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Chapter 032. Oral Manifestations of Disease (Part 1)

Harrison's Internal Medicine Chapter 32. Oral Manifestations of Disease Oral Manifestations of Disease: Introduction As primary care physicians and consultants, internists are often asked to evaluate patients with disease of the oral soft tissues, teeth, and pharynx. Knowledge of the oral milieu and its unique structures is necessary to guide preventive services and recognize oral manifestations of local or systemic disease (Chap. e7). Furthermore, internists frequently collaborate with dentists in the care of patients who have a variety of medical conditions that affect oral health or who undergo dental procedures that increase their risk of medical complications. . | Chapter 032. Oral Manifestations of Disease Part 1 Harrison s Internal Medicine Chapter 32. Oral Manifestations of Disease Oral Manifestations of Disease Introduction As primary care physicians and consultants internists are often asked to evaluate patients with disease of the oral soft tissues teeth and pharynx. Knowledge of the oral milieu and its unique structures is necessary to guide preventive services and recognize oral manifestations of local or systemic disease Chap. e7 . Furthermore internists frequently collaborate with dentists in the care of patients who have a variety of medical conditions that affect oral health or who undergo dental procedures that increase their risk of medical complications. Acknowledgment The author acknowledges the contribution to this chapter by the previous author Dr. John S. Greenspan. Diseases of the Teeth and Periodontal Structures Tooth and Periodontal Structure Tooth formation begins during the sixth week of embryonic life and continues through the first 17 years of age. Tooth development begins in utero and continues until after the tooth erupts. Normally all 20 deciduous teeth have erupted by age 3 and have been shed by age 13. Permanent teeth eventually totaling 32 begin to erupt by age 6 and have completely erupted by age 14 though third molars wisdom teeth may erupt later. The erupted tooth consists of the visible crown covered with enamel and the root submerged below the gum line and covered with bonelike cementum. Dentin a material that is denser than bone and exquisitely sensitive to pain forms the majority of the tooth substance. Dentin surrounds a core of myxomatous pulp containing the vascular and nerve supply. The tooth is held firmly in the alveolar socket by the periodontium supporting structures that consist of the gingivae alveolar bone cementum and periodontal ligament. The periodontal ligament tenaciously binds the tooth s cementum to the alveolar bone. Above this ligament is a collar of attached gingiva