The structure of the human tooth: diagrams and history. permanent teeth. Molars Molars are the main chewing teeth then

There are molars in children and adults, the difference is in quantity. Babies have only 8 of them, and starting from adolescence, adults have 8-12 of them. The last numbers vary depending on how many "eights" a person has. They are also called wisdom teeth. Upper molars have 3 roots, lower molars have 2.

Expert opinion

Biryukov Andrey Anatolievich

doctor implantologist orthopedic surgeon Graduated from the Crimean Medical Institute. institute in 1991. Specialization in therapeutic, surgical and orthopedic dentistry, including implantology and prosthetics on implants.

I think that you can still save a lot on visits to the dentist. Of course I'm talking about dental care. After all, if you carefully look after them, then the treatment really may not reach the point - it will not be required. Microcracks and small caries on the teeth can be removed with ordinary paste. How? The so-called filling paste. For myself, I single out Denta Seal. Try it too.

The number of canals is also different, since there can be several of them per root, moreover, difficult to pass, curved. Children's molars occupy 4th and 5th place on the jaw, adults - 6,7,8.

The structure of the molar

The structure differs, as mentioned above, taking into account the location on the upper or lower jaw.

Upper

These are large units, the chewing surface of which consists of 4 tubercles separated by furrows. The crown part has dimensions of 6.5-9 mm. From the crown to the alveolar process there are 3 roots - 1 palatine, 2 buccal (distal and more elongated medial). The roots are straight, the canals are wide. Approximately 10% of all cases have 4 roots.

Wisdom teeth are usually smaller, very rarely come out abnormally large. When they do not appear at all, this is considered a variant of the norm, since scientists consider them unnecessary for modern man. Previously, a lot of chewing teeth were necessary for prehistoric man, since his diet consisted of solid food.

Civilization has led to the fact that heat treatment has made the products soft, frayed, so there is no need to chew them additionally. On the chewing surface of the third molars, there are 3 tubercles most often, less often - 2 or 4. There are 2 roots, often fused, curved, the canals are difficult to pass.

Such a structure is due to the impossibility of treatment if there is a lesion with periodontitis, pulpitis. Wisdom teeth are difficult to cut through, create conditions for inflammation, cause problems, and are incorrectly positioned.

Lower

They are smaller than the top ones. The structure of 1 and 2 is similar, but the chewing surface of the first consists of 3-6 tubercles, and the second - of 4. Each of the molars below has 2 roots (distal, medial). They are thinner than the upper roots, the channels are also thinner.

Eights are usually underdeveloped, do not erupt completely, are partially covered with gums. The “wisdom” teeth usually have 1 large root at the bottom, rarely 2, but then they are fused. Crooked root canals cannot be treated.

The difference between molars and premolars, incisors and canines

The main feature, if you skip the sequence, eruption period and anatomical structure, is the function of root units, canines, incisors.

The lower first molar is located behind the premolar, and the third is already the so-called. wisdom tooth". Indigenous units are functionally designed to grind food when effort is needed. Due to their size, crowns do a good job with this function.

The premolars are the molars that follow the canines. They are smaller than molars, the chewing surface has only 2 tubercles. Their purpose is to tear food, partially participate in grinding.

The canines are located up to the first molar at the bottom, at the top. They are needed to tear off parts from solid products. These are the most stable units, characterized by a much greater strength than those involved in the formation of a smile.

Incisors - front teeth, the structure of which is distinguished by the presence of a cutting "sharp" edge. Their function is to bite off pieces of food. If we consider the rest of the crowns for comparison, the incisors are the weakest, they will not withstand the chewing load.

Functions of the teeth of the molars

As mentioned above, molars serve to grind food. They have a corresponding shape, the structure is large in size, including the upper part with a wide chewing surface, which other dental units cannot boast of.

The peculiarity of the structure characteristic of chewing units allows it to withstand a load of 70 kg. The upper ones are slightly larger than the lower ones, but all are quite strong.

Molars are used to grind food.

The dimensions are due to the huge load that falls on them during the grinding of food. If they had the shape of incisors, fangs, they would not be able to provide chewing, they would break. According to research data, the load on the molar is about 70 kg, and on the canines - 20-40 kg.

The shape of the chewing units at the top and bottom is slightly different. At the top, the chewing surface has rounded corners, a diamond shape. 3 furrows divide the surface into 4 tubercles. In order for teeth to retain their ability to perform their functions longer, their cleaning needs to be paid more attention than the hygiene of other teeth.

The fact is that the peculiar structure leads to the accumulation of plaque in the grooves, where the remnants of food are very tightly packed during chewing. Therefore, dentists warn that molars are more likely to suffer from caries than others. This happens due to the peculiarities of the structure, their functions, improper / insufficient oral hygiene.

How do molars teeth erupt?

If we compare the symptoms of eruption of the incisors, then the molars come out a little easier. The kid becomes inactive, naughty, worried. The “sixes” of the upper jaw are the first to climb, and the premolars are the last to erupt here - by 2-3 years. There is an increase in temperature, a runny nose, strong salivation, itchy gums, and sometimes diarrhea. Immunity is reduced, so parents need to protect the baby from colds, infectious foci. It is advisable to see a doctor if teething symptoms last more than 2-3 days.

The most active eruption period is up to 2 years. The second chews should have grown by this time. But if they are delayed, this is not considered a pathology, since each child's body develops individually, ecology, heredity, and other factors affect the timing.

Despite the delay, all chewables should be in place by 30 months. Being behind schedule may be due to heredity, but this is rare.

At what age do deciduous molars change to molars?

The first of the other constants will be the incisors and "sixes" of both jaws. They appear in the period of 6-8 years. Moreover, the “sixes” are additional, they are absent in the temporary occlusion, but appear in free places of the jaw that has expanded with age.

In a teenager of 11-13 years old, the second chewing units from below erupt, and on the upper jaw they come out at 12-14 years old. Sometimes there are situations when the molar is ready to come out, but the milk tooth has not yet fallen. It is better to solve such problems in the dentist's office, since the milk tooth not only interferes, but can cause deformation, curvature of the permanent one. Usually the doctor removes the interfering unit.

“Wisdom” or “eight” teeth can be expected by the age of 17-25, but if they are not there, this is a variant of the norm - they will come out later or not appear at all. This will not particularly affect the bite and chewing function.

How to help a child with teething?

To alleviate the condition of the baby, you can use special devices. They are called cutters. Available in wood, plastic, silicone. The best option is water-filled products. They are placed in the refrigerator for 15-20 minutes before giving to the child.

The baby will gnaw on a cold teether, this will anesthetize the disturbing area of ​​\u200b\u200bthe gums, relieve itching and swelling. Mechanical action will help the crown to hatch out faster.

Massaging the swollen gums is a good help. Hands are thoroughly washed, then a finger or a special nozzle gently massage the painful area and around it. Children 2-3 years old are given crackers, apples.

Pharmacy chains offer gels, ointments to relieve the symptoms of teething. Most Popular:

• Holisal. Reduces inflammation. The action is similar to an analgesic;
• Kamistad Baby. Contains lidocaine. Anesthetizes, eliminates pathogenic microbes;
• Dentinorm Baby. Allowed from 3 months of age. This is a homeopathic remedy with practically no contraindications;
• Kalgel. Relieves pain, eliminates harmful microbes.

Prevention of loss of molars

Oral care is recommended from the moment your baby has their first milk tooth. This habit must be maintained by proper hygiene until the baby can do it on his own. And if milk teeth can replace permanent ones during destruction, loss, then with the destruction of indigenous teeth, the problem is practically hopeless - others will not grow.

Do you get nervous before visiting the dentist?

YesNot

Therefore, when permanent molars, canines, incisors are cut, hygiene standards must be strictly followed. The attending physician will explain in detail which brush and paste to choose for the child, how to properly clean in the mornings, evenings, and also during the day.

It is necessary to select pastes with fluorine, calcium. They are alternated to give the enamel the substances it needs. Pasta is chosen taking into account the manufacturer's recommendations for age. In addition to brushing your teeth, it is important to rinse your mouth after each snack, main meals. It is not necessary to brew herbs, buy a pharmacy rinse, if there are no problems, you can use warm water. It is necessary to use dental floss, an irrigator, if cleaning does not get rid of food debris from hard-to-reach places, gaps.

A separate place in the prevention of dental problems is occupied by proper nutrition. Carbonated drinks, sweets harm enamel, create a favorable environment for harmful microorganisms. It is advisable to include foods with vitamins, minerals (including calcium) in the menu.

You need to take care not only of your teeth, but also of your gums. Following the recommendations, you can maintain a healthy smile for a long time.

In the upper area, displacing the anterior buccal, the longitudinal axes of the odontomeres have a different direction towards the central fossa, and the location of the first-order sulcus is shifted to the buccal side.

If the process of reduction - differentiation in the region of the upper molars is significantly expressed, then the shape of the crown can change significantly, however, the mesiodistal parameter still prevails over the vestibulolingual one (Fig. 300-304).

The location of the tubercles along the surfaces of the crown also changes: the 1st order furrow transforms from an H-shaped into an X-shaped one.

The degree of differentiation of the main tubercles is significantly increased, while additional formations appear that give the surface of the tooth a bizarre pattern, furrows of 1, 2, 3, 4 orders are visible.

The variability of the forms of the upper molars is also manifested in a decrease in the size of the posterior palatine tubercle, or in its complete absence (classification by A. Dahlberg). Rice. 305, 306 show the chewing surface of the crown of tooth 17, which has a triangular shape, where the posterior palatine tubercle is completely absent.

Let us analyze in more detail the structure of the upper left second molar.

The chewing surface of the 27th tooth is demonstrated (Fig. 307, 308). The chewing surface of the upper left second molar resembles a diamond shape, where the mesiodistal crown parameter exceeds the vestibulolingual one.

Rice. 307-308. A - distal side; B - medial side; C - palatal side; D - vestibular side; 1 - mediovestibular or anterior buccal tubercle, paraconus (par); 2 - distovestibular or posterior buccal tubercle, metacone (te); 3 - mediopalatinal or anterior palatine tubercle, protoconus (pr); 4 - distopalatinal or posterior palatine tubercle, hypocone (hy); 5 - additional medial tubercle; 6 - additional distal tubercle; 7 - vestibular groove; 8 - medial furrow; 9 - central furrow; 10 - distolingual or distopalatinal, or posterior palatine sulcus; 11 - distal triangular fossa; 12 - central fossa; 13 - transverse anterior furrow

During odontoscopy, the presence of 4 main tubercles - odontomers is noted:

1 - mediovestibular or anterior buccal tubercle,

2 - distovestibular or posterior buccal tubercle,

3 - mediopalatinal or anterior palatine tubercle,

4 - distopalatinal or posterior palatine tubercle.

Each of the odontomere tubercles is bounded by a groove:

7 - vestibular groove separating the anterior and posterior buccal tubercles;

8 - medial groove separating the anterior cervical and anterior palatine tubercles;

9 - central furrow separating the main tubercles;

10 - distolingual or distopalatinal, or posterior palatine, separating the posterior palatine tubercle from the main tubercles.

Similar to the structure of the first molar, three main tubercles are distinguished on the chewing surface of the second molar (anterior buccal (1), posterior buccal (2), anterior palatine (3)), which, when combined with each other, form a trigon (triangle).

The distal palatine tubercle (4) occupies the talon (heel). When examining the chewing surface of the 27th tooth, in addition to the main tubercles, two additional tubercles are visible (5, 6).

Additional medial tubercle (5) is formed as a result of branching of the medial sulcus (8), the main trunk of which cuts through the medial marginal ridge, and also gives a fairly deep and extended branch in the vestibular direction, tending to the top of the anterior buccal tubercle (anterior transverse sulcus - 13).

The accessory distal tubercle (6) forms the distal contact surface and the posterior triangular fossa (11). The highest of the odontomeres of the upper second molar is the anterior buccal cusp (1). It is advanced in the medial-vestibular direction, in connection with which the chewing surface of the crown acquires a rhombic shape.

On its surface, a longitudinal ridge is defined with a pronounced apex, smooth slopes, tending and falling into the medial fissure.

The medial ridge is not expressed. The distal roller is determined, the crest of which descends to the vestibular sulcus. There is a slight depression between the longitudinal idistal ridges of the paracone.

The posterior buccal tubercle (2) occupies a smaller area and height in relation to the anterior buccal tubercle (metaconus reduction), they are separated by a pronounced vestibular fissure (7). On its surface, the main longitudinal ridge is clearly visible, which has a pronounced apex, tending to the central fissure. S-shapedly curved medial ridge flows into the central fossa (12), limited from the longitudinal by a pronounced depression.

The distal ridge merges with the distal marginal ridge of the crown and is separated from the longitudinal ridge by a deep groove running into the distal triangular fossa (11). The anterior palatine tubercle (3) occupies the largest area of ​​the masticatory surface; well-defined longitudinal and marginal ridges can be traced on its surface.

The longitudinal ridge has a rounded top, from which a ridge descends towards the central fossa, formed by wide gentle slopes. The slopes are so wide that the recesses that limit them flow into different zones: the medial into the medial groove; distal to the central fossa.

The medial ridge has an S-shaped bend, descends to the medial fissure. The distal ridge has an independent apex, from which the crest of the ridge extends almost parallel to the central fissure and flows into the central fossa.

The posterior palatine tubercle (4) is oval in shape, separated from the others by the distopalatinal groove.

Its surface is practically undifferentiated, although there is a rounded eminence closer to the palatine margin. Rice. 309, 310 show the vestibular surface of the crown of the upper left second molar.

Two odontomers are clearly visible: one of which occupies a large area of ​​the crown and is anterior buccal (1), the other is smaller (posterior buccal - 2).

The odontomeres are separated from each other by a shallow vestibular groove (4) reaching to the middle of the surface. The top of the anterior palatine tubercle is also visible (3). The brown lines show the course of the longitudinal rollers.

There is a narrowing of the crown of the upper molar towards the neck. Rice. 311,312 reflect the coronal part of the palatal surface of the 27th tooth.

Two odontomeres are well defined:

anterior palatine - (1);

posterior palatine - (2), which are separated from each other by a distal palatine groove (3), located in the occlusal third of the crown.

The anterior palatine tubercle occupies most of the palatal surface, its

the outer contour and course of the main morphological elements (brown lines) resembles a module - an odontomer (canine).

The posterior palatine tubercle also has its own structural features: the longitudinal ridge has a medial arcuate bend and ends with a well-traced tubercle. Rice. 313, 314 show the anterior contact surface of the crown of 27.

When reviewing the medial contact surface of the upper second left molar, the presence of two main tubercles (1 - anterior buccal, 2 - anterior palatine) and one additional medial - 3 is determined.

There is a uniform convexity of the vestibular and palatine contours, increasing in the occlusal third of the crown.

The crests of the main longitudinal ridges along the masticatory slope are clearly visible, converging at a developed angle, where the slope of the anterior buccal tubercle is longer and gentler than the slope of the anterior palatine tubercle. The high medial marginal ridge does not allow a good view of the course of the main fissures.

On the medial surface in the occlusal third, the presence of an additional tubercle, formed by branching of the medial groove, is clearly visible. The place of the greatest convexity and contact with the adjacent tooth is located on the border of the occlusal and middle thirds. The posterior contact surface of the crown of the 27th tooth is shown (Fig. 315, 316).

The presence of two main tubercles is traced (posterior buccal - 1, posterior palatine - 2) and one additional distal - 3.

Similar to the medial contact surface, there is a uniform convexity of the vestibular and palatine contours. The marginal distal ridge is sufficiently pronounced, which limits the view of the masticatory surface of the 27th tooth. The most protruding point is located on the border of the middle and cervical thirds.

Description of the clinical case

Discussion

Conclusion

Supernumerary teeth or hyperdontia is a dental anomaly that is defined as the presence of a tooth or any tooth tissue in excess of a set of 20 primary and 32 permanent teeth. Supernumerary teeth can occur singly, in groups, unilaterally, bilaterally, they can erupt or be impacted on one or both jaws, both in milk and permanent dentition. The frequency of occurrence in milk bite varies from 0.1% to 3.8% and from 0.3% to 0.6%. In permanent occlusion, the anomaly is more common in men than in women in a ratio of 2:1. However, this disproportion by sex is not observed in milk occlusion. There is also evidence that the Asian population is more susceptible to the anomaly. Single supernumerary teeth are found in 76-86% of cases, double in 12-23% and multiple - less than 1%. Multiple hyperodontia is rare in people without any other associated diseases and syndromes. Usually such an anomaly is part of systemic disorders such as cleft lip and palate, cleidocranial syndrome, Gardner syndrome, Fabry-Anderson syndrome, chondroectodermal dysplasia, Euler-Danlos syndrome, and tricho-rhinophalangeal syndrome.

Supernumerary teeth can be found in almost any area of ​​the dental arch. Localization in the upper jaw is much more common than in the lower, especially in the anterior region (80%). Somewhat less often, supernumerary teeth can be located in the distomolar zone, lower and upper premolars, in the zone of upper canines and lower incisors.

Crowns of abnormal teeth have a normal appearance or an atypical shape, and the roots are fully or partially formed.

The position in the dental arch varies: mesiodens, paramolar, distomolar and parapremolar. Mesiodens is the most typical localization between the central incisors in the upper jaw, the paramolar position is an additional molar, usually rudimentary, small in size and located on the buccal or palatal side in relation to one of the molars in the upper jaw. Most often found in the interdental space of the second and third molars on the buccal side; the distomolar position is the fourth permanent molar; parapremolar localization is mainly found in the interdental space on the buccal side between the first and second premolars in the upper jaw. Variations of the morphological form are in a different conical type, the number of tubercles, odontoma. Supernumerary teeth may be small, conical with a normal root; teeth with multiple cusps are usually short, with a barrel-shaped crown and an invaginated rudimentary root. Another version of the supercomplete tooth - an additional one - resembles one of the existing ones and is located behind it. Most of the supernumerary teeth in the milk bite are of the type of additional teeth.

Odontomas are any tumors that develop from the tissues of the tooth. Many authors tend to believe that odontomas are hamartomas or malformations rather than neoplasms. Compound and compound odontomas are two different types described. Compound odontomas are characterized by diffuse dentin tissue that is completely disorganized, while compound odontomas are a malformation that has a superficial anatomical resemblance to a normal tooth.

According to the form, supernumerary teeth are classified into additional (eumorphic) and rudimentary (dysmorphic). If the supernumerary teeth have a normal morphology, they are referred to as "additional", if the morphology is abnormal, the teeth are referred to as rudimentary. The position of supernumerary teeth can be between central incisors, overlapping, and the orientation is described as vertical, inverted, or transversal.

This article presents a clinical case of the presence of an additional molar in a somatically healthy patient. A literature review is also presented regarding the frequency of occurrence, classification, etiology, complications, diagnosis and treatment strategies for this pathology.

Description of the clinical case

A 22-year-old man addressed the Department of Conservative Dentistry and Endodontics with complaints of pain in the posterior segment of the upper jaw on the left. Hereditary history and history of the disease without features, no signs of systemic diseases and syndromes were identified.

Intraoral examination revealed Class I occlusion and no dentition pathology. In addition to the full set of permanent teeth, one supernumerary tooth was found, located on the palatal side between the upper first and second molar on the left (Figure 1).

Figure 1: Intraoral photograph showing the paramolar location of a supernumerary tooth between the upper first and second molar on the left.

The supernumerary tooth is defined as a paramolar. The crown of the paramolar had two cusps and very much resembled the structure of the permanent premolar. The tooth is axially rotated, with the buccal surface located distally and the mesial surface buccally. A carious lesion was found on the mesial side of the paramolar (Figure 2). Examination of the soft tissues revealed periodontal inflammation between the first and second molars and the paramolar. X-rays were taken: panoramic, sighting and occlusal. The panoramic x-ray was difficult to read due to the palatal position of the tooth. Aiming and occlusal images revealed that the supernumerary tooth was affected by caries and had one root (Photos 3 and 4).

Photo 3: Animated x-ray showing a paramolar with a fully formed tooth (indicated by an arrow).

Figure 4: Maxillary occlusal radiograph showing a supernumerary tooth (arrow).

The patient was informed about the existing situation. Removal of the paramolar is recommended due to its inconvenient location for hygiene, possible food retention, recurrence of caries and damage to periodontal tissues. The patient was referred to the Department of Maxillofacial Surgery for paramolar removal.

The extracted tooth was cleaned, disinfected and analyzed. Morphology of the tooth is normal. The length of the root corresponds to the size of the crown. The root apex is fully developed. X-ray examination revealed type I canal configuration (Vertucci). The actual dimensions of the tooth are: mesiodistal and buccal-palatal width of the crown 6 and 10 mm, respectively, crown length 6.5 mm, root length 12 mm. Morphometric measurements showed a high similarity of the supernumerary tooth with the premolar (Photo 2).

Photo 2: Photographs of the extracted tooth: (a) occlusal view, (b) mesial, (c) distal, (d) buccal, (e) palatal.

Discussion

The appearance of paramolars is a rather rare occurrence. The etiology of this anomaly is not fully understood. Several theories have been proposed: phylogenetic, dichotomous, lamina hyperactivity theory, and a combination of genetic and environmental factors.

Phylogenetic theory refers to the process of atavism (evolutionary regression). An atavism is a return to an earlier morphology or type. In past centuries, the third molar was almost always present in permanent occlusion, it was comparable in size to the second molar. Moreover, the fourth molar was also quite common. However, as a result of the evolution of phylogeny, the size of the dental arches gradually decreased, which led to a reduction in both the number and size of human teeth. This was one of the stages of the predominant development of the brain skull over the facial one. Thus, the appearance of additional paramolars can be considered an example of atavism, the genetic memory of the fourth molar in previous generations. It is worth saying that this theory has been rejected by many authors.

The dichotomous theory explains the appearance of supernumerary teeth by splitting the tooth germ. The germ splits into two equal or unequal parts, from which morphologically normal independent teeth develop.

The overactive lamina theory is the most accepted theory. She explains the appearance of paramolars as the result of local, independent, due to special stimulation, increased activity of the dental lamina. According to the theory, lingual expansion of the bud of an additional tooth leads to the development of a morphologically unchanged tooth, and rudimentary forms arise due to the proliferation of epithelial remnants of the lamina, which is induced by the pressure of permanent teeth. Others tend to believe that hyperdontia is associated with multifactorial causes, which at their core still have an overactive lamina. Remnants of the dental lamina may remain in the jaws as epithelial pearls or islets. Under the influence of inducing factors, supernumerary teeth or odontomas can develop from additional rudiments. The most supported hypothesis is that the development of supernumerary teeth is associated with a complex of genetic causes and environmental factors. This is confirmed by the presence of similar anomalies in close relatives. However, despite the literature data, no similar pathology was found in the relatives of the described patient.

Careful analysis of the literature revealed very little information about the appearance of paramolars. Paramolars are somewhat less common in the upper jaw, very rarely bilateral, and almost never in temporary occlusion. They are usually rudimentary, located buccally between the second and third molars, although in some cases they may be located between the first and second molars. Fusion of paramolars with normal teeth is also incredibly rare. The literature describes a single case of endodontic treatment of a fused second left mandibular molar and a paramolar with a split crown.

The diagnosis also needs to differentiate other structures that may appear in the molar area, such as an extra cusp or a fused supernumerary tooth. Bolk in 1916 first described an additional cusp on the buccal surface of the upper and lower permanent molars, which he called the paramolar cusp. Dahlberg in 1945 coined the term paramolar cusp to refer to any abnormal cusp, supernumerary inclusion, or elevation on the buccal surface of both upper and lower premolars and molars. He presented a paleontological nomenclature in which he attributed these structures to the "protostylid" if they are on the lower jaw and to the "parastylid" if they are on the upper jaw. It is generally accepted today that such formations originate from the cervical region of the tooth and are variable in appearance. Often these structures appear on the buccal surface of the mesiobuccal tubercle and quite rarely on the distobuccal tubercle. It is believed that paramolar tubercles may originate from remnants of their own epithelium or be a genetic residue from mammals and lower primates.

Supernumerary teeth may erupt normally, remain impacted, appear axially rotated, or have other abnormalities. Supernumerary teeth with a normal position in the bone usually erupt. However, only 13-34% of supernumerary teeth from the permanent dentition erupt normally, compared to 73% in the deciduous dentition. The rest may remain retained and cause complications.

The development of complications can cause a delay in the eruption of associated permanent teeth, retention, ectopic eruption, disposition, rotation of adjacent teeth, crowding due to insufficient space for eruption, malocclusion due to a decrease in space in the dental arch during eruption of paramolars, tremas in the molars, traumatic occlusion and ulceration of the buccal mucosa with buccal paramolars, difficulties in orthodontic treatment, pathological development of the root of associated permanent teeth, formation of follicular cysts from the follicular sac of the supernumerary tooth, trigeminal neuralgia due to compression, pulp necrosis and root resorption due to excessive paramolar pressure , caries due to plaque accumulation, gingival inflammation and localized periodontitis. As can be seen from the described case, due to the retention of plaque, a carious lesion of the paramolar and inflammation of the surrounding periodontium occurred.

Most supernumerary teeth are impacted and are usually found incidentally on x-ray. However, if the patient presents with complications that are often associated with the presence of a supernumerary tooth, the dentist should consider this anomaly in the differential diagnosis and insist on an appropriate x-ray examination.

The most valuable X-ray examination is the OPG with additional sightings and images of the upper and lower jaw in the occlusal plane. For a clear localization of an unerupted tooth, a vertical or horizontal parallax technique is used. Parallax is a change in the view of an object against a certain background, based on the movement of the browser. This technique can be carried out by taking pictures of the same zone, but from different angles, with two different devices. When using this method, as a rule, the reference point is the root of the adjacent tooth. In addition, cone beam CT can be used. This technology gives a three-dimensional image of the structures of the specified zone and is incredibly informative for the described anomaly.

The clinical management of patients with paramolars depends on the position of the tooth and its effect on surrounding tissues and important anatomical structures. Treatment offers two options: removal or observation. Observation does not include any manipulations other than clinical and radiological monitoring of the patient. This method is advantageous if the presence of the paramolar is asymptomatic and does not cause any discomfort. If there are any complications, it is desirable to extract the tooth. In the case described, we resorted to tooth extraction in order to maintain the proper level of hygiene, prevent caries and to preserve the surrounding periodontium.

Conclusion

The dentist needs to be aware of the different types of supernumerary teeth in order to correctly diagnose and detect this anomaly in a timely manner. Each such case needs careful diagnosis and subsequent appropriate treatment that causes minimal complications.

Greetings, dear readers! When a baby's teeth are cut, it is always painful and unpleasant. Parents suffering from a child cause a lot of trouble. And when it seems that this painful period is over, new "guests" make themselves felt. Let's look at: molars are what kind of teeth, and what are the symptoms of their appearance.

Molars in children

Most parents think that all teeth in young children are milk teeth. Subsequently, they fall out and are replaced by indigenous ones. But it is not so.

The first indigenous units of milk bite are molars. They have the largest chewing area. From above, they are diamond-shaped in shape, from below they resemble a cube. Children have 8 molars - two on each side below and above. Separate the first molar and the second molar. According to the account from the central incisors, they occupy the 4th and 5th position.

Their cutting order is as follows:

• the first in the lower jaw - 13-18 months;
• the first in the upper jaw - 14-19 months;
• the second in the lower and upper jaws erupt approximately the same - at 23-31 months.

Already after a year, parents should prepare to meet these “guests”: the first one will climb in the top row. By the age of two, the second ones erupt. The correct sequence of appearance ensures a beautiful and correct bite.

Many parents like to look into their babies' mouths and check how their teeth are climbing. Do not do this and once again worry the crumbs. Genetics play an important role in this process. No need to interfere: nature will take care of everything itself. To find out what chewing units look like, a photo of molars will help.

To help the child and alleviate his condition, it is very important for parents to know what the symptoms of teething are. Since the process occurs after a year, many children can already point out a sore spot and even say what they feel.

Signs of eruption of milk teeth

Signs of eruption are the following sensations:

Profuse salivation

If by the age of two this sign is not too noticeable, since the baby can already control itself, then in the year when the first chewing unit is preparing to crawl out, the bib may be all wet from flowing saliva. The symptom worries about 2 months before eruption.

whims

Anxiety, whims, disturbed sleep and appetite. If the baby is still breastfeeding, the mother may notice an increased need for lactation.

Temperature

Elevated temperature. Appears a couple of days before the eruption of the first white strip in the gum. Sometimes the temperature can reach high rates - 38-39 degrees. At this time, it is important to understand that this is a sign of an erupting tooth, and not a viral or infectious disease.

Reddening of the gums

Swelling and redness of the gums. If this happens, expect a "guest" in 2-3 days.

Cold symptoms

Often, the appearance of dental units is accompanied by more serious symptoms:

• diarrhea
• conjunctivitis;
• runny nose;
• otitis.

Each baby has these symptoms.

Readers are probably interested in whether or not the chewing units of the milk bite fall out. Of course they fall out. In their place, indigenous ones appear, which remain with a person for life.

Molars and premolars in humans

Replacing the milk bite with indigenous units occurs in the following order:

• The first molars appear between the ages of 5 and 8.
• At 10-12 years old, the first and second premolars are replaced.
• The second appear from 11 to 13 years.
• Third, or wisdom teeth, occur in adulthood from 16 to 25 years.

Doctors have noticed that recently wisdom teeth have rarely erupted. They remain hidden in the gum cavity. In ancient times, they were designed for active chewing of solid food. In modern man, such a need has disappeared, therefore, third chewing pairs become a relic.

Signs of eruption of permanent teeth

• The main sign of eruption is trema - the gaps between the dental units. They are necessary in order to make room for new "tenants". If there are no trems, the teeth begin to fight for space and overlap each other. As a result, the bite is disturbed, and the child must be taken to an appointment with an orthodontist.
• Another sign is the gradual loosening of milk units. The roots gradually dissolve, loss occurs. The process is sometimes accompanied by high fever, loss of appetite, irritability.

The correct and timely appearance of molars is extremely important for the health of the baby. This process must be carefully monitored and in case of abnormal development, contact the dentist.

The rudiments of permanent (molars) teeth begin to form even during fetal development. The molars are divided into small and large. Small ones are located immediately after the canines on each jaw: the first two and two second premolars. They have only two tubercles on the closing surface and, as a rule, one root (in 80%), which in some cases may consist of two canals. The crown of the lower small ones is more spherical in shape.

Small molars take part in cutting and tearing food. Large molars are six back teeth on each jaw (three on the right and left sides), arranged according to a certain pattern: these are the first, second and third molars, the last one erupts later than the others and is called the “wisdom tooth”. Large constants serve mainly for grinding food. It is for this important function that a certain anatomy is provided.

The complex structure includes a massive cube-shaped crown, a large closure area, on which there are three or four tubercles. The upper large permanent teeth have three root canals, while the lower ones have two. Roots of the last molar can join into one conical structure.

fangs

(lat. dentes canini)

Fang - a cone-shaped tooth that serves to tear and grind food. Located between the molars and incisors. In the upper jaw, the fangs have a massive crown and a noticeable middle ridge. This is usually the third (3) tooth from the top. In the lower jaw, the fangs are less pronounced. They have a shorter dense root. They are characterized by a single root with lateral grooves.

molars

(lat. dentes molares)

Molars - molars chewing teeth with an outstanding massive crown, which has several tubercles. They are behind the premolars. A molar has three roots. In the upper jaw, the molars are diamond-shaped. In the lower jaw, they have a shape resembling a slightly elongated cube, flattened vertically. The molars include the sixth tooth (6), the seventh (7) and the eighth (8).

premolars

(lat. dentes premolares)

Premolars are small and large molars that are absent in the milk bite. Actively participate in rubbing and chewing food. Located between canines and molars. Refers to the posterior teeth. The premolars of the upper jaw are usually much larger than the lower ones. The mandibular premolars have a longer root. These include the fourth (4) and fifth (5) tooth.

incisors

(lat. dentes incisivi)

Incisors - front teeth: first (1) and second (2) from the center. They have a spatulate shape with a cutting edge. They cut food of the wrong size, they are needed for biting off food. Only 8 incisors: upper and lower. They have a single root. The lingual surface of the incisors is concave. The upper incisors have a wider crown than the lower ones. The root of the lower incisors is compressed laterally.

Wisdom teeth

(lat. dens serotinus)

The wisdom tooth is the eighth (8) in the dentition, the third molar. It is rudimentary, as it has long lost its purpose. Each jaw may have two teeth. The upper wisdom teeth are smaller than the lower ones and can have a different shape, most often three-cusp. Lower wisdom teeth often have recurved short roots and four cusps on the chewing surface.