. Nerve fibers
d. Uniform throughout the root
d. Argyrophylic fibers
4. The cells usually not found in PDL are
11. Cementicles, calcified bodies found in
a. Osteoblasts and fibroblasts
PDL, are possibly formed by
b. Cementoblasts and osteoclasts
a. Degenerated epithelial cells
c. Cementoclasts
b. Blood vessels
d. Odontoblasts
c. Fibers
5. The cells that resemble osteoclasts are d. Osteoblasts
a. Cementoblasts
12. The width of PDL ranges from
b. Cementoclasts
a. 0.12 mm to 0.25 mm
c. Odontoblasts
b. 0.15 mm to 0.38 mm
d. Fibroblasts
c. 0.18 mm to 0.39 mm
6. The most numerous fibers found in PDL d. 0.20 mm to 0.41 mm
are
13. The cell that is responsible for remodeling
a. Apical group
of collagen in PDL is
b. Gingival group
a. Fibroblast b. Epithelial cell
c. Horizontal group
c. Osteoblast d. Cementoblast
d. Oblique group
14. The majority of collagen fibers in PDL are
7. Cells of the dental follicle give rise to arranged in definite and distinctive fiber
a. Cementoblasts bundles. They are called
b. Fibroblasts a. Principal fibers
c. Osteoblasts b. Bundle fibers
d. All of the above c. Group fibers
8. Human PDL is made-up of d. Gingival fibers
a. Collagen fibers 15. The richest supply of proprioceptive
b. Elastic fibers nerve endings found in PDL is in
c. Nerve fibers a. Incisors b. Molars
d. Argyrophylic fibers c. Canines d. Premolars
1-b, 2-b, 3-b, 4-d, 5-b, 6-d, 7-d, 8-a, 9-d, 10-a, 11-a, 12-b, 13-a, 14-a, 15-c
264 DADH Made Easy
16. The cells of PDL which have synthesizing 24. PDL is thickest at
and resorbing function are a. Apical region
a. Osteoblasts b. Alveolar crest region
b. Fibroblasts c. Furcation region
c. Cementoblasts d. Mid-root region
d. Fibrocytes 25. Desmodont is another name for
17. Cementicles are found in a. The tooth with one wall pocket
a. Pulp b. Dentin b. Tooth with three walled pocket
c. PDL d. Cementum c. Periodontal ligament
18. Which is a part of periodontium d. Dehiscence
a. Gingiva 26. The blood supply of PDL is derived from
b. Alveolar bone a. Branches from apical vessel that
c. PDL supply dental pulp
d. All of the above b. Branches from intraalveolar vessel
19. Which of the following cells of PDL are c. Branches from gingival vessels
epithelial in origin d. All of the above
a. Fibroblasts 27. A particular glycoprotein which occurs
b. Rests of Malassez in filamentous form in PDL is called
c. Osteoblasts a. Fibronectin
d. Osteoclasts b. Proline
c. Hydroxyproline
20. PDL fibers that help to maintain arch
integrity are d. Chitin
a. Transseptal fibers 28. What is most appropriate about inter-
b. Oblique fibers mediate plexus in PDL
c. Horizontal fibers a. It may appear as fibers arising from
d. Apical fibers cementum and bone joined in the mid
region of periodontal space
21. Which of the following has proprioceptive b. It provides a site where rapid re-
mechanism modelling of fibers occur
a. Pulp b. Dentin c. It is an artifact
c. Cementum d. PDL d. All of the above
22. Fibers of PDL are arranged at 29. PDL appears to be made-up of
a. 64° striated pattern a. Type I and Type II collagen
b. 90° striated pattern b. Type I and Type III collagen
c. 30° striated pattern c. Type II and Type III collagen
d. Straight with no striations d. Only Type III collagen
23. Nerve supply of PDL is by 30. The function of PDL is/are
a. Unmyelinated nerves a. Support and nutrition
b. Myelinated nerves b. Synthesis and resorption
c. Both c. Proprioception
d. None d. All of the above
16-b, 17-c, 18-d, 19-b, 20-a, 21-d, 22-a, 23-c, 24-b, 25-c, 26-d, 27-a, 28-c, 29-b, 30-d
31. The periodontium comprise of how many 38. The periodontal fibers not attached to
connective tissues bone are
a. 2 b. 3 a. Horizontal
c. 4 d. 5 b. Circular
32. The interradicular group of fibers is present c. Oblique
a. Between two roots of multirooted d. Apical
teeth 39. Gingival fibers seen in free gingiva are
b. In the apex a. Alveologingival group
c. In between two teeth b. Dentogingival group
d. All of the above c. Circular group
33. The following group of fibers of the PDL is d. Transseptal group
most likely to be found in the middle third 40. The ageing of PDL leads to
of the root a. Widening of the ligament
a. Apical b. Oblique b. Narrowing of the ligament
c. Horizontal d. Transseptal c. Loss of ligament
34. The following fibers of the PDL provide d. All of the above
the major support to the tooth during 41. The cells of PDL include all except
function a. Fibroblasts
a. Apical b. Cell rests of Malassez
b. Oblique c. Defense cells
c. Horizontal d. Langerhans cells
d. Alveolar crest
42. Fibers of PDL which prevent intrusion are
e. Interradicular
a. Apical
35. PDL develops from b. Interradicular
a. Enamel organs c. Oblique
b. Dental papilla d. None of the above
c. Dental follicle
43. The type of collagen present in PDL is
d. Perifollicular mesenchyme
a. II and III
36. Transseptal fibers are present between b. III and IV
a. Cementum of two teeth c. I and III
b. Septal areas d. Both a and b
c. Interradicular area 44. Procollagen formation is dependent on
d. Apical area a. Vitamin A
37. The principal fibers of PDL are b. Vitamin C
a. Reticular b. Elastic c. Vitamin E
c. Collagenous d. Oxytalan d. All of the above
31-c, 32-a, 33-b, 34-b, 35-d, 36-a, 37-c, 38-b, 39-c, 40-b, 41-d, 42-c, 43-c, 44-b
266 DADH Made Easy
19
Bone
LAQ (10 Marks)
Q. 1. Describe the histological structure of alveolar process. (Oct. 2004)

Ans. Introduction
Alveolar process is that part of the maxilla and the mandible that forms and supports the
sockets of the teeth.
Anatomically there is no distinct boundry between the body of the maxilla or mandible and
their respective alveolar processes. As a result of its adaptation to function, two parts of the
alveolar process can be distinguished:
A. Alveolar bone proper, which consists of thin lamella of bone that surrounds the root of the
tooth and gives attachment to principal fibers of the periodontal ligament. The second
part is
B. Supporting alveolar bone, the bone that surrounds the alveolar bone proper and gives
support to the socket.
A. Alveolar Bone Proper

It consists partly of lamellated and partly of bundle bone and is about 0.1–0.4 mm thick.
a. Lamellated bone
Some lamellae are arranged parallel to the surface of the adjacent marrow spaces, whereas
others form Haversian systems.
b. Bundle bone
It is that bone in which the principal fibers of the periodontal ligament are anchored.
It is termed as ‘bundle’ because the bundles of the principal fibers continue into the bone as
Sharpey’s fibers (Fig. 19.1).
As bundle bone contains fewer fibrils than lamellated bone, it appears dark in hematoxylin
and eosin stained sections and lighter in preparation with silver.
Bundle bone is formed in areas of apposition and lines of rest are seen in it.
Radiographically, bundle bone is referred to as lamina dura because of increased radiopacity.
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Bone 267
This is due to the presence of thick bone without trabeculations that X-rays have to
penetrate.
Alveolar bone proper forming the inner wall of the socket is perforated by many openings.
These carry branches of the interalveolar nerves and blood vessels into the periodontal ligament
and is therefore called cribriform plate.
Bone between the teeth is composed of cribriform plate entirely and is called interdental
septum.
The interdental and interradicular septa contain the perforating canals of Zuckerkandl and
Hirschfeld (nutrient canals) which house the interdental and interradicular arteries, veins, lymph
vessels and nerves.
Fig. 19.1: Bundle bone, Resting and Reversal lines
B. Supporting Alveolar Bone

Consists of two parts:
a. Cortical plates
b. Spongy bone
a. Cortical plates
Consists of compact bone and forms the outer and inner plates of the alveolar processes and
are covered by gingiva. They are continuous with the compact layers of the maxillary and
mandibular body.
They are thinner in the maxilla than in mandible and are thickest in the premolar and molar
region of the lower jaw, especially on the buccal side.
Histologically:
The cortical plates consists of longitudinal lamellae and Haversian systems.
Both cribriform plate and cortical plate are compact bone separated by spongy bone.
b. Spongy bone
This fills the area between the cortical plates and the alveolar bone proper.
268 DADH Made Easy
Histologically:
The bony substance in spongy bone consists of large trabeculae of lamellar bone. These are
surrounded by marrow that is rich in adipocytes and pluripotent mesenchymal cells. Trabeculae
are arranged along the lines of stress to withstand the forces applied to bone. The marrow
spaces in spongy bone are large and trabeculae surround them to derive the nutrition.
Trabeculae buttress the functional forces to which alveolar bone proper is exposed. The
cancellous component in maxilla is more than in the mandible.
Spongiosa of the alveolar process is classified radiographically into two types.
i. Type I: In this type the interdental and interradicular trabeculae are regular and horizontal
in a ladder-like arrangement.
This is most often in the mandible and fits into the trajectory pattern.
ii. Type II: Show irregularly arranged, numerous, delicate interdental, and interradicular
trabeculae. This lacks trajectory pattern and has greater number of trabeculae. This
arrangement is common in maxilla.
Marrow Tissue
Marrow space in the alveolar process many contain hematopoietic marrow but usually contain
fatty marrow. In the condylar process, in the angle of the mandible and in the maxillary
tuberosity, hematopoietic cellular marrow is found.
Crest of Alveolar Septa

In a healthy mouth, the distance between the cementoenamel junction and the free border of
the alveolar bone proper is constant and is usually 1.5 to 2 mm.
1. Bone is sensitive to pressure, whereas tension acts as a stimulus to new bone formation.
This quality of bone is utilised in orthodontic tooth movement.
2. Periodontal disease is associated with horizontal and vertical resorption of bone which is
related to bacteria present in plaque.
3. Resorption of alveolar bone occurs after tooth loss. In maxilla, resorption is upwards and
inwards whereas in mandible it is downwards and outwards.
4. Lamina dura is important diagnostic landmark in determining health of the periapical
tissue. Loss of density usually means infections, inflammation and resorption of bony
socket.
5. In the anterior teeth region, the supporting bone is very thin and the cortical plate is fused
with alveolar bone proper. In this area and in the premolar and molar regions of the maxilla,
defects of outer alveolar wall are common.
SAQs (3 Marks)
Q. 1. Describe histology of mature bone.

Ans. Introduction
• Bone is a living tissue and is one of the hardest structures of human body.
• Bone can be histologically classified as mature and immature bone.
• Mature bone is further classified as compact and cancellous bone.
Bone 269
Mature Bone
• All mature bones have a dense outer sheet of compact bone and a central medullary cavity
which is filled with red or yellow marrow.
• This cavity shows a network of bony trabeculae, termed as trabecular, spongy or cancellous
bone.
a. Compact bone
• Outer aspect of compact bone is surrounded by periosteum which has an outer fibrous layer
and an inner osteogenic layer, next to the bone surface consisting of bone cells, their
precursors, and a rich vascular supply.
• The inner surfaces of compact and cancellous bone are covered by a thin cellular layer, endosteum.
• At the periosteal and endosteal surfaces, circumferential lamellae are present, while deep to
these, the lamellae are arranged as small concentric layers around a central vascular canal,
Haversian canal.
• Haversian (vascular) canal and the concentric lamellae together is known as osteon or Haversian
system, which is the basic metabolic unit of bone.
• Interstical lamella: These are remnants of osteons, left behind during remodeling.
• Reversal line (Refer fig 19.1): The cement line of mineralized matrix, reversal line, delineates
the Haversian system. It marks the limit of bone erosion prior to formation of osteon. It
appears irregular and is basophilic due to more glycoproteins and proteoglycans.
• Resting line (Refer fig. 19.1): A more regular and eosinophilic line which denotes the period
of rest during formation of bone is resting line.
• Volkman’s canals: Adjacent Haversian canals are interconnected by Volkman’s canals,
which contain blood vessels. This creates a rich vascular network, throughout the compact
bone.
• Cells: Osteocytes are present in lacunae at the junctions of lamellae. Small canaliculi radiate
from lacunae to Haversian canal, which connect all the osteocytes in an osteon together.
Osteoblasts, cells responsible for synthesis of organic matrix of bone, are found on the surface
of growing or remodeling bone (Fig. 19.2).
Fig. 19.2: Osteoblasts, Osteocytes and Osteoclasts

270 DADH Made Easy
b. Spongy bone
• Spongy bone and compact bone have the same cells and intercellular matrix, but differ in
the arrangement of components. In spongy bone, bony substance is arranged in the form of
large slender spicules called trabeculae with large marrow spaces in between.
• In jaw bone, the alveolar process has alveolar bone proper, which is partly lamellated and
partly bundle bone and supporting bone which has cortical plates. Spongy bone is present
between the buccal and lingual cortical plates.
Q. 2. Describe alveolar bone proper. (Oct. 2002, May 2009)

Ans. ALVEOLAR BONE PROPER
Alveolar process is that part of maxilla or mandible that forms and supports the sockets of
teeth. Anatomically there is no distinct boundary between the body of maxilla or mandible
and their respective alveolar processes. As a result of its adaptation to function, two parts of
alveolar process can be distinguished:
A. Alveolar bone proper
B. Supporting alveolar bone
Alveolar bone proper consists partly of lamellated and partly of bundle bone (Refer Fig. 19.1).
a. Lamellated bone
Some lamellae are arranged parallel to the surface of the adjacent marrow spaces, whereas
others form Haversian systems.
b. Bundle bone
It is that bone in which the principal fibers of the periodontal ligament are anchored.
The term ‘bundle’ because, the bundles of the principal fibers continue into the bone as
Sharpey’s fibers.
As bundle bone contains fewer fibrils than lamellated bone, it appears dark in hematoxylin
and eosin stained sections and lighter in preparation with silver. Bundle bone is formed in
areas of apposition and lines of rest are seen in it.
Radiographically bundle bone is referred to as lamina dura because of increased
radiopacity. This is due to the presence of thick bone without trabeculations, that X-rays have
to penetrate.
Alveolar bone proper forming the inner wall of the socket is perforated by many openings.
These carry branches of the interalveolar nerves and blood vessels into the periodontal ligament
and is therefore called cribriform plate. Bone between the teeth is composed of cribriform plate
entirely and is called interdental septum.
The interdental and interradicular septa contain the perforating canals of Zuckerkandl and
Hirschfeld (nutrient canals) which house the interdental and interradicular arteries, veins, lymph
vessels and nerves.
Lamina dura is an important diagnostic landmark in determining health of the periapical
tissue. Loss of density usually means infections, inflammation and resorption of bony
socket.
Bone 271
Q. 3. Write about woven bone/immature bone. (June 2004)

Ans. Introduction
• Bone is a living tissue and is one of the hardest structures of human body.
• Histologically, bones are classified as mature and immature bone or woven bone.
• Woven bone is the first formed bone with irregularly oriented collagen fibers of varying diameters.
Fig. 19.3: Immature/Woven bone
Location
This type of bone is usually not seen after birth. It is seen only in the alveolar bone and during
healing of fractures.
Composition: Mineral density is lower and water content is higher in woven bone.
Histology (Fig. 19.3)
• Woven bone is an immature bone characterized by interwined collagen fibers oriented in
many directions, hence the name woven.
• It has greater number, size, and irregular arrangement of osteocytes as its rate of formation
is fast.
• In woven bone, there is more interfibrillar space that is occupied by mineral crystals and
acidic proteins.
• Mineral density is lower and water content is high in woven bone matrix.
• Woven bone is enriched in BAG-75 (bone acidic glycoprotein-75) and BSP (bone sialoprotein).
Bone Deposition and Resorption
• Rate of deposition and mineralization is higher and matrix vesicles participate in initiation
of mineralization of woven bone.
• Woven bone can be entirely removed by osteoclasts, whereas only a portion of lamellar
bone is resorbed at one time.
Staining
The matrix of woven bone in hematoxylin and eosin stained section is tinged with blue as it
has higher proteoglycan content.
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X-ray Features
On roentgenogram, immature bone appears more radiolucent as it has greater number of
osteocytes and reduced volume of calcified intercellular substance.
During healing of fractures or extraction wounds, this embryonic bone is formed which later
gets replaced by mature bone.
Q. 4. Write about osteoblasts and osteocytes. (June 2006)

Ans. OSTEOBLASTS AND OSTEOCYTES
• Bone is a connective tissue composed of cells, fibers, and ground substance.
• Cells present in bone are:
– Osteoblasts
– Osteocytes
– Osteoclasts.
OSTEOBLASTS
• They are mononucleated cells responsible for the synthesis and secretion of organic matrix
of bone.
Origin
• They are derived from osteoprogenitor cells of mesenchymal origin which are present in
the bone marrow and other connective tissue. Periosteum also serves as an important
reservoir of osteoblasts.
Morphology
• They are mononucleated, basophilic, plump, cuboidal cells.
• They are found on the forming surface of growing or remodeling bone.
• They produce organic matrix of bone which consists of collagenous and non-collagenous
proteins.
• They exhibit abundant and well-developed protein synthesis organelles.
• The intense cytoplasmic basophilia is due to abundance of rough endoplasmic reticulum
(RER).
• The procollagen and other organic constituents of bone matrix are synthesized by RER and
are transferred to golgi complex and are assembled in golgi complex in secretory granules.
• These granules release their contents on the surface of forming bone where it assembles
extracellularly as fibrils to form osteoid. Noncollagenous proteins are also released along
the surface of osteoblasts which participate in regulating mineral deposition.
• Nucleus of these cells is situated eccentrically in the cell, away from the adjacent bone surface.
• The organic matrix is deposited around the cell bodies and their cytoplasmic processes
resulting in the formation of canaliculi.
• Osteoblasts contact one another by adherence and gap junctions. Osteoblastic layer
completely covers the osteoid surface and functions in a coordinated manner.
• They contain bundles of actin, myosin and cytoskeletal proteins which are associated with
maintenance of cell shape, attachment and motility.
Bone 273
Functions
1. Formation of new bone by synthesis of various proteins and polysaccharides.
2. Regulation of bone remodeling and mineral metabolism.
3. Mineralization of osteoid.
Regulation of osteoblast activity

• Parathormone and vitamin D enhance bone resorption at high concentration but support
bone formation at low concentration by their action on osteoblasts.
• Various other hormones and proteins like growth harmone, insulin, bone morphogenetic
proteins, fibroblast growth factor, etc. help to maintain the overall integrity of bone.
Bone lining cells

• Once osteoblasts have completed their function they are either entrapped in bone matrix
and become osteocytes or remain on the surface as lining cells. Osteoblasts flatten, when
bone is not forming and extend along the bone surface. They contain very few organelles
but retain their vitality.
OSTEOCYTES (Refer Fig. 19.2)

• As the osteoblasts form the bone matrix, they get entrapped within the matrix they secrete
and are called osteocytes.
• The number of osteoblasts that become osteocytes depend on the rapidity of bone formation.
Embryonic (woven) bone and repair bone, show more osteocytes, than lamellar bone, as
they are formed rapidly.
• Within the bone matrix, the osteocytes reduce in size, creating a space around it, called the
osteocytic lacuna.
• Lacunae could be ovoid or flattened. Narrow extension of these lacunae form channels
called canaliculi. Osteocytic processes are present within these canaliculi. These processes
contact the processes of the adjacent cell, i.e. other osteocytes in the same system. They also
maintain contact with osteoblasts and bone lining cells at the surface. This interconnecting
system maintains the bone integrity and bone vitality.
• Canaliculi penetrate the bone matrix and permit diffusion of nutrients, gases, and waste
products between osteocytes and blood vessels.
• Osteocytes possess an ellipsoid cell body with long axis parallel to the lamellae. Nucleus is
oval with a narrow rim of faintly basophilic cytoplasm. Cell has few organelles, but contain
sufficient RER and large golgi region which suggests that these cells are capable of keeping
the bone matrix in a state of good repair.
• Osteocytes secrete few matrix proteins.
• Old osteocytes when die, their lacunae and canaliculi get plugged with debris. The death of
osteocytes leads to resorption of the matrix by osteoclasts.
Functions
• Osteocytes sense the changes in environment and send signals that affect the response of
cells to bone remodeling.
• The interconnecting system of osteocytes through canaliculi maintains bone integrity and
bone vitality. Failure of this leads to sclerosis and death of bone.
274 DADH Made Easy
Q. 5. Describe about osteoclasts. (May 2009, Nov. 2010, May 2013)

Ans. Introduction
The word osteoclast is derived from the Greek word for “bone and broken”. Osteoclast is a
type of bone cell that removes bone tissue by removing the mineralized matrix of bone.
Origin
• Osteoclasts are derived from hemopoietic cells of monocyte macrophage lineage.
Morphology (Refer Fig. 19.2)

• Osteoclast is a physiological multinucleated giant cell responsible for bone resorption.
• They are found in bay-like depressions called “Howship’s lacunae”.
• They are large, about 40–100 μm in diameter with 15–20 closely packed nuclei. Number of
nuclei is related to the activity of the cell.
• Osteoclasts with many nuclei resorb more bone than osteoclasts with few nuclei.
• They are variable in shape due to their motility.
• Cytoplasm shows acid-phosphatase containing vesicles and vacuoles. Mitochondria and
golgi complex are extensive and arranged in stacks. Rough endoplasmic reticulum is sparse.
Cathepsin containing vesicles are present close to the ruffled border.
• They are rich in acid phosphatase, which distinguishes them from other multinucleated
giant cells.
Function
• It resorbs bone by removal of minerals and organic components of extracellular matrix of
bone. They develop a ruffled border and area devoid of organelles and containing smooth
plasma membrane called sealing zone close to the resorbing surface of bone. There is
dissolution of the minerals by the action of hydrochloric acid. Protons are released by
osteoclast across the ruffled border into the resorption zone which leads to fall in pH and
therefore dissolution of mineralized component of bone. Degradation of organic matrix
occurs by action of enzymes released by osteoclasts.
Regulation of Osteoclastic Activity

• Interaction between (receptor activator of nuclear factor kB RANK) ligand and RANK on
the surface of osteoclast precursors is necessary for the differentiation of the osteoclast.
Factors regulating osteoclast activity are estrogen, paratharmone, vitamin D3 and calcitonin.
Q. 6. Describe resorption of alveolar bone. (Nov. 2010)

Ans. Introduction
• Bone is a highly dynamic connective tissue with a capacity for continuous remodeling and
the two principal cell types, osteoclast and osteoblast are the major effectors in this process.
• Bone remodeling is the ‘coupling’ of bone synthesis and bone resorption.
• Bone resorption is the removal of mineral and organic components of extracellular matrix of bone.
• Cells responsible for bone resorption are osteoclasts.
Sequence of Events in Bone Resorption

• First phase is formation of osteoclast progenitor in the hematopoietic tissues, followed by their
vascular dissemination and generation of resting preosteoclasts and osteoclasts in the bone itself.
Bone 275
• Second phase is activation of osteoclasts.

• Third phase involves resorption of bone by activated osteoclasts.
• They create cavities for themselves known as ‘Howship’s lacunae’ on the surface of the bone
to be resorbed (Refer fig. 19.2).
• Resorption involves alterations in the osteoclast, dissolution of hydroxyapitite, degradation
of organic matrix and removal of degradation products.
1. Alterations in the osteoclast

• Immediately before resorption, osteoclasts undergo changes which facilitate bone resorption.
• There is development of ruffled border and a ‘sealing zone’ of the plasma membrane of the
cell that is next to the bone surface.
• The ruffled border (Fig. 19.4) consists of many infoldings of the cell membrane, resulting in
finger-like projections of the cytoplasm. This increases the surface for an intensive exchange
between the cell and bone.
• Adjacent to the ruffled border, cell cytoplasm is devoid of cell organelles but contain
contractile actin microfilaments. This region is called the clear (sealing) zone (Fig. 19.4). This
zone serves to attach the cell very closely to the surface of the bone to be resorbed.
• This creates an isolated microenvironment in which resorption takes place without diffusion
of the hydrolytic enzymes into adjacent tissues.
Fig. 19.4: Osteoclast
2. Dissolution of mineralized component of bone

• At the resorption site, osteoclast cell membrane attaches to the bone matrix at the sealing
zone.
• There is dissolution of the minerals by the action of hydrochloric acid.
• Protons for the acid arise from the activity of cytoplasmic carbonic anhydrase II, synthesized
in the osteoclast.
• Protons are then released across the ruffled border into the resorption zone, which leads to
a fall in pH in the osteoclast resorption space and dissolution of the mineralized component
of bone.
3. Degradation of organic matrix

• Next step involves digestion of organic components of bone matrix.
• Protolytic enzymes cathepsin–K and matrix metalloproteinase-9 are synthesized by
osteoclast. These enzymes are released into the sealed compartment where they degrade
collagenous and non-collagenous proteins of bone matrix.
276 DADH Made Easy
4. Removal of degradation products

• Once liberated from bone, the free organic and non-organic particles of bone matrix are
taken in or endocytosed from the resorption lacunae, across the ruffled border into the
osteoclast.
• These are then packed into membrane-bound vesicles which are passed across the cell and
released by exocytosis into extracellular space.
• Following resorption, osteoclast undergoes apoptosis, limiting the resorption activity.
• Resorbing surface of bone appears scalloped and exhibits scattered osteoclasts.
Q. 7. Write about bundle bone? (May 2012)

Ans. Introduction
Bundle bone is a part of alveolar bone proper. Alveolar bone proper is that part of alveolar
process which surrounds the roots of the teeth. It consists partly of lamellated and partly of
bundle bone.
Bundle bone is that bone in which principal fibers of the periodontal ligament are
anchored.
Histology (Refer Fig. 19.1)

• The term bundle was chosen because the bundles of the principal fibers continue into the
bone as Sharpey’s fibers.
• Bundle bone is characterised by scarcity of fibrils in the intercellular substance. These fibrils
are arranged at right angle to Sharpey’s fibers.
• In some areas, the alveolar bone proper consists mainly of bundle bone.
• Bundle bone is formed in areas of recent bone apposition and lines of rest are seen in it.
• Alveolar bone proper forming the inner wall of the socket is perforated by many openings
that carry branches of interalveolar nerves and blood vessels into the periodontal ligament
and is therefore called cribriform plate. The perforating canals are called as canals of Zuckerkandl
and Hirschfeld (nutrient canals).
Staining
• Bundle bone has fewer fibrils than lamellated bone and therefore it appears dark is routine
hemotoxylin and eosin stained sections and lighter in preparations stained with silver than
lamellated bone.
X-ray Features
• Radiographically, bundle bone is referred as the lamina dura, because of increased
radiopacity.
• This is due to the presence of thick bone without trabeculations, that X-rays have to penetrate
and not due to any increased mineral content.
• Lamina dura is an important diagnostic landmark in determining the health of the supporting
tissues of teeth.
• Loss of density of lamina dura means infection, inflammation and resorption of bone
socket.
Bone 277
Q. 8. Write about resting and reversal lines.

Ans. Introduction
• Bone, a living tissue, is one of the hardest structures of human body.
• All bones have a dense outer sheet of compact bone and central medullary cavity, which
shows a network of bony trabeculae called as trabecular spongy or cancellous bone.
• In order to maintain its integrity and stability, bone undergoes constant remodeling, that is,
‘coupling’ of bone resorption and formation.
• Bone shows irregularly appearing reversal lines and regularly appearing resting lines.
Reversal Line
• Lamellated bone has a Haversial system or osteon. Osteon is the basic metabolic unit of
bone.
• A cement line of mineralised matrix delineates the Haversian system. This is a reversal
line.
• Reversal line denotes the junction between bone resorption and bone formation.
• It contains little or no collagen, and is strongly basophilic, due to high content of
glycoproteins and proteoglycans.
• Reversal line marks the limit of bone erosion prior to the formation of osteon.
• This line is irregular as it is formed by the scalloped outline of the Howship’s lacunae.
Resting Line
• The production and mineralization of the organic matrix of bone is phasic, i.e. it stops and
starts again. During these alternating periods of activity and quiscence, the character of the
organic matrix varies and also there is variation in the degree of mineralisation.
• This phasic formation of bone is reflected in its structure as resting lines. Resting line denotes
the period of rest during the formation bone.
• It is more regular and is eosinophilic.
• These are seen in ground section because of variation in mineralization and also in a
mineralized section due to variation in matrix composition (Refer Fig. 19.1).
Q. 9. Describe histology of alveolar socket of permanent maxillary first molar. (June 2008)
Ans. Bone that forms and supports the sockets of teeth is alveolar process bone. As a result of
its adaptation to function, two parts of alveolar bone are:
1. Alveolar bone proper: Which consist of a thin lamellae of bone that surrounds the roots of
the teeth and gives attachment to principal fibers of the periodontal ligament.
2. Supporting alveolar bone: It is the bone that surrounds the alveolar bone proper and gives
support to socket.
Describe alveolar bone proper as described in answer of LAQ.1 (Refer Fig. 19.1).
Supporting alveolar bone has cortical plates and spongy bone. In maxillary premolar and
molar region, no spongy bone is found and the cortical plate is fused with the alveolar bone
proper.
In maxilla, cortical plates are much thinner.
In maxilla, interdental and interradicular trabeculae show irregular arrangement known as
type II.
(Describe compact and spongy bone as described in LAQ.1)
278 DADH Made Easy
Q. 10. Explain buccolingual section through dentulous mandible.

Ans. BUCCOLINGUAL SECTION THROUGH DENTULOUS MANDIBLE
• Buccolingual section through dentulous mandible will show buccal and lingual cortical plates
enclosing spongy bone. Bone which forms and supports the sockets of teeth is alveolar process.
• Describe entirely the histology of alveolar bone as described in LAQ.1.
Q. 11. Write functions of alveolar bone. (Oct. 2002, May 2009)
Ans. FUNCTIONS OF ALVEOLAR BONE
• Alveolar bone is that part of maxilla or mandible that forms and supports the sockets of the
teeth.
• As a result of its adaptation to function, two parts of alveolar process can be distinguished,
the alveolar bone proper and the supporting alveolar bone.
Functions of alveolar bone are:
1. It houses the roots of the teeth.
2. Anchors the roots to the alveoli through Sharpey’s fibres.
3. Helps the tooth to move for better occlusion.
4. Helps to absorb and distribute occlusal forces generated during tooth contact.
5. Supplies vessels to the periodontal ligament.
6. Houses and protects developing permanent teeth while supporting primary teeth..
7. Organizes eruption of primary and permanent teeth.
Q. 12. What are differences between mature and immature bone? (June 2007)
Ans. Introduction
• Bone, a living tissue, is one of the hardest structures of human body.
• Histologically, bone is classified as mature bone and immature or woven bone.
• Woven bone is the first formed bone which is usually not seen after birth except in the
alveolar bone and during healing of fractures.
• Mature bone is of two types, compact and cancellous.
Differences between mature and immature bones

MATURE BONE IMMATURE BONE
(Lamellar/trabecular bone) (Woven bone)
1. Distinctive, orderly arrangement: Mature bone 1. Immature bone is characterized by interwined
which is due to repeated addition of uniform collagen fibers oriented in many directions,
lamellae to bony surfaces during appositional growth. hence the name woven.
2. Direction of collagen fibrils: In a lamella 2. Collagen fibers are oriented in many directions.
mature bone lies at right angles to that of the
fibrils in the adjacent lamella.
3. Interfibrillar space is less. 3. It is more and is occupied by mineral crystals
and acidic proteins.
4. Chemical composition: 4. Chemical composition:
• Mineral density is high and water content • Mineral density is low and water content is
is low. high.
• Mature bone is enriched in osteocalcin. • Immature lone is enriched in bone acidic
glycoprotein-75 and bone sialoprotein.
(Contd.)
Bone 279
Differences between mature and immature bones (Contd.)

MATURE BONE IMMATURE BONE
(Lamellar/trabecular bone) (Woven bone)
5. Staining: 5. Staining:
In H and E stained section lamellar bone shows The matrix of woven bone is tinged with blue
uniform acidophilic staining of the matrix. indicating that it has higher proteoglycan
content.
6. Bone formation: 6. Bone formation:
• Rate of deposition and mineralization is slow. • Rate of deposition and mineralization is faster.
• Collagen mediated mechanism is operative in • Matrix vesicles participate in initiation of
calcification of lamellar bone. mineralization of woven bone.
7. X-ray features: 7. X-ray features:
• More radiopaque. • More radiolucent due to less mineral density
8. Clinical significance: 8. Clinical significance:
Bone is a vascularised connective tissue which It is not seen after birth except for alveolar bone
is one of the hardest tissue of human body but proper and at the sites of fractures.
highly plastic as well.
Osteoclast
Howship’s lacuna
Woven bone/
Bony trabecular immature bone
Osteocytes
Osteoblasts
Osteoblasts
Osteocytes
Blood vessels
Bone marrow
Mature bone Immature/Woven bone

280 DADH Made Easy
1. The supporting bone (cortical plate and 7. During healing of fractures or extraction
spongy bone) is very thin in the wounds, the type of bone that is formed is
a. Anterior region of mandible a. Embryonic bone
b. Posterior region of mandible b. Immature bone
c. Anterior region of maxilla c. Coarse fibrillar bone
d. Anterior teeth of both the jaws d. All of the above
2. The inorganic and organic constituents 8. Lamina dura is same as
of bone are a. Bundle bone
a. 65% inorganic and 35% organic b. Cribriform plate
b. 55% inorganic and 45% organic c. Alveolar bone socket
c. 65% organic and 35% inorganic d. All of the above
d. 40% inorganic and 60% organic 9. High level of enzyme acid phosphatase
3. Organic material of bone is is a characteristic feature of
a. Type I collagen a. Osteocyte b. Chondrocyte
b. Type II collagen c. Osteoclast d. Mast cell
c. Type III collagen 10. Which of the following can be considered
d. Type I and type III collagen as chondroid bone
4. The organic matrix of bone that is devoid a. Mandibular basal bone
of mineral salts and stains eosinophilic b. Maxillary basal bone
with hematoxylin and eosin stain is called c. Alveolar process
a. Cementoid tissue d. Frontal bone
b. Osteoid tissue 11. Osteoclasts are rich in
c. Lymphoid tissue a. Acid phosphatase
d. Enameloid tissue b. Alkaline phosphatase
5. The interdental and interradicular septa c. Citrases
contain the perforating canals which d. Peroxidase
have the interdental and interradicular 12. The bone immediately surrounding the
arteries, veins, nerves, and lymph vessels. roots and giving support for insertion of
These are periodontal fibers is
a. Zuckerkandl canals a. Supporting bone b. Alveolar bone
b. Hirschfeld canals c. Spongy bone d. Woven bone
c. Nutrient canals 13. Odontoclasts help in resorption of
d. All of the above a. Dentin b. Bone
6. The successive processes that occur c. Cementum d. All of the above
during bone resorption are 14. Supporting bone is
a. Decalcification a. Spongy bone
b. Degradation of matrix b. Woven bone
c. Transport of soluble products c. Immature bone
d. All of the above are correct d. None of the above
1-d, 2-a, 3-a, 4-b, 5-d, 6-d, 7-d, 8-d, 9-c, 10-c, 11-a, 12-b, 13-a, 14-a
Bone 281
15. Growth of alveolar bone depends on 22. All the following enzymes are essential
presence of for bone formation except
a. Ramus b. Condyle a. Alkaline phosphatase
c. Teeth d. None of the above b. Acid phosphatase
16. In a healthy mouth, the alveolar process c. ATPase
is thinnest at d. Pyrophosphates
a. Lingual to maxillary central incisor 23. The cortical plates are thickest in the
b. Labial to mandibular central incisor region of
c. Lingual to maxillary canine a. Anterior maxillary
d. Lingual to mandibular first molar b. Anteror mandibular
c. Posterior maxillary
17. Fusion of alveolar bone to tooth is called d. Posterior mandibular
as
24. The space in which developing tooth is
a. Ankylosis
present in the jaw bone is called
b. Hypercementosis
a. Alveolar bone
c. Gomphosis
b. Alveolar process
c. Bony crypt
18. The shape of the outline of the crest of d. Supporting bone
the alveolar septa in radiogrpah is
dependent on 25. The canal which houses, interdental and
interradicular nerves and vessels is
a. Anatomy of alveolar process
a. Retzius
b. Position of gingival margin
b. Von Ebner
c. Position of adjacent teeth
c. Salter
d. Amount of underlying trabecular bone
d. Zuckerkandl and Hirschfeld
19. The external most layer of the alveolar
process is colectively called 26. The alveolar bone seen between the first
molar teeth is called the
a. Spongy layer
a. Interdental septum
b. Cortical plate
b. Interalveolar septum
c. Cribriform plate
c. Interradicular septum
d. Cancellous bone
d. Both a and b
20. Thinnest cortical bone occurs at
27. The density of the alveolar bone is more
a. Facial surface of mandibular incisors
in the
b. Facial surface of maxillary incisors
a. Anterior region of the maxilla
c. Buccal plate of maxillary canine b. Anterior region of the mandible
d. Buccal plate of mandibular first c. In the posterior region of maxilla and
molar mandible
21. The bone that is not found in anterior part d. Both a and b
of both jaws is 28. The distance between the cemento-
a. Spongy bone enamel junction and the crestal margin
b. Supporting bone of the alveolar bone is
c. Compact bone a. 2–5 mm b. 5–7 mm
d. Cortical bone c. 1.5–2 mm d. 2.5–3 mm
15-c, 16-b, 17-a, 18-c, 19-b, 20-b, 21-a, 22-b, 23-d, 24-c, 25-d, 26-c, 27-d, 28-c
282 DADH Made Easy
20
Oral Mucous Membrane
LAQs (10 Marks)
Q. 1. Classify and give functions of oral mucous membrane, describe macro and
microscopic features of gingiva. or (Nov. 2010)
Classify and give functions of oral mucous membrane. (SAQ, Oct. 2007)
Ans. Surface of oral cavity is lined by mucous membrane.
• Based on the functional criteria, the oral mucosa is divided into three major types:
1. Masticatory mucosa (gingiva and hard palate)
2. Lining or reflecting mucosa (lip, cheek, vestibular fornix, alveolar mucosa, floor of mouth
and soft palate)
3. Specialized mucosa (dorsum of the tongue and taste buds)
• Based on the type of epithelium, oral mucosa can be divided into :
1. Keratinized areas:
a. Masticatory mucosa
b. Specialized mucosa
c. Vermilion zone of lip
2. Nonkeratinized areas:
a. Lining mucosa
• Masticatory mucosa is bound to bone and does not stretch. It bears forces generated when
food is chewed.
• Lining mucosa covers the musculature and is distensible, adapting itself to the contraction
and relaxation of the muscles.
• Specialized (sensory) mucosa is so called because it bears the taste buds, which have a
sensory function.
Oral Mucosa has many Important Functions
1. Defence: Integrity of the oral epithelium is an effective barrier for the entry of the
microorganisms. Oral mucosa is impermeable to bacterial toxins. It also secretes antibodies
and has an efficient humoral and cell mediated immunity.
282
Oral Mucous Membrane 283
2. Lubrication: Saliva keeps the oral cavity moist thereby ensuring an intact oral epithelium
which helps in speech, mastication, swallowing and in the perception of taste.
3. Sensory: Oral mucosa is sensitive to touch, pressure, pain and temperature. The sensation
of taste is a unique sensation, felt only in anterior two-thirds of the dorsum of the tongue.
Swallowing, gagging, retching, and salivating reflexes are intiated by receptors in the oral
mucosa.
4. Protection: Oral mucosa protects the deeper tissues from mechanical forces resulting from
mastication and from abrasive nature of foodstuffs.
GINGIVA
• Gingiva is keratinized and constitutes masticatory mucosa along with hard palate.
• Gingiva is that part of oral mucosa which covers the alveolar processes. It extends from the
dentogingival junction to the alveolar mucosa.
• It is limited on the outer surface of both jaws by the mucogingival junction, which separates
it from the alveolar mucosa.
• It can be divided into free gingiva, attached gingiva and the interdental papilla. The dividing
line between the free gingiva and the gingiva is the free gingival groove, which runs parallel
to the margin of the gingiva at a distance 0.5 to 1.5 mm.
Macroscopic Features of Gingiva

• Gingiva is pink but sometimes has a grayish tint.
• The surface may be translucent or transparent permitting the colour of the underlying tissues
to be seen.
• Gingiva can be divided into the free gingiva, the attached gingiva and the interdental
papilla. The dividing line between the free gingiva and the gingiva is the free gingival groove
which runs at a distance of 0.5 to 1.5 mm from the margin of gingiva.
• Free or marginal gingiva is the unattached portion of gingiva that forms and surrounds
the teeth in a collar like fashion. It is coronal most portion of gingiva and it follows a scalloped
line on the facial and lingual surface of the teeth. It forms the soft tissue wall of the gingival
sulcus.
• Gingival sulcus is a shallow crevice between inner aspect of gingiva and the tooth. Normal
gingival sulcus depth is 2 mm. The bottom of the gingival sulcus corresponds to the free
gingival groove.
• The attached gingiva is 4–6 mm. It is firm, resilient immobile portion of gingiva which is
tightly bound to the alveolar bone. It extends from free gingival groove to mucogingival
junction.
• Attached gingiva is stippled. This is because portions of epithelium are elevated, between
these elevations, there are shallow depressions. Disappearance of stippling is an indication
of edema, an expression of an involvement of the gingiva in gingivitis. Males have more
heavily stippled gingiva than females.
• Intedental grooves are the vertical folds present on the gingiva between adjacent teeth.
• The interdental papilla is that part of the gingiva that fills the space between two adjacent
teeth.
• The interdental papilla between anterior teeth is pyramidal and that between posterior
teeth appears tent shaped. In this tent shaped interdental papilla, the central concave area
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below the oral and the vestibular corners is depressed, valley like and is called col. Col
is covered by thin nonkeratinized epithelium and is more vulnerable to periodontal
disease.
• The mucogingival junction seperates the gingiva from the alveolar mucosa. Mucogingival
junction is 3–5 mm below the level of the crest of the alveolar bone.
Microscopic Features of Gingiva

Gingiva is subjected to the friction and pressure of mastication. Morphology of both epithelium
and connective tissue indicates the adaptation to these forces.
Epithelium
• Stratified squamous epithelium of gingiva is parakeratinized in 75%, orthokeratinized in
15% and nonkeratinized in 10% of the population.
• In parakeratinized epithelium, superficial cells retain pyknotic nuclei and show some signs
of being keratinized. The stratum granulosum is absent. In keratinized (orthokeratinized)
epithelium, the superficial cells form scales of keratin and lose their nuclei. Stratum
granulosum is present in it.
• Keratinized gingival epithelium has stratum basale, stratum spinosum, stratum granulosum
and stratum corneum.
• Inflammation which is frequently seen in gingiva, interferes with keratinization.
• In nonkeratinized epithelium, surface cells are nucleated and show no signs of keratinization.
• The epithelium of the gingiva is keratinized but epithelium of the col and that lining the
sulcus is nonkeratinized.
• Presence of melanin pigment in the epithelium gives it brown to black coloration.
Pigmentation is most abundant at the base of the interdental papilla. It may increase in
various pathologic states.
• The epithelium of gingiva interdigitates with underlying connective tissue by long, narrow
rete ridges.
Lamina propria
• Papillae of the connective tissue are long, slender, and numerous.
• Underlying lamina propria of gingiva is dense connective tissue that does not contain large
vessels.
• Collagen fibers of the lamina propria may either insert into the alveolar bone and the
cementum or blend with the periosteum.
• Lamina propria contains few elastic fibers, most of which are confined to the walls of the
blood vessels. Oxytalan fibers are also present. Elastic fibers are more numerous in
submucosa and are thick also.
• Gingival fibers of the periodontal ligament enter into the lamina propria attaching the gingiva
firmly to the teeth.
• The collagen fibers in the lamina propria of the gingiva are arranged in various groups,
referred as the gingival ligament. They serve to support the free gingiva, bind attached
gingiva to the alveolar bone and link one tooth with the other.
• These gingival fibers are dentogingival, alveologingival, circular, dentoperiosteal and
transseptal. Apart from these, semicircular, vertical and transgingival fiber groups are
also described.
• Gingiva is firmly attached to the periosteum of the alveolar bone and this arrangement is
referred as mucoperiosteum. Here a dense connective tissue, consisting coarse collagen bundles
extends from the bone to the lamina propria.
• The lamina propria of gingiva differs from other regions in arrangement of collagen fibers,
in its composition and response of its matrix to the stimuli and also, in the nature of the
fibroblast.
• Fibroblasts of gingiva have less contractile protein and also lack alkaline phosphatase. Matrix
contains less of type III collagen, more of hyaluron and has a lower turnover rate. They
release more prostaglandins in response to histamine.
• Small number of lymphocytes, plasma cells, and macrophages are present in the connective
tissue of gingiva which are involved in defense and repair.
Sulcular Epithelium
• It lines the gingival sulcus.
• Sulcular epithelium is nonkeratinized with flat interface with the underlying connective
tissue.
Junctional or Attachment Epithelium

• The epithelium of the gingiva which gets attached to the tooth is junctional or attachment
epithelium. The union between this epithelium and tooth is referred to as epithelial
attachment.
• Junctional epithelium is nonkeratinized. It has the highest turnover rate of 5–6 days
(Fig. 20.1).
Fig. 20.1: Gingiva
Clinical Considerations of Gingiva

1. Metal poisoning (lead, bismuth) causes characteristic discoloration of the gingival margin.
2. Periodontal disturbances produce a deepened gingival sulcus, called periodontal pocket,
as a response to plaque toxins.
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Q. 2. Describe anatomy of dorsum of the tongue, histology of anterior two-thirds of the

tongue and nerve supply of tongue. OR (Oct. 2003)
Classify oral mucous membrane, give its functions and describe in detail about specialized
mucosa. OR (May 2013)
Describe in detail specialized mucosa. (May 2009)
Ans. Introduction
• The surface of oral cavity is lined by mucous membrane. Structure of oral mucous membrane
varies in different regions as per the adaptation to function.
• Superior surface of tongue is rough and irregular and is lined by the specialized (sensory)
mucosa as it bears the taste buds, which have a sensory function. However, the mucous
membrane of the inferior surface of tongue is smooth, thin and nonkeratinized.
• A ‘V’ shaped line divides the superior surface into an anterior two-thirds part, or body and
posterior one-third part, or base.
Anterior two-thirds of dorsum of tongue: Papillae of tongue/lingual papillae.
(SAQ, June 2004, Oct. 2004)
• Anterior part of tongue is termed ‘papillary’ as it has numerous, fine pointed, cone shaped
papillae, while the posterior third of tongue is called lymphatic portion.
• The dorsolingual mucosa has numerous papillae many of which contains taste buds which
helps in the perception of taste and therefore regarded as specialized mucosa.
• Papillae are epithelial projections with a core of connective tissue.
• Papillae present on tongue are filiform, fungiform and vallate. On the lateral border of the
posterior part of the tongue, large foliate papillae are present.
Filiform (thread-shaped) papillae (Fig. 20.2A)

• These are the most numerous papillae, but they do not contain taste buds. They are fine
pointed, cone shaped papillae that give a velvet like appearance.
• They are epithelial structures containing a core of connective tissue from which secondary
papillae protrude towards the epithelium.
• Their epithelium is keratinized and forms tufts at the apex of the dermal papilla.
Fungiform (mushroom shaped) papillae (Fig. 20.2A)

• These are interspersed between filiform papillae.
• These are round, reddish prominences on tongue. Their red colour is due to rich capillary
network visible through the relatively thin epithelium.
• They contain 1–3 taste buds, present on their dorsal surface.
Circumvallate (walled) papillae (Fig. 20.2B) (SAQ, 2000, 2001)

• These are present in front of the dividing ‘V’ shaped terminal sulcus.
• They are 8–10 in number.
• They do not protrude above the surface of the tongue and are bounded by a deep circular
furrow.
• Their free surface shows numerous secondary long papillae that are covered by a thin,
smooth epithelium.
Fig. 20.2A: Filliform and fungiform papillae
Fig. 20.2B: Circumvallate papillae
• On the lateral surface, they have numerous taste buds, which are responsible for taste
perception.
• The ducts of small serous glands called von Ebner’s glands open into the trough.
Foliate papillae
• They are present on the lateral border of the posterior part of the tongue.
• They contain taste-buds.
Taste buds (Fig. 20.3) (SAQ, Oct. 2004, May 2012)

• These are small ovoid or barrel-shaped intraepithelial organs present within the papillae of
tongue.
• They are responsible for the perception of taste.
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Fig. 20.3: Taste buds
• They are numerous on the inner wall of the trough surrounding the vallate papillae, in the
folds of the foliate papillae, on the posterior surface of epiglottis and on some of the fungiform
papillae at the tip and the lateral borders of the tongue. They are not present on fungiform
papillae.
• They are 80 μm high and 40 μm thick. They extend from the basal lamina to the surface of
the epithelium.
• Their outer surface is covered by a few flat epithelial cells, which surround a small opening,
the taste pore. The pore leads into a narrow space lined by the supporting cells of the taste
bud.
• The outer supporting cells are arranged like the staves of a barrel. The inner and shorter
ones are spindle shaped. Between these, 10 to 12 neuroepithelial cells are arranged. These
are the receptors of taste stimulus. These are slender, dark-staining cells that carry finger
like processes at their superficial end.
• A rich plexus of nerves is found below the taste buds. Some fibers enter the epithelium and
contact with the sensory cells of the taste bud.
• Taste sensation is perceived in different regions of the tongue. Sweet taste is perceived at
the tip, salty at the lateral border of the tongue, bitter and sour on the palate and also in the
posterior part of the tongue bitter in the middle and sour in the lateral areas of the tongue.
• Bitter and sour taste sensations are mediated by the glossopharyngeal nerve, and sweet
and salty taste are mediated by chorda tympani.
• Foramen cecum is located at the angle of the ‘V’ shaped terminal groove on the tongue. It is
the remnant of the thyroglossal duct.
• Posterior to this, surface of tongue shows lingual follicles each of which shows one or more
lymph nodules. Lingual follicles together form the lingual tonsil.
BLOOD AND NERVE SUPPLY OF TONGUE (SAQ, MAY 2007)

Blood Supply
• The tongue and floor of the mouth are supplied by lingual artery.
• The lingual artery is a branch of external carotid artery.
• Its dorsal lingual branch supplies the base of the tongue.

• The deep lingual branch supplies the body and apex of the tongue.
• One of its terminal branches communicates with the deep lingual artery of the opposite
side and is called the arcus raninus.
• Venous drainage of tongue is quite peculiar and is from two different routes for two different
parts of tongue. The dorsal surface and side of the tongue drains into lingual vein, ventral
surface drains into deep lingual veins.
• Venous blood from lingual vein drains into facial vein and later into internal jugular veins.
Nerve Supply
• The tongue is developed from the contribution of different arches which is reflected in its
nerve supply.
• Mucous membrane of anterior two-thirds of the tongue is supplied by mandibular branch
of trigeminal nerve.
• Lingual branch of the mandibular branch of trigeminal nerve supplies the anterior two-
thirds of the tongue for general sensation of pain, temperature, touch, etc.
• Chorda tympani branch of the 7th cranial nerve, supplies the anterior two-thirds for special
sensation of taste.
• Posterior one-third of the tongue is supplied by glossopharyngeal nerve, the ninth cranial
nerve which carries the taste and general sensation from the posterior part.
• Posterior most part of the tongue is innervated by vagus nerve via internal laryngeal branch.
• The hypoglossal nerve, the 12th cranial nerve supplies the voluntary muscles of tongue,
except for palatoglossus which is supplied by cranial part of accessory nerve through the
pharyngeal plexus.
Clinical Considerations of Tongue

Changes of the tongue are sometimes diagnostically significant.
1. In scarlet fever, atrophy of the lingual mucosa causes redness of tongue, known as stawberry
tongue.
2. Systemic diseases such as pernicious anemia, and vitamin deficiencies, especially vitamin
B-complex lead to characteristic changes such as magenta tongue and beefy red tongue.
SAQs (3 Marks)
Q. 1. Describe histology of keratinized oral mucous membrane. (Dec. 2005)

Ans. Introduction
• Based on the type of epithelium, oral mucous membrane is either keratinized or
nonkeratinized.
• Keratinized areas in oral mucosa are masticatory mucosa, that is gingiva and hard palate,
and vermilion border of lip.
• In keratinized oral epithelium, four cell layers are seen (Fig. 20.1):
Stratum Basale
It is made-up of a single layer of cuboidal cells. These cells synthesize DNA and undergo
mitosis. The basal and parabasal spinous cells are referred to as the stratum germinativum.
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Basal cells are made-up of two populations of cells. One population is serrated and heavily
packed with tonofilaments, which are adopted for attachment and the other is non-serrated
and consists of slowly cycling stem cells. Basal cells are attached to the connective tissue through
hemidesmosomes while they are connected to adjacent cells by desmosomes.
Stratum Spinosum
These cells are polyhedral and larger than basal cells. Cells are joined by intercellular bridges.
Tonofibrils course from cell to cell across these bridges. The tonofilament network and
desmosomes make-up a tensile supporting system for the epithelium. The intercellular spaces
of the spinous cells in keratinizing epithelia are large or distended thus making desmosomes
more prominent which gives prickly appearance. The spiny appearance of the spinous layer
is due to shrinkage of cells during tissue processing causing them to separate at points where
desmosomes do not anchor them together. Spinous cells are most active in protein synthesis
which is required for keratinization.
Stratum Granulosum
This layer has flatter and wider cells. They are known as granulosum due to presence of the
basophilic keratohyalin granules in them. Nuclei show signs of degeneration and pyknosis.
Protein synthesis rate is low in these cells. Tonofilaments are more dense and are associated
with keratohyaline granules. A lamellar granule, known as keratinosome, Odland body or
membrane coating granule is formed in the upper spinous and granular cell layer. These
lamellar granules discharge their contents into the intercellular space forming an intercellular
lamellar material which contributes to the permeability barrier. At the same time a highly
resistant electron dense cornified envelop is formed by proteins involucrin and loricrin, just
beneath the plasma membrane.
Stratum Corneum
It is made-up of keratinized squamae. Cellular organelles disappear. Layer is acidophilic and
histologically amorphous. Keratohyaline granules disappear. Ultrastructurally, the cells are
composed of densely packed filaments developed from the tonofilaments, altered, and coated
by basic protein of keratohyalin granule, filagrin. Filagrin causes aggregation of filaments in
these cells. Cross linking of tonofilaments by disulfide bonds facilitates close packing of the
filaments and gives mechanical and chemical resistance to this layer. The keratinized cell
becomes compact and dehydrated and is closely applied to adjacent squamae. In
parakeratinization, the cells retain pyknotic and condensed nuclei and contain partially lysed
cell organelles until they desquamate.
Q. 2. Describe histology of hard palate.

Ans. Introduction
• Hard palate is lined by masticatory mucosa.
• Masticatory mucosa is bound to bone and does not stretch.
• It bears forces generated when food is chewed.
Histology of Hard Palate

The mucous membrane of the hard palate is tightly attached to the underlying periosteum
and is pink in colour. It has following zones.
1. Gingival region—which is adjacent to teeth.

2. Palatine raphe or median area—extends from the incisive or palatine papillae
posteriorly.
3. Anterolateral area or fatty zone—between the raphe and gingiva.
4. Posterolateral area or glandular zone—present between the raphe and gingiva.
1. Lingual/gingival region: Here the palatine tissue is identical with the gingiva and shows
the same structure as gingiva. Epithelium is well-keratinized. Only lamina propria and
periosteum are present below the epithelium and submucosa is absent.
2. Palatine raphe: Structure is same.
3. Anterolateral and posterolateral parts of hard palate: (Figs 20.4A and B)
• Epithelium of hard palate is keratinized.
• The mucous membrane is immovably attached to the periosteum of the maxillary and
palatine bones by dense bands and trabeculae of fibrous connective tissue.
Fig. 20.4A: Hard palate (anterolateral area/fatty zone)
Fig. 20.4B: Hard palate (posterolateral area/glandular zone)

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• The lamina propria is thicker in the anterior than in the posterior parts of the palate and
has numerus long papillae.
• The submucous space is divided into irregular intercommunicating compartments. In
anterolateral part, they are filled with adipose tissue and in posterior part with mucous
glands.
• Laterally, at the junction of the alveolar process and the horizontal plate of the hard
palate, the anterior palatine vessels and nerves course in loose connective tissue. This
wedge-shaped area is smaller in anterior part and larger in posterior part.
Significance: Presence of fat or glands act as a cushion.
Incisive papilla: Oral incisive (palatine) papilla contains the oral parts of the vestigeal
nasopalatine ducts, which are lined by simple or pseudostratified columnar epithelium rich
in goblet cells.
Functions: In mammals, together with Jacobson’s organ, nasopalatine ducts are considered
as auxiliary olfactory sense organs.
Palatine rugae: They are ridges of mucous membrane extending laterally from the incisive
papilla and the anterior parts of the raphe.
Epithelial pearls: They are present in the midline, in the region of incisive papilla. They
are found in lamina propria. They consist of concentrically arranged keratinized epithelial cells.
They are remnants of the epithelium found in the line of fusion between the palatine
processes.
1. Due to firmness of attachment of masticatory mucosa to the underline bone, infiltration of
local anesthesia into it is difficult and causes pain.
2. Palatine torus when present has thinner mucous membrane. While constructing denture,
this area has to be relieved.
3. In the region of incisive papilla, small mucous glands open into the lumen of the
nasopalatine ducts which may become cystic, resulting into formation of nasopalatine
duct cysts.
Q. 3. Write about nonkeratinocytes. (July 2005, May 2013, 2016)

Ans. Introduction
Epithelial cells that keratinize are called keratinocytes. However, epithelium contains a smaller
population of cells that do not possess cytokeratin filaments, hence do not keratinize. These
group of cells are termed nonkeratinocytes.
Characteristics of Nonkeratinocytes
1. They do not have cytokeratine filaments, hence cannot keratinize.
2. They do not show mitotic activity.
3. They do not undergo maturative changes or desquamate.
4. They are not arranged in layers.
5. They do not form desmosomal attachments with adjacent keratinocytes.
6. They are usually dendritic and appear unstained or clear in hematoxylin and eosin stain
and therefore are referred as clear cells.
7. They are identified by special stains or by immunocytochemical methods.

8. They migrate to oral epithelium from neural crest or from bone marrow.
Nonkeratinocytes are (Flowchart 20.1)

1. Melanocytes
2. Langerhans’ cells
3. Merkel cells are the nonkeratinocytes found in oral epithelium.
4. Inflammatory cells such as lymphocytes and neutrophils found in certain regions of
epithelium, are also considered as nonkeratinocytes.
Flowchart 20.1
1. Melanocytes
Location
They reside in basal layer of epithelium.
Origin
• They are derived from the embryologic neural crest and migrate into the epithelium.
• Each melanocyte establishes contact with 30–40 keratinocytes through their dendritic
processes.
• Keratinocytes release mediators essential for normal melanocyte function.
Functions
• Melanin produced by the melanocytes is transferred through their dendritic processes to
the adjacent basal cell keratinocytes which store pigment in the form of melanosomes.
• Variation in the degree of pigmentation in different regions is related to the activity of
melanosomes and not to their numbers.
Appearance
• Melanocytes appear as clear cells in hematoxylin sections and their dendritic appearance is
revealed by silver stains. Hence are called as clear or dendritic cells.
Special stains
a. Silver stain reveals their spider like (dendritic) appearance and dye the melanin pigment.
b. They are also stained by Mason-Fontana stain.
c. Oral pigmentation can be studied by use of dopa reaction.
• Melanin pigment dispersed in connective tissue is phagocytosed by macrophages,
melanophages, which also stain positively with dopa.
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2. Langerhans’ cell
Location: It is another clear or dendritic cell found in the upper layers of the skin and mucosal
epithelium, restricted to zones of orthokeratinization.
Structure: Cell has a convoluted nucleus and characteristic rod-like granules in the
cytoplasm, termed Birbeck granules.
It has vimentin type intermediate filaments.
Origin: It is of hematopoietic origin. It penetrates epithelium from lamina propria.
Special stains: It stains with gold chloride, ATPase, and immunofluorescent markers.
Functions: It is involved in immune response. In presence of antigenic challenge by bacterial
plaque, Langerhans’ cells migrate into the gingiva. They present the antigen to helper T-cells.
Epithelium of skin and oral mucosa have immunologic functions and for this, it interacts
with the lymphoid system in concert with the Langerhans’ cells.
3. Merkel Cells
Location: They are found among the basal cells. They are commonly seen in masticatory mucosa
but are absent in lining mucosa.
Structure: They are not dendritic. Ultrastructurally, the nucleus shows a deep invagination
and characteristic electron-dense granules that are located at the side of cytoplasm in contact
with axon terminals.
Origin: These cells migrate from the neural crest.
Special stain: They are stained by PAS stain.
Function: They are specialized neural pressure sensitive receptor cells. They respond to
touch sensation.
4. Lymphocytes and Polymorphonuclear Leukocytes

They are found at various levels of the epithelium. These cells are transient and can pass
through the epithelium to the surface.
Function: Immune function.
A comparative study of nonkeratinocytes

Melanocytes Langerhans cell Merkel cell Inflammatory
cells such as
lymphocytes
and neutrophils
Location Basal layer Upper layer of Among basal cells Various levels
of epithelium skin and mucosa of epithelium of epithelium
Origin Neural crest Hematopoietic Neural crest Hematopoietic
Structure Dendritic or Dendritic cells have Non-dendritic Non-dendritic
clear cells convoluted nucleus cells with
and Birbeck electron-dense
granules granules
(Contd.)
A comparative study of nonkeratinocytes (Contd.)

Melanocytes Langerhans cell Merkel cell Inflammatory
cells such as
lymphocytes
and neutrophils
Special Silver stains, Gold chloride, PAS Seen in hemato-
stain Mason-Fontana, ATPase, xyline and eosin
Dopa reaction Immunofluorescent stained sections
markers
Functions Transfer melanin Immune response, Neural pressure Immunity
to adjacent basal presents antigen sensitive receptor
keratinocytes. to helper T-cells. cell. They respond
to touch sensation.
Q. 4. Write about vermilion border of lip. (May 2008)

Write about transitional zone of lip. (Nov. 2010, IIrd B.D.S. old course)
Ans. Introduction
• The transitional zone between the skin of the lip and the mucous membrane of the lip is the
red zone or the vermilion zone (Fig. 20.5).
• Vermilion border is the line that separates the skin from the vermilion zone.
• It is found only in humans.
• The zone is present between the skin on the outer surface of the lip and the inner aspect of the lip.
• Skin on the outer surface of the lip: It is covered by a moderately thick, keratinized epithelium
with a thick stratum corneum. The papillae of the connective tissue here are few and short.
Many sebaceous glands are found with hair follicles. Sweat glands are present in between them.
• Transitional zone: Has thick, mildly keratinized epithelium and numerous densely arranged,
long papillae of the lamina propria reaching deep into the epithelium and carrying large
capillary loops close to the surface.
Thus, blood is visible through the thin parts of the translucent epithelium which gives the
red colour to the lips.
Fig. 20.5: Vermilion/Transitional/Red zone

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• Inner aspect of the lip: Keratinization decreases towards the lips, but the thickness of
epithelium increases. Here the epithelium is thicker and nonkeratinized.
Significance of Transitional Zone

• Like skin, the transitional zone is exposed to the atmosphere but it has no glands to keep it
moist or prevent it from drying. It is for this reason, lips become dry easily and we lick our
lips to moisten it.
Q. 5. What is gingival stippling? (May 2008)

Ans. GINGIVAL STIPPLING
• Gingiva is characterized by a surface that appears stippled. Portions of the epithelium appear
to be elevated and between these elevations there are shallow depressions, the net result of
which is stippling. Attached gingiva, a part of gingiva attached to bone or teeth, appears
specifically stippled.
• They are probably functional adaptations to mechanical impacts.
• Degree of stippling varies with the age and sex. Males have more heavily stippled gingiva
than do females.
• Histologically in stippled gingiva, depressions in between the elevations correspond to the
center of heavy epithelial ridges.
Significance
Disappearance of stippling is an indication of edema, an indication of an involvement of the
gingiva in progressing gingivitis.
Q. 6. Explain shift of dentogingival junction. (Nov. 2014)

Ans. Introduction
• Dentogingival junction is the junction between the gingiva and the tooth. It is a unique
junction as it is an attachment of epithelium with the hard tissue.
• The epithelium of the gingiva which gets attached to the tooth is called junctional or
attachment epithelium.
• The union between the attachment/junctional epithelium and the tooth is referred to as
epithelial attachment.
Structure of Epithelial/Junctional Epithelium

• The firmness and mechanical strength of the dentogingival junction is though mainly
attributable to the connective tissue attachment, the attachment of the epithelium to the
enamel is also strong.
• The junctional epithelium extends up to 2 mm on the surface of the tooth.
• It has highest turnover rate of 5–6 days, hence regenerates readily.
• It structurally resembles reduced enamel epithelium. It has a basal layer and few layers of
flattened cells. It is nonkeratinized.
• It is highly permeable and has large intercellular spaces.
Epithelial attachment (SAQ, 2004)

• The union between the junctional/attachment epithelium of the tooth is referred as epithelial
attachment.
• It is submicroscopic, 40 nm wide and formed by attachment epithelium.

• The reduced ameloblasts and gingival epithelial cells form an electron microscopic basal
lamina on enamel and cementum. Hemidesmosomes of the epithelial cells attach to this
basal lamina.
• The adhesive forces in this zone are molecular in nature and act across a distance smaller
than 40 nm.
Clinical Significance of Dentogingival Junction
• Dentogingival junction is of great physiologic and clinical importance.
• The dense, and resilient lamina propria take up impacts produced during mastication. When
the connective tissue is injured, fibroblasts form collagen and ground substance contributing
to repair.
• Lymphocytes and plasma cells found in the connective tissue below the junctional
epithelium, contribute to defense against the bacterial injury.
• The lysosomes of the junctional epithelium have a phagocytic function. These defense
reactions constitute barrier against invasion of bacteria and the penetration of toxins.
Development of Dentogingival Junction

• After completion of enamel formation, the crown of unerupted tooth is covered by reduced
enamel epithelium (REE). During eruption, the tip of the tooth approaches the oral mucosa
and the REE and the oral epithelium meet and fuse.
• The epithelium that covers the tip of the crown degenerates in its center, and the crown
emerges through this perforation into the oral cavity.
• The REE remains organically attached to the part of the enamel that has not erupted yet.
Once the tip of the crown has emerged, the REE is termed as primary attachment epithelium.
• A shallow groove, the gingival sulcus develops between the gingiva and the surface of the
tooth and extends around its circumference.
• Gingival sulcus is bounded by the attachment epithelium at its base and by the gingival
margin laterally. It deepens as a result of separation of the reduced dental epithelium from
the actively erupting tooth.
• Later, the reduced enamel epithelium gets gradually replaced by the growth of gingival
epithelium and this is known as secondary attachment epithelium.
Shift of Dentogingival Junction
• The position of the gingiva on the surface of the tooth changes with time.
• The tooth erupts until it reaches the plane of occlusion. The attachment epithelium separates
from the enamel surface while the crown emerges into the oral cavity.
• Active eruption: The actual movement of the tooth toward the occlusal plane is active eruption.
• Passive eruption (SAQ, 2000): The separation of the primary attachment epithelium from
the enamel is passive eruption. Further, recession exposing the cementum may occur.
• Passive eruption describes various levels of attachment that may occur as the gingiva recedes
onto the cementum.
• Crown exposure involving passive eruption and further recession is described in four stages.
First two stages are considered normal while the last two are pathologic.
1. First stage: In this stage, the bottom of the gingival sulcus remains in the region of the
enamel-covered crown and the apical end of the attachment epithelium stays at the
298 DADH Made Easy
cementoenamel junction. This relation persists in primary teeth almost up to 1 year of

age before shedding and in permanent teeth, usually to the age of 20 or 30 years.
2. Second stage: In this stage, the bottom of the gingival sulcus is on the enamel and the
apical end of the attachment epithelium has shifted to the surface of the cementum. This
shift of dentogingival junction occurs by destruction of fiber bundles that were anchored
in the cervical parts of the cementum and an apical shift of the gingival and transseptal
fibers. This stage of tooth exposure lasts to the age of 40 years or later.
3. Third stage: In this stage, the enamel-covered crown is fully exposed, the gingival sulcus
is at the cementoenamel junction and the epithelial attachment is entirely on the
cementum. This exposure of tooth is regarded as the body’s attempt to maintain an intact
dentogingival junction in the face of factors that cause its deterioration.
4. Fourth stage: This stage represents recession of the gingiva caused pathologically. The
entire attachment is on cementum and the clinical crown appears larger than anatomic
crown.
• The shift of dentogingival junction occurs because the junctional epithelium moves apically
due to detachment of basal lamina. It then replicates a new basal lamina. The epithelial cells
then migrate along this basal lamina.
• The hemidesmosomes hold the cells to this structure so that the strength of the attachment
is not diminished despite of migration. Thus, the epithelial attachment re-establishes and
the shift occurs.
• If there occurs difference in the position of the top of the epithelial attachment relative to
the marginal gingiva resulting in deepened gingival sulcus, a periodontal pocket develops.
This occurs as a response to plaque toxins.
• The level of the gingival attachment to the tooth plays an important role in restorative
dentistry.
• With gingival recession and exposure of the cervical part of anatomic crown, cemental caries
or abrasion may occur.
1. The arrangement of tonofibrils in 7. One of the distinguishing features of an

keratinized epithelium is epithelial cell, regardless of its function
a. In bundles is that one of the components of its
b. Dispersed cytoskeleton is
c. End to end a. Keratin intermediate filaments
b. Desmin
d. Whorl pattern
c. Vimentin
2. The connective tissue component of the d. None of the above
oral mucosa that supports the overlying
epithelium is called 8. Epithelial cell is also known as
a. Submucosa a. Keratinocyte
b. Keratosome
b. Dermis
c. Odland body
c. Lamina propria
d. Hyaline body
d. Reteplase
9. Nonkeratinized epithelium does not have
3. Which of the following cells are non- a. Basal layer
keratinocytes b. Prickle cell layer
a. Melanocytes c. Granular layer
b. Langerhans’ cells d. Intermediate layer
c. Merkel cells
10. The distinguishing feature of squamous
d. All of the above epithelial cell is that it contains
4. Basket cell is a synonym used for a. Tonofilaments
a. Myoepithelial cell b. Desmosomes
b. Mucous cells c. Keratin filament
c. Serous cells d. All of the above
d. None of the above 11. Adhesion between epithelium and
lamina propria is provided by
5. Ectopic location of sebaceous glands in a. Desmosomes
the buccal mucosa represents
b. Hemidesmosomes
a. Koplik’s spots
c. Plasma membrane
b. Fordyce spot
d. Pellicle
c. Linea alba
12. The functions of the oral epithelium are
d. None of the above a. Permeability
6. The only minor serous salivary gland b. Protection
found in oral mucosa c. Sensation
a. Labial salivary gland d. All of the above
b. Von Ebner’s salivary gland 13. The oral epithelium does not have the
c. Glands in the posterolateral zone of following function
hard palate a. Permeability b. Absorptive
d. None of the above c. Secretive d. Formative
1-a, 2-c, 3-d, 4-a, 5-b, 6-b, 7-a, 8-a, 9-c, 10-d, 11-b, 12-d, 13-b
300 DADH Made Easy
14. All nonkeratinocytes, except one type of 21. Unlike collagen fibers elastic fibers
cell has desmosomal attachment to a. Run in bundles
adjacent cells b. Branch and anastomose
a. Melanocytes c. Run singly
b. Langerhans’ cells d. Both b and c
c. Merkel cells
22. The feature that contributes to the more
d. Inflammatory cells rapid healing of the oral mucosa when
15. Gingiva is attached to the tooth by the compared with skin is due to
a. Epithelial attachment a. Rich blood supply
b. Pellicle b. Rich anastomoses of arterioles and
c. Periodontal ligament capillaries
d. Reduced enamel epithelium c. Arteriovenous shunts
16. Macrophages are also termed as d. Both a and b
a. Mast cells 23. The specialized mucosa which is non-
b. Monocytes keratinized and contains taste buds is
c. Histiocytes a. Fungiform papillae
d. Lymphocytes b. Filiform papillae
17. Principal functions of macrophages
c. Lateral walls of circumvallate papillae
are d. Both a and c
a. Ingestion of damaged tissue 24. The primitive oral cavity comes to be
b. Stimulation of fibroblast proliferation lined by epithelium at about
for repair a. 24 days in utero
c. Formative b. 25 days in utero
d. Both a and b c. 26 days in utero
18. Von Ebners salivary glands at the base d. 30 days in utero
of circumvallate papillae are 25. Membrane-coating granules are also
a. Mucous glands known as
b. Serous glands a. Fordyce granules
c. Mixed glands b. Desmosomes
d. None of the above c. Keratinosomes
19. Basal lamina is an d. Tonofibrils
a. Electron microscopic structure 26. Masticatory mucosa is made-up of
b. Light microscopic structure a. Gingiva b. Hard palate
c. Macroscopic structure c. Soft palate d. Both a and b
d. Both a and b
27. Anterior two-thirds of the tongue is
20. Lamina propria consists of supplied by
a. Collagen fibers a. Trigeminal nerve (lingual branch)
b. Elastic fibers b. Glossopharyngeal nerve
c. Oxytalan fibers c. Temporal nerve
d. Both a and b d. Occulomotor nerve
14-c, 15-a, 16-c, 17-d, 18-b, 19-a, 20-d, 21-d, 22-d, 23-d, 24-c, 25-c, 26-d, 27-a
28. Posterior third of the tongue is supplied by 36. The outermost layer of oral epithelium
a. Glossopharyngeal nerve of buccal mucosa is called
b. Trigeminal nerve a. Stratum granulosum
c. Temporal nerve b. Stratum basale
d. Occulomotor nerve c. Stratum corneum
29. The area of masticatory mucosa which d. Stratum superficiale
does not have submucosa is 37. Gingiva is attached to the tooth by
a. Gingiva a. Periodontal ligament
b. Lateral areas of hard palate b. Pellicle
c. Median raphe c. Reduced enamel epithelium
d. Both a and c d. Epithelial attachment
30. The sulcular epithelium gets renewed in 38. Epithelium covering the mucosa on the
a. 5 days b. 8 days dorsal surface of the tongue is
c. 10 days d. 12 days a. Specialized mucosa
31. General oral mucosa gets renewed in b. Keratinized mucosa
a. 8–10 days c. Parakeratinized mucosa
b. 10–12 days d. Nonkeratinized mucosa
c. 12–13 days 39. Mucous membrane of the posterior part
d. 15–20 days of tongue gets its nerve supply by
a. Lingual nerve
32. Gingiva is parakeratinized in
b. Glossopharyngeal nerve
a. 75% of normal population
c. Superior laryngeal nerve
b. 72% of normal population
d. Inferior laryngeal nerve
c. 60% of normal population
d. 50% of normal population 40. The connective tissue component of
the anterior two-thirds of the tongue is
33. Epithelium of col of interdental papilla is
derived from
a. Parakeratinized
a. First arch mesenchyme
b. Nonkeratinized
b. Second arch mesenchyme
c. Hyperkeratinized
c. Third arch mesenchyme
d. Keratinized
d. Fourth arch mesenchyme
34. The width of the basement membrane
is 41. Stippling is a feature present in
a. 1–4 mm b. 2–3 mm a. Attached gingiva
c. 2–5 mm d. 3–6 mm b. Alveolar mucosa
c. Free gingiva
35. Racial pigmentation present in gingiva
is the result of d. All of the above
a. Size of the melanin granule 42. The lining mucosa is the one that lies the
b. Difference in number of melanocytes a. Hard palate
c. Difference in ratio of melanin pro- b. Dorsum of the tongue
duction c. Gingiva
d. All of the above d. Soft palate
28-a, 29-d, 30-c, 31-c, 32-a, 33-b, 34-a, 35-d, 36-d, 37-d, 38-a, 39-b, 40-a, 41-a, 42-d
302 DADH Made Easy
43. The type of collagen fibers of the 51. Epithelial cells which ultimately get
basement membrane are keratinized are
a. Type IV b. Type I a. Keratinosomes
c. Type III d. All of the above b. Keratinocytes
44. Minor salivary gland in the oral cavity are c. Nonkeratinocytes
present in all tissues except d. All of the above
a. Alveolar mucosa 52. Which component of oral mucous mem-
b. Lip brane contains glands and adipose tissue
c. Palate a. Epithelium
d. Gingiva b. Lamina propria
45. Mucous membrane of soft palate is c. Submucosa
a. Keratinized d. All
b. Nonkeratinized 53. Of all the four layers of epithelium the
c. Parakeratinized layer which is more active in protein
d. Orthokeratinized synthesis is
a. Spinous layer
46. Programmed cell death is also known as
b. Granulosum
a. Shedding b. Exfoliation
c. Stratum Corneum
c. Apoptosis d. None of the above
d. Basal cell layer
47. Connective tissue of lamina propria of
the oral mucosa is derived from 54. Clear cells of epithelium of oral mucous
membrane are
a. Neural crest cells
a. Keratinocytes
b. Mesoderm
b. Keratinosomes
c. Endoderm
c. Nonkeratinocytes
d. Ectoderm
d. None
48. Stratum spinosum is also known as
55. Nonkeratinocyte that does not have
a. Basal cell layer desmosomal attachment is
b. Superficial layer a. Melanocyte
c. Granular layer b. Langerhans cell
d. Prickle cell layer c. Merkel cell
49. The function of Odland body is d. Both a and b
a. Nutrition 56. The nonkeratinocytes referred as dentritic
b. Sensory cells are
c. Exchange of fluids a. Melanocytes b. Langerhans cell
d. Permeability barrier c. Merkel cell d. Both a and b
50. The part of gingiva that is susceptible to 57. The only nonkeratinocyte having
infection and nonkeratinized is desmosomal attachment is
a. Palatal gingiva a. Langerhans cell
b. Sulcular gingiva b. Merkel cell
c. Attached gingiva c. Melanocyte
d. Marginal gingiva d. Lymphocyte
43-a, 44-d, 45-b, 46-c, 47-a, 48-d, 49-d, 50-b, 51-b, 52-c, 53-a, 54-c, 55-d, 56-d, 57-b
58. Racket-shaped Birbeck granules are 66. Free gingiva is made-up of

found in a. Circular group of fibers
a. Langerhans cells b. Transseptal fibers
b. Merkel cells c. Dentogingival fibers
c. Melanocytes d. All of the above
d. Both b and c 67. The boundaries that define the attached
59. Taste buds are not present in gingiva are
a. Filiform papillae a. From the gingival crest to the
b. Fungiform papillae interdental groove
c. Circumpallate papillae b. From the mucogingival junction to the
d. None of the above free gingival groove
c. From the epithelial attachment to
60. Langerhans cells can be studied by
cementoenamel junction
using
d. From the free gingival groove to the
a. Silver stain
gingival crest.
b. Dopa reaction
68. The embrassure surrounding the contact
c. Gold chloride
area of anterior teeth is
d. Hemotoxylin and eosin stain
a. Gingival, cervical, facial, lingual
61. Melanocytes can be studied using b. Incisal, cervical, facial, lingual
a. Silver stain c. Incisal, cervical, facial only
b. Mason-Fontana d. Cervical and lingual only
c. Dopa reaction 69. Gingival sulcus is deepest on
d. All of the above a. Incisal surface of incisors
62. The component of oral mucous membrane b. Lingual suface of incisors
which contains glands and adipose c. Mesial surface of incisors
tissue is d. Distal surface of incisors
a. Epithelium b. Lamina propia 70. Oral mucous membrane is thinnest in
c. Submucosa d. All of the above a. Soft palate
63. Neurosecretory cells are b. Labial mucosa
a. Melanocytes b. Merkel cells c. Buccal mucosa
c. Keratinocytes d. Lymphocytes d. Floor of the mouth
71. Bitter and sour taste are mediated by
64. Richest nerve sensation is in
a. Chorda tympani
a. Anterior two-thirds of tongue
b. Glossopharyngeal nerve
b. Posterior one-third of tongue
c. Hypoglossal nerve
c. Lateral border of tongue d. None of the above
d. Tip of the tongue
72. The papillae responsible to recognize
65. Dentogingival junction is sour taste is
a. Primary attachment epithelium a. Vallate papillae
b. Secondary attachment epithelium b. Foliate papillae
c. Attachment epithelium c. Fungiform papillae
d. All of the above d. Filiform papillae
58-a, 59-a, 60-c, 61-d, 62-c, 63-b, 64-a, 65-c, 66-d, 67-b, 68-b, 69-b, 70-d, 71-b, 72-b
304 DADH Made Easy
73. The number of circumvallate papillae 80. The epithelium of the oral mucous
ranges from membrane is
a. 20–25 a. Stratified columnar
b. 15–20 b. Simple squamous epithelium
c. 8–10 c. Stratified squamous
d. 4–5 d. Non-stratified squamous
74. The most numerous group of gingival 81. The specialized mucosa is present on
fibers is a. Lips and cheeks
a. Dentoperiosteal b. Gingiva and hard palate
b. Dentogingival c. Dorsum of the tongue and taste
c. Alveogingival buds
d. Circular d. Floor of the mouth and soft palate
75. The disappearance of stippling occurs 82. Majority of the taste buds are found on
due to the
a. Trauma a. Filiform papillae
b. Old age b. Fungiform papillae
c. Progressive gingivitis c. Circumvallate papillae and the adjacent
d. None of the above trench wall
76. Jacobson’s organ is also known as d. All of the above
a. Vomeronasal organ 83. The oral epithelium is
b. Considered as auxillary olfactory a. Nervous tissue
c. Ellipsoidal structure lined with b. Muscle tissue
olfactory epithelium c. Connective tissue
d. All of the above d. Avascular tissue
77. Of the four layers, the cells most active 84. Lamina propria of the oral mucous
in protein synthesis are of membrane contains
a. Stratum corneum a. Ectoderm b. Bone
b. Stratum granulosum c. Keratin d. Blood vessels
c. Stratum spinosum 85. The last organic material secreted by the
d. Stratum basale ameloblast is
78. The epithelium of the cheek and a. Primary enamel cuticle
sublingual tissue is b. Secondary cuticle
a. Nonkeratinized c. Enamel tufts
b. Parakeratinized d. Tomes’ process
c. Keratinized 86. The papillae of the tongue which are
d. None of the above keratinized and do not have taste buds
79. The epithelium in gingiva is are
a. Parakeratinized a. Fungiform
b. Nonkeratized b. Filiform
c. Keratinized c. Vallate papillae
d. Any of the above d. Both b and c
73-c, 74-b, 75-c, 76-d, 77-c, 78-a, 79-d, 80-c, 81-c, 82-c, 83-d, 84-d, 85-a, 86-b
87. The sebaceous glands lateral to the 94. The labial masticatory mucosa is narrowest
corner of the mouth and often seen on the following mandibular tooth
opposite the molars are called a. First molar
a. Fordyce spot b. Second molar
b. Hutchinson spot c. First premolar
c. Koplik’s spot d. Central incisor
d. Miller’s spot 95. The following type of mucosa characterizes
88. Vermilion border, which is transitional attached gingiva
zone between the skin of the lip and the a. Free b. Alveolar
mucous membrane of the lip, is also c. Specialized d. Masticatory
know as
96. Oral mucosa exhibits
a. White zone
a. Humoral immunity
b. Red zone
b. Cell mediated immunity
c. Violet zone
c. Both of the above
d. Pink zone
89. The gingiva is
97. Lining mucosa includes all except
a. 75% parakeratinized
a. Lip
b. 15% keratinized
b. Cheeks
c. 10% nonkeratinized
c. Floor of mouth
d. All of the above
d. Dorsum of tongue
90. The pigmentation is more abundant at
the 98. Oral mucosa is lined by the
a. Buccal gingiva a. Stratified squamous epithelium
b. Labial gingiva b. Cuboidal
c. Lingual gingiva c. Columnar
d. Base of the interdental papilla d. None of the above
91. Filaggrin protein is present in 99. Mucoperiosteal attachment is seen in the

a. Periodontal ligament a. Gingiva b. Lips
b. Pulp c. Cheeks d. All of the above
c. Oral epithelium 100. The epithelium of oral cavity is derived
d. All of the above from
92. The only purely serous minor salivary a. Ectoderm
gland is located in the lamina propria b. Endoderm
of the c. Mesoderm
a. Tongue b. Hard palate d. None of the above
c. Soft palate d. Buccal mucosa 101. Hemidesmosomes help in
93. Keratohyaline granules are found in a. Adhesion between epithelium and
a. Granulosum connective tissue
b. Spinosum b. Adhesion between cells of epithelium
c. Basal cell layer c. Both a and b
d. Prickle cell layer d. None of the above
87-a, 88-b, 89-d, 90-d, 91-c, 92-a, 93-a, 94-a, 95-d, 96-c, 97-d, 98-a, 99-a, 100-a, 101-a
306 DADH Made Easy
102. Desmosomes are c. Production of melanin pigment

a. Two-attachment plaque d. All of the above
b. One attachment plaque 106. Characteristic of Langerhans cells are
c. Three-attachment plaque a. Presence of Birbeck granules
d. Four-attachment plaque
b. Antigen presenting cells
103. Odland body is seen in the c. They are derived from bone marrow
a. Stratum spinosum
d. All of the above
b. Stratum granulosum
c. Stratum intermedium 107. Basal lamina has
d. Stratum superficiale a. Type I collagen
b. Type II collagen
104. Most prominent finding in stratum
granulosum is c. Type IV collagen
a. Presence of keratinosome d. All of the above
b. Keratohyaline granules 108. The epithelium present in the inter-
c. Langerhans cells mediate zone is
d. All of the above a. Nonkeratinized
105. Characteristic features of melanocytes are b. Orthokeratinized
a. Clear cells c. Parakeratinized
b. Spider-like appearance in silver stains d. None of the above
102-a, 103-a, 104-b, 105-d, 106-d, 107-c, 108-c

21
Salivary Glands
LAQ (10 Marks)
Q. 1. Describe histology of parotid/submandibular/sublingual gland. Major salivary glands.

Ans. Salivary glands are a group of compound exocrine glands secreting saliva.
They are classified as:
1. Based on size:
• Major: Major salivary glands are three bilaterally paired major salivary glands namely,
parotid, submandibular and sublingual.
• Minor: Minor salavary glands are located beneath the epithelium in oral cavity except
gingiva, anterior raphe region of hard palate, and anterior two-thirds of the dorsum of
the tongue.
(e.g. labial glands, buccal glands, lingual glands, palatine, and glassopalatine glands,
etc.)
Major salivary glands are located, extraorally and their secretions reach the mouth by
long ducts. While minor salivary glands consist of several small groups of secretory units
which open via short ducts directly into the mouth.
2. Based on histochemical nature of secreting product:
• Serous
• Mucous
Parotid gland is a pure serous gland, the submandibular and the sublingual glands are
mixed glands. While, submandibular gland is predominantly serous and the sublingual gland
is predominantly mucous gland.
PAROTID GLAND
• Introduction:
– It is the largest major salivary gland.
– It has: (a) superficial portion—located subcutaneously in front of the external ear.
(b) deeper portion—lies behind the ramus of the mandible.
– It measures 5.8 cm craniocaudally and 3.4 cm ventrodorsally. It weighs between
14–28 grams.
307
308 DADH Made Easy
• Excretory duct: It is Stenson’s duct, which opens at a papilla at the buccal mucosa opposite
the maxillary second molar.
• Blood and nerve supply:
– Blood supply—branches of the external carotid artery.
– Parasympathetic nerve supply—ninth cranial nerve reaching the gland via otic ganglion
and the auriculotemporal nerve.
– Sympathetic innervation—for all salivary glands is by postganglionic fibers from superior
cervical ganglion.
– Lymphatic drainage—is to the superficial and deep cervical lymph nodes.
• Histology :
– Parotid gland is enclosed in a well-defined connective tissue capsule which sends septa
into the gland, separating it into lobes and lobules.
– It is a pure serous gland (Fig. 21.1).
– Describe serous cells histology as described in answer of SAQ 2.
– The intercalated ducts of the parotid are long and branching.
– Striated ducts are numerous.
– Connective tissue septa in the parotid contain numerous fat cells which increase with
age.
Fig. 21.1: Serous salivary gland
SUBMANDIBULAR GLAND (SAQ, NOV. 2011)

• Introduction:
– It is the second largest major salivary gland.
– It is also called as submaxillary salivary gland.
– It is located on the medial aspect of the body of the mandible in the submandibular
triangle, posterior and superficial to the mylohyoid muscle.
• Excretory duct—It is Wharton’s duct which runs forward above the myolohyoid muscle
lying just below the mucosa of the floor of the mouth. It opens at the sublingual papillae,
caruncula sublingualis, lateral to the lingual frenum.
Salivary Glands 309
• Blood and Nerve supply:

– Blood supply—from the lingual and facial arteries.
– Parasympathetic innervation—from 7th cranial nerve reaching the gland through lingual
nerve.
– Lymphatic drainage—to the deep cervical and jugular chain of nodes.
• Histology:
– It is a branched tubuloacinar gland of mixed type (Fig. 21.2).
– It has a well defined capsule.
– It has both serous and mucous secretory units. Serous units predominate.
– Describe both serous and mucous acini as described in answer of SAQ 3.
– Mucous terminal portions are capped by demilunes of serous cells.
– Intercalated ducts are shorter than those of the parotid and striated ducts are usually
longer.
Fig. 21.2: Mixed salivary gland
SUBLINGUAL GLAND
• Introduction :
– It is the smallest of the major salivary glands.
– It is almond shaped and lies between the floor of the mouth, below the mucosa and
above the mylohyoid muscle.
• Excretory duct:
– Bartholin’s duct is the main duct which opens with or near the submandibular duct.
– Several small ducts; duct of Rivinus, open independently along the sublingual fold.
• Blood and nerve supply:
– Blood supply – from the sublingual and the submental arteries.
– Parasympathetic nerve supply – from the 7th cranial nerve.
– Lymphatic drainage – is to the submandibular lymph nodes.
• Histology:
– It is composed of one main gland with several small glands.
310 DADH Made Easy
– It is a mixed gland (Fig. 21.2), with mucous secretory units seen predominantly.
– Mucous cells are arranged in a tubular pattern.
– Serous demilunes may be present.
– Describe the histology of mucous cells as described later in SAQ.
– The intercalated and striated ducts are poorly developed.
1. Salivary glands are subject to a number of pathologic conditions. These include
inflammatory diseases such as viral, bacterial or allergic sialadenitis, a variety of benign
and malignant tumors, autoimmune diseases such as Sjögren’s syndrome and genetic
diseases. One of the most common surface lesions of the oral mucosa is mucocele, which
is produced from the severance of the duct of a minor salivary gland and pooling of
saliva in the tissues.
2. A loss of salivary function or reduction in volume of saliva secreted is called
xerostomia. This leads to dryness of the mouth resulting in caries, mucosal ulceration and
oral infection.
SAQs (3 Marks)
Q. 1. Write differences between serous and mucous acini. (Oct. 2004)

Ans. DIFFERENCES BETWEEN SEROUS AND MUCOUS CELLS
Differences between serous and mucous cells

Serous cells Mucous cells
1. Serous acini are spherical. 1. Mucous acini are tubular.
2. Serous acini have smaller lumen. 2. Mucous acini have larger lumen.
3. Serous cells are pyramidal with a broad base 3. Mucous cells are also pyramidal but are larger and
on the basement membrane. have a broader luminal surface.
4. Has spherical nucleus placed at the basal 4. Has oval or flat nucleus pressed against the base
region. of the cell.
5. Apex of the cell has zymogen granules. Apical 5. Cells show large amount of mucous secretory
portion stains strongly with H and E. product at the apical cytoplasm. Apical portion
stains weakly with H and E.
6. Serous secretion has enzymatic activity. 6. Has little or no enzymatic activity. It is thick and
It is watery and thin. viscid.
7. Contributes less to the lubrication. 7. Has main function as lubrication and protection
of the oral tissues.
8. Carbohydrate content is less in secretion. 8. Carbohydrate to protein ratio is greater.
Zymogen granules are glycolated proteins.
9. Secretion is by exocytosis. 9. Secretion is by fusion of the membrane of mucous
droplets to the apical plasma membrane.
10. Special stain: Apical portion shows numerous 10. Apical portion stains strongly with carbohydrate
eosinophilic secretory granules which stain stains like PAS and Alcian blue.
with toluidine blue.
(Contd.)
Salivary Glands 311
Differences between serous and mucous cells (Contd.)

Serous cells Mucous cells
11. Electron microscopy: Extensive RER in 11. Prominent golgi regions are located between
parallel aggregates, lateral and basal to nucleus and secretory droplets. Secretory droplets
nucleus. Golgi regions are located apical to are irregular and larger than serous (Fig. 21.4).
nucleus. Secretory granules are smaller, seen
at apical area and are covered by unit
membrane (Fig. 21.3).
Fig. 21.3: Serous salivary gland Fig. 21.4: Mucous salivary gland
Q. 2. Write about serous acini. (July 2006, 2012, May 2012)

Ans. SEROUS ACINI
• Salivary glands are a group of compound exocrine glands secreting saliva. Saliva regulates
a healthy environment in oral cavity.
• The basic functional unit of a salivary gland is the terminal secretory unit called acini, which
is made-up of epithelial secretary cells, namely serous and mucous cells.
• Serous or mucous cells along with myoepithelial cells are arranged in an acinus with a
roughly spherical or tubular shape and a central lumen.
Serous Cell Histology (Refer Fig. 21.1)

• Serous acini are roughly round in shape.
• Serous cells are main secretory cells in parotid and submandibular major salivary gland
and in von Ebner’s minor salivary gland.
• Serous secretory cells are pyramidal with a broad base on the basement membrane and the
apex faces the lumen.
• They have a spherical nucleus placed at the basal region.
• Apical cytoplasm of these cells shows accumulation of secretory granules, which are 1 μm
in diameter with a distinct limiting membrane. These are zymogen granules and are formed
by glycolated proteins. They can be stained by toluidine blue.
312 DADH Made Easy
• Serous cell is a typical protein secreting cell. Basal cytoplasm of serous cells is packed with
protein synthesizing organelles like ribosomes and rough endoplasmic reticulum. It also
shows good number of mitochondria.
• Newly synthesized proteins are sent to the Golgi apparatus, which are located apically and
laterally to the cell nucleus. In the Golgi saccules, they are packed into vacuoles. These are
the forming secretory granules. These presecretory immature granules increase in size and
density to mature.
• Many secretory proteins undergo structural modification prior to their secretion.
• The mature granules stored at the apex of the cell are emptied into the lumen by exocytosis.
Membrane of the granules fuses with the plasma membrane of the cell and contents are
released into lumen.
Staining
• With hematoxylin and eosin, apical portion stains strongly.
• Apical portion shows numerous eosinophilic secretory granules, zymogen granules, which
stains with toluidine blue.
Secretion
• Serous secretion is thin and watery. Zymogen granules are glycolated proteins. Secretion is
rich in enzymatic and non-enzymatic proteins and contain small amount of carbohydrate.
Functions
• Serous secretion has enzymatic activity. The serous cell devote 80% of its capacity in the
production of secretory granules, zymogen granules.
• Lysosomes are seen with hydrolytic enzymes in these cells, which help to destroy foreign
material and worn out cell organelles.
• Serous cells are considered to be powerhouses for numerous synthetic and transportation
proceses.
Q. 3. Write histology of mucous salivary gland. (Nov. 2014)
Ans. MUCOUS CELL HISTOLOGY (Fig. 21.5)
• Mucous cells are the predominant secretory cells in the sublingual glands and majority of
minor salivary glands in oral cavity.
• Mucous acini are tubular and have larger lumen than serous acini.
• Mucous cells are specialized for the synthesis, storage, and secretion of a secretory product.
• They are pyramidal in shape, larger than serous cells, and have broader luminal surface.
• Nucleus of the mucous cell is oval or flattened. The nucleus and a thin rim of cytoplasm are
compressed against the base of the cell.
• Mucous cell shows accumulation of large amounts of secretory product at the apical
cytoplasm.
• Mucous cells have rough endoplasmic reticulum, mitochondria and large Golgi apparatus
which adds large amount of carbohydrate to the secretion.
• Secretion of mucous cells occurs by fusion of the membrane of the mucous droplets with
the apical plasma membrane of the cell. After this, the separating membrane may fragment
and is lost with the discharge of mucous or the droplet may be discharged with the membrane
intact.
Salivary Glands 313
Fig. 21.5: Mucous salivary gland
Staining
In hematoxylin and eosin stained section, apical portion of mucous cells appears empty. Basal
cytoplasm appears basophilic. Special stain such as Mucicarmine or Periodic Acid Schiff stain or
Alcian blue can be used to reveal the secretory granules.
Secretion
• They have no enzymatic activity and serve mainly for lubrication and protection of the oral
tissues.
• The secretion is rich in glycoproteins and is thick.
• Ratio of carbohydrate to protein is greater and larger amounts of sialic acid and sulfated
sugars are present.
Function
1. Due to presence of large amount of glycoproteins, main function is lubrication therefore,
protection of the oral tissues.
2. Well-lubricated oral tissues facilitates speech and deglutition.
Q. 4. Write about myoepithelial cells. (June 2007, 2008)

Ans. MYOEPITHELIAL CELLS
Introduction
Salivary glands are a group of compound exocrine glands secreting saliva.
Myoepithelial cells are contractile cells closely related to the secretory and intercalated duct
cells of salivary glands.
Location
They are located around the terminal secretory units and the first portion of the duct system.
They are situated between the basal plasma membrane of parenchymal cells and basement
membrane supporting the secretory unit or duct.
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Histology
They are stellate or spider-like, with a flattened nucleus, scanty cytoplasm and long branching
processes that embrace the secretory and duct cells.
In intercalated ducts they are more fusiform in shape and have short processes.
They resemble a basket cradling the secretory unit, hence they are also termed as ‘basket
cells’.
They contain cytokeratin, intermediate filament and contractile actin filaments. The plasma
membrane of the myoepithelial cell closely parallels the basal membrane of the parenchymal
cell and are joined by desmosomes. Numerous micropinocytotic vesicles are located on the
plasma membrane of these cells.
They are innervated through the parasympathetic motor nerve.
Origin
They are similar to smooth muscle cells but are derived from epithelium. Presence of cytokeratin
confirms their epithelial origin.
Identification
• They are difficult to identify in routine histologic preparations. They can be detected by
histochemical tests that can demonstrate ATPase reaction.
• Presence of cytokeratin and actin helps in identification of these cells by immuno-
histochemistry.
Functions
Structural details of myoepithelial cells indicate their contractile property.
1. They accelerate the initial outflow of the saliva from acini.
2. They reduce luminal volume.
3. Contribute to secretory pressure in the acini or duct.
4. Support the underlying parenchyma and reduce the back permeation of fluid.
5. Help salivary flow to overcome increase in peripheral resistance of the ducts.
6. They produce a number of proteins that have tumor suppressor activity, which act as barriers
against invasive epithelial neoplasms.
Q. 5. Write about minor salivary glands. (June 2008, Nov. 2010)

Ans. MINOR SALIVARY GLANDS:
Minor salivary glands consist of several small groups of secretory units opening via short
ducts directly into the mouth. They contribute to 5–10% of the total saliva secreted.
They are located beneath the epithelium in almost all parts of the oral cavity except for
gingiva, anterior raphe of hard palate and anterior two-thirds of dorsum of tongue.
Minor salivary glands are:
1. Labial and buccal glands
2. Glossopalatine glands
3. Palatine glands
4. Lingual glands
5. von Ebner’s glands.
Salivary Glands 315
1. Labial and buccal glands:

• Glands of the lips and cheeks are mixed consisting of mucous tubules with serous
demilunes.
2. Glossopalatine glands:
• They are pure mucous glands and are located in the region of glossopalatine fold and
may extend to soft palate.
3. Palatine glands:
• These are pure mucous.
• They are located in the posterolateral region of the hard palate and in the submucosa of
the soft palate and uvula.
4. Lingual glands:
The glands of the tongue can be divided as:
a. Anterior lingual glands (Glands of Blandin and Nuhn):
• They are located near the apex of the tongue.
• The anterior regions of the glands are chiefly mucous whereas the posterior portions
are mixed.
• Ducts open on the ventral surface of the tongue near the lingual frenum.
b. Posterior lingual mucous glands:
• These are located lateral and posterior to vallate papillae.
• These are purely mucous.
• Ducts open onto the dorsal surface of tongue.
5. von Ebner’s glands (posterior lingual serous glands):
• These are group of posterior lingual serous glands.
• They are purely serous and are located between the muscle fibers of the tongue below
the vallate papillae.
• Their ducts open into the trough of the vallate papillae.
• Functions:
– Secretion by minor salivary glands is thick and mucous.
– The secretion is rich in proteins and they have an important role in innate
immunity.
1. Serves to wash out the trough of the papillae and ready the taste receptors.
2. Has protective and digestive functions.
3. Has antibacterial enzymes, peroxidase and lysozyme.
4. Has secretory enzyme with lipolytic activity. It has lingual lipase, which has an acidic
pH and therefore is capable of hydrolyzing triglycerides in the stomach.
Q. 6. Write about ductal system of salivary glands.

Ans. DUCTAL SYSTEM OF SALIVARY GLANDS (Fig. 21.6)
• Salivary glands are a group of compound exocrine glands secreting saliva.
• The parenchymal elements of the gland consist of terminal secretory units leading into
ducts that open into the oral cavity.
• Ductal system is a pipeline or conduit for the passageway for the saliva and it participates
in the production and modification of saliva.
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• In a major gland, the smallest ducts are the intercalated ducts connecting the terminal secretary
units, acini, to the next larger duct, the striated ducts. In the interlobar tissue the ducts continue
to join one another increasing in size until the main excretory duct is formed.
• Intercalated and striated ducts are intralobular ducts while excretory ducts are interlobular.
1. Intercalated ducts: They are lined by a single layer of low cuboidal cells. They modify the
saliva through secretory and resorptive process. They contribute components like lysozymes
and lactoferrin. They also house undifferentiated cells which undergo differentiation to
replace damaged or dying cells.
2. Striated ducts: They receive saliva from intercalated ducts. They are lined by a layer of tall
columnar epithelial cells with large, spherical, centrally placed nuclei. Cytoplasm is abundant
and shows striations at the basal ends due to infoldings of the plasma membrane, which
are packed with mitochondria.
These ducts are site of electrolytic reabsorption especially of sodium and chloride and
secretion of potassium and bicarbonate, which results into a hypotonic luminal fluid.
3. Excretory ducts: Striated ducts join each other to form larger intralobular ducts. Along the
path, the duct becomes large to become the excretory interlobular duct. It has two layers,
the mucosa and the outer connective tissue adventitia which allow passive stretching of the
duct to allow and accommodate varying volumes of saliva. Lining epithelium of the duct is
pseudostratified columnar with occasional goblet and ciliated cells.
Main excretory duct of parotid gland is Stensen’s duct which opens at the buccal mucosa
opposite the maxillary 2nd molar. Wharton’s duct, is the main excretory duct for
submandibular gland which opens at the sublingual papillae at the floor of the mouth.
Bartholin’s duct, excretory duct of sublingual gland, opens near submandibular duct.
In contrast to major salivary gland, where their secretions reach to, mouth by long ducts,
minor salivary glands have short ducts which open directly in mouth.
Function
• Ductal system of salivary gland helps in passage and formation of saliva.
Formation of saliva occurs in two stages.
– In the first stage, cells of the secretory end pieces and intercalated ducts produce primary
saliva, which is an isotonic fluid containing most of the organic components and all of
Fig. 21.6: Ductal system of salivary glands

Salivary Glands 317
the water secreted by the salivary glands. In the second stage, the primary saliva is modified
as it passes through the striated and excretory ducts by reabsorption and secretion of
electrolytes, so the final saliva is hypotonic. Thus, ductal system of salivary gland acts as
conduit for passage of saliva and also participates in production and modification of
saliva.
Q. 7. What are demilunes?

Ans. DEMILUNES
• Salivary glands are compound exocrine glands, main function being secretion of saliva.
• The basic functional unit of a salivary gland is the terminal secretory unit called acini,
which is made-up of epithelial secretory cells, namely serous and mucous cells.
• Sometimes mucous acini have bonnet or crescent shaped covering which is made of serous
cells. These are called demilunes (demilune-half moon).
• However, the presence of demilunes is questioned. It has been shown that demilunes are a
result of an artifact during tissue processing.
• Recent advanced techniques have shown that serous cells align with mucous cells to
surround a common lumen.
Q. 8. Elaborate functions of saliva.

(2000, 2001, May 2009, Oct. 2002, Nov. 2010, Old course, IInd B.D.S.)
Ans. FUNCTIONS OF SALIVA
• Saliva is a complex fluid, produced by the salivary glands, the most important function of
which is to maintain the well-being of the mouth.
• There are three pairs of major salivary glands, which are located extraorally. While minor
salivary glands are located in almost all parts of oral cavity.
Functions
Protection is the main function of salivary gland while, the other functions are being assisting
in digestion, speech, mastication, taste, and tissue repair.
1. Protection of the oral cavity and oral environment:
• Constant secretion of saliva prevents dessication of the oral tissues.
• It washes/flushes away debris and non-adherent bacteria.
• Mucin and glycoproteins provide lubrication to the oral, oropharyngeal and esophageal
tissues. The mucins also form a barrier against toxicologic stimuli, microbial toxins, and
minor trauma.
• Saliva protects mucosa from chemical and thermal insults.
• It causes dilution of detritus and oral acid neutralization.
• It maintains high pH, which is nonconducive for cariogenic bacteria to survive, ferment
carbohydrate, and produce acid. Thus, preventing tooth decay.
• It promotes remineralization of the tooth enamel. Remineralization of the initial carious
lesions can be enhanced by fluoride ions in saliva.
• Antimicrobial property of saliva:
It contains many antimicrobial substances like lysozymes, lactoferrins calprotectin,
lactoperoxidase, immunoglobulins, etc. High molecular weight glycoproteins of saliva
aggregate microorganisms and facilitate their clearance.
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Acinar cells and ductal system secrete thiocyanate which establishes bactericidal system.
Saliva has antibacterial protein in it, lysozyme, which hydrolyzes the polysaccharide of
bacterial cell walls resulting in cell lysis.
Predominant salivary immunoglobulin is IgA which inhibits adherence of
microorganisms.
Saliva has antibacterial substance, lactoferrin, which enhances the inhibitory effect of
the antibody on microorganisms.
Antifungal action of saliva is exerted by histatins, chromogranin A and
immunoglobilins.
2. Digestion:
• Saliva solubilizes food and taste substances through digestive enzyme, amylase.
• Amylase acts on ingested carbohydrates to produce glucose and maltose.
• Lingual lipase produced by lingual serous glands initiate digestion of dietary lipids.
3. Mastication and deglutition:
• Saliva moistens food and breaks it down into smaller particles.
• It helps in bolus formation and facilitates deglutition.
• It moistens dry food and reduces temperature of hot foods.
4. Taste perception:
• Food is emulsified in saliva and is dissolved which is a prerequisite for perception of taste.
• This is due to the presence of water and lipocalins in saliva.
5. Speech:
• Saliva keeps oral cavity moist and lubricated which facilitates speech and deglutition.
6. Tissue repair:
• Growth factors and trefoil proteins in saliva promote tissue growth, differentiation, and
wound healing.
7. Excretion:
• Many substances from blood reach saliva, thus saliva can be considered as a route of
excretion.
• Due to this property, electrolytes and drug concentrations can be assessed in saliva.
Q. 9. Describe factors influencing the flow of saliva. (May 2002)

Ans. FACTORS AFFECTING THE FLOW OF SALIVA
Saliva is a complex fluid, produced by the salivary glands, the most important function of
which is to maintain the well-being of the oral cavity.
Secretion of saliva depends on many factors.
1. Physiologic control of salivary gland secretion is mediated by ANS, particularly
parasympathetic nervous system. Postganglionic fibers of both, sympathetic and
parasympathetic divisions, innervate the secretory cells, myoepithelial cells, intercalated
and striated duct cells. Release of neurotransmitter from the vesicle in the nerve terminals
adjacent to parenchymal cells stimulates them to discharge their secretory granules, secrete
water and electrolytes and cause contraction of myoepithelial cells. Secretion elicited in
response to sympathetic stimulation differ in protein and electrolyte from that due to
parasympathetic.
Salivary Glands 319
2. Blood vessels in the salivary glands are innervated. Vascular response elicited by the
autonomic stimulation determines the availability of water, electrolytes and metabolic
substances during secretory activity.
3. Control of secretion is also linked to changing taste and smell. Secretion of saliva can alter
from 0.1 ml/min at rest to 4.0 ml/mm at actively stimulated times.
4. Secretion of saliva also depends on age, duration and nature of stimulus. Secretion of saliva
is minimum at birth and does not contain salivary amylase. In old age the secretory reserve
becomes decreased.
5. Proportion of the components of saliva depends on the sources of saliva, the nature and the
intensity of the secreting stimulus and the time of the day.
6. Saliva produced by major salivary gland differ from others. Parotid gland secretes a watery
saliva rich in enzymes while submandibular gland has higher proportion of glycosylated
substances such as mucin.
7. Other factors affecting the composition of saliva are flow rate, differential gland contribution,
circardian rhythm, duration of stimulus, nature of stimulus and diet.
Each of these factors is capable of modifying the amount and consistency of the salivary
secretion. Gustatory stimulus is more important than masticatory stimulus for salivary
secretion.
Q. 11. Write about composition of saliva.

Ans. COMPOSITION OF SALIVA
• Most important function of the salivary gland is the production and secretion of saliva.
Protection of the oral cavity is the major function of saliva, though it also serves other
function such as digestion, speech, mastication, taste, and tissue repair.
• Saliva consists of 99% water. Iorganic ions, secretory glycoproteins of serum constituents
and other substances account for 1% or less (Flowchart 21.1).
Flowchart 21.1
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• Main electrolytes of saliva are Na, K, Ca, Cl, HCO 3– and HPO –4. Other electrolytes are Mg,
SO 4–, F, SCN and I.
• Main organic substances found in saliva are secretory proteins. These include enzymes
such as amylase, ribonuclease, kallikrein, peroxidase, lysozymes, lactoferrin and acid
phosphatase. Mucin containing large amount of bound carbohydrates, proline rich proteins
and glycoproteins are also present.
• Other organic constituents of saliva include secretory immunoglobulins like IgG and
IgM, blood clotting factors, amino acids, urea, uric acid, glucose, various lipids and
hormones.
• Saliva produced by secretory end pieces and intercalated duct is primary saliva. It is isotonic
containing most of the organic components and all of water secreted by the salivary glands.
The primary saliva is modified as it passes through the striated and excretory ducts, mainly
by reabsorption and secretion of electrolytes.
• Proportion of the components of saliva are variable depending upon the source of saliva,
the nature and intensity of the secretory stimulus and the time of the day.
Whole Saliva (Mixed Saliva)

• It is the secretion of all the minor and major salivary glands. In addition to the
components derived by the gland, the whole saliva also contains desquamated oral
epithelial cells.
• Total volume of saliva is 750-1000 ml/day of which submandibular accounts for
60%, parotid for 30% and sublingual about 5% and 1% is desired from minor salivary
glands.
• Saliva produced by parotid gland is watery and is rich in enzymes such as amylase, proteins
and glycoproteins. Secretion by submandibular gland contains higher proportion of mucin.
Sublingual gland produces viscous saliva rich in mucin.
• Resting flow rate of whole saliva is 0.2 to 0.4 ml/min.
• pH of whole saliva is 6.4 to 7.4.
1. In elderly individuals, parenchyma of salivary glands is replaced by fatty tissue resulting
in its decreased secretory activity.
2. Xerostomia: It is loss of salivary function or reduction in volume of saliva. It is due to various
reasons like Sjögren’s syndrome, chemotherapy, radiation therapy or as a result of
variety of medications. Decreased salivary secretion leads to caries, mucosal ulceration and
oral infection.
3. Ptyalism or sialorrhea: Excessive salivary secretion.
4. Salivary glands are affected by many pathologic conditions like viral, bacterial, or allergic
sialdenitis, benign and malignant tumors, autoimmune diseases and genetic diseases.
5. Mucocele: It is a lesion produced by severance of the duct of a minor salivary gland and
pooling of the saliva in the tissues.
6. Salivary gland and sialochemistry is of value in the diagnosis of glandular and systemic
diseases. Sialochemistry is also used to monitor plasma concentration of certain therapeutic
drugs.
Salivary Glands 321
Q. 12. Write about anticaries property of saliva. (July 2005)

or
Write about antimicrobial property of saliva. (Oct. 2002, Dec. 2005)
Ans. ANTICARIES PROPERTY OF SALIVA
Protection of the oral cavity is the major function of saliva. It has anticaries property.
• It flushes away debris and nonadherent bacteria.
• Saliva is supersaturated with calcium and phosphate ions. The solubility of these ions is
maintained by calcium binding proteins, i.e. acidic proline rich proteins and statherin. At the
tooth surface, the high concentraction of calcium and phosphate results in a posteruptive maturation
of the enamel, increasing its surface hardness and resistance to demineralization.
• Remineralization of initial carious lesion is enhanced by the presence of fluoride ions in saliva.
• Saliva helps in maintaining a high pH. Primary buffering system of saliva is formed by bicarbonates,
phosphate ions and salivary proteins. This high pH prevents survival of cariogenic bacteria,
fermentation of carbohydrates and acid production, thus preventing tooth decay.
• Anticaries activity of saliva is also due to its antimicrobial action. In addition to the barrier
effect provided by mucins, saliva contains many antibacterial substances like lysozymes,
lactoferrins, calprotectin, lactoperoxidose, immunoglobulins, etc. The major salivary
immunoglobulin, secretory IgA, causes agglutination of specific microorganisms preventing
their adherence to oral tissue.
Q. 13. Enumerate differences among major salivary glands.
Ans. DIFFERENCES AMONG MAJOR SALIVARY GLANDS
Sr. Characteristic Parotid Submandibular Sublingual
No. features
1. Type of gland Purely serous Mixed, predominantly Mixed, predominantly
serous mucous
2. Secretion Serous (watery) Seromucous Mucous (thick and viscous)
3. Contribution 25% 70% Minimum
to saliva
4. Excretory duct Stenson’s duct, opens Wharton’s duct, opens • Bartholin’s duct, opens
at buccal mucosa at sublingual papillae near submandibular
opposite to maxillary lateral to lingual gland duct.
2nd molar frenum • Ducts of Rivinus, open
in the floor of the mouth
5. Nerve supply Presynaptic-glosso- Facial nerve-chorda Facial-chorda tympani
pharyngeal post- tympani
synaptic-auriculote-
mporal nerve
6. Blood supply External caroid artery Lingual/facial artery Sublingual/submental
arteries
7. Lymphatic Paraparotid/intraparo- Deep cervical, jugular Submandibular lymph-
drainage tid nodes which drain nodes. nodes
to deep cervical nodes
8. Function Enzymatic activity is • Serves mainly for • Serves for lubrication
more. Amylase lubrication and pro- and protection of oral
activity is maximum. tection of tissues tissues
• Lysozymeactivity
is also seen.
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Q. 14. Enumerate differences between major and minor salivary glands.

Ans. DIFFERENCES BETWEEN MAJOR AND MINOR SALIVARY GLANDS
Sr. Characteristic Major salivary glands Minor salivary glands

No. features
1. Number 3, parotid, submandibular, and 600–1000
Sublingual
2. Location Extraoral Intraoral:
Labial and buccal glossopalatine,
palatine, lingual and von Ebner’s
glands. Minor salivary glands are
not present in gingiva, anterior
raphe of hard palate and anterior
two-thirds of the dorsum of the
tongue.
3. Contribution to 90–95% 5–10%
whole saliva
4. Excretory duct Single, long Multiple, short
5. Type of secretion • Thin, watery • Thick, mucous
• Mostly mixed except parotid • Mucous or mixed except von
which is purely serous Ebner’s gland which is serous
6. Function • Rich in enzymes, mucous • Rich in proteins
and proteins
• Therefore, helps in digestion, • Has important role in innate
lubrication and protection immunity
Salivary Glands 323
1. The largest salivary gland, situated in 8. The pH of whole saliva varies from
front of the ear, weighing 14–28 g, is a. 6.8–7.8
a. Submandibular b. 6.7 to about 7.4
b. Sublingual c. 6.5 to 7.5
c. Parotid d. 6.4–7.0
9. Minor salivary glands are seen every-
2. The main excretory duct of the parotid where in the oral cavity except
gland is a. Anterior part of hard palate and gingiva
a. Wharton’s duct b. Tongue
b. Stenson’s duct
c. Soft palate
c. Bartholin’s duct
d. Buccal mucosa
d. Thyroglossal duct
3. All the minor salivary glands are mucous 10. Serous cells primarily secrete
glands except a. Mucus b. Amylase
a. Labial b. Palatine c. Lipids d. Sialic acid
c. Von Ebner d. Buccal 11. The function of the myoepithelial cells
4. The smallest of the three paired major which are found around acini is
salivary glands is a. Secreting mucus
a. Parotid b. Secreting amylase
b. Submandibular c. Releasing secretory material from the
c. Sublingual acinor cells
d. None of the above d. Secreting lipids
5. Total volume of saliva secreted daily by 12. The substance produced by the con-
humans is nective tissue of salivary gland, having
a. 300–500 ml b. 500–750 ml bactericidal property is
c. 750–1000 ml d. 1000–2000 ml a. Peroxidase b. Lysozyme
6. About 60% of total saliva is secreted by c. IgA d. Amylase
a. Parotid salivary gland 13. Blandin and Nuhn glands are
b. Submandibular a. Anterior lingual minor salivary gland
c. Sublingual
b. Posterior lingual minor salivary gland
d. Minor salivary gland
c. Purely mucous glossopalatine
7. The proportion of water to other con-
d. Purely mucous palatine glands
stituents in the saliva is
a. 50% H2O : 50% inorganic + organic 14. Reduction of salivary flow is seen in
substance following conditions
b. 85% H2O: 15% inorganic + organic sub- a. Sicca syndrome or Sjögren’s syndrome
stance b. After irradiation of head and neck
c. 90% H2O: 10% inorganic + organic sub- region
stances c. Because of use of certain therapeutic
d. 99% H 2O: 1% inorganic + organic drugs
substance d. All of the above
1-c, 2-b, 3-c, 4-c, 5-c, 6-b, 7-d, 8-b, 9-a, 10-b, 11-c, 12-c, 13-a, 14-d
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15. Sialochemistry (quantity and composition) 22. The principal immunoglobulin found in
of saliva is of value in the diagnosis of the saliva is
a. Glandular or systemic diseases a. IgA b. IgM
b. Monitoring of plasma concentration of c. IgG d. All of the above
drugs 23. Parotid gland is a
c. To determine ovulation time a. Pure serous gland
d. All of the above b. Mucous gland
16. Sialography is useful in the diagnosis of c. Mixed gland
a. Tumors d. Predominantly serous gland
b. Sjögren’s syndrome 24. Submandibular and sublingual both are
c. Salivary calculi a. Mucous b. Serous
d. All c. Mixed d. Predominantly mucous
17. Mucoceles may be found throughout the 25. Carancula sublingualis is the opening of
oral cavity wherever minor salivary a. Wharton’s duct
glands are present, but most common
b. Stenson’s duct
on the
c. Bartholin’s duct
a. Soft palate
b. Tongue
c. Lower lip 26. The Stensen's duct opens into the oral cavity
d. Upper lip a. On the floor of the mouth
18. Salivary duct stones are more common in b. Near the lower lip
a. Stenson’s duct c. Opposite the maxillary second molar
b. Wharton’s duct d. None of the above
c. Bartholin’s duct 27. The Wharton's duct opens
d. All of the above a. Opposite maxillary second molar
19. The salivary glands that produce only a b. Near the mandibular second molar
serous secretion are the c. At the carancula sublingualis
a. Parotid glands d. None
b. Minor salivary glands on the floor of 28. Basket cell is a
the mouth a. Mucous cell
c. Submandibular glands b. Serous cell
d. Sublingual gland c. Myoepithelial cell
20. The average specific gravity of saliva is d. None
a. 1.001 b. 1.003 29. Demilunes that are found in mixed
c. 1.010 d. 1.012 salivary gland are
21. The secretion from submandibular a. Serous cells capped by crescents of
salivary gland is mucous cells
a. Serous only b. Mucous cells capped by crescents of
b. Mucous only serous cells
c. Predominantly mucous c. Both
d. Predominantly serous d. None
15-a, 16-d, 17-c, 18-b, 19-a, 20-b, 21-d, 22-a, 23-a, 24-c, 25-a, 26-c, 27-c, 28-c, 29-b
Salivary Glands 325
30. The shape of the basket cell is 39. The enzyme which plays major role in
a. Cuboidal b. Columnar starch digestion is
c. Stellate d. Squamous a. Amylase
31. Pure mucous glands are b. Maltase
a. Labial and buccal gland c. Lactase
b. Glossopalatine gland d. All of the above
c. Sublingual gland 40. Which of the following are purely serous
d. Lingual gland in nature
a. von Ebner and parotid
32. Total number of minor salivary glands in
oral cavity are b. Sublingual and submandibular
a. 1000 b. 500 c. Submandibular and von Ebner
c. 100 d. 800 d. Sublingual and von Ebner
33. Salivation is controlled by 41. Salivary glands arise from
a. Hormonal system a. Hypobranchial eminence
b. Neural system b. Oral mesenchyme
c. Both c. Oral epithelium
d. None of the above d. Dental lamina
34. Serous crescent is also known as 42. The structure of salivary gland may be
a. Crescent of Giannuzzi described as
b. Demilune of Heidenhain a. Mixed or compound tubuloalveolar
c. Both of the above b. Simple tubuloalveolar
d. None of the above c. Compound acinar
35. Salivary glands are derived from d. Simple tubular
a. Mesoderm b. Ectoderm 43. Most viscous saliva is present in
c. Endoderm d. Both b and c a. Parotid salivary gland
36. Saliva contains b. Sublingual salivary gland
a. 99% water b. 80% water c. Submandibular salivary gland
c. 70% water d. 60% water d. Minor salivary gland
37. The three bilaterally paired major salivary 44. Circumvallate papillae contain a minor
glands are located salivary gland in its trough called
a. Extraorally a. Blandin and Nuhn
b. Intraorally b. Zuckerkandl
c. In tongue c. Stenson’s
d. In neck d. von Ebner
38. Human parotid gland produces a 45. Saliva contains one of the following
hormone which is known as digestive enzymes
a. Serotonin a. Peptin
b. Parotin b. Amylase
c. Prohormone c. Lysozome
d. None of the above d. Insulin
30-c, 31-b, 32-b, 33-b, 34-c, 35-d, 36-a, 37-a, 38-b, 39-a, 40-a, 41-c, 42-d, 43-c, 44-d, 45-b
326 DADH Made Easy
46. Primordia of submandibular and parotid c. Aminoacids

salivary glands appear during d. Bicarbonates
a. 6th week of foetal life 50. Striations seen in striated duct are due
b. 7th week of foetal life to
c. 8th week of foetal life a. Basal cell membrane infoldings
d. 9th week of foetal life b. Lysosomes
47. Parasympathetic ganglion associated c. Mitochondria
with parotid salivary gland is d. Both a and c
a. Otic b. Geniculate 51. Lingual lipase enzyme is secreted by the
c. Submandibular d. Trigeminal a. Parotid gland
48. Zymogen granules are seen commonly b. Submandibular salivary gland
in c. Parotid and von Ebner’s salivary
a. Serous cell glands
b. Mucous cell d. None of the above
c. Myoepithelial cell 52. Antifungal property is present in
d. All of the above a. Peroxidase
49. Neutralization of saliva is due to b. Mucins
a. Mucin c. Lactoferrin
b. Ammonia d. Histatin
46-a, 47-a, 48-a, 49-d, 50-d, 51-c, 52-d

22
Tooth Eruption
LAQs (10 Marks)
Q. 1. Define eruption and explain physiologic tooth movement.

or
What are the various patterns of tooth movement?
Ans. Introduction
• Eruption is the axial or occlusal movement of the tooth from its developmental position
within the jaw to its functional position in the occlusal plane.
It is a part of total pattern of physiologic tooth movement. Physiologic tooth movement
is required to bring the teeth into occlusal plane, to maintain their position in the growing
jaws and to compensate for masticatory wear.
• Physiologic tooth movement is described as consisting of :
I. Preeruptive tooth movement
II. Eruptive tooth movement
III. Posteruptive tooth movement
I. Preeruptive Tooth Movement
• These are the movements made by both deciduous and permanent tooth germs within the
jaws before they begin to erupt.
These movements position the tooth and its crypts within the growing jaws at the correct
position for eruption.
• Preeruptive movements occur due to bodily movement of the tooth germ and its eccentric
growth. Tooth germ is present in bony crypt. Bodily movement of tooth germ results from
resorption of the bony crypt on one side and deposition on other side.
• In eccentic growth, base of the tooth germ is fixed while rest of it continues to grow causing
a shift in the centre of the tooth germ. Eccentric growth of tooth germ exerts pressure which
results in resorption of bone on the required side and movement of the tooth germ.
Pattern of preeruptive tooth movement
• When deciduous tooth germs first differentiate they are very small and space is present
between them. This space is used because of the rapid growth of the tooth germs and
crowding results.
327
328 DADH Made Easy
• This crowding is relieved by the growth of jaws. This permits drifting of anterior tooth
germs forward and posterior tooth germs backwards which involves bodily movement of
these tooth germs.
• Anterior region: Initially, permanent teeth are lingually placed to their predecessors in the
same bony crypt. As the jaws increase in size and primary teeth erupt, permanent tooth
germs move and occupy lingual and apical position to the roots of primary teeth.
• Posterior region: Premolar tooth germs move and reside between the roots of primary molars.
– Permanent molar tooth germs move distally and occupy their position within the jaws.
– Initially due to lack of space, the occlusal surface of maxillary molar is positioned distally
and the mandibular molar is positioned mesially. This gets corrected as jaws further
grow in size.
Histology of preeruptive tooth movement

• It involves drifting or growth of the tooth germs.
• It requires remodeling of the bony wall of the crypt.
• Deposition and removal of bone results from osteoblastic and osteoclastic activity.
• Skeletal morphogenesis is also involved in determining the tooth position before eruption.
II. Eruptive Tooth Movement (Prefunctional Eruptive Movement)

Eruption is the axial or occlusal movement of the tooth from its developmental position within
the jaws to its functional position in occlusion.
Direction or pattern of movement

Axial or occlusal is the principal direction of movement in eruption. But movement other than
axial is superimposed on eruptive movement.
Histology of eruptive movement

• Significant developmental events occur along with eruptive tooth movement which bring
the tooth into the oral cavity.
• This includes formation of roots, formation and organization of periodontal ligament and
remodeling of bone.
Mechanism of tooth movement

• Mechanism that brings about tooth movement is likely to be a combination of a number of
factors.
• Theories which have been put forth to explain this process of eruption are:
1. Root formation theory
2. Bone remodeling theory
3. Vascular pressure theory
4. Periodontal ligament traction theory
1. Root formation theory:
• This theory proposes that the eruptive tooth movement in axial or occlusal direction is
mainly because of the formation of root.
• According to this theory, the growth of root impinges upon a sling of connective tissue,
cushion-hammock ligament to produce the necessary thrust for tooth eruption.
Tooth Eruption 329
• But, root formation is unlikely to be the cause of tooth eruption because:

It is found that some teeth move a greater distance than the length of their fully formed
roots.
Eruptive tooth movement can occur even after the root formation is complete.
In certain developmental disturbances, rootless teeth erupt into oral cavity.
Teeth with completely formed roots and impacted teeth do not erupt.
Onset of root formation is not synchronous with the onset of axial tooth movement.
If it has to be believed that the root formation results in an eruptive force, then the
apical growth of the root needs to be translated into occlusal movement for which a fixed
base is required. But, no such fixed base exists. The bone at the base of the socket cannot
act as a fixed base because pressure on bone results in its resorption.
Advocates of the root growth theory, proposed that there exists a ligament, the cushion-
hammock ligament at the base of the socket which provides a fixed base against which
the growing root can react. But, this ligament was found to be a pulp delineating
membrane and cannot act as a fixed base.
• These facts indicate that root formation cannot be responsible for eruptive tooth
movement. It could be a prerequisite for eruption.
2. Bone remodeling theory:
• According to this theory, resorption of the bone at the site of pressure and deposition of
bone at the site of tension may cause eruption.
• Bone remodeling is important to permit tooth movement during eruption.
• However, bone remodeling that occurs around the teeth, causes or is the effect of tooth
movement is not clear.
• Through experiments it was found that dental follicle is an absolute requirement to achieve
bone remodeling and tooth eruption.
3. Vascular pressure theory:
• According to this theory, local volume changes in arteries can produce tooth movement.
• It was found that increase of hydrostatic pressure induced by hypotensive drugs, increases
the rate of eruption.
• Though vascular pressure can play an important role by generating an eruptive force,
whether these pressures are primarily responsible for eruption is not proved.
4. Periodontal ligament traction theory:
• Evidence through experiments has suggested that the eruptive force resides in the dental
follicle-periodontal ligament complex.
• This theory states that the fibroblasts of the dental follicle by their contraction can generate
a force which can pull the teeth into occlusion. The fibroblasts have their processes attached
to the collagen fibers by a sticky protein called fibronectin and as their processes are in
contact with each other, it produces a summative force. This force is transmitted to the
extracellular compartment via fibronexus and to collagen fiber bundles.
• These collagen fiber bundles are inclined at an angle to bring about tooth movement
resulting in eruption of tooth.
• The dental follicle plays an important role in tooth eruption. It produces factors for
promoting osteoclastic bone resorption in the coronal part and by promoting bone
formation in the apical part.
330 DADH Made Easy
• It was found that when the tooth germ is removed experimentally and the dental follicle
is left intact, an eruptive pathway forms in the overlying bone.
• If silicon replica is substituted for the tooth germ, it also erupts.
• Abnormalities of dental follicle as seen in certain diseases are associated with delayed
permanent teeth eruption.
• Drugs that interrupt the proper formation of collagen in the ligament also interfere with
eruption.
• All these experiments show that as long as dental follicle or developing periodontal
ligament exist tooth eruption can occur.
• It is said that eruptive movement is multifactorial like vascular pressure at the apex along
with contractile force generated by the dental follicle playing an important part and bone
formation and resorption facilitating the process.
III. Posteruptive tooth movement

Functional eruptive movement
• Posteruptive tooth movements are those that maintain the position of the erupted tooth,
while the jaw continues to grow. This movement occurs in an axial direction to keep pace
with the increase in height of the jaws.
• This movement compensates for occlusal and proximal wear:
– Occlusal and proximal wear of teeth occurs after the teeth have erupted in the oral
cavity.
– To compensate for occlusal wear the same mechanism responsible for moving the tooth
axially during eruption, is most likely to be used.
– The movement which compensates for the proximal wear of teeth and maintain their
position, consists of mesial migration of teeth called as physiologic mesial drift.
– Mesial or proximal drift involves a combination of two separate forces resulting from
occlusal contact of teeth and contraction of transseptal ligaments between teeth.
– Forces causing mesial drift are multifactorial and include:
a. Occlusal force.
b. Contraction of the transseptal ligament between teeth.
Mesial drift is achieved by contraction of transseptal fibers and enhanced by occlusal
forces.
a. Occlusal force:
When teeth are brought into contact (e.g. in clenching of the jaws), force is generated in
a mesial direction because of summation of cuspal planes and because many teeth
have a mesial inclination. An anterior component of this occlusal force is responsible
for mesial drift.
b. Contraction of transseptal fibers:
Periodontal ligament plays an important role in maintaining tooth position.
Transseptal ligament fibers running between teeth across the alveolar process, draw
neighboring teeth together and maintain them in contact.
• Thus, physiologic mesial drift helps to compensate for proximal wear.
Tooth Eruption 331
Q. 2. Prepare a table exhibiting normal eruption age and sequence of all deciduous and
permanent teeth. (2005, Nov. 2009)
Ans. Eruption is the axial or occlusal movement of the tooth from its developmental position
• Timely initiation and eruption of teeth into oral cavity is important for healthy dentition.
• Human beings have two sets of dentition where deciduous dentition is replaced by
permanent dentition due to increase in the size of jaws and increasing masticatory forces.
• Deciduous teeth eruption starts at the age of 6–7 months of life.
• Sequence of eruption of deciduous teeth is
AB D C E
A B D CE
Age of eruption of deciduous teeth

Teeth Maxillary Mandibular
Central incisors 7 months 6 months
Lateral incisors 9 months 7 months
First molars 14 months 12 months
Canines 18 months 16 months
Second molars 24 months 20 months
Sequence of eruption of permanent dentition
6 1 2 4 5 3 7 8
6 1 2 3 4 5 7 8
Age of eruption of permanent dentition

Teeth Maxillary Mandibular
First molars 6–7 years of age 6–7 years of age
Central incisors 7–8 years 6–7 years
Lateral incisors 8–9 years 7–8 years
First premolars 10–12 years 10–11 years
Canine 11–12 years 9–10 years
Second premolar 10–12 years 11–12 years
Second molar 12–13 years 11–13 years
Third molar 17–21 years 17–21 years
Q. 3. Write about gubernacular cord.

Ans. GUBERNACULAR CORD
• Eruption is the axial or occlusal movement of the tooth from its developmental position
• Significant histologic changes occur in the tissue overlying the erupting tooth.
• Bone removal is necessary for permanent teeth to erupt.
332 DADH Made Easy
• In case of those teeth with deciduous predecessors, there is an additional anatomic feature,
the gubernacular canal and its contents, the gubernacular cord.
• When the successional tooth germ first develops within the same crypt as its deciduous
predecessor, bone surrounds both tooth germs but does not completely close over them.
• As the deciduous tooth erupts, the permanent tooth germ becomes situated apically and is
entirely enclosed by bone except for a small canal, gubernacular canal.
• This canal is filled with connective tissue and often contains epithelial remnants of the
dental lamina. This connective tissue mass is termed as gubernacular cord.
• Thus, the dental follicle that surrounds the succedaneous tooth germ is connected to the
lamina propria of the oral mucous membrane by the gubernacular cord. This may have an
influence on eruptive tooth movement.
• The cord of tissue is believed to be the remnant of the dental lamina.
Functions
• It may have function in guiding the permanent tooth as it erupts.
• As the permanent tooth starts erupting through the gubernacular canal, local osteoclastic
activity is seen around the canal to widen it so that the tooth erupts into the oral cavity.
SAQs (3 Marks)
Q. 1. Define eruption. Decribe any two theories. (Oct. 2004)

or
Enumerate various theories of eruption of tooth and explain the most accepted theory
of tooth eruption. (May 2009)
Enumerate theories of eruption, describe periodontal ligament traction theory.
or (June 2006)
Define eruptive tooth movement and enumerate various theories. (Dec. 2000)
or
Describe eruptive tooth movement or describe prefunctional eruptive movement.
Ans. Eruption is the axial or occlusal movement of the tooth from its developmental position
within the jaws to its functional position in occlusion.
Direction or Pattern of Movement
Axial or occlusal is the principal direction of movement in eruption. But, movement other
than axial movement is superimposed on eruptive movement.
Histology of Eruptive Movement
• Significant developmental events occur along with eruptive tooth movement which brings
the tooth into the oral cavity.
• This includes formation of roots, formation and organization of periodontal ligament and
remodeling of bone.
Mechanism of Tooth Movement
• Mechanism that brings about tooth movement is likely to be a combination of a number of
factors.
Tooth Eruption 333
• Theories which have been put forth to explain this process of eruption are :
1. Root formation theory
2. Bone remodeling theory
3. Vascular pressure theory
4. Periodontal ligament traction theory.
• Explain various theories of tooth eruption as described in answer of LAQ 1.
Q. 2. What is physiologic mesial drift? (May 2008)
or
Describe posteuptive movement.
or
Describe functional eruptive movement.
Ans. POSTERUPTIVE TOOTH MOVEMENT
Functional Eruptive Movement
• Posteruptive tooth movements are those that maintain the position of the erupted tooth
while the jaw continues to grow. This movement is like eruptive movement which occurs
in an axial direction to keep pace with the increase in height of the jaws. Physiologic mesial
drift is a part of posteruptive tooth movement.
• Posteruptive tooth movement also compensates for occlusal and proximal wear :
– Occlusal and proximal wear of teeth occurs after the teeth have erupted in the oral cavity.
– To compensate for occlusal wear the same mechanism responsible for moving the tooth
axially during eruption, is most likely to be used.
– The movement which compensates for the proximal wear of teeth and maintain their
position consists of mesial migration of teeth and is called as physiologic mesial drift.
– Mesial or proximal drift involves a combination of two separate forces resulting from
occlusal contact of teeth and contraction of transseptal ligament between teeth.
– Forces causing mesial drift are multifactorial and include:
a. Occlusal force.
b. Contraction of the transseptal ligament between teeth.
• Physiologic mesial drift is achieved by contraction of transseptal fibers and enhanced by
occlusal forces.
a. Occlusal force:
When teeth are brought into contact (e.g. in clenching of the jaws), force is generated in a
mesial direction because of summation of cuspal planes and because many teeth have a
mesial inclination. An anterior component of this occlusal force is responsible for mesial
drift.
b. The contraction of transseptal fibres:
Periodontal ligament plays an important role in maintaining tooth position.
Transseptal ligament fibers running between teeth across the alveolar process draw
neighboring teeth together and maintain them in contact.
• Physiologic mesial drift helps to compensate for proximal wear.
• Histologically mesial drift is seen as a selective deposition and resorption of bone on the
socket walls by osteoblasts and osteoclasts respectively and by collagen remodeling in the
periodontal and transseptal ligament.
334 DADH Made Easy
23
Shedding of
Deciduous Teeth
SAQs (3 Marks)
Q. 1. Describe mechanism of resorption and shedding. (Oct. 2004)
Describe process of shedding. Describe process of shedding of deciduous teeth.

(June 2006)
Ans. Introduction
The physiologic process resulting in elimination of deciduous dentition is called exfoliation
or shedding.
Shedding is the result of progressive resorption of the roots of teeth and their supporting
tissue, periodontal ligament (PDL).
Factors Responsible for Resorption

• Pressure from erupting tooth.
• Forces of mastication applied on deciduous teeth.
– Increasing masticatory forces in growing individual exert forces on deciduous tooth
greater than its PDL can withstand. This results in trauma to PDL and initiation of
resorption.
– As there is resorption of roots, there is progressive loss of surface area for attachment of
PDL. This weakening of tooth support results in exfoliation.
Mechanism and Histology of Shedding

• Shedding is a physiological process by which deciduous teeth roots and parts of crown
undergo resorption by multinucleated giant cells called odontoclasts.
It involves:
a. Resorption of dental hard tissues.
b. Resorption of soft tissues.
a. Resorption of dental hard tissues:
• Odontoclasts (dentinoclast) are multinucleated giant cells responsible for removal of
dental hard tissues.
334
Shedding of Deciduous Teeth 335
• Pressure from erupting successional tooth plays a key role in resorption.

• Odontoclasts appear at sites of pressure.
• These cells occupy resorption bays on the surface of dental hard tissue to be resorbed.
• Its surface near the hard tissue forms a ruffled border.
• Peripheral to the ruffled border, is a clear or a sealing zone in which the cytoplasm is
devoid of organelles but rich in contractile proteins, actin and myosin.
• Sealing zone helps in attaching the odontoclast to the hard tissue surface, thereby
creating a sealed space in which odontoblasts pump hydrogen ions.
• This results in fall in pH and therefore dissolution of minerals. Thus, dental hard tissue
is degraded.
• Primary lysosomes of odontoclasts secrete their enzymatic contents to degrade the
organic matrix.
b. Resorption of dental soft tissues:
• Apoptotic cell death (programmed cell death) is involved in resorption of dental
soft tissues, the pulp and the PDL.
• Remnants of deciduous teeth: Sometimes parts of the roots of deciduous tooth may escape
resorption and its remnants remain embedded in the jaw, more frequently with mandibular
second molars.
• Overretained deciduous teeth: More often deciduous maxillary lateral incisors, less frequently
mandibular second molars and rarely mandibular central incisor are retained for a long-
time beyond their usual shedding schedule. Frequently, upper permanent canine is
embedded and therefore, deciduous canine remains overretained.
• Submerged teeth: Trauma to deciduous tooth results in ankylosis. These ankylosed deciduous
teeth cannot continue to erupt like adjacent teeth. Hence, they lie below occlusal plane and
are referred to as submerged teeth. Submerged deciduous teeth should be removed as they
can prevent eruption of their permanent successors or force them from their position.
Q. 2. Write differences in resorption of single rooted and multirooted teeth.

Ans. The physiologic process resulting in elimination of deciduous dentition is called exfoliation
or shedding.
Exfoliation of Single Rooted Tooth

• Because of the developmental position of the permanent incisors and canine tooth germs
and their subsequent movement in an occlusal and vestibular direction, resorption of the
roots of the deciduous incisors and canine begins on their lingual surfaces. Later these
permanent teeth occupy a position directly apical to the deciduous tooth and they erupt in
the position of their deciduous predecessors.
• However, the apical positioning of the tooth germs of the permanent mandibular incisors
may not occur and they frequently erupt lingual to the still functioning deciduous teeth.
• Single rooted teeth are usually shed before root resorption is complete.
Exfoliation of Multirooted Teeth
• Resorption of the roots of deciduous molars begins on their inner surface because the
early developing bicuspids are formed between them. Resorption of the roots of deciduous
336 DADH Made Easy
molars occurs long before they are shed due to the expansion of their growing permanent
successors.
• In multirooted teeth, the roots are usually completely resorbed and the crown is also partially
resorbed before exfoliation.
Q. 3. What are overretained deciduous teeth?

Ans. Introduction
These are the deciduous teeth which are retained for a long-time beyond their usual shedding
schedule.
• These teeth are invariably out of function.
• Upper lateral incisors are the most commonly overretained deciduous teeth. Less frequently
mandibular second molar and rarely the lower central incisor are overretained.
Etiology
• Either there is no permanent successor or the permanent successor is impacted.
• Ankylosed or impacted permanent teeth. This is seen most commonly with deciduous and
permanent canine.
• Presence of supernumerary tooth or an odontogenic tumor may prevent eruption of
permanent teeth. In such cases, ankylosis of the deciduous tooth may occur.
Overretained deciduous tooth can affect function and esthetics.
Q. 4. What are submerged deciduous teeth?

Ans. SUBMERGED DECIDUOUS TEETH
• Trauma can result in damage to either the dental follicle or periodontal ligament. This
prevents eruption of the tooth and it becomes ankylosed to the bone of the jaw.
• Due to the continuous eruption of the adjacent teeth and increased height of alveolar bone,
the ankylosed tooth remains submerged in the alveolar bone.
• Submerged deciduous tooth prevents the eruption of its permanent successor or force it to
erupt in an abnormal position.
• Such submerged deciduous teeth should be extracted.
Q. 5. Explain shedding of deciduous 2nd mandibular molar. (May 2008)

Ans. Introduction
• The physiologic process resulting in the elimination of the deciduous dentition is called
shedding or exfoliation.
• Decidous teeth exfoliate because a second dentition consisting of larger and more teeth is
required for the larger jaws of the adult.
• Shedding involves progressive resorption of the roots of teeth and their supporting tissue,
• There is difference in shedding of single rooted and multirooted teeth.
• Resorption of roots of mandibular deciduous second molars begin on the inner surface
because the early developing bicuspids are formed between them.
• Its resorption occurs long before the deciduous molar is shed due to expansion of their
growing permanent successor, second premolar.
• In molars, the roots are completely resorbed and the crown is also partially resorbed before
exfoliation.
• Shedding involves resorption of dental hard tissues by odontoclasts and resorption of soft
tissues.
• Remnants of mandibular deciduous second molar are frequently found embedded in the
jaw. The reason is that the roots of the lower second deciduous molar are strongly curved
or divergent. The mesiodistal diameter of the second premolar is much smaller than the
greatest distance between the roots of the deciduous molar.
338 DADH Made Easy
1. Early in the preeruptive phase, the 6. The resorption of deciduous molars

successional permanent teeth develop initially takes place on
a. Labial to and near the apical level of a. Inner surface of the root below furcation
their primary predecessors b. At the apex of the root
b. Lingual to and near the incisal or c. Outer surface of the root at the cervical
occlusal level of their primary pre- level
decessors d. Outer surface of the root below furcation
c. Both are correct
7. The permanent incisors develop
d. Both are incorrect
a. Labial to the roots of deciduous teeth
2. At the end of the preeruptive phase the b. Lingual to the roots of deciduous
successional permanent teeth develop teeth
lingual to deciduous teeth at c. Mesial/distal to the deciduous roots
a. Incisal or occlusal level d. Below the apices of deciduous roots
b. Middle third level
8. An anatomic feature having influence on
c. Apical third level
eruptive tooth movement of successional
d. Occlusal level teeth is
3. The change in the position of the a. Enamel cord
permanent tooth germ is due to b. Gubernacular cord
a. Apical movement of permanent tooth c. Epithelial cord
germ d. Enamel knot
b. Eruption of primary teeth
9. The remarkable property of the principal
c. Increase in height of supporting supporting tissues of the tooth (PDL and
tissues bone) is
d. Both b and c a. Elasticity
4. The tooth moves more rapidly in the b. Plasticity
socket during c. Stretchability
a. Preeruptive phase d. Resiliency
b. Prefunctional phase 10. The mesial drift is achieved by
c. Posteruptive phase a. Oblique ligament
d. Postfunctional phase b. Alveolar ligament
5. The permanent teeth which have no c. Transseptal ligament
deciduous predecessors are d. Horizontal ligament
a. Mandibular and maxillary second 11. Resorption of the roots of the deciduous
premolars incisors and canines begins on their
b. Mandibular and maxillary first a. Labial surface
premolars b. Lingual surface
c. Mandibular and maxillary molars c. Apical surface
d. Maxillary and mandibular canines d. All the surfaces
1-b, 2-c, 3-d, 4-b, 5-c, 6-a, 7-b, 8-b, 9-b, 10-c, 11-b
12. Most common congenitally missing 19. Maxillary primary root resorption begins
teeth are at
a. Permanent upper lateral incisor a. 4 years b. 5 years
b. Permanent lower lateral incisors c. 6 years d. 7 years
c. Permanent lower first molars 20. Maxillary premolars erupt at
d. Permanent upper canine a. 8–9 years b. 9–10 years
13. The cells responsible for removal of c. 10–12 years d. 13–14 years
dental hard tissue are 21. The most likely factor responsible for
a. Odontoclasts tooth eruption is
b. Odontoblasts a. Vascular pressure
c. Osteoblast b. Developing periodontal ligament
d. Fibroblasts (PDL)
14. Most frequently the remnants of deciduous c. Bone growth
teeth are found in association with d. Growing root
a. Maxillary canines 22. The most accepted theory for tooth
b. Mandibular incisors eruption is
c. Premolars a. Root growth theory
d. Maxillary laterals b. Pulp constriction theory
15. The most often retained deciduous teeth c. Periodontal ligament traction theory
are d. Pulp growth theory
a. Lower central incisors 23. When a successional tooth germ is
b. Upper canines missing, shedding of deciduous teeth is
c. Upper lateral incisors a. Premature
d. Lower canines b. Normal
16. The most frequently retained deciduous c. Delayed
tooth due to the impaction or ankylosis d. None of the above
of its permanent successor is 24. The upper first permanent molars develop
a. Deciduous central incisor in the tuberosity of the maxilla and in the
b. Deciduous lateral incisor beginning their occlusal surfaces faces
c. Deciduous canine a. Labially b. Lingually
d. Deciduous molars c. Mesially d. Distally
17. The most common primary teeth to 25. At first the occlusal sur face of the
remain/appear submerged are permanent mandibular molar faces
a. Primary canines a. Mesially b. Distally
b. Primary first molars c. Lingually d. Labially
c. Primary mandibular second molars 26. The PDL fibers which has a key role in
d. Primary incisors maintaining tooth position is
18. The deciduous maxillary canine exfoliates a. Horizontal group fibers
at the age of b. Apical group
a. 6–7 years b. 2–3 years c. Oblique group
c. 10–11 years d. 11–12 years d. Transseptal ligament fibers
12-a, 13-a, 14-c, 15-c, 16-c, 17-c, 18-c, 19-a, 20-c, 21-b, 22-c, 23-c, 24-d, 25-a, 26-d
340 DADH Made Easy
27. The transseptal ligament fibers connect c. 8 years

a. Bone to bone d. 9 years
b. Cementum to bone
34. Posteruptive tooth movement is to
c. Gingiva to bone compensate for
d. Cementum of one tooth to the a. Occlusal and proximal wear
cementum of the adjacent tooth
b. Occlusal wear only
28. The actual eruptive movement occurs in c. Proximal wear only
a. Horizontal direction d. Cervical abrasion
b. Rotational way
c. In an axial direction 35. Time taken for root completion of primary
teeth after eruption is
d. All of the above
a. 3 years
29. Final position of the tooth in the oral b. 2 years
cavity is determined by
c. 6 months
a. Pressure exerted by tongue and teeth
d. 1 year
b. Pressure exerted by the adjacent teeth
c. Both of the above 36. Time taken for root completion of
d. None of the above permanent teeth after eruption is
30. In case of delayed resorption of primary a. 0.5–1 year
incisors, the permanent incisors may be b. 2–3 years
expected to erupt c. 4–5 years
a. Facial to the normal arch form d. 6–7 years
b. Lingual to the normal arch form
37. The cell which resorbs dentin is
c. Mesial to the normal arch form
a. Fibroblast
d. Distal to the normal arch form
b. Ameloblast
31. The following movement of a tooth through c. Odontoclast
the surrounding tissue due to which the
d. Osteoclast
clinical crown appears longer is
a. Eruption 38. Fibronexus is seen in
b. Exfoliation a. PDL
c. Mastication b. Alveolar bone
d. Longitudinal development c. Pulp
32. The percentage of root calcification d. Gingiva
completed at the time of eruption is
39. Shedding is
a. 25%
a. Pathologic
b. 50%
c. 75% b. Physiologic
d. 100% c. Anatomical
d. All of the above
33. The resorption of the roots of primary
molars begins at about the age of 40. Odontoclasts are
a. 6 years a. Resorptive cells
b. 7 years b. Formative cells
27-d, 28-c, 29-c, 30-b, 31-a, 32-d, 33-d, 34-a, 35-d, 36-b, 37-c, 38-a, 39-b, 40-a
c. Blood forming cells 43. Resorption is a

d. Defence cells a. Continuous process
41. Howship’s lacuna is b. Active process
a. Resorption bay c. Period of activity and intervening rest
b. Elevated area period
c. Clear zone d. None of the above
d. Attachment apparatus 44. Submerged teeth
42. Origin of odontoclasts is from a. Appear at a lower level
a. Lymphocytes b. Force their permanent successors from
b. Macrophages their position
c. Dendritic cells c. Prevent eruption of permanent successor
d. Circulating monocytes d. All of the above
41-a, 42-d, 43-c, 44-d

342 DADH Made Easy
24
Preparation of Specimen for

Histologic Study
LAQ (10 Marks)
Q. 1. Different steps in the preparation of a slide for staining of a soft tissue biopsy.
(Nov. 2009)
Describe in detail the method of preparation of histological section of a soft tissue
specimen by paraffin embedding technique.
Ans. Introduction
• The morphologic study of tissue involves the preparation of tissue sections for microscopic
examination.
• Tissue processing is the treatment of tissue necessary to keep them in as life like manner as
possible and to impregnate them with a solid medium so as to give them enough rigidity to
facilitate the production of sections for microscopy.
• The most commonly used method of preparing soft tissues for study with an ordinary light
microscope is that of embedding the specimen in paraffin and then cutting 4–6 microns
thick sections. The sections are mounted on microscope slides, stained and then viewed
under microscope.
Steps in preparation of soft tissue specimen for sectioning:
1. Obtaining the specimen
2. Fixation of the specimen:
• Immediately after removal of the specimen, it must be placed in a fixing solution to
prevent autolysis and putrefaction.
• Most commonly used fixative is neutral 10% buffered formalin.
• The purpose of fixation is to coagulate the proteins so as to reduce alteration by subsequent
treatment and to make the tissues more readily permeable to the subsequent application
of reagents.
• After fixation, the tissue is washed overnight in running water.
3. Dehydration of the specimen:
• After being washed in formalin, the specimen is gradually dehydrated in alcohol to remove
water. This is done because paraffin, in which the tissue is to be embedded and water in
which the tissue is washed after fixation are not miscible.
342
Preparation of Specimen for Histologic Study 343
• For dehydration, tissue is passed through a series of increasing percentages of alcohol,

40%, 60%, 80%, 95% and absolute.
4. Clearing of the specimen:
• Since alcohol and paraffin are not miscible, the specimen is passed from alcohol through
two changes of xylene, a clearing agent which is miscible with both alcohol and paraffin.
• This step helps in improving the refractive index of the tissue. Tissue appears clear and it
allows light to pass through, hence the procedure is called clearing.
5. Infiltration of the specimen with paraffin:
• Now the tissue is removed from the xylene and placed in a dish of melted paraffin at
about 60°C.
• Embedding the specimen: When the specimen is completely infiltrated with paraffin, it
is embedded in the center of a block of paraffin.
• For this either a small paper box, or two ‘L’ shaped metallic pieces, usually made of brass
or aluminium are used.
• The tissue should be properly oriented and placed in the paper box or ‘L’ shaped pieces
containing paraffin.
6. Cutting the sections of the specimen:
• After cooling the hardened paraffin block is removed, is trimmed and sectioned on a
microtome.
• Sections are usually 4–6 mm thick.
7. Mounting the cut sections on slides:
• A microscope slide is coated with a thin film of Meyer’s albumin adhesive.
• A short length cut paraffin ribbon with tissue sections is floated in a pan of warm water.
• The prepared slide is then slipped under the ribbon and is then lifted from the water
with the ribbon.
• The slide is then placed on a constant temperature drying table at about 42°C, so that the
sections adhere to the slide.
8. Staining the sections:
• For routine microscopic study hematoxylin and eosin stain is commonly used.
• The stained slides are mounted with DPX. Once DPX is hardened, the slide is ready for
microscopic examination.
SAQs (3 Marks)
Q. 1. Write about fixatives? (2001, Oct. 2002)

Write about tissue fixation? (May 2009)
Ans. FIXATION
• It is the technique to maintain the tissue in as much a life-like state as possible, by preventing
autolysis and putrefaction.
• The principle is to coagulate the tissue proteins, thus reducing alteration of tissue by
subsequent treatment and to make it more readily permeable to the subsequent application
of reagents.
• This is accomplished by using optimum osomotic conditions, cold temperatures, controlled
pH of the fixing solutions, and minimum possible exposure to the fixative.
344 DADH Made Easy
Techniques and fixatives used are:

1. Chemical fixatives
• Formaldehyde
• Acrolein and glutaraldehyde: Electron microscopy
• Rossman’s fliud: For glycogen, glycoproteins, and proteoglycans
• Carnoy’s fliud: Nucleic acids
2. Fresh frozen sections
3. Freeze drying—Liquid nitrogen
• The most commonly used fixative is 10% formalin.
• Formaldehyde is considered to be one of the ideal fixatives, especially for enzymes and
other proteins. This is due to its ability to react with major reactive groups of proteins to
form polymeric or macromolecular networks.
Q. 2. Write about ground section. (Oct. 2003, May 2008, Nov. 2009)
Ans. GROUND SECTION
Decalcification of bone and teeth often obscures the structures. Teeth in particular are damaged
because tooth enamel, being about 96% mineral substance, is usually completely destroyed by
ordinary methods of decalcification. Undecalcified teeth and undecalcified bone may be studied
by making thin ground sections of the specimens.
This can be done by slicing the undecalcified specimen, which is ground down to a section
of about 50 mm on a revolving stone or disc.
Equipment required: The equipment used for making ground section includes a
laboratory lathe, a coarse and a fine abrasive lathe wheel, a stream of water, a wooden
block, adhesive tape, a camel’s hair brush, ether, mounting medium, microscope slides and
cover slips.
Procedure: Before making of ground section, extracted tooth should be preserved in 10%
formalin. Using coarse abrasive lathe, the tooth is ground down to the level of the desired
section. The coarse wheel is then exchanged for a fine abrasive lathe wheel so that the rough
surfaces are removed. The cut surface of the tooth is ground until the level of the desired
section is reached. The tooth is ground down to a thickness of about 0.5 mm. Throughout the
procedure, the specimen should be protected from heat and should not be allowed to dry. The
finished ground section is dried and mounted on a slide with mounting media. For making
sections out of enamel, hard tissue microtomes are used.
Q. 3. Write about decalcification. (June 2010)

Ans. DECALCIFICATION
• Specimens that contain teeth and bone cannot be cut with a microtome knife unless these
calcified tissues are made soft by decalcification.
• Decalcification is the removal of the calcified substance from hard tissues like bone and
teeth to make them soft for sectioning.
• This is usually done by using 5% nitric acid.
• After fixation, the specimen is decalcified. One of the methods is to suspend the specimen
in about 400 ml of 5% nitric acid. The acid is changed daily for 8–10 days and then the
specimen is tested for complete decalcification. One way to test is by piercing it with a
needle, another way is to test it by precipitation method.
• After decalcification the procedure is same as that of soft tissue processing.

• Instead of embedding in puraffin wax, decalcified tissues can be embedded in parlodian
which is purified nitrocellulose dissolved in ether-alcohol. Parlodian embedding gives better
sectioning, but the procedure is cumbersome.
• Except enamel all hard tissues can be processed by these methods and studied.
Q. 4. Write about hematoxylin and eosin stain. (Nov. 2009)

Ans. Hematoxylin and eosin stain is the most commonly used stain for routine microscopic
study of tissue specimens.
HEMATOXYLIN AND EOSIN STAIN

Principle
Hematoxylin is basic stain which stains nuclei whereas eosin is acidic stain which stains
cytoplasm. Hematoxylin is converted to hematin by oxidation.
Hematoxylin stains section regressively with a stain at sufficient power and for long enough
to ensure some overstaining of nuclei. Excess stain is removed by treatment with acid-alcohol.
This is most popular stain and is called routine stain.
Solutions
Hematoxylin is a natural product obtained from logwood of Mexican tree.
Eosin is chemically or artificially prepared in laboratory.
i. Harri’s alum hematoxylin
ii. 1% eosin
iii. 1% acid-alcohol
Procedure
i. Deparaffinization: First dip in xylene to remove paraffin, then dip in alcohol to remove
xylene, then wash in running water for 5 minutes.
ii. Rinsing: Rinse in water for 15 minutes.
iii. Staining: Put sections in hematoxylin jar for 10–15 minutes (stains the neclei).
iv. Decolorization: 1–2 drops in 1% acid-alcohol (to decolorize section).
v. Counter staining: Counter staining with 1% eosin for 2 minutes (stains cytoplasm).
vi. Dehydration: Dehydrate with absolute alcohol (dehydrate sections and remove excess
alcohol).
vii. Clearing: One dip in xylene (clears alcohol).
viii. Blot dry and mount in DPX.
Results
Nuclei – Blue
Cytoplasm – Pink
Connective tissue – Pink
Blood vessels – Pink
Collagen fibers – Pink
346 DADH Made Easy
Application
Hematoxylin and eosin stain is most commonly used stain for routine microscopic study of
tissue specimens as well as for cytological smears.
Q. 5. Write about periodic acid Schiff (PAS) stain. (May 2007)

Ans. PERIODIC ACID SCHIFF (PAS) STAIN
This is the most frequently used stain for detection of carbohydrates.
Principle
1% periodic acid oxidizes the glycol groups of carbohydrates to aldehydes. These aldehydes
then react with Schiff’s solution (reagent) giving magenta red color.
Solution
i. 1% periodic acid
ii. Schiff’s reagent
iii. Hematoxylin reagent (Iron Hematoxylin)
Procedure
i. Deparaffinization: First dip to deparaffinize the section.
ii. Oxidation: Oxidize in PAS solution for 5 minutes
iii. Place in Schiff’s reagent for 20–30 minutes.
iv. Rinsing: Rinse in water and blot dry.
v. Wash in running water for 5 minutes to develop pink color.
vi. Stain with iron hematoxyline for 4–5 minutes.
vii. Wash in water, then counter stain with saturated solution of picric acid.
viii. Dehydration: Dehydrate, clear and mount in DPX.
Results
Nucleus – Blue black
Basement membrane – Magenta red
Glycogen content – Magenta red
Background – Yellow (due to picric acid)
Acid mucopolysaccharide – Magenta red
Applications
It is a special stain for acid mucopolysaccharides present in basement membrane. They take
up magenta red color on staining.
The break in basement membrane can be well-observed and studied by PAS in case of
suspicion of oral squamous cell carcinoma.
1. The methods used for the preparation of 7. The method to determine the end of
oral tissues for microscopic examination decalcification procedure is
are a. Probing with a needle
a. Paraffin embedding b. Radiography
b. Parlodion embedding c. Precipitation test
c. Ground sections of mineralized tissues d. All of the above
d. Frozen sections 8. Special stain used for keratin is
e. All of the above a. Van Gieson’s stain
2. The most commonly used method for b. Masson trichrome stain
preparing specimens of gingiva, cheek c. Mallory stain
and tongue is d. Periodic acid Schiff stain
a. Ground section
9. Hematoxylin is a
b. Frozen section
a. Counter stain
c. Paraffin embedding
b. Basic stain
d. All of the above
c. Acidic stain
3. During tissue processing water from tissue d. None of the above
is removed by using solution of
a. Xylene 10. Eosin is a
b. Alcohol a. Counter stain
c. Formalin b. Basic stain
d. Saline c. Acidic stain
4. The clearing solution used in tissue
processing is 11. Special stain used for basement mem-
a. Xylene brane is
b. Alcohol a. Van Gieson’s stain
c. Water b. Periodic acid Schiff stain
d. Saline c. Prussian blue
d. Hematoxylin and eosin
5. The most commonly used method for
preparing specimens of hard tissues is 12. Extracted teeth should be preserved in
by embedding in a. 10% formalin
a. Paraffin b. 10% alcohol
b. Parlodion c. Normal saline
c. Celloidin d. Hydrogen peroxide
d. All of the above
13. For decalc2ification of bone the solution
6. The decalcifying solution used is used is
a. 10% formalin a. Xylene
b. 10% nitric acid b. Formalin
c. 5% nitric acid c. Alcohol
d. 5% formalin d. Nitric acid
1-e, 2-c, 3-b, 4-a, 5-b, 6-c, 7-d, 8-c, 9-b, 10-c, 11 – b, 12-a, 13-d
348 DADH Made Easy
14. The most ideal fixative is 21. Most commony used mountant is
a. Sodium hypochlorite a. DPX b. Glycerine
b. Formaldehyde c. Araldite d. Balsam
c. Acetaldehyde 22. The thickness of section obtained in
d. H2SO4 routine tissue processing is
15. Formaldehyde as a fixative is used as a. 3–5 mm b. 13–15 mm
a. 10% solution c. 23–25 mm d. 33–35 mm
b. 20% solution 23. The thickness of ground section is
c. 30% solution a. 10 mm b. 50 mm
d. 40% solution c. 100 mm d. 150 mm
16. The special stain used for glycoprotein is 24. The instrument used to obtain frozen
a. Silver stain sections is
b. Alcian blue a. Cryostat
c. Ninhydrin stain b. Microscope
d. Hematoxylin and eosin stain c. Microtome
17. Dehydration of the specimen for d. Tissue floatation both
embedding in paraffin is carried out by 25. The thickness of frozen section is
passing through a. 10–15 mm
a. Decreasing percentage of alcohol b. 100–150 mm
b. Increasing percentage of alcohol c. 10–15 mm
c. Increasing percentage of ether d. 100–150 mm
d. Increasing percentage of xylene 26. Which of the following is the aim of
18. Special stain used to demonstrate mucin fixation
is a. Preserve tissues in a lifelike manner
a. Mallory b. Prevent autolysis and putrefaction
b. Von Gieson c. Prevent change in shape or volume of
c. Mucicarmine tissue
d. Massons’ trichrome d. All of the above
19. The most commonly used fixative for light 27. Fixation for demonstration of lipids should
microscopy is be done by
a. Formalin a. Formaldehyde
b. Glutaraldehyde b. Carnoy’s solution
c. Acetone c. Freeze drying
d. Ether d. Formol calcium
20. The most commonly used fixative for 28. Fixative used for demonstration of
electron microscopy is nucleic acid is
a. Formalin a. Acrolein
b. Glutaraldehyde b. Glutaraldehyde
c. Acetone c. Formaldehyde
d. Ether d. Carnoy’s solution
14-b, 15-a, 16-b, 17-b, 18-c, 19-b, 20-b, 21-a, 22-a, 23-b, 24-a, 25-a, 26-d, 27-c, 28-d
29. Demonstration of nucleic acid is done by c. Fixation, clearing, embedding, dehydra-

a. Sudan Black B tion
b. Feulgen technique d. Fixation, dehydration, embedding,
c. PAS technique clearing
d. Mucicarmine method 33. The minimum volume of fixative required
30. The best known staining method for is
studying carbohydrate is a. Five times more than the volume of
a. Mallory the tissue
b. Von Gieson b. Fifteen times more than the volume of
c. Mucicarmine the tissue
d. PAS c. Forty-five times more than the volume
of the tissue
31. The maximum thickness of ground
d. Hundred times more than the volume
section is
of the tissue
a. 1 mm b. 0.5 mm
c. 0.2 mm d. 0.1 mm 34. Which of the following is a fixative
a. DPX b. Formalin
32. The correct order of steps in tissue pro-
cessing is c. Paraffin wax d. Xyline
a. Fixation, embedding, clearing, Dehydra- 35. The instrument used to obtain thin sections
tion is
b. Fixation, dehydration, clearing, embed- a. Cryostat b. Microscope
ding c. Microtome d. Tissue floatation bath
29-b, 30-d, 31-b, 32-b, 33-b, 34-b, 35-a

Section III
Practical Guide
25. Carving of Teeth
26. Guide for Identification of Teeth
27. Age Determination of Dental Casts
25
Carving of Teeth
MEASUREMENT OF TEETH (in mm)

Length Length Total MD at MD at Labio-lingual Labio-
of of Length contact cervix at crest of linguo at
Crown Root of Tooth area curvature cervix
MAXILLARY
CI P 10.5 13 23.5 8.5 7 7 6
D 6 10 16 6.5 4.5 5 4
LI P 9 13 22 6.5 5 6 5
D 5.6 11.4 17 5.1 3.7 4 3.7
C P 10 17 27 7.5 5.5 8 7
D 6.5 13.5 20 7 5.1 7 5.5
PM P 8.5 14 22.5 7 5 9 8
First
M D 5.1 10 15.1 7.3 5.2 8.5 6.9
PM P 8.5 14 22.5 7 5 9 8
Second
M D 5.7 11.7 17.4 8.2 6.4 10 8.3
First
M P 7.5 12 13 20.5 10 8 11 10
Second B L
M P 7 11 12 19 9 7 11 10
MANDIBULAR
CI P 9 12.5 21.5 5 3.5 6 5.3
D 5 9 14 4.2 3 4 3.5
LI P 9.5 14 23.5 5.5 4 6.5 5.8
D 5.2 10 15.2 4.1 3 4 3.5
C P 11 16 27 7 5.5 7.5 7
D 6 11.5 17.5 5 3.7 4.8 4
PM P 8.5 14 22.5 7 5 7.5 6.5
First
M D 6 9.8 15.8 7.7 6.5 7 5.3
PM P 8 14.5 22.5 7 5 8 7
(Contd.)
353
354 DADH Made Easy
MEASUREMENT OF TEETH (in mm) (Contd.)

Length Length Total MD at MD at Labio-lingual Labio-
of of Length contact cervix at crest of linguo at
Crown Root of Tooth area curvature cervix
MANDIBULAR
Second
M D 5.5 11.3 16.8 9.9 7.2 8.7 6.4
First
M P 7.5 14 21.5 11 9 10.5 9
Second
M P 7 13 20 10.5 8 10 9
P = Permanent M = Molar C = Canine D = Deciduous PM = Premolar
LEARNING TOOTH MORPHOLOGY

• Tooth carving: It is one of the best methods for learning tooth morphology because it gives
a three dimensional understanding of the details of tooth form.
• It cannot be mastered in a day. It can be learnt only with practice and patience.
• Good carving skills come handy in clinical practice, especially during restoration of lost
tooth structure.
Materials Required for Carving

• Standard size wax block made of paraffin wax 3 × 1.25 × 1.25 cm
• Lecron carver
• Six inches metal scale ruler
• A gauze piece
• Soap, water, cotton wool for final polishing.
Lecron Carver: (Fig. 25.1)

• It is double ended stainless steel tool. It has a handle and two working ends.
• The shaft is generally serrated to facilitate firm grip of the instrument.
• One working end is knife-shaped which has both straight and curved part. This working
end is used for major part of carving.
• The other working end is spoon-shaped/scoop like which is generally used for carving
depressions/fossa.
• It is used with modified pen-grip for almost all the steps in carving except when big chunks
of wax have to be removed or major reduction is required then the palm-grip is used.
Fig. 25.1
Carving of Teeth 355
Modified Pen-grip
• In modified pen-grip, the carver is held at its neck with the thumb, index finger and middle
finger.
• Middle finger is placed closer to the blade.
• Index-finger bends at its second joint.
• The neck is held with thumb and index finger.
• Blade is supported with the middle finger.
• Middle finger rests on the ring finger and little finger.
• Support is gained by resting the ring finger and little finger on the fingers of the block
holding hand.
Before carving a tooth the student can practice some imaginary carvings like carving of
single dumbbell, a ball, a pencil, a doll, a dice, a flower, or any other object one can think of.
This will help the student to learn how to hold the carver, how much pressure to apply on
wax, how to cut, shape and polish wax. It will help the student to learn the properties of wax.
It is a basic process of learning.
We have tried to give some guidelines for a few objects.
EXERCISE – 1
BLOCK
Carve a Block of dimension 3 cm × 1 cm × 1 cm.
Fig. 25.2
To make the block of given size, keep 1 mm extra on all the surfaces while marking.
STEP 1
Reduce the surface A to bring the length of the block to 3.1 cm. Then level the surface A.
Fig. 25.3
STEP 2
• In Fig. 25.2 the block is resting on the surface C and the surface A is on your right side.
• In Fig. 25.4 and Fig. 25.5 the block is resting on the surface B, and surface C is on your right
side and surface D is facing you.
356 DADH Made Easy
On the surface A and B mark a point at a distance of 1 cm on the sides

a and b of both the surfaces. Join the points (Fig. 25.4).
Reduce the surface C up to the lines marked.
Level the surface C.
A is top surface
B is bottom surface
C and D are adjacent surfaces.
To maintain the levels and smoothness, instead of reducing all
6 surfaces we are reducing only 3 surfaces A, C and D.
STEP 3 (FIG. 25.5) Fig. 25.4

Mark 1 cm on the sides c and d of both the surfaces A and B.
Join all the points.
Reduce the surface D up to the lines marked.
Level the surface D.
• The given block is bigger is size.
• It has 6 surfaces.
• To make the block of required size we reduce the three surfaces A, C, D.
OR
Single Step
Reduce the length of the block to 3.1 cm by reducing the surface A. Level it.
Then on the surface A and B mark two points to make a square of 1 cm each Fig. 25.5
side. Join all the points. Reduce two adjacent surfaces only (Fig. 25.6).
Fig. 25.6
EXERCISE – 2
SINGLE DUMBBELL
To carve a sphere or a ball 1 cm in diameter centered over a cylinder (bar, rod) of length 1.5 cm
or 1 cm and diameter of 8 mm (Fig. 25.7).
STEP 1
Draw two horizontal lines at a distance of 1 cm and 1.5 on all the four surfaces
of the block. Each surface is divided into three parts 1 cm for sphere, 1.5 cm for
the cylinder and remaining is the base.
STEP 2
Mark midline (vertical) on two opposite surfaces.
• Draw a circle with 1 cm diameter on upper part. Fig. 25.7
• Mark 4 mm on either side of the midline and draw two lines on the
middle part.
• Remove the wax from the shaded portion on two opposite surfaces
of the block.
• The bottom part forms the base.
STEP 3
Now mark the mid-line on other two opposite surfaces, i.e. the surfaces
you have reduced.
Draw the circle and two vertical lines.
After all the four surfaces have been reduced you get a gross
carving.
Using your judgement and while turning the block, keep on
rounding off the sphere and the cylinder. Fig. 25.8
EXERCISE – 3
PYRAMID
Fig. 25.9
STEP 1
Divide the 3 cm block (exercise 1) into 3 parts 1 cm each by drawing two
horizontal lines at a distance of 1 cm.
• Draw a mid-line on both the opposite surfaces.
• Mark equilateral triangles on the upper and lower 1 cm part of the block,
Fig. 25.10
on both the opposits surfaces.
358 DADH Made Easy
Carve out the wax outside of the marked lines.

Repeat the same on other two opposite surfaces.
PREPARATION OF BLOCK FOR TOOTH CARVING

• Read the details of the tooth to be carved along with odontometric data and read and see
the diagrams of the tooth from all five aspects.
• While carving, either keep a plaster model of the tooth to be carved or a clean extracted
tooth in front of you.
• Areas in the figure where lines are drawn indicate removal of wax in that area.
TIPS FOR CARVING

1. Maxillary anterior teeth:
• Let the length of the block remain as it is.
• Reduce the four sides of the crown and root part of the block so that the top surface is a
square with each side measuring 1 cm/10 mm.
• Make the incisal ridge/cuspal ridge of maxillary anterior teeth thick and centered over
the root axis.
2. Maxillary posterior teeth:
• Reduce the four sides of the crown and root part of the block so that the top surface is a
square with each side measuring 11 mm.
3. Mandibular anterior teeth:
• Reduce the four sides of crown and root part of the block so as to get a square on the top
surface with each side measuring 8 mm.
• The incisal/cuspal ridge of mandibular anterior teeth is thin and not centered over the
root axis, it is towards lingual.
4. Mandibular posterior teeth:
• No reduction of the block required.
INCISORS
CLASS TRAITS
1. Incisors have an incisal edge instead of the cusps that are found on the canines and posterior teeth.
• Incisal ridge is that part of the crown which makes up for the complete incisal portion.
When the incisor is newly erupted, the incisal portion is rounded and merges with the
mesial and distal incisal angles and labial and lingual surfaces. This is the incisal ridge.
Incisal edge comes into existence only after the occlusal wear has created a flattened
surface linguo-incisally, which forms an angle with the labial surface.
Incisal edge is formed by the junction of linguo-incisal and labial surface.
2. Mamelons are found on the newly erupted permanent incisors.
• Mamelons are the rounded extensions of enamel on the incisal ridge of the newly erupted
incisors.
3. Marginal ridges are located on mesial and distal borders of the lingual surface and are in
vertical plane.
4. Incisors have thin blade-like crown, La-Li dimension is less than in any other class of tooth.
5. Contact points are small and more incisally placed.
MAXILLARY CENTRAL INCISOR

PALMER NOTATION
1 1
ODONTOMETRIC DATA
On distal 2.5 mm
Fig. 25.11: Labial aspect Fig. 25.12: Lingual aspect

360 DADH Made Easy
Fig. 25.13: Proximal aspect Fig. 25.14: Incisal aspect
STEPS FOR CARVING

STEP 1a
THIS PREPARATION OF THE BLOCK REMAINS SAME FOR ALL TEETH (Fig. 25.15)
For Measurements, Refer the Chart on page 353
• Prepare the standard size wax block for carving by making it smooth with the straight part
of the blade. Rub it with a piece of gauze.
• Divide the wax block into three parts by marking two lines
for crown length and root length as in the Fig. 25.15.
• Extend the two lines on all the four surfaces.
• The block is divided into 3 parts crown, root and base.
• Mark initials on all four surfaces on base part: (Fig. 25.15)
B/L – Buccal/Labial
Li – Lingual or P – Palatal
M – Mesial
D – Distal
• Draw a vertical midline on all the surfaces of the crown and Fig. 25.15
root part of the block.
STEP 1b
For maxillary central incisor make the block of length 24 mm,
and top surface square of each side 10 mm. So that the block is
centered over the base (Fig. 25.16).
STEP 2
Divide incisal surface (top square) into two equal halves by a
single ‘line 2’ (midline) mesiodistally Draw two more lines on
either side of the midline, line 1 and line 3 at a distance of 1 mm
each from the midline to get a thick incisal ridge.
• Purpose of dividing incisal aspect into two equal parts is not
to cross that line while carving the labial surface convex,
because incisal ridge of the maxillary central incisor is Fig. 25.16
centered over the root and it is 1.5 to 2 mm thick (Fig. 25.17).
Fig. 25.17
STEP 3
THIS STEP IS COMMON TO ALL ANTERIOR TEETH
Carving of Labial Surface
Carve the labial surface to create convexity. Convexity is more in
cervical third and tends to be less towards the incisal third.
Method
Divide the labial surface of the crown into three parts (Fig. 25.18).
1. Incisal third
2. Middle third
3. Cervical third
Fig. 25.18
• Hold the carver above the cervical third and move it towards
incisal ridge in upward direction and remove wax till the marked line 1 (Fig. 25.19).
Fig. 25.19
Proximal View (Fig. 25.20)

• After carving convexity in middle and incisal third merge the incisal two-thirds with cervical
third.
362 DADH Made Easy
Fig. 25.20
STEP 4
Carving of lingual surface
Method
Divide lingual surface of the crown into three parts (Fig. 25.21):
1. Incisal third
2. Middle third
3. Cervical third.
Fig. 25.21
• Hold the carver above cervical third, in the middle third and move it up and down to create
concavity. Then move it in upward direction in incisal third till line 3. This will create
lingual fossa (Fig. 25.22).
• Since the wax is not removed from the cervical third area it can be modified into cingulum
by narrowing and rounding it.
• Remove irregularities and sharp angles from cingulum area.
Fig. 25.22
Proximal View: (Fig. 25.23)
Fig. 25.23
STEP 5
THIS STEP IS COMMON TO ALL THE ANTERIOR TEETH
Giving Cervical Constriction to the Crown (Fig. 25.24)
• Give MD constriction on labial and lingual surface of the crown.
• This is done by removing wax in the cervical third of the crown on the mesial and distal
surfaces as per dimensions.
• After this is done, taper the root from cervix to apex so that at
cervix, crown and root are in same plane (refer Fig. 25.24).
• Make the markings on the block as shown in Fig. 25.24
• Make sure that wax is removed till the marked lines so that from
cervical third of the crown to the apex of the root, the M and D
surfaces are in same plane.
• This step will give constriction to the crown (from labial and lingual
view) and will also show gross carving of the root.
• Since the crown and root are more narrower towards the lingual
side, remove more wax on M and D surfaces towards lingual side.
• Once again mark the crown length, cervical line curvature on all Fig. 25.24
four surfaces.
364 DADH Made Easy
STEP 5a
Finishing Labial Surface
• At this step complete the carving of the crown by finishing the labial surface with the M
and D outlines, and the appropriate dimension of the crown at contact point and at cervix
and carving the MIA and DIA.
• Make both mesial and distal angle sharp 90°. Then rub the DI with index finger to make it
rounded (Fig. 25.25).
Fig. 25.25
STEP 6a
Reduction of La-Li Dimension
• Grossly the labial and lingual surfaces have been carved. Now to reduce the
labiolingual dimension remove wax from base of the root upwards towards
the cingulum on the lingual surface and towards the cervical third of the crown
on the labial surface till the demension is 7.5 to 8 mm in the cervical third of
the crown is created (Fig. 25.26).
Fig. 25.26
STEP 6b
Lingual Carving of Fossa, Incisal and Marginal Ridges
• Draw the ‘V’ or ‘W’ shaped outline for fossa on the incisal two-thirds of the lingual surface
by keeping 1 mm space on both sides for the M and D marginal ridges.
Fig. 25.27
• Remove wax within the marked ‘W’ shape with the carver’s opposite end. (scoop)
Fig. 25.28
• While making the lingual fossa deep, keep some space mesially, distally as well as incisally
so as to make—mesial and distal marginal ridges and incisal ridge more prominent.
Fig. 25.29
STEP 7
Marking of Cervical Line and Finishing
• Cervical line is more convex on mesial surface.
• By keeping morphology in mind finish the carving.
• Measure the dimensions of the finished curving.
– Check labiolingual dimension if bulky reduce it from labial surface mainly by keeping
the surface convexity proper and reduce lingual surface slightly without reducing the
prominence of the cingulum.
– Check mesiodistal width. If it is more reduce it from mesial and distal sides
Fig. 25.30
366 DADH Made Easy
• Finish cervical area.

• Finish lingual surface.
• Check the convexities of labial surface and cingulum from mesial, distal, incisal and labial aspect.
• Using gauze piece remove roughness on the carving.
• Polish with cotton dipped in soap water without pressure to achieve mirror
like polish.
STEP 8
Carving of Root
In step 5 the gross carving of root was done. Carve it further in proportion to the
crown. So that the root is conical, gradually tapering from cervix to apex
(Fig. 25.31).
While carving root or while polishing hold the carving at the neck (cervix)
Fig. 25.31
with the index finger and thumb so that it does not break.
MAXILLARY LATERAL INCISOR
PALMER NOTATION
2 2
ODONTOMETRIC DATA
On distal 2.0 mm
Fig. 25.32: Labial aspect Fig. 25.33: Lingual aspect

CARVING
The method for carving maxillary lateral incisor is same as that of central incisor except for the
size and few differences.
• Labial surface is more convex mesiodistally and incisogingivally than central incisor
(Fig. 25.36).
Fig. 25.36
• Mesial and distal marginal ridges and cingulum are relatively more prominent than central
incisor.
• Lingual fossa is deeper and usually ‘V’ shaped.
• Lingual pit near the center is common finding in lateral than central incisor (Fig. 25.37).
Fig. 25.37
368 DADH Made Easy
MANDIBULAR INCISORS
MANDIBULAR CENTRAL INCISORS MANDIBULAR LATERAL INCISORS

Palmer Notation Palmer Notation
1 1 2 2
ODONTOMETRIC DATA ODONTOMETRIC DATA
Length of crown 9.0 mm Length of crown 9.5 mm
Length of root 12.5 mm Length of root 14.0 mm
Mesiodistal width of crown 5.0 mm Mesiodistal width of crown 5.5 mm
Mesiodistal width of crown at cervix 3.5 mm Mesiodistal width of crown at cervix 4.0 mm
Labiolingual width of crown 6.0 mm Labiolingual width of crown 6.5 mm
Labiolingual width at cervix 5.3 mm Labiolingual width at cervix 5.8 mm
Curvature of cervical line on mesial 3.0 mm Curvature of cervical line on mesial 3.0 mm
On distal 2.0 mm On distal 2.0 mm
Fig. 25.38: Labial aspect Fig. 25.40: Proximal aspect
Fig. 25.39: Lingual aspect Fig. 25.41: Incisal aspect

CARVING OF MANDIBULAR INCISORS

• Method remains same as maxillary incisors except that the demensions are smaller.
• Incisal ridge (from proximal view) is little lingual to the root axis.
• Roots are flatter mesiodistally you can feel the flatness with your finger and thumb.
• From proximal view both crown and root are wider labiolingually than mesiodistally.
• In maxillary incisors we have reduced the block above the base to 10 mm square on
top.
• In mandibular incisor reduce it from all four sides (after marking) so as to get the top surface
as square of each side measuring 7 mm.
• Step 2 is different from that of maxillary incisor because the incisal ridge is thin, it is not
centered it is slightly lingually placed.
• Since the crown and root are thin, while carving and polishing take care that the root does
not break from the base.
Hold the block (carving) at the cervix and not at the base.
• M and D root surfaces of both incisors have root depressions.
370 DADH Made Easy
CANINES
CLASS TRAITS
• Canine has a single pointed cusp.
Incisal ridge of canine is divided into two inclines or slopes by a cusp as opposed to a straight
ridge in incisors and therefore gives crown a pentagon shape. The mesial slope is shorter than
the distal slope. Canines usually do not have mamelons but have notch on either cusp slope.
• It has a single long, and strong root.
• Canine is the only anterior tooth having labial surface prominently convex in the form of
vertical labial ridge.
• Canine is the longest tooth in the mouth.
• Maxillary canine has a functional lingual surface.
CARVING OF MAXILLARY CANINE

PALMER NOTATION
3 3
ODONTOMETRIC DATA
On distal 1.5 mm
Fig. 25.46 : Labial aspect Fig. 25.47: Lingual aspect

STEPS FOR CARVING
STEP 1
THIS STEP IS COMMON TO CANINE, PREMOLAR, AND MOLAR
• Prepare the wax block and divide the wax block in three parts—crown, root, and base.
• Mark initials of each surface as labial, lingual, mesial and distal.
• Each cusp has 4 inclined planes (IP). 2 IP on B/P/la surface and 2 IP on li/occlusal surface
(Fig. 1.8 page 8).
• A cusp can be carved by making a hut-shape that is making two inclined lines meeting at
a point and removing wax along the inclines.
STEP 2 (Fig. 25.50 and 25.51)

• Divide and mark the labial surface of the crown into three parts incisal, middle, and cervical
third.
• Divide and mark the incisal/top surface into two halves M and D.
Fig. 25.50 Fig. 25.51
STEP 3
Carving hut shape: (Marking two inclines for the incisal ridge) Fig. 25.52.
On the labial and lingual surface, in the incisal one-third make hut-shaped outline for carving
the slopes of the cusp.
372 DADH Made Easy
Fig. 25.52
• In maxillary canine mesial slope is shorter than distal slope. Cusp tip is centered.
• Remove wax along the hut-shape (Fig. 25.53 and 25.54), i.e. along the mesial and distal
slopes of the hut-shape, both towards labial and lingual surfaces.
Fig. 25.53 Fig. 25.54
STEP 4
Give cervical constriction to the crown on both labial and lingual surface
by carving out wax from mesial and distal surfaces, only in the cervical
third (Fig. 25.55).
• Method for giving constriction is same as Step 5 in maxillary central
incisor including gross carving of root (page 363, Fig. 25.24).
STEP 5
Carving of Labial Surface Fig. 25.55
Make the labial surface convex so that crest of
curvature on labial surface is in cervical third.
Method
1. Before making surfaces convex divide
incisal surface, (top surface) into two parts
labial and lingual by drawing a midline.
Draw two more lines on either side of the
midline as in maxillary central incisor to get
thick (prominent) cusp tip and cusp ridges
(Fig. 25.56). Fig. 25.56
• Purpose of making the midline is, not to cross this line while making labial surface
convexity so that the incisal ridge is in the center of the crown, and it is thick when
viewed from proximal aspect.
Carving of labial surface is similar to that of central incisor except that along with
making convexity in the cervical third, labial ridge and its inclined planes also need to be carved.
2. Divide the labial surface into 3 parts, incisal, middle, and cervical thirds.
From the cusp tip to the cervical line draw a midline to carve 1 mm thick labial ridge (Fig. 25.57).
While carving the labial surface carve only the incisal two-thirds of the labial surface of
the crown on either side of the labial ridge.
This step will give you a very prominent labial ridge and 2 inclined planes on either side
of it.
Fig. 25.57
• Merge the incisal two-thirds and the cervical third make the labial ridge less prominent
in the incisal third, then merge it with cervical third.
3. When viewed from proximal, the labial ridge is less prominent in incisal third, more
prominent in middle third and then merges with cervical third. You can see the height of
contour in the cervical third (Fig. 25.58).
Fig. 25.58
4. Make mesioincisal sharp and distoincisal angles slightly rounded.

Make the distal slope longer so that it extends to middle third of
the labial surface and make distoincisal angle more rounded
(Fig. 25.59).
Fig. 25.59
374 DADH Made Easy
STEP 6
Carving of Lingual Fossa
Method
1. Divide the lingual/palatal surface in three parts: (Figs 25.60A and B)
a. Incisal third
b. Middle third
c. Cervical third
Fig. 25.60A Fig. 25.60B
2. Define cervical constriction on lingual side from M and D (Fig. 25.61).
Fig. 25.61
3. After giving constrictions on lingual surface, carve out shallow concavity (as in central
incisor) above the cervical line in the middle-third till the line 3 on the incisal surface (26.60B)
so that when you view the crown from proximal apect, it has S-shape (Fig. 25.62).
Fig. 25.62
This is gross reduction of lingual surface to make concavity.

Make this concavity in such a way that labial and lingual cusp tips and cusp ridges come
closer and thickness of 1 mm is maintained (Fig. 25.60b).
At this step give roundedness to the cingulum as in maxillary central incisor.
• Before carving lingual fossae and lingual ridge further, reduce the labiolingual dimension
maintaining the height of contour and proper measurements.
• Reduce the MD dimension as per the required measurement by reducing the M border of
the crown by moving the carver from cervix to the sharp mesioincisal angle (MIA). Reduce
the D border by moving the carver from rounded distoincisal angle (DIA) to the cervix.
• At this step carve the root on M and D so that at cervix both crown and root are in same
plane. Gross carving of root is already done in step 4.
• Carve crown and root both more narrow towards lingual.
Carving of Lingual Fossae

• Finally, make two lingual fossae into the concavity already made in the
incisal two-thirds of the lingual surface.
• Now for making the two lingual fossae, two marginal ridges and one lingual
ridge (Fig. 25.63):
– Mark one line each parallel to M and D cusp slopes at a distance of 1 mm
from the cusp line.
– Mark 1 line each parallel to M and D marginal borders at a distance of
1 mm from the borders. Fig. 25.63
– Mark 2 parallel lines 1 mm apart from cusp tip to the cingulum as in Fig. 25.63.
• Remove the wax within the markings with the help of short curved blade or scoop, moving
the carver parallel to the lines.
• Rub the fossa with gauze piece, you get 2 shallow lingual fossae.
• Next step is rounding off the cingulum.
• Define the lingual surface. M and D marginal ridges and cusp ridges are raised and are 1 mm
thick above the two lingual fossae.
• Carve the lingual ridge in such a way that when viewed proximally it is S-shaped. At cusp
tip and incisal third it is raised/thick, in the middle third it is little concave and in the
cervical third it merges with cingulum.
Check the measurements.
Carve the cervical line with the tip and short curved blade of the carver (Fig. 25.64).
Fig. 25.64
376 DADH Made Easy
Complete the Carving of Root

In step 4 and 6, gross carving of root is done. Shape the root further in proportion to the
crown. Tapering from cervix to apex.
CARVING OF MANDIBULAR CANINE

PALMER NOTATION
3 3
ODONTOMETRIC DATA
On distal 1.0 mm

The points to be noted during the carving of mandibular canine.

• While making hut-shape make the two slopes less inclined and make obtuse angle.
• Keep the crown length longer.
• MD width of crown is less.
• Constriction at cervix is less.
M and D borders of the crown are more or less parallel.
• Mesial border of the crown and root are in same plane.
• Lingual ridge, lingual fossa less prominent. Cingulum less prominent and distally placed.
• Lingual inclination of the cusp ridge (as in mandibular incisors).
• Root ends in a pointed apex.
378 DADH Made Easy
PREMOLARS
CLASS TRAITS
Premolars have a single buccal cusp.
They usually have two cusps one buccal and one lingual and are called bicuspids but the
term is a misnomer because mandibular second premolars may have 3 cusps.
They may have one or two roots.
CARVING OF MAXILLARY PREMOLARS

MAXILLARY FIRST PREMOLAR MAXILLARY SECOND PREMOLAR
4 4 5 5

Mesiodistal width of crown 7.0 mm Mesiodistal diameter of crown 7.0 mm
Mesiodistal width of crown at cervix 5.0 mm Mesiodistal diameter of crown at cervix 5.0 mm
Fig. 25.69: Buccal aspect Fig. 25.71: Proximal surface
Fig. 25.70: Palatal aspect Fig. 25.72: Occlusal outline

Fig. 25.73: Buccal aspect Fig. 25.75: Proximal surface
Fig. 25.76: Occlusal outline

Fig. 25.74: Palatal aspect
Steps for Carving

STEP 1
Preparation of Wax Block
1. Prepare the wax block as described earlier.
2. Divide wax block in three parts.
3. Mark initials on each surface as M, D, B, and palatal (P).
STEP 2
Divide buccal surface of crown into three parts: (Fig. 25.77)
1. Occlusal third
2. Middle third
3. Cervical third
Fig. 25.77
380 DADH Made Easy
STEP 3
Carve the occlusal surface inclined from buccal to palatal (about 1 mm) and carve it narrow
from B to P also.
Proximal view: (Figs 25.78A and B)
Fig. 25.78A Fig. 25.78B
Occlusal View
Reduce the crown from B to P mesiodistally to narrow it towards palatal (Figs 25.79A
and B).
Fig. 25.79A
Fig. 25.79B
STEP 4
Making Inclines on Occlusal Surface
• Mark hut-shape, 2 inclines in the occlusal third of buccal surface and palatal surface
(Figs 25.80A and B).
Fig. 25.80A Fig. 25.80B
• On the occlusal surface, carve along the marked inclined lines from B to P. So as to get two
inclined planes (Fig. 25.81).
Fig. 25.81
STEP 5
Carving of Mesiodistal Constrictions
On buccal surface and palatal surface in the cervical third give constriction as in canine.
So the crown is wider occlusally and narrower cervically (Fig. 25.82).
Towards palatal side give more constriction.
Fig. 25.82
382 DADH Made Easy
STEP 6
Carving of Buccal and Palatal Surfaces
Method
• Before making surfaces convex divide the occlusal surface into two parts by a midline (c) and
then each half into 2 parts.
• On occlusal surface draw two more lines.
Mark line ‘a’ 1 mm from B cusp tip and line ‘b’ 1 mm from P cusp tip. Remaining part
between line a and b is for carving occlusal table (Fig. 25.83).
Purpose of marking these lines is to give convexities and not to cross these lines while
removing the wax from buccal and palatal surfaces.
Fig. 25.83
• Carve the buccal surface as you have carved the labial surface of canine but till line 'a'
(only) on the occlusal surface for the buccal convexity. So as to give convexity on the buccal
surface in cervical third. Carve on both the sides of the buccal ridge (Fig. 25.84).
Fig. 25.84
• By using same method, remove wax from occlusal half of palatal surface till line b on occlusal
surface (Fig. 25.85).
Fig. 25.85
• Since the height of contour on palatal surface is in the middle of the palatal surface, remove
little wax from mid of palatal surface to the cervical line.
• Then merge occlusal and cervical half and make the palatal cusp spheroidal.
STEP 7
• Before carving of occlusal surface, check all the dimensions. (Including MD dimension at
contact area, cervix, tapering of crown at cervix, and root at apex).
• Mark the cervical line and check the length of the root.
– Carve the M and D surfaces of the root from cervix to the apex in the same plane .
– Now rub the entire block with the gauze piece.
– The carving will appear as in Fig. 25.86.
Fig. 25.86
STEP 8
Carving of Occlusal Surface
Redefine the occlusal surface, divide into two equal parts.
Before starting the inclined planes on the occlusal surface mark the outlines for triangular
fossa on both mesial and distal side and the central groove (CG) dividing the buccal and
palatal halves (Fig. 25.87).
Fig. 25.87
• On either side of the central groove (CG) at shaded areas remove 1 mm wax towards groove
(make a V-shaped notch).
• The inclined planes are planes that incline from cusp tip, cusp ridges, and triangular ridges
to the triangular fossa marking and to the central groove marking.
384 DADH Made Easy
• The 2 triangular ridges which form the transverse ridge also incline from cusp tip to the
central groove and they are continuous (Fig. 25.88).
• As shown in Fig. 25.88 remove wax along the inclined planes.
• While carving stop at the markings so as to get prominent triangular grooves and the central
groove (CG).
• In the marked triangular area remove the wax with the small part of the tip of the carver or
scoop to make a triangular fossae MTF and DTF.
Fig. 25.88: Occlusal view
While carving inclined planes carve more towards

the central groove so as to get prominent triangular
ridges which incline towards the central groove from
the cusp tips as in Fig. 25.89.
Carving fine Details: (Figs 25.90 and 25.91)

1. Make triangular fossa, pits and groove pattern more
defined.
2. Mesial marginal groove: It is characteristic feature
in maxillary first premolar that extends from mesial Fig. 25.89: Proximal view
pit crosses the mesial marginal ridge and reaches onto
the mesial surface.
Fig. 25.90 Fig. 25.91

3. Carving of canine fossa on the mesial surface, above the cervical line. Scoop out little wax
from marked area (Fig. 25.92).
Fig. 25.92: Mesial view
CARVING OF ROOT
• In step 7 we have already done gross carving of root.
• On the proximal surface of the root mark the two curved lines from mid of the root to the
apex as shown in Fig. 25.93.
• Remove wax from the shaded part on both M and D surfaces. When the carver passes
through and through, clean up the empty area, smooth the margins.
• To clean up pass the rolled up corner of the gauze piece.
• Be gentle, be focused, do not break the root.
Fig. 25.93
Maxillary Second Premolar

The carving of maxillary second premolar is same as that of maxillary first premolar except
for a few differences:
• Both the buccal and lingual cusps are at same height.
• Occlusal surface outline is ovoid.
• Buccal cusp is less sharp.
• The root is single.
386 DADH Made Easy
CARVING OF MANDIBULAR PREMOLARS
MANDIBULAR FIRST PREMOLAR MANDIBULAR SECOND PREMOLAR

4 4 5 5

Mesiodistal width of crown 7.0 mm Mesiodistal width of crown 7.0 mm
Mesiodistal width of crown at cervix 5.0 mm Mesiodistal width of crown at cervix 5.0 mm
MADIBULAR FIRST PREMOLAR
Fig. 25.95: Lingual aspect Fig. 25.97: Occlusal aspect

MANDIBULAR SECOND PREMOLAR
Fig. 25.98: Labial aspect

Fig. 25.100: Proximal aspect
Fig. 25.99: Lingual aspect
MLG = Mesiolingual groove

BTR = Buccaltriangular ridge B
DBDG = Distobuccal developmental groove
MBDG = Mesiobuccal DG groove
MLDG = Mesolingual DG
MG = Mesial groove
DG = Distal groove
CP = Central pit
C
Fig. 25.101: Occlusal aspect
STEPS FOR CARVING OF MANDIBULAR FIRST PREMOLAR
STEP 1
First, carve the occlusal surface. From buccal to lingual make a slope also make the lingual
side narrower (Fig. 25.102) (same as in maxillary first premolar).
388 DADH Made Easy
Fig. 25.102
STEP 2
Divide buccal surface into three parts (Fig. 25.103).
Fig. 25.103
Mark hut-shaped outline in occlusal third on buccal surface (Fig. 25.104). Carve along the
hut-shape, give cervical constriction. (Steps are same as in other premolars.)
Fig. 25.104
STEP 3
For Carving Buccal Surface
• Divide the occlusal surface into 2 parts by marking a midline.
• Carve out the buccal surface in the occlusal two-thirds on either side of the buccal ridge till
you reach the midline on the occlusal surface (Fig. 25.105). The result is, the occlusal two-
thirds of the buccal surface is inclined towards lingual. You can see the buccal ridge along
with both inclined planes (IP) and the buccal cusp tip, the M and D cusp slopes in the centre
of occlusal surface (Figs 25.106 and 107).
Fig. 25.105
Fig. 25.106 Fig. 25.107
• Define all the above features.

• Now, redefine cervical constriction on the buccal surface by reducing wax from the
mesioincisal angle to the cervix and distoincisal angle (MIA and DIA) to the cervix. While
giving constriction to the crown grossly carve the root, thus making it taper from cervix to
apex (Fig. 25.108).
Fig. 25.108
STEP 4
Occlusal Surface
Occlusal surface has pentagon shape with mesial and distal cusp ridges, M and D borders and
one narrow and rounded lingual side (Fig. 25.109).
390 DADH Made Easy
Fig. 25.109
• Now, divide the occlusal surface into 2 unequal parts the buccal two-thirds and lingual
one-third and mark the triangular fossa (Fig. 25.110).
Fig. 25.110
• In the buccal two-thirds part carve two inclined planes on either side of the long prominent
buccal triangular ridge (BTR) as you have carved in maxillary first premolar while doing so
define the triangular fossae, marginal ridges, mesial, and distal pits.
• On the remaining one-third of the occlusal surface carve the lingual cusp tip with short and
straight lingual triangular ridge and the cusp slopes and inclined planes.
• Mark the mesiolingual groove (MLG) from the mesial pit on to the lingual surface
(Fig. 25.111).
Fig. 25.111
STEP 5
Lingual Surface
• Carve the lingual surface spheroidal as you have carved for maxillary first premolar. Make
the lingual cusp tip pointed.
• Define the MLG by carving both from mesial and lingual surface towards the groove.
• Define all the features. In mandibular first premolar the MMR is not horizontal, it is inclined
and parallel to the buccal triangular ridge, therefore carve to make it inclined.
• Complete the root carving as done in other teeth.
• Carve the MMR inclined so that it is parallel to the long prominent buccal triangular ridge.
• Distal marginal ridge is horizontal and more occlusal.
• Complete the root as described before.
CARVING OF MANDIBULAR SECOND PREMOLAR

Buccal cusp of mandibular second premolar has less inclination towards lingual as compared
to mandibular first premolar.
Based on groove pattern there are three types of occlusal surfaces in mandibular second
premolar.
• In 3-cusp type premolar the groove pattern is Y-shaped.
– Occlusal outline is more or less square.
– There is one buccal cusp which is largest. There are two lingual cusps the mesiolingual
cusp is larger than distolingual cusp.
Buccal cusp highest, next high is ML and shortest is DL but difference in height is not
much, ML and DL are separated by lingual groove (LG).
• In 2-cusp type premolar the groove pattern is U and H type.
The lingual cusp is slightly narrower and shorter than the buccal cusp.
• In U-type groove: The central groove forms crescent shape along with mesiobuccal
developmental groove (MBDG) and distobuccal developmental groove (DBDG).
• In H-type groove: The central groove is short and forms H-shape along with MBDG and
mesiolingual developmental groove (MLDG) and DBDG and distolingual developmental
groove (DLDG).
Steps for carving Y-shaped Mandibular Second Premolar
STEP 1
Reduce the block on all sides by 2 mm.
STEP 2
Occlusal Surface
Divide the block on the occlusal surface into two equal parts
(Fig. 25.112) by marking the midline.
Do not narrow or slope the block from buccal to lingual.
Divide the buccal half of the occlusal surface into 2 equal parts by Fig. 25.112: Occlusal
marking line 1 (Fig. 25.113). Mark line 2 on lingual half. view
392 DADH Made Easy
Fig. 25.113: Occlusal surface
STEP 3
Buccal Surface
Make hut-shape on the buccal surface and carve along the inclines and give height of contour
by removing wax from the occlusal two-thirds of the buccal surface till the line 1. Complete
the buccal surface carving along with root as done in other premolars (Fig. 25.114).
STEP 4
Lingual Surface (Fig. 25.115)
Extend the line 2 on to the lingual surface.
Draw two huts on either side of the line.
Carve along the slopes of the hut. Extend the IP
on the L half of occlusal surface.
The lingual surface has 2 cusps one lingual
groove, two lingual ridges, four inclined planes
and height of contour in the middle of the crown,
carve inclined planes and height of contour as
in other premolars.
Constrict the crown in the cervical third and
extend this on the root. This step is also same as
other teeth.
Fig. 25.115
STEP 5
Buccal Half of Occlusal Surface
Mark the triangular fossae and carve buccal cusp along with triangular-ridges and incline
planes as carved in other premolars (Fig. 25.116).
Fig. 25.116
STEP 6
Lingual Half of the Occlusal Surface (Fig. 25.117A)
Carve out the two lingual cusps along with 2 lingual triangular ridges, 4 inclined planes and
lingual groove (LG) as you have carved individual cusps in other premolars.
• Define the triangular fossae, M and D pits.
• Define the midline to form 2 grooves. One longer mesial developmental groove (MG) from
central pit to MTF and shorter DG from central pit to DTF.
• Redefine the LG
• The 3 grooves together form the Y-type groove pattern (Fig. 25.117A).
• U, H and Y type groove pattern (Fig. 25.117B).
Fig. 25.117A
Fig. 25.117B
394 DADH Made Easy
MOLARS
CLASS TRAITS
• Molars are largest and strongest teeth.
• They have the largest occlusal surface of all the teeth.
• They are the only teeth having two buccal cusps (more than one)
• They have three to five cusps.
• They have two to three roots.
MAXILLARY FIRST MOLAR MAXILLARY SECOND MOLAR
6 6 7 7

Length of root—buccal root 12.0 mm Length of root—buccal root 11.0 mm
Length of root—palatal root 13.0 mm Length of root—palatal root 12.0 mm
Mesiodistal diameter of crown 10.0 mm Mesiodistal diameter of crown 9.0 mm
Mesiodistal diameter of crown at cervix 8.0 mm Mesiodistal diameter of crown at cervix 7.0 mm
Buccopalatal diameter of crown 11.0 mm Bucco-palatal diameter of crown 11.0 mm
Buccopalatal diameter at cervix 10.0 mm Bucco-palatal diameter at cervix 10.0 mm
MAXILLARY FIRST MOLAR

Fig. 25.118: Buccal aspect
Fig. 25.119: Palatal aspect Fig. 25.121: Occlusal aspect

MAXILLARY SECOND MOLAR

Fig. 25.122: Buccal aspect
Fig. 25.123: Palatal aspect Fig. 25.125A and B: Occlusal aspect
STEPS OF CARVING OF MAXILLARY MOLARS
STEP 1
• Do not reduce the block.
• Divide the block into crown, root, and base.
• Mark M, D, B and P on the base.
• Make sure that BP dimension is more than
MD dimension (Occlusal view).
• Start with occlusal aspect.
• The occlusal outline of permanent first molar
is rhomboid so make the mesiobuccal and
distopalatal angles acute and distobuccal
and mesiopalatal angles obtuse (Fig. 25.126).
• Divide the occlusal surface into two equal
halves by a line ‘C’. Fig. 25.126
396 DADH Made Easy
STEP 2
• Divide buccal side of occlusal surface into 2 equal parts by a line ‘2’ to get mesiobuccal and
distobuccal parts (Fig. 25.127).
• Divide palatal side into 2 unequal parts by a line ‘1’ to get mesiopalatal—larger and
distopalatal—smaller parts (Fig. 25.127).
Fig. 25.127
STEP 3 AND STEP 4

STEP 3 and STEP 4 are for gross carving of B, P, O, surfaces
and giving constriction.
Divide the buccal and palatal surface of crown into three parts
(Fig. 25.128):
1. Occlusal third
2. Middle third
3. Cervical third
In the cervical third give constriction, i.e. in the cervical
third of M and D surfaces remove wax (towards both B and
P surfaces) (Figs 25.129A and 25.129B).
(Method is same as in premolar.) Fig. 25.128
A B
Figs 25.129A and B
STEP 4
Extend the lines 1 and 2 (which are on occlusal surface) onto the mid of palatal and buccal
surfaces. Draw 2 hut shapes on either side of the extended lines on palatal and buccal surfaces.
• Remove wax along the hut shape on the occlusal surface till line ‘C’ (Fig. 25.127).
This gives gross carving of inclines of 2 buccal and 2 patal cusps. (Cusp inclines on occlusal
as well as buccal surfaces and palatal surfaces.)
STEP 5
Buccal Surface
• On the buccal surface of the crown as in Fig. 25.129A, carve along the inclines of the two
huts, only in occlusal two-thirds, (as you have carved the buccal ridge and inclines), in
premolar so as to get 2 buccal ridges of 2 buccal cusps and buccal groove (BG).
• In the cervical third, remove little wax towards the cervical line and then merge the cervical
third with the occlusal two-thirds so as to get the height of contour in cervical third.
STEP 6
Palatal Surface
• On the palatal surface as in Fig. 25.129B carve along the inclines of two huts in occlusal half
so as to get 2 palatal ridges and the palatal groove.
• In the cervical half remove some wax towards cervical line and then merge it with occlusal
half to get height of contour in the middle of the palatal surface.
2 mm cervical to the MP cusp ridge carve a curved depression with the pointed tip of the
carver to make the cusp of carabelli.
STEP 7
Occlusal Surface
• Once again make sure that BP > MD and outline of the occlusal surface is rhomboid with
MP angle and DB angle being rounded/obtuse and MB and DP angle being acute. The
largest cusp is MP and smallest is DP.
• You have already divided the occlusal surface into 4 parts. Gross carving of 4 cusps and
ridges is done. Now, redefine the lines 1 and 2 as shown in Fig. 25.130. Read the labelling.
• Extend the line 2 into the MP cusp for 1 mm as line ‘S’. Mark the M and D triangular pits
and fossae (Figs 25.130 and 25.131).
While carving the triangular ridge (TR) and inclined planes (IP) of each cusp move the
carver from the ridge to the depression (groove), along the cusp slopes in doing so the
groove and the ridge get defined (Fig. 25.131).
• First carve the DP cusp which has one straight triangular ridge (TRDP), and two inclined
planes IP (Fig. 25.131). While defining the IP, define the DOG or linear groove (Fig. 25.130).
Then carve the MB cusp which also has a straight triangular ridge TRMB with two inclines.
• Now carve the DB cusp in such a way that its triangular ridge (TRDB) runs little mesially.
• Define both triangular fossae and pits:
• We have already carved the triangular ridges of MB, DB and DP cusps, M and D triangular
fossae (TF).
• MP cusp is largest. It has two triangular ridges (TR) separated by ‘Stuart groove’ (SG).
398 DADH Made Easy
MP mesiopalatal cusp
DP distopalatal cusp
MB mesiobuccal cusp
DB distobuccal cusp
Pits:
Mesial (M), Central pits (C), distal pits (D)
Line 2 is Buccal groove BG
Line 5 is Stuart groove SG ‘S’
Central groove CG
Triangular grooves TG
Line 1 is Linear groove or DOG distal oblique groove
or transverse groove
Fossa:
Mesial and distal triangular fossae MTF, DTF
Fig. 25.130: Cusps, grooves, pits
Inclined plane IP
Triangular ridge TR
Triangular ridge of DP cusp TRDP
Triangular ridge of DB cusp TRDB
Triangular ridge of MB cusp TRMB
Mesial TR of MP cusp MTRMP
Distal TR of MP cusp DTR MP
MTRMP + TRMB = Transverse Ridge
DTRMP + TRDB = Oblique ridge = OR
Fig. 25.131: Ridges
• The two triangular ridges are the mesial TR of MP cusp and the distal TR of the MP cusp
(MTRMP and DTRMP).
• The MTRMP joins the TRMB cusp to form ‘transverse ridge’ and the DTRMP joins the TR of
DB cusp to form the oblique ridge.
STEP 8 (Fig. 25.131)

Carve the Transverse and Oblique Ridge
• To carve the transverse ridge, extend the TR and the IP of the MB cusp into the MP cusp for
about 1 mm.
• Define the Stuart groove.
• Extend the inclined planes of the DB cusp in the mesial direction into the MP cusp for about
1 mm to form the oblique ridge. While defining the IP of oblique ridge define the DOG.
• Define the OR, the Stuart groove and the distal oblique groove.
• Carve out the remaining part of the MP cusp.
• Grossly the occlusal surface is carved.
• See the Figs 25.130 and 25.131 and define the central groove, M, D and C pits, buccal and palatal
groove, carve out the M and D triangular fossae keeping the M and D marginal ridges intact.
• Define the central groove by carving on both buccal and palatal side of it so that the TR and
OR are inclined towards the CG.
• On the palatal surface of MP cusp, 1 mm below the MP cusp carve out a curved line to make
the cusp of carabelli (Fig. 25.129B).
OR
Carve the oblique ridge by joining triangular ridge of DB cusp and the distal cusp ridge of
MP cusp TRDB + DCRMP, as given in other texts (refer Fig. 25.132) (No Stuart groove).
ROOT CARVING
STEP 1
Make roughly triangular outline of root before making furcation by:
• Make the root wider mesiodistally and narrower palatally. Mark the shape of the root as
follows and remove wax from shaded area.
• Mark, the outline of the buccal roots on the buccal surface (Figs 25.133A and B).
• Mark outline of palatal root on the palatal surface (Fig. 25.134).
Mark the mesial and distal root (Figs 25.135 and 2.136).
• As palatal root is flaring buccopalatal width is more.
Remove the remaining wax other than the marked outline form of root from buccal and
palatal surface. (Remove wax from shaded area.)
• By using above method we can carve the outer outline form of root.
Figs 25.133A and B

400 DADH Made Easy
Fig. 25.134
• After carving outer root outline on the buccal and palatal surfaces, mark outline of the
individual root on the buccal, mesial and distal surface respectively. So as to carve the
bifurcation on each surface (i.e. buccal, mesial and distal) (Figs 25.137– 25.139).
Remove wax from shaded area on B, M and D surface.
Fig. 25.135 Fig. 25.136

• Continue mesial and distal bifurcation with the buccal bifurcation.
– Remove all irregularities from carved bifurcated area.
– Roots should be rounded and tapering towards apex.
– Polish the roots with dry cotton first and then with cotton dipped in soap water.
Fig. 25.137 Fig. 25.138 Fig. 25.139


Maxillary second molar resembles the first molar except a few differences. Steps for carving
remain same except for the occlusal surface.
Start with the occlusal surface.
Rhomboid Occlusal Surface

• BP dimension is same as that of first molar. MD dimension is 1 mm less.
• The occlusal outline is sharply rhomboid.
• MB angle is more acute. MB cusp is larger than DB cusp.
• DP angle is more acute and DP cusp is much smaller than MP cusp.
• There is no cusp of carabelli.
• Roots are not divergent.
All steps are same as that of the first molar.
Heart-shaped Occlusal Surface

• See to it that MD dimension is less than BP dimension.
• DP cusp is absent.
• MP cusp is the largest cusp.
• MB cusp is wider and longer than DB cusp.
• To make the occlusal outline heart-shaped.
• Divide the occlusal surface into 2 equal parts.
• Divide the Buccal of occlusal into 2 unequal parts and carve the 2 buccal cusps. All the steps
for carving buccal surface and occlusal part of buccal surface are same as for first M.
• MP angle make more obtuse, DB make less obtuse.
• Mark the MP cusp on the occlusal surface (Fig. 25.140).
• Remove the DP corner by rounding it off and making it the distal cusp slope of the MP
cusp.
• Mark the triangular fossae. Carve the inclined planes (IP) of the MP cusp till the marked
lines.
• Define the marginal ridges and the triangular fossae.
Fig. 25.140
402 DADH Made Easy
MANDIBULAR FIRST MOLAR MANDIBULAR SECOND MOLAR

6 6 7 7
Mesiodistal diameter of crown 11.0 mm Mesiodistal diameter of crown 10.5 mm
Mesiodistal diameter of crown at cervix 9.0 mm Mesiodistal diameter of crown at cervix 8.0 mm
Buccopalatal diameter of crown 10.5 mm Buccopalatal diameter of crown 10.0 mm
Buccopalatal diameter at cervix 9.0 mm Buccopalatal diameter at cervix 9.0 mm
Fig. 25.141: Buccal aspect Fig. 25.144: Occlusal aspect
Fig. 25.142: Lingual aspect Fig. 25.145: Buccal aspect
Fig. 25.143: Proximal aspect Fig. 25.146: Lingual aspect

Fig. 25.147: Proximal aspect Fig. 25.148: Occlusal aspect
STEPS FOR CARVING OF MANDIBULAR FIRST MOLAR

• For both mandibular molars make sure that MD dimension is more than BL dimension
(Fig. 25.149).
• Divide the block into crown, root and base.
Mark the surfaces M, D, B, L on the base.
STEP 1
Occlusal View
Occlusal aspect is pentagon in shape. From buccal aspect distal
border is more rounded than mesial border, so reduce more from
distal side on wax block (Fig. 25.150).
Divide occlusal surface into 5 parts: (Fig. 25.150) by line a, b, c.
Fig. 25.149
STEP 2
Buccal Surface
• Divide the B surface of the crown in 3 parts. In the cervical third
carve out some wax towards cervical line.
• Carve the occlusal two-thirds of the crown so as to give little
inclination to the buccal surface towards lingual (Fig. 25.151).
• Merge the cervical third with occlusal two-thirds to give height
of contour in the cervical third (Fig. 25.152).
Fig. 25.150
• Give constriction in the cervical third towards both B and L. Which
Fig. 25.151 Fig. 25.152

404 DADH Made Easy
means remove wax from the cervical third of the M and D surfaces of the crown
(Fig. 25.151).
• These two steps are same as in other teeth.
STEP 3 (Fig. 25.153)
• Extend the 2 lines a and b (Fig. 25.150) onto the buccal surface:
– On buccal surface there are three cusps. MB, DB, D.
– MB is widest.
D cusp is pointed and part of it is on the distal surface.
– Mark 3 hut shapes.
Carve the cusps on B surface with buccal ridges and inclined
planes only in occlusal two-thirds then once again merge occlusal
two-thirds with cervical third to give height of contour in cervical
third. (This step is same as any other buccal surface.) Fig. 25.153
STEP 4
Lingual Surface
• Divide the lingual surface of the crown into two parts for two
lingual cusps by extending the line c drawn on occlusal surface
(Fig. 25.150).
• Make 2 huts on either side of the extended line and carve two
lingual cusps with their cusp tips, lingual ridges and inclined
planes in the occlusal half.
• Carve out little wax in the cervical half.
• Then merge occlusal half with cervical half to give height of
contour in middle of the lingual surface (Fig. 25.154).
Make the crown narrow at the cervix by removing wax on the Fig. 25.154
M and D surfaces only in cervical third of the crown.
STEP 5
Occlusal Surface: (With no Transverse Ridges)
• Because of the inclination of the buccal surface towards
lingual, the midline on occlusal surface appears to be
more buccally placed (Fig. 25.155).
Mark the triangular fossa. Mesiobuccal groove MBG,
distobuccal groove (DBG) and lingual groove (LG)
already marked, midline is the CG.
• Carve the occlusal surface as you have carved on other Fig. 25.155
molars (Fig. 25.156).
• While carving the TR and IP see (Fig. 25. 157) and follow the direction of the TR so as to get
zig-zag central groove.
• Carve all the five TR and IP inclined towards the CG define the triangular fossa TF and
marginal ridges (MR).
• TRMB extends (distal to MP) linguallly.
• TRDB extends M to CP
• TRD extends M to DP
• TRML extends D to TRMB
• TRDL extends M to TRD
TR = Triangular ridge
MB cusp = MB
Triangular ridge of MB cusp is TRMB
IP = Inclined planes
MP = Mesial pit
Fig. 25.156: Cusps
Fig. 25.157: Triangular ridges and Grooves
OR
Occlusal surface having two transverse ridges (Fig. 25.158).
• Mesial transverse ridge formed by joining of triangular ridge of MB cusp and triangular
ridge of ML cusp. TRMB + TRML.
• Distal transverse ridge formed by joining of TRDB and TRDL cusp.
Fig. 25.158
CARVING OF ROOT
• It has a root trunk which bifurcates to form mesial and distal roots.
• Both roots are widest buccolingually.
• Two roots are usually about the same length.
• For carving root of mandibular molar use same method as given in carving of root of
maxillary molar except following points:
– For bifurcation of root, mark outline only on buccal and lingual surfaces and not on
mesial and distal surface because mandibular molar has two roots.
406 DADH Made Easy
MANDIBULAR SECOND MOLAR

Carving of mandibular second molar is very similar to carving of first molar except for a few
differences.
Make sure that MD dimension is more than BL dimension.
• Divide the block into crown, root, base.
• Mark the surfaces M, D, B, L.
STEP 1
Give occlusal outline form to the wax block. Remove wax from shaded areas (Fig. 25.159).
Divide the occlusal surface into 4 parts (Fig. 25.160).
Fig. 25.159
Fig. 25.160
STEP 2
Buccal Surface
• Divide the B surface of the crown into 3 parts. In the cervical third carve out some wax.
• Carve the occlusal two-thirds of the crown so as to give little
inclination to the buccal surface towards lingual (Fig. 25.161).
• Merge the cervical third with occlusal two-thirds to give height of
contour in the cervical third (Fig. 25.162).
• Give constriction in the cervical third towards both B and L. Which
means remove wax from the cervical third of the M and D surfaces
of the crown. (Same method as in other teeth.)
• Extend the line 1 in Fig. 25.160 on to the buccal surface:
– On buccal surface there are two cusps MB and DB. MB is slightly
larger than DB.
– Mark 2 hut shapes. Fig. 25.161
Carve the cusps on B surface with buccal ridges and inclined planes only in occlusal two-
thirds (Fig. 25.163).
Both cusps are separated by buccal groove. Cusps are not very sharp.
• Then merge the occlusal two-thirds with cervical one-third to give height of contour in
cervical third on buccal surface (redefine).
Fig. 25.162 Fig. 25.163
STEP 3
Lingual Surface
• Divide the lingual surface into two parts by extending the line (1) in
Fig. 25.160 on lingual surface for 1 mm.
• Carve out little wax in the cervical half.
• Make 2 huts on either side of the extended line and carve two lingual
cusps with their cusp tips, lingual ridges and inclined planes in the
occlusal half.
• Then merge occlusal half with cervical half to give height of contour
in middle of the lingual surface (Fig. 25.164).
Fig. 25.164
STEP 4
Occlusal Surface
• 2 lines in cross pattern are already marked, mark the M and D triangular fossae (TF).
• Carve the occlusal surface as you have carved that of other molars (Fig. 25.165).
• Carve 4 cusps with the TR and IP. TR of MB cusp joins the TR of
ML cusp to form a transverse ridge.
• TR of DB cusp joins the TR of DL cusp to form a transverse ridge.
• Define the TF, CG, BG, LG and the pits M, D and C.
• Follow the direction of the ridges and grooves (Fig. 25.165).
STEP 5
Carve the root as you have carved in first molar.
The 2 roots are more or less parallel to each other. Fig. 25.165
408 DADH Made Easy
26
Guide for
Identification of Teeth
INTRODUCTION
Identification of teeth is one of the important practical exercises in the study of ‘Tooth
Morphology’.
The thorough knowledge of tooth morphology can be acquired by reading about the tooth
from all five aspects, by carving the tooth, by studying the plaster models, by drawing diagrams,
and by collecting and studying the extracted teeth.
CLASSES OF TEETH
• In permanent dentition there are four classes of teeth incisors, canines, premolars, and
molars.
Trait
A trait is a distinguishing characteristic. It helps in comparing the similarities and differences
between the teeth.
• Set trait or dentition trait distinguishes the primary teeth from permanent teeth.
• Class trait distinguishes the four classes of teeth namely—incisors, canines, premolars,
and molars.
• Arch trait distinguishes maxillary teeth from mandibular teeth.
• Type trait distinguishes the teeth within the same class, e.g. central incisor from lateral
incisor, first premolar from second premolar.
• Following are the guidelines to write about each permanent tooth of right side.
• Student is expected to identify and write about the tooth as per the instructions given by
the instructor.
INCISORS
MAXILLARY CENTRAL INCISOR
Identification
The given tooth is permanent maxillary central incisor of right side.
408
DECIDUOUS AND PERMANENT TEETH IN DIFFERENT NUMBERING SYSTEM
UNIVERSAL NUMBERING SYSTEM FDI NUMBERING SYSTEM PALMER NOTATION
Maxillary Teeth Maxillary Teeth Maxillary Teeth
Right side Left side Right Quadrant 1 Left Quadrant 2 Right side Left side
3M 2M 1M 2PM 1PM C LI CI CI LI C 1PM 2PM 1M 2M 3M 3M 2M 1M 2PM 1PM C LI CI CI LI C 1PM 2PM 1M 2M 3M 3M 2M 1M 2PM 1PM C LI CI CI LI C 1PM 2PM 1M 2M 3M
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
PERMANENT TEETH
Mandibular Teeth Mandibular Teeth Mandibular Teeth
UNIVERSAL NUMBERING SYSTEM FDI NUMBERING SYSTEM PALMER NOTATION
Maxillary Teeth Maxillary Teeth Maxillary Teeth
2M 1M C LI CI CI LI C 1M 2M 2M 1M C LI CI CI LI C 1M 2M 2M 1M C LI CI CI LI C IM 2M
A B C D E F G H I J 55 54 53 52 51 61 62 63 64 65 E D C B A A B C D E
T S R Q P O N M L K 85 84 83 82 81 71 72 73 74 75 E D C B A A B C D E
DECIDUOUS TEETH
Guide for Identification of Teeth
Mandibular Teeth Mandibular Teeth Mandibular Teeth

409
410 DADH Made Easy
Notation
Palmer notation 1
Universal #8
FDI 11
Set Trait or Dentition Trait

• It is a large yellowish white rectangular/square tooth.
• Cervical constriction is much less as compared to that in deciduous incisor.
• The mamelons are present on the incisal ridge of newly erupted permanent tooth.
Class Trait
1. Presence of incisal ridge.
2. Mamelons on incisal ridge in newly erupted tooth.
3. Of all the classes of teeth incisor has narraowest labio-lingual dimension.
4. Lingual surface has a lingual fossa, cingulum and marginal ridges almost parallel to the
root axis.
Arch Trait
It is maxillary central incisor because:
1. Mesiodistal dimension is more than the labiolingual dimension. (Incisal view)
2. Incisal ridge is either centered over root axis or labially placed. (Proximal view)
3. Cingulum, lingual fossa and marginal ridges are more prominent. (Lingual view)
4. Crown is long and wide, shape is either rectangular or square. (Labial view)
5. Root is conical and not much longer than the crown.
Type Trait
The tooth is maxillary central incisor of right side because:
1. Crown is long and wide.
2. Incisal ridge is straight.
3. Mesioincisal angle is sharp (90°), distoincisal angle is slightly rounded.
4. Mesial border of the crown is less convex as compared to the distal border of the crown.
5. Crown is narrower on lingual, shallow lingual fossa in incisal two-thirds of the crown.
6. Cingulum is off-centered to distal.
7. Root is conical and not much longer than the crown.
MAXILLARY LATERAL INCISOR

Identification
The given tooth is permanent maxillary lateral incisor of right side.
Notation
Palmer notation 2
Universal #7
FDI 12
Guide for Identification of Teeth 411
Set Trait or Dentition Trait

• It is a larger tooth, yellowish white in colour.
• Cervical constriction is much less as compared to deciduous teeth.
• Mamelons are present on incisal ridge of newly erupted tooth.
Class Trait
2. On the newly erupted incisor mamelons present.
3. Of all the classes of teeth incisors have narraowest labiolingual dimension.
4. Lingual surface has a lingual fossa, cingulum and marginal ridges are almost parallel to the
root axis.
Arch Trait
1. From incisal view crown is wider mesiodistally than labiolingually.
2. From proximal aspect the incisal ridge is either labial to root axis or centered over root axis.
3. Lingual pit at the base of the fossa may be present on maxillary lateral incisor.
4. It is a more rounded tooth.
5. Root is conical, longer as compared to crown and may have a distal bend.
Type Trait
It is maxillary lateral incisor because:
1. It is short, narrower and more rounded tooth.
2. Incisal ridge slopes cervically towards distal.
3. Mesioincisal angle is rounded, distoincisal angle is more rounded.
4. Cingulum is centered.
Lingual fossa is small and deep (more prominent).
5. Root is much longer as compared to the crown; it is conical and may have a distal bend.
PERMANENT MANDIBULAR CENTRAL INCISOR

Introduction
The given tooth is permanent mandibular central incisor of right side.
Notation
Palmer notation 1
Universal #25
FDI 41
Set Trait
• It is smaller yellowish white in color but larger as compared to deciduous tooth.
• The mamelons are present.
Class Trait
2. On the newly erupted incisors mamelons present.
412 DADH Made Easy
3. Of all the classes of teeth incisors have narraowest labiolingual dimension.

4. Lingual surface has a lingual fossa, cingulum and marginal ridges almost parallel to root
axis.
Arch Trait
The given tooth is a mandibular incisor because:
1. Central incisor is much smaller than the maxillary central incisor. It is long and narrow.
2. From proximal view incisal ridge is lingual to root axis.
3. From incisal view labiolingual dimension is more than mesio-distal dimension.
4. Lingual fossa, cingulum and marginal ridges are less prominent.
5. The root is flat mesiodistally with mesial and distal root depressions.
Type Trait
It is mandibular central incisor because:
1. It appears bilaterally symmetrical and it is a small tooth.
2. Incisal ridge is straight and at right angles to long axis of the tooth.
3. Mesio and disto incisal angles are sharp (90°).
4. Cingulum is centered.
MANDIBULAR LATERAL INCISOR

Identification
The given tooth is permanent mandibular lateral incisor of right side.
Notation
Palmer notation 2
Universal #26
FDI 42
Set Trait
It is a permanent tooth. Deciduous teeth are much smaller and whiter in color as compared to
permanent teeth.
Class Trait
2. On the newly erupted incisors mamelons present.
3. Of all the classes of teeth incisors have narrowest labiolingual dimension.
4. Lingual surface has a lingual fossa, cingulum and marginal ridges which are almost parallel
to root axis.
Arch Trait
It is a mandibular incisor because:
1. From incisal view labiolingual dimension is more than mesiodistal dimension.
2. From proximal view, incisal ridge is lingual to root axis.
3. The root is mesiodistally flat. Root depressions are present on both mesial and distal surfaces.
Type Trait
It is mandibular lateral incisor because:
1. The crown is not symmetrical and is wider and longer than the central incisor.
2. Distal border of the crown has a bulge.
3. Incisal ridge is not straight, it has a lingual twist at distoincisal angle.
4. The cingulum is off-centered to distal.
CANINES
PERMANENT MAXILLARY CANINE
Identification
The given tooth is permanent maxillary canine of the right side.
Notation
Palmer notation 3
Universal #6
FDI 13
Set Trait
• It is a permanent tooth.
• It is large yellowish white tooth with a single pointed cusp.
Class Trait
It is a canine.
1. It has a single pointed cup with two inclines making an angle at the cusp tip instead of an
incisal ridge.
2. There is presence of a labial ridge.
3. It has a single, long, strong root.
4. It has a functional lingual surface.
Arch Trait
1. It is a permanent maxillary canine. The inclines of the cusp make an acute angle at the tip
of the cusp.
2. The mesial cusp slope is shorter than the distal cusp slope.
3. The crown is short, wide and converging at cervix (compared to mandibular canine).
4. Distoincisal angle is very much rounded. Mesioincisal angle is less rounded.
5. Mesial and distal borders of the crown converge at the cervix.
6. The labial ridge is more prominent.
7. Lingual ridge and 2 lingual fossae are prominent, cingulum is large, rounded, and centered.
8. From incisal view the distal part of the labial surface is pinched.
9. The long, stout, conical root may have a distal bend in the apical third.
There is no Type Trait
The tooth is of right side because:
1. Mesial cusp slope shorter than distal before wear.
2. Rounded distoincisal angle which is more cervically placed.
414 DADH Made Easy
3. From incisal view there is distal pinch on the labial surface.

4. Distal bend of the root apex.
PERMANENT MANDIBULAR CANINE

Identification
The given tooth is permanent mandibular right canine.
Notation
Palmer notation 3
Universal #27
FDI 43
Set Trait
• It is a permanent tooth.
• It is large yellowish white tooth with a single cusp. Deciduous tooth is smaller and
whiter.
Class Trait
It is a canine because:
1. It has a single cusp with two inclines instead of incisal ridge.
2. There is presence of a labial ridge.
3. It has a single, long, strong root.
Arch Trait
1. It is a permanent mandibular canine.
2. It is long, narrow, single cusped tooth.
3. The shorter mesial cusp slope and longer distal cusp slope meet at an obtuse angle at the
tip of the cusp.
4. Mesial and distal outlines (border) of the crown converge less at the cervix.
5. Cingulum is off centered to distal.
6. Root is flat mesiodistally, wider labio-lingually and ends in a pointed apex.
7. The labial ridge, the lingual ridge and fossa are less prominent.
There is no type trait. The tooth is of right side because:
1. Mesial cusp slope shorter than distal cusp slope.
2. Cingulum is off-centered to distal.
3. Mesiol border of the crown is in line with the mesial border of the root.
PREMOLARS
MAXILLARY FIRST PREMOLAR
Identification
The given tooth is a maxillary first premolar of the right side.
Notation
Palmer notation 4
Universal #5
FDI 14
Set Trait
Premolars have no set traits as there are no premolars in deciduous dentition.
Class Trait
• They are called bicuspid, when one buccal and one lingual cusp present. Second premolar
may have 3 cusps.
• Premolars have a single buccal cusp.
• They may have of one or two roots.
Arch Trait
1. Occlusal outline of maxillary premolars is hexagonal or oval, that of mandibular premolars
is square or rounded.
2. Maxillary premolars are wider buccopalatally compared to mesiodistal dimension.
3. From proximal view the maxillary premolars do not have a lingual tilt whereas mandibular
premolars have a lingual tilt.
4. From proximal view the outline of maxillary premolar is trapezoidal whereas outline of
mandibular premolar is rhomboidal.
Type Trait
1. Mesial slope of the buccal cusp is longer than the distal cusp slope. (Right from left) in
first premolar. Cusp tip pointed. Angular outlines
2. From proximal view, lingual cusp is about 1 mm shorter than the buccal cusp in first premolar.
3. On the mesial surface of the crown of maxillary first premolar there is presence of mesial
concavity (canine fossa) which is continuous with the concavity on root.
4. There is presence of mesial marginal groove crossing the mesial marginal ridge from the
occlusal to the mesial surface. This MMRG is not present on second premolar (right from left).
5. Occlusal surface sharply hexagonal in shape in maxillary first premolar, in second premolar
it is oval in shape.
6. In maxillary first premolar more often there are two roots, one buccal and one lingual.
Maxillary second Premolar has single root.
MAXILLARY SECOND PREMOLAR

Identification
The given tooth is maxillary second premolar of the right side.
Notation
Palmer notation 5
Universal #4
FDI 15
416 DADH Made Easy
Set Trait
Premolars have no set traits as these are no premolar in deciduous dentition.
Class Trait
may have 3 cusps.
• Premolars have single buccal cusp.
• There is presence of one or two roots.
Arch Trait
1. Occlusal outline of maxillary premolars in hexagonal or oval, that of mandibular premolars
is square or round.
2. Maxillary premolars are wider buccolingually compared to mesiodistal dimension and
mandibular premolars are almost equal buccolingually and mesiodistally.
3. From proximal view maxillary premolars do not have a lingual tilt, while mandibular
premolars have a lingual tilt.
4. From proximal view the outline of maxillary premolars is trapezoidal whereas outline of
mandibular premolar is rhomboidal.
Type Trait
1. Less angular outlines. Crown is shorter compared to that of 1st premolar.
2. Mesial cusp slope of buccal cusp is shorter than the distal cusp slope.
3. From proximal view both buccal and lingual cusps are almost at same level.
4. There is no mesial marginal groove, no canine fossa on the mesial surface of the
crown.
5. Tip of the lingual cusp is towards mesial (right from lift).
6. Mesial marginal ridge is more occlusal compared to distal marginal ridge (R from L).
7. Occlusal surface has oval outline.
8. In maxillary second premolar there is single root.
MANDIBULAR FIRST PREMOLAR

Identification
The given tooth is mandibular first premolar of the right side.
Notation
Palmer notation 4
Universal #28
FDI 44
Set Trait
Class Trait
may have 3 cusps.
• They may have one or two roots.
Arch Trait
• Occlusal outline of mandibular premolars is more or less square or rounded and that of
maxillary premolars is hexagonal or oval.
• From proximal view mandibular premolars have a lingual tilt, the maxillary premolars do
not have a lingual tilt.
• From proximal view the outline of mandibular premolar is rhomboidal whereas in maxillary
premolars, it is trapezoidal.
Type Trait
• In mandibular first premolar the buccal cusp tip is more pointed and the lingual cusp is
very small and non-functional.
In mandibular second premolar the buccal cusp tip is less pointed and the lingual cusp is
not very small and it is functional.
• There is presence of mesiolingual groove in the first premolar, separating the mesial-
marginal ridge from the mesial cusp slope of the lingual cusp.
• From proximal view the buccal cusp tip is in line with the root axis.
• The occlusal surface of the first premolar is diamond shaped and that of second premolar,
2 cusp type is more or less rounded and 3 cusp type is more or less square.
RIGHT FROM LEFT

• The presence of mesiolingual groove on lingual surface.
• The mesial-marginal ridge not straight but inclined lingually and parallel to buccal triangular
ridge.
MANDIBULAR SECOND PREMOLAR

Identification
The given tooth is mandibular second premolar of the right side.
Notation
Palmer notation 5
Universal #29
FDI 45
Set Trait
Class Trait
may have 3 cusps.
418 DADH Made Easy

• There is presence of one or two roots.
Arch Trait
1. Occlusal outline of mandibular premolars is square or round. Maxillary premolars is
hexagonal or oval.
2. Mandibular premolars are almost equal mesiodistally and buccolingually (MD and BL)
whereas maxillary premolars are wider buccolingually compared to mesiodistal dimension.
3. From proximal view mandibular premolars have a lingual tilt, the maxillary premolars do
not have a lingual tilt.
4. From proximal view the outline of mandibular premolar is rhomboidal while that are
maxillary premolars is trapezoidal.
Type Trait
Y-type groove pattern
• There are 3 cusps, one buccal cusp and 2 lingual cusps. Mesiolingual cusp is larger than
distolingual cusp (right from left).
• A lingual groove separates the two lingual cusps.
• The long mesial groove, the short distal groove, and the lingual groove together form a
Y-shaped groove pattern.
• The occlusal outline is square-shaped.
• The mesial marginal ridge (MMR) is more occlusal compared to distal marginal ridge (right
from left).
H-type groove pattern

• There are two cusps, one buccal and one lingual. Lingual cusp is not as short as that of first
premolar.
• The straight short central groove along with mesiobuccal, mesiolingual, distobuccal, and
distolingual developmental grooves form H-shaped groove pattern.
• Lingual tilt of the crown is less as compared to that of first premolar.
• MMR is more occlusally placed compared to DMR.
U-type groove pattern

• There are two cusps, one buccal and one lingual. Lingual cusp is not as short as that of first
premolar.
• The occlusal outline is more or less rounded.
• The crescent shaped central groove along with mesiobuccal developmental groove and
distobuccal developmental groove form a U-shaped groove pattern.
• Lingual tilt of the crown is less as compared to that of first premolar.
• Mesial marginal ridge is more occlusally placed than the distal marginal ridge (right and left).
• Lingual cusp tip may be towards mesial or may be just opposite to the buccal cusp tip.
GROOVES ON PREMOLARS
• Mesial marginal ridge groove (MMRG) is present on the mesial surface of maxillary first
premolar (both from mesial and occlusal view).
• Mesiolingual groove (MLG) is present on the lingual surface of mandibular first premolar.
• Lingual groove (LG) present between ML and DL cusps of mandibular second premolar
Y-type.
MOLARS
MAXILLARY FIRST MOLAR
Identification
The given tooth is permanent maxillary first molar of the right side.
Notation
Palmer notation 6
Universal #3
FDI 16
Set Trait
Permanent first molars are larger than and similar to deciduous second molars.
• Primary first molars are smaller than the primary second molars.
• Primary maxillary and mandibular second molars are similar to permanent maxillary and
mandibular first molars and also smaller than the permanent first molars, which erupt
distal to the primary second molars.
Class Trait
2. Molars are largest and strongest teeth.
3. They have largest of all the occlusal surfaces.
4. They are multicusp teeth with 3–5 cusps.
5. They have 2–3 large roots.
Arch Trait
1. Maxillary molars are narrower mesiodistally and wider buccolingually whereas mandibular
molars are wider mesiodistally and narrower buccolingually.
2. Occlusally, shape of the crown is rhomboidal in maxillary molars. In mandibular molars it
is rectangular or hexagonal.
3. There is presence of oblique ridge on the occlusal surface of maxillary molars.
4. In maxillary molars 3 roots are present; in mandibular molars 2 roots are present.
5. In maxillary molars, the lingual cusps are unequal, whereas in mandibular molars, the lingual
cusps are more or less equal in size.
Lingual cusps are longer than buccal cusps in mandibular molars.
6. Maxillary molars do not have lingual tilt.
Type Trait
• The cusp of carabelli is present on palatal surface of mesio palatal cusp of first molar.
• In first molar the distopalatal cusp is well developed whereas in second molar, distopalatal
cusp is very small or absent.
420 DADH Made Easy
• In first molar, the mesiobuccal and distobuccal cusps are more or less of same size. In second
molar the distobuccal cusp is much smaller than the mesiobuccal cusp.
• The roots are more divergent in first molar.
RIGHT FROM LEFT SIDE

• The distopalatal cusp is smallest cusp.
• Cusp of carabelli present on palatal surface of mesiopalatal cusp of first molar.
• Mesial marginal ridge is more occlusally placed compared to distal marginal ridge.

Identification
The given tooth is permanent maxillary second molar of the right side.
Notation
Palmer notation 7
Universal #2
FDI 17
Set Trait
• Primary first molars are smaller than the primary second molars whereas permanent first
molars are larger than permanent second molar.
mandibular first molars and also smaller than the permanent first molars which erupt distal
to the primary second molars.
Class Trait
3. They have largest of all occlusal surfaces.
Arch Trait
1. Maxillary molars are narrower mesiodistally and wider buccolingually whereas mandibular
molars are wider mesiodistally and narrower buccolingually.
2. Occlusally, shape of the crown is rhomboidal in maxillary molars. In mandibular molars it
is rectangular or hexagonal.
3. There is presence of oblique ridge on the occlusal surface of maxillary molars.
4. In maxillary molars 3 roots are present; in mandibular molars 2 roots are present.
5. In maxillary molar, the lingual cusps are unequal, whereas in mandibular molars the lingual
cusps are more or less equal in size.
6. Lingual cusps are longer than buccal cusps in mandibular molars.
7. Mandibular molars have a lingual tilt (Proximal view).
Type Trait
As compared to first molar
• From occlusal view the shape of the crown is more twisted (accentuated rhomboid shape)
in second molars or may have heart-shape.
• The mesiobuccal cusp is wider than the distobuccal cusp.
• The distopalatal cusp is very small in rhomboid shape and absent in heart-shaped second
molar mesiopalatal cusp is longer and larger.
• The crown is narrow on the palatal side.
• The roots are less spread and within the confines of the crown.
• Oblique ridge is less prominent.
In rhomboid shape, to distinguish right from left:
• Mesiobuccal cusp is wider than the distobuccal cusp.
• Distopalatal cusp is very small.
• Mesial marginal ridge is more occlusal.
In heart-shape to distinguish right from left:
• MB cusp is wider than DB cusp.
• Mesiopalatal cusp is more towards mesial due to absence of distal cusp.
• MMR is more occlusal as compared to DMR.
• DMR is longer than MMR.

Identification
The given tooth is permanent mandibular first molar of the right side.
Notation
Palmer notation 6
Universal #30
FDI 46
Set Trait
molars are larger than permanent second molar.
mandibular first molars and also smaller than the permanent first molars, which erupt
distal to the primary second molars.
Class Trait
422 DADH Made Easy
Arch Trait
1. Mandibular molars are wider mesiodistally and narrower buccolingually. Maxillary molars
are narrower mesiodistally and wider buccolingually.
2. Occlusally, shape of the crown in mandibualr molars is rectangular or hexagonal. It is
rhomboidal in maxillary molars.
3. In mandibular molars the oblique ridge is absent. There is presence of oblique ridge on the
occlusal surface of maxillary molars;
4. In mandibular molars 2 roots are present. In maxillary molars 3 roots are present.
5. In mandibular molars, the lingual cusps are more or less equal in size. In maxillary molars,
the lingual cusps are unequal.
Lingual cusps are longer than buccal cusps in mandibular molars.
6. From proximal view, the mandibular molars have a lingual tilt.
Type Trait
• Mandibular first molars have 5 cusps. 3 buccal cusps and 2 lingual cusps. Second molars
have 4 cusps, 2 buccal and 2 lingual cusps.
• First molars have zig-zag groove pattern. Second molars have cross shaped groove pattern.
• First molars are larger than the second molars.
• The 2 roots of first molars are widely separated and curve distally whereas the roots of
second molars are closer and parallel.
RIGHT FROM LEFT SIDE

• The distal cusp on the buccal surface is the smallest.
• The mesial marginal ridge is more occlusal as compared to distal marginal ridge.
MANDIBULAR SECOND MOLAR

Identification
The given tooth is permanent mandibular second molar of the right side.
Notation
Palmer notation 7
Universal #31
FDI 47
Set Trait
molar is larger than the permanent second molar.
mandibular first molars and also smaller than the permanent first molars.
Class Trait

Arch Trait
1. Mandibular molars are wider mesiodistally and narrower buccolingually. Maxillary molars
are narrower mesiodistally and wider buccolingually.
2. Occlusally shape of the crown in mandibualr molars is rectangular or hexagonal. It is
rhomboidal in maxillary molars.
3. There is no oblique ridge on mandibular molars. There is presence of oblique ridge on the
occlusal surface of maxillary molars.
4. In mandibular molars 2 roots are present. In maxillary molars 3 roots are present.
5. In mandibular molars the lingual cusps are more or less equal in size. In maxillary molar,
the lingual cusps are unequal.
6. Lingual cusps are longer than buccal cusps in mandibular molars.
7. From proximal view the crown has a lingual tilt.
Type Trait
Compared to first molar
• The cervical ridge on the mesiobuccal cusp is more prominent (occlusal view).
• The second molar is smaller in size.
• It has 4 cusps and cross-shaped groove pattern, 4 cusps are more nearly equal.
• The roots are closer and parallel.
• The roots are less wide buccolingually.
Right from Left Side

• Prominent cervical ridge on the buccal aspect of mesiobuccal cusp.
• Mesial marginal ridge more occlusal as compared to distal marginal ridge, which has a
V-shape notch and it is often crossed by mesial marginal groove.
• Crown tapers from mesial to distal (occusal aspect).
• Crown is shorter from mesial to distal (buccal aspect).
424 DADH Made Easy
27
Age Determination of
Dental Casts
CHRONOLOGY OF THE HUMAN PRIMARY DENTITION

Tooth Hard tissue Amount of enamel Enamel Eruption Root
formation begins formed at birth completed completed
Maxillary
Central incisor 4 mos. in utero Five sixths 1½ mos. 7 ½ mos. 1½ years
Lateral incisor 4 ½ mos. in utero Two-thirds 2½ mos. 9 mos. 2 years
Cuspid 5 mos. in utero One-third 9 mos. 18 mos. 3¼ years
First molar 5 mos. in utero Cusps united 6 mos. 14 mos. 2½ years
Second molar 6 mos. in utero Cusp tips still isolated 11 mos. 24 mos. 3 years
Mandibular
Central incisor 4 ½ mos. in utero Three-fifths 2½ mos. 6 mos. 1½ years
Lateral incisor 4 ½ mos. in utero Three-fifths 3 mos. 7 mos. 1½ years
Cuspid 5 mos. in utero One-third 9 mos. 16 mos. 3¼ years
First molar 5 mos. in utero Cusps united 5½ mos. 12 mos. 2¼ years
Second molar 6 mos. in utero Cusp tips still isolated 10 mos. 20 mos. 3 years
CHRONOLOGY OF THE HUMAN PERMANENT DENTITION

at or after birth
Maxillary
Central incisor 3–4 mos. —”— ……. 4–5 years 7 – 8 years 10 years
Lateral incisor 10–12 mos. ……. 4–5 years 8 – 9 years 11 years
Cuspid 4–5 mos. ……. 6–7 years 11–12 years 13–15 years
First bicuspid 1½–1¾ years ……. 5–6 years 10–11 years 12–13 years
Second bicuspid 2–2¼ years ……. 6–7 years 10–12 years 12–14 years
First molar At birth Sometimes a trace 2½–3 years 6–7 years 9–10 years
Second molar 2½–3 years ……. 7–8 years 12–13 years 14–16 years
(Contd.)
424
Age Determination of Dental Casts 425
CHRONOLOGY OF THE HUMAN PERMANENT DENTITION (Contd.)

at or after birth
Mandibular
Central incisor 3–4 mos. ……. 4–5 years 6–7 years 9 years
Lateral incisor 3–4 mos. ……. 4–5 years 7–8 years 10 years
Cuspid 4–5 mos. ……. 6–7 years 9–10 years 12–14 years
First bicuspid 1¾–2 years ……. 5–6 years 10–12 years 12–13 years
Second bicuspid 2¼–2½ years ……. 6–7 years 11–12 years 13–14 years
First molar At birth Sometimes a trace 2½–3 years 6–7 years 9–10 years
Second molar 2½–3 years ……. 7–8 years 11–13 years 14–15 years
SEQUENCE OF ERUPTION OF TEETH IN DECIDUOUS DENTITION

Maxillary teeth Age of eruption Mandibular teeth Age of eruption
in months in month
Central incisor 7 Central incisor 6
Lateral incisor 9 Lateral incisor 7
First molar 14 First molar 12
Canine 18 Canine 16
Second molar 24 Second molar 20
SEQUENCE OF ERUPTION OF TEETH IN PERMANENT DENTITION

Maxillary teeth Age of eruption Mandibular teeth Age of eruption
in years in years
First molar 6–7 First molar 6–7
Central incisor 7–8 Central incisor 6–7
Lateral incisor 8–9 Lateral incisor 7–8
First premolar 10–11 Canine 9–10
Canine 11–12 First premolar 10–12
Second premolar 10–12 Second premolar 11–12
Second molar 12–13 Second molar 11–13
Third molar 17–21 Third molar 17–21
CAST IDENTIFICATION AND AGE DETERMINATION

• Cast identification and age determination is an important practical exercise in dental
Anatomy. It further helps to learn and revise the classes of teeth and different traits of
teeth.
• Before attempting this exercise, the student is expected to read and learn the tooth anatomy
from all aspects and numbering system and also learn the age and sequence of eruption of
teeth.
• The age of the cast should be assessed on the basis of eruption status of deciduous and
permanent dentition.
426 DADH Made Easy
• The identification of teeth on the cast becomes easy after learning tooth morphology and
carving of teeth.
• The following points/features need to be analysed for assessment of probable age of the
Normal dentition cast.
1. Arch: Maxillary or mandibular cast.
2. Dentition: Deciduous, mixed or permanent.
3. Position of teeth.
4. Last erupted tooth in the dentition.
1. Arch Identification
For identification of arch, refer the Figs 27.1–27.3.
• To view the cast hold it as shown in Fig. 27.1.
• Maxillary cast has rugae on palate. Mandibular cast has tongue space.
• To identify the cast, to identify the side, to name the teeth, hold the maxillary cast with pointed
narrow anterior surface away from you and the flat, wide posterior surface towards you.
Hold the mandibular cast with narrow, pointed anterior surface towards you and flat,
wide, posterior surface away from you.
• By viewing the cast as in Figs 27.1–27.3, it becomes easy to write the correct side (right or
left) of the tooth and write the correct tooth number.
Maxillary cast
Mandibular cast
Fig. 27.1
Maxillary cast
Fig. 27.2
Mandibular cast
Fig. 27.3
2. Dentition (Figs 27.4–27.6)

• Deciduous cast is smaller in size with smaller teeth.
– In each quadrant of the normal deciduous dentition cast
5 or less than 5 teeth are present.
– The teeth present are incisors canine and molars.
• Mixed and permanent dentition cast:
– If more than 5 teeth are present in each quadrant of a
normal dentition cast then it is either mixed dentition cast
or permanent dentition cast.
3. Position of Teeth (Figs 27.1 and 27.6)

The followig explanation is given to understand the position,
name and number of teeth in a Normal Dentition Cast
• From the midline:
– The first and second teeth would be central and lateral incisors. Fig. 27.4: Deciduous dentition
428 DADH Made Easy
Fig. 27.5: Mixed dentition Fig. 27.6: Permanent dentition
– The third tooth would be canine.

– The Fourth tooth could be either deciduous first molar D or first premolar.
– The Fifth tooth could be either deciduous second molar E or second premolar.
– The sixth tooth in a normal dentition would be permanent first molar.
– The seventh and eight teeth in a normal dentition would be second and third permanent
molars.
• Deciduous incisors and permanent incisors in the first and second positions can be
identified on the basis of size and presence of mamelons (Fig. 27.7).
– Deciduous incisors are smaller in size as compared to permanent incisors.
– Deciduous incisors are short and wider as compared to permanent incisors which are
longer and narrower.
– The newly erupted permanent incisors would have mamelons on their incisal ridges
whereas the incisal ridges of deciduous incisors could be attrited.
Fig. 27.7
• Deciduous and permanent canines in the third position can be identified on the basis of
their size and sharpness of their cusp tip.
– The deciduous canine is smaller and narrower as compared to permanent canine.
– The newly erupted permanent canine would have a sharp-pointed cusp tip as compared
to the attrited cusp tip of deciduous canine.
– Usually, permanent mandibular canine would erupt before the eruption of mandibular
first and second premolars (9–10 years).
– Usually, permanent maxillary canine would erupt after the eruption of maxillary first
and second premolars (11–12 years).
• Deciduous molars and premolars in fourth and fifth position could be identified on the
basis of the width, buccal aspect and occlusal outline of the crown (Fig. 27.8).
– To distinguish deciduous first molar D from the first premolar in the fourth position
following points may be noted;
Fig. 27.8
• Deciduous maxillary first molar when viewed from buccal aspect:

– Would have a crown wider MD than cervicoincisally,
– Would have not so sharp two cusps MB cusp being longer than DB cusp.
– Cervical line would be more curved towards mesial whereas occlusal aspect would show
rectangular outline, MB corner shows a bulge.
• Maxillary first premolar when viewed from buccal aspect:
– Would have a crown longer cervicoincisally than MD.
– Would have a single pointed cusp.
– Cervical line would be uniformaly curved whereas occlusal aspect would show
hexagonal outline.
430 DADH Made Easy
• Deciduous mandibular first molar when viewed from buccal aspect:

– Would have a crown wider MD than cervicoincisally.
– Would have two cusps MB > DB.
– Cervical line would be more curved towards mesial whereas occlusal aspect would show
a rhomboidal otline.
• Mandibular first premolar when viewed from buccal aspect:
– Would have a longer crown.
– Would have a single, long, pointed cusp.
– Cervical line would be uniformly curved whereas occlusal aspect would show diamond-
shaped outline and a very small lingual cusp.
• To distinguish deciduous second molar E from the second premolar in the fifth position
is not at all difficult because the deciduous second molar (E) does not resemble a premolar
at all. It resembles the first permanent molar in the sixth position.
– It is larger than the tooth in the fourth position.
– It is smaller and similar to the tooth in sixth position.
• In normal dentition in the sixth position it is always permanent first molar:
– which is similar in morphology to the deciduous second molar E in fifth position and
larger than E.
– and in the seventh position it is always the permanent second molar.
4. The Last Erupted Tooth

• Following points would help to identify the last erupted tooth.
– It is the tooth which has not reached its occlusal or functional position.
– If the last erupted tooth is anterior tooth it may be lingually placed (Fig. 27.10).
– If it is a posterior tooth, only cusp tip may be seen.
– Sometimes the last erupted tooth may be associated with deciduous tooth which has not
yet exfoliated and is overretained then it needs to be mentioned.
Following points would help the student to present the write-up for age determination
of the cast.
1. Identify the arch and dentition.
2. Write the teeth present, in palmer notation.
Fig. 27.9
Fig. 27.10
3. If the tooth is erupting write it in palmer notation with (↑) up arrow.

4. If permanent tooth is erupting and deciduous tooth is overretained write both in palmer
3
notation. C
5. If the tooth is missing write it as—in palmer notation.

6. If there is any discrepancy in eruption on both sides, of the arch, e.g. Fig. 27.9.
5 4 4 E. Age of the cast will be 10–12 years.
7. Write the specifications (over retained, rotated, erupting) in palmer notation as well as in
sentence form.
8. Write age of the cast giving reason also.
9. Write other specifications in a sentence form.
For example,
CAST 1: (Fig. 27.11)
• The given cast is maxillary cast showing mixed dentition.
Fig. 27.11
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• Teeth present are:

Palmer Notation FDI Notation
14
4 4 11 12 53 54 55 16 R
6 E D C 2 1 1 2 C D E 6 21 22 63 64 65 26 L
24
• Permanent teeth right and left first molars central and lateral incisors have erupted.
• Deciduous first molars have not exfoliated and first premolar is erupting buccally.
• The approximate age of eruption of maxillary first premolar is 10–11 years.
• Since the first premolars are the last erupting teeth the approximate age of the cast is
10–11 years.
CAST 2 (Fig. 27.12)

• The given cast is maxillary cast with mixed dentition.
• Teeth present are:
Palmer Notation FDI Notation
13 15 ↑
↑ 5 3 11 12 53 14 55 16 17 R
7 6 E 4 C 2 1 1 2 3 4 5 6 7 21 22 23 24 25 26 27 L
• On the left side, permanent first molar, central

and lateral incisor, canine first and second
premolars and second molar have erupted.
• On right side, permanent first molar, central and
lateral incisor first premolar have erupted.
Deciduous canine is over retained due to
which permanent canine is erupting palatally.
Deciduous second molar is over retained due to
which second premolar is erupting buccally.
• The approximate erutpion age of maxillary canine
and second premolar is 10–12 years and second
molar is 12–13 years.
• Permanent canine second premolar and second
molar on right side are erupting teeth. Therefore, Fig. 27.12
age of the cast is 11–13 years.
Bibliography
1. Avery JK, Chigo Jr DJ. Essentials of oral histology and embryology: a clinical approach, ed. 3, Canada,
Mosby Elsevier, 2006.
2. Bath-Balogh M, Fehrenbach MJ. Dental embryology, histology and anatomy, ed. 2, St. Louis Missouri,
Saunders, 2006.
3. Berkovitz BKB, Holland GR. Moxhan BJ. Oral anatomy, histology and embryology, ed. 3, Mosby Elsevier,
2009.
4. Fuller JL, Denehy GE, Schulein TM. Concise dental anatomy and morphology, ed. 4, 2001, Michigan,
University of lowa Publications Dept.
5. Kumar GS. Orban’s histology and embryology, ed. 4, 2015, India, Elsevier.
6. Nanci A. Ten Cate’s oral histology, development, structure and function, ed. 7, St. Louis Missouri, Mosby
Elsevier 2008.
7. Nelson SJ, Ash Jr M. Wheeler’s dental anatomy, physiology, and occlusion, ed. 9, St. Louis Missouri,
Saunders 2010.
8. Scheid RC, Weiss G. Woelfels Dental Anatomy, ed. 9, Wolters Kluwer 2016.
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DADH

Dental Anatomy | Dental Histology

Jayshree Daiya Mavani

Sheetal Korde Choudhari

CBS Publishers & Distributors Pvt Ltd

I t gives me immense pleasure to foreword the book titled “DADH Made

Jayshree Daiya Mavani

Jayshree Daiya Mavani

Foreword by Sangeeta Patankar v

Section I—Dental Anatomy

Section II—Dental Histology

15. Dentin 204

Section III—Practical Guide

25. Carving of Teeth 353

26. Guide for Identification of Teeth 408

ABBREVIATIONS USED IN THE BOOK ARE FOR EASE OF REPRESENTATION ONLY

Q 1. What are elevations on the surface of the tooth?

Cusp (Fig. 1.4)

Cingulum (Fig. 1.1)

Fig. 1.2: Lobes

Ridge (SAQ, May 2009) (Fig. 1.6)

Mamelons (SAQ, 2000) (Fig. 1.3)

Sulcus (Fig. 1.4)

Groove (SAQ, Nov. 2004) (Fig. 1.5)

Lingual Fossa (Refer Fig. 1.1)

Ridges and Fossae: Maxillary first premolar, occlusal aspect TBC.

Fig. 1.8: Inclined planes

Q 4. What is human dentition?

The root formation is complete one year after eruption.

Mixed Dentition (SAQ 2000)

Q 5. What is clinical and anatomical crown. (SAQ, May 2002)

Fig. 1.9: Tissues of a tooth

Q 6. What is contact point and contact area? (SAQ, July 2005)

Q 7. What are developmental lobes? (May 2007)

Q 8. Define bifurcation and trifurcation. (SAQ, Dec. 2005)

Q 9. State human dental formula. (SAQ, Dec. 2005)

• Maxillary central incisors erupt next at around 7–8 years.

Q 11. Explain nomenclature system.

• Permanent teeth are numbered 1 to 8 in each quadrant from midline.

6 is maxillary right first molar.

• In LL quadrant the teeth are lettered K to O,

e.g. Maxillary Left Central incisor

Q 12. What are the functions of teeth?

Fig. 1.10: Line angles

Point angles of both anterior and posterior teeth are four.

Anterior teeth [4] Posterior teeth [4]

Figs 1.11A and B: Point angles

Figs 1.12A and B: Embrasures

MULTIPLE CHOICE QUESTIONS (MCQs)

110-b, 111-b, 112-b, 113-e

The Permanent Incisors

Q 1. Describe type traits of maxillary incisors. (May 2008, Nov. 2015)

Type Traits of Maxillary Incisors

Central incisor (CI) Lateral incisor (LI)

Fig. 2.1 Fig. 2.2

Central incisor (CI) Lateral incisor (LI) (Contd.)

Fig. 2.3 Fig. 2.4

Fig. 2.5 Fig. 2.6

Central incisor (CI) Lateral incisor (LI) (Contd.)