Dr. Daniel Vinograd has established a long and prosperous career as the dentist San Diego prefers, because of his holistic, pain-free and biocompatible approach to dentistry. What you may not know is that he has a longstanding relationship with his alma mater, the University of Southern California.
Today, he’s a professor of dentistry for the university where he received his DDS degree.
USC is a private university founded in 1880 and based in Los Angeles. It’s the oldest private research institution of higher learning in California, trains a large number of international students and fully embraces its close proximity to Hollywood. It’s also consistently rated as one of the top colleges in the nation.
Here’s a bit of trivia that makes dentists like Dr. Vinograd proud: USC’s well-regarded fight song “Fight On” was composed by dental student Milo Sweet in 1922 — although Glen Grant has to be given partial credit for the lyrics.
Even if you’ve never been on the USC campus, you’ve probably seen it. That’s because its location means it features prominently on film and on television. You may have seen it in Forrest Gump, Ghostbusters, The Social Network or The Graduate. You may have also seen it on The Fresh Prince of Bel-Air, House MD, The Office or Monk, to name only a few of the many TV series that have filmed on the campus. Even Wheel of Fortune and Jeopardy have shot there.
The University of Southern California’s close relationship with Hollywood and pop culture doesn’t mean it takes its professional programs less seriously. If you think about it, good teeth are an important part of any Hollywood career, and quite a number of the entertainment industry’s top names depend on USC dental school graduates for their award-winning smiles.
Will you be the next to turn to the San Diego dentist citizens of all types entrust with their precious teeth? Getting started is as easy as setting up an appointment.
Not really concerned what brand of toothpaste you buy? Not interested in making your own toothpaste when you can buy one at the store that works pretty well?
Perhaps the best reason of all for making toothpaste at home, or carefully choosing what brand you use, is avoiding SLS. But what is SLS and why is it so bad? Keep reading and you’ll understand.
Getting To Know SLS
Sodium Lauryl Sulfate or SLS is found a lot of personal care products. But it doesn’t really belong there. In fact, putting it there doesn’t make much sense at all.
While it serves as a surfactant — a substance that breaks surface tension so a product can penetrate — it can cause skin irritation, the worsening of skin problems and other issues. Even worse, some people have an allergy to it, causing even more severe adverse reactions. And still worse yet, it can cause canker sores — those round white sores in your mouth that sting for days — and can cause dry mouth.
If you have a problem with skin issues, canker sores or dry mouth, you need to eliminate SLS from your toothpaste and from your other skin, mouth and healthcare products. Doing so could eliminate your problems or at least make them not as bad. In fact, research has proven a decrease in canker sores when using an SLS-free toothpaste.
If You Love Food…
Perhaps worst yet if you’re a foodie, SLS in toothpaste has been shown in one study to cause a temporary alteration in your ability to taste. Have you ever noticed that food tastes strange if you eat immediately after brushing your teeth? SLS could be the reason.
The reason this issue isn’t talked about more is that most people intentionally avoid eating after brushing their teeth to keep their teeth clean, so they may not necessarily notice this side effect.
Simply put, avoid SLS at all cost to avoid its side effects for a healthier and better life.
For a great homemade toothpaste recipe without SLS, visit: http://homemadetoothpaste.net
To make an appointment for Invisible Braces, call (619) 382-3884.
Part of proper Botulinum Toxin Eduction is learning the uses and side effects of botox alternatives (such as Voluma):
- Patient can feel tenderness and swelling right next to the points of injection
- When touching the skin, the patient may feel firmness or lumps
- Redness, discoloration or bruising
In order to help counteract the side effects, it is essential that you follow the advices of your professional injector. These advices may include avoiding prolonged exposure to sun, makeup and warm places. You need to consult your provider to learn more about these side effects.
Voluma can lift your skin for longer periods of time
You will not find another FDA-approved HA filler that can restore volume loss in the cheeks, except for Juvéderm Voluma. This product really works in lifting your skin, compared to other products that just fill in lines.
While we age, we practically lose volume in our cheeks and our youthful profile decreases.
This factor was kept secret by the plastic surgeons for numerous years. Fat amounts found in our cheeks may sag in time, and only an efficient facelift can be used to correct this aspect. Even though Voluma will not reposition cheek fat, it will restore the volume of the midface with the help of a thicker cross-linked formula. Therefore, Juvéderm Voluma can help you obtain a youthful appearance without the use of facelift.
You will be able to observe significant improvements after the subtle lift achieved with this product. Various patients have declared that they look up to 5 years younger after the treatment. Moreover, the effects of Juvéderm Voluma can last up to 2 years.
Besides restoring the volume in your cheeks, Juvéderm Voluma can also help you remove wrinkles and lines in other areas of the face. However, the treatment may produce different results in different patients, according to the depth and location of the wrinkles.
Major improvements are being performed in the aesthetic non-surgical field. Experts can use the new products to improve the 3-D effects of aging in the midface first and fill the rest of the face later, without taking care of each wrinkle separately. Therefore, it is clearly obvious why the new product Juvéderm Voluma works so well with its related products called Juvederm.
Voluma & Botox Training: Explaining the XC component
Many individuals are wondering what XC really is? These two letters suggest the presence of lidocaine in the filler, a compound that will make the treatment more comfortable for the patients. There is also 25% more content included in the Juvederm XC syringes. You can also find smaller and cheaper syringes on the market, that don`t contain licodaine. Avoid using these products, and talk with your provider before purchasing a particular product.
What sets Voluma Training apart from Botox Training?
Botox Training and Voluma training mainly differ in two components: cost and patient goals. First of all, these products are created to treat different cosmetic goals. With the injection treatment called Botox, patients can reduce winkles and obtain a smoother skin. The main areas targeted by this treatment are the frown lines, brow furrows, crow`s feet and bunny lines near the nose. To obtain a younger appearance, patients can combine these two treatments efficiently.
For more information about Botox Training, visit: http://dentox.com/botox-training/
“Along with non-toxic dentistry, and helping fearful patients, the awareness and prevention of Gum Disease is a priority in our practice. We invite you to sign up for a free cleaning during our awareness week.” – Dr. Daniel Vinograd, DDS
To schedule your free cleaning in our San Diego office, call (619) 550-4904
Biological dental protocols for non-toxic dentistry:
One other thing that starts to become rather prominent here is this distal lingual cusp. This entire mass starts to become smaller in overall dimension. And this groove that comes out, the distal lingual groove, as it crosses our cusp ridge here and starts to come down to the lingual surface, it doesn’t usually cross this height of contour on the lingual surface and we don’t usually get this deep groove crossing the height of contour. We don’t very often have any groove down the root here at all. Just comes down part way on the lingual surface and stops. It’s lost its characteristic prominence. Our buccal groove does carry on onto our buccal surface and carries down on the surface away but again isn’t quite as sharp and as deep and as prominent as it what would be on the first. I should make one comment in looking at these buccal surfaces here. Usually our buccal cusps, our both first and second, are approximately equal in size. Very similar in size being equal. Equal in their width as well as their height. And this buccal groove frequently will come right down the middle of the buccal surface. On the lingual we find that this is not true. Our mesial lingual cusp is usually about 2/3 width of our lingual surface, 2/3 the mass dimension and our distal buccal cusp is smaller.
Come to our second this occurs even more so. We may have three quarters of our lingual surface mesial lingual cusp. Maybe only one quarter our distal lingual cusp. And actually when we go to our thirds we’ll find out that frequently we have our entire lingual surface, maybe just this mesial lingual cusp or we may not have any or maybe very, very small distal lingual cusp area here. But one thing we also should note and that is when this groove does come down on the lingual surface by the time it crosses the height of contour on the first it’s usually pretty close to the mid portion of the tooth. It comes out at an oblique angle and by the time it reaches a height of contour it’s almost in the middle of the tooth. In our seconds this is not reaching the height of contour and we are not flattening [inaudible] our lingual root here. Lingual root is usually very round in this area as is our outline of our tooth because this groove just isn’t crossing. Our anatomy occlusally is basically the same as far as the terminology. We have all four of the same cusp, we have same surfaces, same line angles, same point angles, same marginal ridges with again mesial marginal ridge being closer to the occlusal, further the from the cervical, either way you want to put it. And our distal marginal ridge dipping closer to the cervical. One thing that is fairly characteristic about this oblique ridge in this tooth is that it’s not nearly as prominent in the second as we find that we’re losing a lot of our general overall prominency.
Often times this central groove will cross right through this oblique ridge. And this becomes important when we are restoring the tooth. We kind of like to know whether we want to follow that groove out or whether we want to stop on this sharp incline of our oblique ridge and very frequently this will cross right over the ridge into the distal pit, make a groove right through it. Our root structure on our second is usually contained within the crown and I didn’t really point this out too prominently in the first…let me show you difference here in existence….but within the first our root structure is said to be trifurcated very close to the crown and we have a short root trunk. In the second our trifurcation is not as close to the crown and we have a longer root trunk. In the first this lingual root in particularly usually extends well beyond limits of the crown. It’s much broader than what the crown is. In our second we usually we usually will see this lingual roots is contained beneath the crown, it doesn’t extend significantly out beyond the width of the crown. On the buccal surface of the first we find that the roots are trifurcated close to the cervical and that the roots are well spread. On the second these roots are generally not spread very wide. Sometimes they will be a little bit but certainly not as wide as they are in the first. Sometimes they’ll actually fuse and here we can see a fusion occurring in them. Actually a little bit of bone that was left in that fusion. This becomes a problem anatomically where our roots separate towards the middle portion of the root and then fuse again at the apex. Then when you try to remove these teeth you got a little piece of bone that grows right through this area and locks right in on it but they’re not nearly as widely spread. The root structure in general is shorter. But again our crown structure is shorter. If we compare these with our bicuspids we’ll find that a mandibular…pardon me…the maxillary first molar has a shorter crown. We just got done saying that the mesial distal dimension, buccal lingual dimensions are all greater but the crown height from the cervical line to the tip of the cusp is about a millimeter shorter than our bicuspids. And when we go to our second molars again our crown becomes shorter for half a millimeter or so. As we go to our thirds it becomes even shorter yet. But our root structure does start to vary rather significantly and this becomes rather important in relation to surgery, in relation to our building restorative restoration on these teeth because we like a nice, heavy, strong root structure to hold these restorations and bridges and partials and other structures into the mouth. Also becomes very important as far as periodontal problems. If we get infection down in this trifurcation area this is very difficult to control. We have to go a lot further down the root surfaces to get this in second premolar or second molar where as in first molar we got just a very short distance before a gingival recession and pocket formation [inaudible] before we get into this trifurcation. So frequently it’ll cause us quite a little difficulty.
One thing I should point out here as I see these rings of calculus. This is kind of a ring of hardened calculus on here and this is a ring of calculus on this tooth here…little soft tissue. We showed you some bone and what have you. One of the things that’ll occur on these teeth are little white lines like this and this isn’t a surface deposit of any nature. And if you were to take your explorers and go over these teeth you’d find that some of these little areas you can’t feel. They just feel completely smooth. What we have here is what is called a decalcification line. At one time when this child evidently was 6 probably 8, 10 years old, before the second maxillary molar came in, he lost his toothbrush for 6 months or something and we got a plaque formation and a generalized beginning decalcification of this tooth, right at the gingival line. This is evidently where the gingival line was at that time. And this has started to decalcify which is the first beginning stage of our decay. But evidently he found his tooth brush, gingiva tissues receded and it stopped at that point and never did become a problem not having gone any further. Our outlined form, at least from the occlusal, on our third molars is no longer referred to as being rhomboid. Because of the prominent lack of this distal lingual cusp and a very large mesial lingual cusp we pick up more of a heart shape. So frequently we hear the maxillary third molars referred to as heart shaped teeth. If you look at the inner occlusal on these…we’ve got couple of them sat here… we find that they are rather distinctly irregular. We don’t find prominent pits, prominent grooves, we get just a lot of accessory fissures what we call supplementary accessory fissures and grooves developed in all types of irregular directions. We have some of our characteristics still prominently present including our three basic cusps on this. On the lingual having mainly our just mesial lingual. We’ve got very little distal lingual cusp on this. Our marginal ridges are still present though. we got… and our central fossa is still rather prominently present. s to if we have any oblique ridge or mesial distal ridges…we certainly have very little of any distal lingual groove or no lingual groove down the lingual surfaces of tooth at all. We looked to the root structure on these teeth. We frequently find that they are often times becoming fused and that they can be separate or they can be fused. If they are fused you’ll find that there’s usually grooves in between where the roots should be.
This sometimes frustrates student because they have difficulty identifying maxillary mandibular unless the can count 1 or, pardon of me, 2 or 3 roots. When they’re all fused into one this creates a problem. We have basically the same type of a situation with a very broad, flat, mesial surface as we have this broad, flat, mesial root and on our distal we have this much shorter, smaller or rounded distal buccal root which is usually distinctly different than other roots on it. We’re not going to spend a lot of time as I indicated studying these third molars because of the large variation that does exist. Because really the lack of importance in the mouth and many times they’re not present in the mouth at all but you should be able to identify first and second rather characteristically and if we haven’t got a first or a second then we generally toss it into third category. If we look at the pulpal anatomy on these maxillary molars you can see that in order to get into the pulp chamber of these molars we need to place our opening into the central and mesial fossa. Here you can actually see the lingual root canal exiting out of the pulp chamber. This opening is actually mesial to oblique ridge. Actually I should mention that this oblique ridge sometimes is referred to as a transverse ridge. Technically it is an oblique ridge and on our examinations and the State Board examinations, national boards it will be ab oblique ridge but in common daily terminology occasionally it’ll be referred to as a transverse ridge. So if somebody talks about a transverse ridge in a maxillary first molar you’ll know that they are really discussing the oblique ridge. It’s kind of a interchangeable term. You can see the type of opening that is needed in this tooth. You can see some of the pulp canals starting under the basal chamber.
Let’s look at the cross section here. We have a mesial distal section of the tooth which shows our two pulp horns in this section. Actually this tooth has four cusps now so it’ll have four pulp horns. We got our mesial buccal pulp horn and our distal buccal pulp horn. Our pulp chamber, very well defined in these teeth and then our two canals. We have our…oh, let’s see…we got to get our orientation right here. I think I called this one the mesial buccal…it will be over here…is our mesial buccal pulp horn. This is our distal buccal pulp horn. Distal buccal is a little bit smaller. We’ve indicated that our two buccal cusps are usually of equal size. Actually the mesial cusp is usually a little bit larger and not a lot and certainly it doesn’t have the variation in size that our lingual cusps have on our maxillary first molar. So this is our mesial side. We have our mesial buccal pulp horn pulp chamber and our mesial buccal root. Usually this mesial buccal root will have a little bit of a gentle curvature towards the distal line whereas our distal root is frequently straighter. And both these roots are protruding towards the distal a little bit. These canals are basically rather narrow from the mesial to the distal. If we look at a buccal lingual section on this tooth we find that we can just see one of our buccal canals. And this is our mesial buccal one here.
This is the largest root, the flat one, quite wide from the mesial to the distal. As we indicated sometimes this will have a concavity. Occasionally in a small percentage of these this will actually be two separate canals but most of the time it’s just one canal which is a little bit broader from the buccal to lingual sine our root is broader. We have to remember our external morphology on it. Our lingual root which is usually the longest root although we’ve got the tip on this one broke off here, is round and our canal frequently is round in this tooth. And it’s usually the largest canal on the tooth. It’s also the largest root usually on the tooth. Our maxillary second molars are usually very similar in our mesial distal section. We’re sectioning through our two buccal roots here again. We got our two pulp horns which are prominent, mesial buccal and distal buccal. And we’ve got our chamber and our canals which again are very narrow from the mesial to the distal. In this instance we got a little piece of bone that actually came out and stayed with this tooth. As the apex of our teeth became closer together it kind of pinched off a little piece of bone right in here. We look to our buccal lingual section on our second and we should have identified our pulp horns or mesial buccal pulp horns since we’re going through the mesial buccal root here, mesial buccal cusp… this will just be our mesial lingual pulp horn. This is the largest cusp on the lingual. We have a mesial lingual pulp horn we’re actually sectioning through here. But again we’ve got our round, rather long, fairly good sized lingual canal, lingual root canal. Then on the mesial we got our mesial buccal root canal. And again there’s a possibility that this could be two separate canals on this tooth although we usually just have one. They usually will constrict just before they come out the apex of the tooth at the apical foramen on these.
Distal marginal ridge is frequently just a little bit closer to the cervical. We have sometimes a groove that will come up to this mesial marginal ridge and occasionally will cross it just a slight amount and this again would a mesial marginal groove. Kraus text book talks about this groove. We haven’t found very many teeth in which this shows prominently enough to really point out. It’s not a really strong groove. Our real strong one is our central pit in our central groove that comes up to the mesial. Now we can look at these cusps and we find that we have ridges coming from the cusps, not only our triangular ridge that comes down into the central sulcus area. Again central sulcus would be a valley depression between our cusps and our central sulcus area pretty much includes our occlusal table. Remember our occlusal table is the portion in which our food divides and goes to the outside of the tooth or to the inside of the tooth into the central portion of it. So our triangular ridges will come down into our sulcus, central sulcus, area here. Now with our distal buccal cusp here our triangular ridge is what almost connects up to our ridge, triangular ridge from this mesial lingual cusp. We got several ridges, triangular ridges, coming down into the central area of the teeth. We also have ridges coming from these cusps which are cusp ridges but you have to be a little bit more specific in the terminology of these cusp bridges. Fact is we have two, for instance, two mesial buccal cusp ridges.
We got a mesial buccal cusp ridge on the mesial buccal cusp. And we got a, I should say, buccal cusp ridge…we got a cusp…mesial buccal would be…mesial buccal cusp ridge on the mesial cusp and a mesial buccal cusp ridge on this distal buccal cusp. So we may have to identify these further and say mesial buccal cusp ridge of the mesial buccal cusp or the mesial buccal cusp ridge of the distal buccal cusp. Let’s look at the root structure on these teeth. Actually as a group they are probably the most easily identifiable teeth in the mouth in so much as they have three distinct roots and they are the only teeth, maxillary molars, that have three distinct roots. And the root structure is quite characteristic between first, second and third molars but it doesn’t outweigh the prominence or characteristics of the occlusal anatomy.
The occlusal and crown anatomy is much more reliable than the root anatomy. Root anatomy varies. But on these 3 roots we’ve got specific terms for all 3 roots as we did for our multiple rooted premolars and even our multiple rooted mandibular cuspids. In the molars the roots are termed simply by the location. Now if we look at the occlusal to get our orientation mesially and distally here I would hope, we would find that one root comes out right under this lingual groove. And this is right in the center of the lingual surface and this is called a lingual root. Very same term and same type of location as we had in our maxillary premolars when we had the [inaudible] a lingual root. But on the buccal surface we usually have two roots. And these are termed by the area they are located at. We have a mesial buccal root and a distal buccal root. Now where these 3 roots join we have area which we are now calling a trifurcation meaning three roots joining. We called it a bifurcation when we had 2. Now we’re calling it trifurcation or sometimes abbreviated furcation, meaning division of roots but this is a trifurcation. The actual shape of these roots I think is important for many reasons. Not only from endodontic standpoints but also from surgical standpoints, periodontal stand… many reasons. Our lingual root is usually the longest root on this tooth. It’s a single root supporting the lingual half so it’s little larger and longer than our buccal roots. And has a [inaudible] tendency to be round in its overall structure. It’s the large, round type root. Our mesial buccal root is rather a broad, flat root. This is more similar to our roots on our mandibular incisors. It’s kind of a ribbon shaped broad flat root. And actually occasionally you will have a concavity down the center of it. It’s so broad and flat on this mesial surface and very frequently it will have a concavity on the distal surface of these mesial buccal root, right down on the inside in here. And this becomes rather significant when you’re trying to remove this tooth because this really locks into some bone there and becomes quite a problem.
Our distal buccal root is the smallest root and it’s kind of in between. It’s not really round and it’s not really flat and has a tendency to be a little bit on the broad side towards the occlusal but it has a tendency to round off as it gets down towards the apex. I really should say cervical. It doesn’t really come close to the occlusal. Usually referred to the cervical portion of the root here. Make sure I get my terminology straight here too. We have one section of this root here that we should’ve pointed this out on our premolars. Before the roots trifurcate here or bifurcate which is called the root trunk. That’s actually a new term for you. The root trunk is that portion of the root before we get a division. We have a root trunk. Actually if we go back and look at our occlusal outline on this tooth, this is often referred to as being rhomboid in shape. Mesial distal surface are somewhat parallel but not necessarily at right angles to the buccal and lingual surface. And we’ll make a drawing of this or if you make a drawing of it I should say we can make this rhomboid basically in its shape. That’s what they referring to. One other prominent characteristic I think we should point out to this and that is that even though we have four rather distinct line angles, our buccal line angles are more prominent or I guess you can say sharper. A little bit sharper than our lingual line angles which have a tendency to round more. We have one line angle which rounds very sharply as it gets toward the cervical. And this is your distal buccal line angle. Right as it gets to the cervical it becomes very rounded. In fact as the whole tooth has a tendency to tuck in in this area and this again becomes quite a problem in restorative and periodontal [inaudible] and should be noted. We had this present on the distal cervical area of our mandibular laterals and cuspids. We’ve pointed this out. For this rounding occurs very sharply and prominently on the cervical third of the distal buccal line angle area here. Sometimes this tooth is referred to as having a fifth cusp. When we have a fifth cusp present it kind of joins is and grows with the largest cusp on this tooth which we indicated to you as what? Mesial lingual being the largest cusp. Sometimes we’ll get an additional cusp which will occur in this area right here and I have a few of them. Sometimes it’s not present at all as in this tooth. And it can be present in varying degrees here. Again we find none here. It’s being our mesial lingual here. We find a small crevice right in here which indicates a very tiny cusp development.
Here this is getting just a little bit larger. Here our cusp has gotten so large that we’re actually creating a pit between the mesial lingual cusp and this fifth cusp. In this one you can see we have a very large fifth cusp and again a deep pit. I find that this pit frequently has a tendency to become carious and actually requires a separate restoration right in this pit that occurs between the mesial lingual and this fifth cusp. This is usually called just a fifth cusp or it could be called a cusp of Carabelli. It seems to be a jingling term that has gotten quite a lot of popularity. Cusp of Carabelli or just plain fifth cusp. Not always present and it’s rather highly variable in its amount and degree in size but generally always occurring when it does appear on this mesial aspect of this mesial lingual cusp. One thing we could point out to you also is our contact areas. Sometimes on these molars they start to become rather prominent and often times they will stain quite dark. And this becomes a problem occasionally when you lose the deciduous teeth that are in front of these and parents look into mouth and find a dark contact area and they rush Johnny in because he’s got a cavity. And you get to checking it and you find that it’s hard and stained and it’s just simply a contact area that has become stained. Here again we got a contact area on this tooth right in here that has stained up a bit. Notice how this calculus is collecting here. Notice where that is. It has a big tendency to collect there. That’s where we get that tremendous rounding of that distal buccal line angle right in the cervical. Very prominent area for calculus to collect because tooth just takes a sharp dip in that area. If we go to our 2nd and 3rds we’ll do more of a comparison study here, maybe pick up a few additional terms on it. We have differences in size and within the same mouth this becomes most important. This difference in size is about a millimeter in mesial distal width within the same mouth and our 2nd molar. And within the third molar, well, this can vary. Again about a millimeter smaller than the second [inaudible] in the mesial distal width. But this third molar becomes so variable and is so highly irregular and sometimes not even present. We are not going to spend too much time in studying this.
We’ll give you a little bit of information identification of it but we’re certainly not going to spend the time on it that it justifies in relation to the amount of a variations it has because it’s got a thousand and one variations. Our second molars are usually fairly characteristic in their occlusal anatomy. They are fairly sound in their anatomy. We have about the same width from the mesial to the distal, pardon me, from the buccal to the lingual as we do in our first molar within the same mouth that is. But we’re a little shorter on the mesial distal dimension as I indicated about a millimeter. We still have the basic rhomboid shape in it although our line angles, and particularly on the buccal here, are becoming rounded. Remember this was a characteristic between the first and second premolars. Our second premolars started to get quite a little rounding in the line angles while our 2nd molar does the same thing in comparison to first. It just starts to round out in our general anatomy. In our anatomy occlusally again it’s not quite as sharp and distinct and prominent as was our first molar. That’s the same basic characteristic between the second and first premolars.
Watch the video: http://www.learnerstv.com/video/Free-video-Lecture-4747-Dental.htm
In this presentation we will discuss the anatomy of the maxillary molars. Our objectives in this presentation will be to discuss the location and position of these teeth, to concern ourselves in relation to the occlusion, to study the morphology and the terminology on these teeth and to study identifying characteristics of the maxillary molars. We’ve got 3 maxillary molars which we will be concerned with. They are simply called first, second and third. I should say we have 3 in each quadrant: 3 on the right and 3 on the left. On the right there would be tooth number 1, 2 and 3 and on the left it would be 14, 15 and 16. Our first maxillary molar is the one that comes in about age 6, very frequently confused with deciduous, baby or primary teeth. Next one, second maxillary molar, comes in about age 12. Our third maxillary molar, frequently referred to as our wisdom tooth, varies in its eruption coming in anywhere from 17, 18 up to late twenties. It’s the one that has such a reputation as being a troublemaker and frequently, I shouldn’t say frequently, about 20 percent of the time it’s not found at. It seems to be disappearing in its presence. If we look at the cutaway scull on this we can get an idea of the root structure on it. Notice that we are seeing two buccal roots on each of these molars. And we’ll also notice that the angulation is a little bit forward on all of these teeth. They are coming a little bit forward on their angulation. We should start to take more specific notice in relation to the occlusion of these teeth and how they are actually occluding with mandibular. We may have mention that our bicuspids actually are what we call interdigitating.
We’ve got a cusp-fossa relationship but more specifically we can turn this cusp-embrasure relationship because the cusp of the bicuspids is actually coming up and touching on the marginal ridge areas in our premolar areas here. We’ll define embrasure more specifically for you but this is an area associated with the marginal ridges. We still have a significant amount of difference in the width of our arches here, our maxillary arch being much wider than our mandibular arch. And the difference in this width is measure term cold which is called overjet. Overjet is the distance the maxillary teeth overlap the mandibular teeth in a horizontal direction. It is also called horizontal overlap. And we can take a look at our gauge here. We can actually put on a gauge and measure this amount by using the back side of our boley gauge and measure the specific amount that we would have in overjet and measure right down to a tenth of a millimeter or so. We’ve noticed that with these maxillary molars as they are interdigitating we are getting the combination of cusp to embrasure or to our marginal ridge and we’re also getting cusps associated with the central portion of our teeth or the actual fossas. So we get a cusp embrasure and a cusp fossa relationship on these molars. We’ll break down a little further as we go. If we look at the other side here we’ll also notice one other relationship I think we should take note of and that is that we have a maxillary sinus [inaudible] and this is [inaudible] width about apex of our maxillary molars. If we were to take our skull part here a we’d note that these roots have a tendency to be directly in a relation to these [inaudible], these maxillary sinus. [inaudible] often can effect these teeth. Actually the lingual root of this maxillary first molar is penetrating into the floor of the sinus and sometimes the roots of second or third molars may also penetrate into the maxillary sinus. This can lead to confusing clinical symptoms. If we go to our individual teeth we’ll start to identify some [inaudible] marks here.
Actually we’re picking up a lot of new terminology with these teeth here now but the terminology is not really complex because it is associated with the mesial distal buccal and lingual. Those are our four basic surfaces so we probably should identify those first. If we look at the tooth in outlined form here, this is the easiest way to really identify the buccal and the lingual because our buccal surface has a height of contour that is closer to the cervical. This height of contour can also be called the buccal cervical ridge or the cervical ridge. It is a bulbous prominence down in here and frequently will be just called the cervical rage, meaning the height of contour. And then from this area up towards occlusal we have a tendency to flatten a bit through the middle third and actually into the occlusal third until we get up to our buccal cusp. On our lingual surface our height of contour is [inaudible] through the mid portion and our lingual surface is more evenly convexed. So this is the easiest way to identify our buccal and lingual. In identifying our mesial and distal I guess the best way would really be to look at your occlusal surface because you have one cusp which is prominently larger than the other. And this is the mesial lingual cusp. And this is always to the mesial surface. Actually we have 4 cusps on this tooth and they’re identified strictly by the surfaces. We got our mesial lingual being the largest in bulk, also being the largest in height or the farthest from the cervical. We have our mesial buccal, our distal buccal and our smallest cusp usually which is the distal lingual cusp. So we are basically talking about 4 cusp tooth when we are talking about our maxillary first molar. Our second and thirds have characteristics very similar to these and as a result we’ll spend much of our terminology identification on this and then just point out the differences in second and third molars. We have basically the same line angles at the junctions of the surfaces.
We’ve got basically the same point angles on this. If we look at the buccal surface of this tooth we can see our mesial and distal outline. Our most important characteristic in this view is the height of contour. Our height of contour is similar to our maxillary premolars. On the mesial it is usually found in the occlusal 1/3. On the distal the surface is usually rounding more and the height of contour is usually found in the middle 1/3. Our overall width on this tooth is about 1 millimeter wider from the mesial…no, it’s a 1 millimeter wider from the buccal lingual dimension than it is from the mesial distal. So the tooth is usually similar to the maxillary premolars, wider buccal lingually than it is from the mesial to the distal. But the tooth overall is about 2 millimeters wider both on the buccal lingual dimension as well as in the mesial distal dimension than our premolars were. We’ve got some other rather strong characteristics on this tooth that we should identify for you and start to put some terms in. Again terms are very similar to the surfaces and the cusps what have you but the most prominent features on this tooth is our central pit. One of the biggest problems in this tooth because this central pit is usually very deep and often times has a tendency to become carious. Now we have a fossa around this pit area. Sometimes these fossas will be called triangular fossas because of the…actually apexing into this single pit. And we’re getting groove from the central groove and the other grooves that seem to apex right in this. We generally [inaudible] triangular terminology. We’re just calling it a central fossa or mesial fossa or distal fossa or whatever it is and leave the triangular out. It doesn’t seem to add a great deal to the term other than just carrying some additional jargon with it. We have a mesial pit which is usually not nearly as distinct or located quite as prominent that it would be towards the mesial aspect of the tooth. We have a distal pit which is usually fairly prominent in the distal portion of the tooth. We have a central groove that connects up to the mesial pit but it doesn’t connect to the distal pit very well because we have a rather strong ridge that crosses the tooth. Let me see if I can point out this ridge to you here.
This ridge runs from the mesial lingual cusp distally a bit and then crosses the tooth to our distal buccal cusp. And this ridge is termed the oblique ridge. It runs crossways of the tooth not straight crossways but goes to the distal and runs across the tooth. Remember on our mandibular first premolars we had a transverse ridge. That was characteristic of the first mandibular premolar only. This oblique ridge is characteristic of our maxillary molars and very prominently in our maxillary first. It’s sometimes also in existence in our seconds and occasionally in our third molars but very prominent in this first. This will be a very important characteristic particularly when we get into restorative dentistry and reconstructing these for crown and bridge and [inaudible] and the variety of other purposes so that’s one area I warn you we have to know and know very well, it’s this oblique ridge across through here. There are two very prominent grooves on this tooth which we should point out and identify for you. One comes out in the central pit and comes to the buccal and it’s simply called the buccal groove. And it actually crosses the marginal…or I should say cusp ridge and it divides the cusp ridge. We’ll go over these cusp ridges in a minute. And extends down on to the buccal surface about half the way down on to the buccal surface but it doesn’t cross this cervical ridge or height of contour. Actually it comes right down the center almost of our buccal surface here. The other very prominent characteristic ridge, or groove I should say, is this distal buccal… distal lingual groove, excuse me. Which comes out of the distal pit and traverses at an oblique angle and comes to the lingual surface. And actually it does cross the height of contour of the tooth down on the center of the lingual surface. And in the outlined form you can see a little dipping that exists in this height of contour down here. Fact is it not only crosses the height of contour but it frequently in the maxillary first will go down and groove right into this root surface. That’s a very strong groove, particularly in the maxillary first molar. We have the same marginal ridge basically on our molars. Got our mesial marginal ridge and our distal marginal ridge.