Linking Diagnostic Findings to Personalized Treatment

Linking Diagnostic Findings to Personalized Treatment

Brief overview of orthodontic treatment for kids and the importance of imaging methods in diagnosis and treatment planning

In the field of orthodontics, the journey from diagnosis to personalized treatment is a meticulously crafted path that relies heavily on various diagnostic tools and techniques. These instruments not only help in identifying the unique dental and facial characteristics of each patient but also play a crucial role in tailoring treatment plans that are specifically designed to meet individual needs. Among the most commonly used diagnostic tools in orthodontics are X-rays, photographs, and digital scans. Each of these tools offers a unique perspective and contributes valuable information that, when combined, provides a comprehensive view of a patient's orthodontic needs.


X-rays, or radiographs, are a fundamental diagnostic tool in orthodontics. They allow orthodontists to see beyond the surface of the teeth and into the jawbone and underlying structures. There are several types of X-rays used in orthodontics, including panoramic X-rays, which provide a broad view of the entire mouth, and cephalometric X-rays, which offer a side view of the skull and help in assessing the relationship between the teeth, jaws, and facial structure. Orthodontic treatment can help improve your child's smile Youth orthodontic correction dental braces. These images are invaluable for identifying issues such as impacted teeth, bone loss, and the position of unerupted teeth, which are critical in planning effective treatment strategies.


Photographs, both intraoral (inside the mouth) and extraoral (outside the mouth), serve as another essential diagnostic tool. Intraoral photographs capture detailed images of the teeth and gums, highlighting issues like misalignment, crowding, and gum health. Extraoral photographs, on the other hand, provide a visual record of the patient's facial profile and symmetry, which are important for assessing the aesthetic outcomes of orthodontic treatment. Together, these photographs help orthodontists evaluate the overall dental and facial appearance, track changes over time, and communicate treatment goals and progress with patients.


Digital scans have revolutionized the field of orthodontics by offering a precise and detailed view of the teeth and jaws. These scans are typically obtained using intraoral scanners, which capture a three-dimensional image of the inside of the mouth. This technology allows for the creation of digital models of the teeth, which can be manipulated and analyzed in ways that traditional plaster models cannot. Digital scans are particularly useful for planning complex treatments, designing custom orthodontic appliances, and predicting the outcomes of various treatment options.


The integration of these diagnostic tools into orthodontic practice has significantly enhanced the ability of orthodontists to link diagnostic findings to personalized treatment plans. By providing a comprehensive view of a patient's dental and facial structures, these tools enable orthodontists to identify the specific issues that need to be addressed and to select the most appropriate treatment modalities. Whether it's through the use of traditional braces, clear aligners, or other orthodontic appliances, the goal remains the same: to achieve optimal dental health and aesthetics for each individual patient.


In conclusion, the use of X-rays, photographs, and digital scans in orthodontics is not just about capturing images; it's about gathering the necessary information to create a tailored treatment plan that addresses the unique needs and goals of each patient. These diagnostic tools are the cornerstone of modern orthodontic practice, enabling orthodontists to provide personalized care that leads to successful and satisfying outcomes.

The early diagnosis of orthodontic issues in children is a critical aspect of ensuring optimal treatment outcomes. Recognizing and addressing these problems at an early stage can significantly influence the effectiveness and efficiency of orthodontic interventions. This essay will explore the significance of early diagnosis in identifying orthodontic issues and its impact on treatment outcomes.


Firstly, early diagnosis allows for the identification of potential orthodontic problems before they become more severe. Conditions such as malocclusions, overcrowding, and misalignments can often be detected during routine dental check-ups. By diagnosing these issues early, orthodontists can implement preventive measures or begin treatment when the child's jaw and facial structure are still developing. This can lead to more straightforward and less invasive treatments, reducing the need for extensive procedures later in life.


Moreover, early diagnosis plays a crucial role in personalized treatment planning. Each child's orthodontic needs are unique, and early assessment allows orthodontists to tailor treatment plans that address specific issues. For instance, a child diagnosed with a significant overbite may require different interventions compared to one with spacing issues. Personalized treatment plans not only enhance the effectiveness of orthodontic care but also improve patient compliance and satisfaction.


Additionally, the psychological impact of early orthodontic intervention should not be underestimated. Children who receive timely treatment are less likely to experience self-esteem issues related to their dental appearance. This can have long-lasting positive effects on their social interactions and overall well-being. Early diagnosis and treatment can help children develop a positive self-image, which is essential during their formative years.


Furthermore, early orthodontic treatment can contribute to better long-term oral health. By correcting alignment issues early, orthodontists can help prevent future dental problems such as tooth decay, gum disease, and temporomandibular joint (TMJ) disorders. Proper alignment facilitates easier cleaning and maintenance of teeth, reducing the risk of plaque buildup and other oral health issues.


In conclusion, the significance of early diagnosis in identifying orthodontic issues in children cannot be overstated. It not only leads to more effective and personalized treatment outcomes but also contributes to the overall oral health and psychological well-being of the child. Orthodontists and parents alike should prioritize regular dental check-ups to ensure that any potential issues are identified and addressed promptly.

Citations and other links

Description of the benefits and limitations of each imaging method, including factors such as radiation exposure, image quality, and cost

In the realm of pediatric dentistry, the process of linking diagnostic findings to personalized treatment plans is a nuanced and crucial aspect of ensuring optimal oral health outcomes for children. Each child's dental and facial structure is unique, and understanding these individual differences is key to providing effective and tailored care.


When a child visits a pediatric dentist, the diagnostic process begins with a comprehensive examination. This includes assessing the alignment of teeth, the development of jaws, the presence of any dental anomalies, and the overall oral health. Diagnostic tools such as X-rays, photographs, and models of the teeth are often used to gain a deeper understanding of the child's dental structure.


These diagnostic findings serve as the foundation for developing a personalized treatment plan. For instance, if a child is found to have crowded teeth, the treatment plan might involve orthodontic intervention to create space and align the teeth properly. In cases where a child has a malocclusion (misalignment of the jaws), the plan might include orthodontic treatment combined with possible orthognathic surgery in more severe cases.


Moreover, the diagnostic findings also inform the timing of interventions. For example, interceptive orthodontics might be recommended for young children to guide the growth of jaws and erupting teeth, preventing more complex issues in the future.


Personalized treatment plans are not just about addressing current dental issues but also about anticipating future needs. For instance, a child with a genetic predisposition to certain dental conditions might require closer monitoring and earlier intervention.


In conclusion, the integration of diagnostic findings into personalized treatment plans in pediatric dentistry is a dynamic and essential process. It ensures that each child receives care that is specifically tailored to their unique dental and facial structure, promoting not only immediate oral health but also long-term well-being.

Description of the benefits and limitations of each imaging method, including factors such as radiation exposure, image quality, and cost

Discussion of the role of digital imaging technologies in modern orthodontics, including the use of 3D imaging and computer-aided design and manufacturing (CAD/CAM) systems

When it comes to ensuring the dental health of children, orthodontic treatment plays a crucial role. Not only does it address misalignments and bite issues, but it also contributes to the overall confidence and well-being of young individuals. The exploration of various orthodontic treatment options available for kids is essential for both parents and dental professionals. By linking diagnostic findings to personalized treatment, we can ensure that each child receives the most appropriate and effective care.


Traditional braces remain one of the most common and reliable orthodontic treatments for kids. Comprising metal brackets and wires, they are highly effective in correcting a wide range of dental issues, from crooked teeth to severe malocclusions. Modern advancements have made traditional braces more comfortable and less obtrusive than in the past, though they still require diligent care and regular adjustments.


Clear aligners represent a more discreet alternative to traditional braces. These custom-made, removable trays are virtually invisible when worn, making them a popular choice among older children and teenagers who may be self-conscious about their appearance. Clear aligners offer the flexibility of being taken out for eating and cleaning, but they require a higher level of compliance from the patient to be effective.


Functional appliances are another valuable option, particularly for younger children. These devices are designed to correct jaw discrepancies and improve the relationship between the upper and lower jaws. Functional appliances can be fixed or removable and are often used in conjunction with other orthodontic treatments. They are particularly beneficial in growing children, as they can guide jaw development in a positive direction.


Linking diagnostic findings to personalized treatment is a fundamental aspect of modern orthodontics. Through comprehensive evaluations, including X-rays, photographs, and dental impressions, orthodontists can pinpoint specific issues and develop tailored treatment plans. This approach ensures that each child receives the most suitable treatment based on their unique dental structure, growth patterns, and personal needs.


In conclusion, the exploration of various orthodontic treatment options for kids-traditional braces, clear aligners, and functional appliances-highlights the importance of personalized care. By carefully linking diagnostic findings to treatment plans, orthodontists can provide effective, efficient, and comfortable solutions that promote both dental health and self-confidence in young patients.

Overview of the importance of proper image interpretation and analysis in orthodontic treatment planning, including the use of landmarks, measurements, and tracings

In recent years, the role of technology in orthodontics has become increasingly significant, particularly in enhancing diagnostic accuracy and treatment planning. This transformation is not only revolutionizing the field but also ensuring that patients receive personalized care that is both effective and efficient.


One of the most notable technological advancements in orthodontics is the use of digital imaging and 3D scanning. Traditional methods relied heavily on plaster models and two-dimensional photographs, which often fell short in providing a comprehensive view of a patient's dental structure. With digital imaging, orthodontists can now capture highly detailed, three-dimensional images of a patient's teeth and jaw. This allows for a more accurate diagnosis of misalignments, bite issues, and other orthodontic concerns. The precision offered by these images ensures that treatment plans are tailored to the unique needs of each patient, leading to better outcomes.


Moreover, software applications have been developed to analyze these digital images, providing orthodontists with quantitative data that can inform their diagnostic decisions. These applications can measure angles, distances, and other critical metrics with a level of accuracy that was previously unattainable. As a result, orthodontists can identify even the subtlest irregularities and develop treatment plans that address these issues specifically.


The integration of artificial intelligence (AI) into orthodontic practice is another game-changer. AI algorithms can analyze vast amounts of data to predict treatment outcomes and suggest the most effective courses of action. This not only enhances diagnostic accuracy but also helps in creating personalized treatment plans. For instance, AI can simulate the progression of treatment over time, allowing orthodontists to visualize the potential results and make adjustments as needed. This proactive approach ensures that patients are on the right track throughout their treatment journey.


In addition to diagnostics, technology is also playing a crucial role in the actual treatment phase. Clear aligners, such as Invisalign, are a prime example. These custom-made, removable aligners are designed using digital impressions and software algorithms that map out the step-by-step movement of teeth. Patients can see a virtual representation of their treatment progress, which not only keeps them informed but also motivates them to adhere to their treatment plan.


Furthermore, the use of intraoral scanners has streamlined the process of taking impressions. Traditional impression materials can be uncomfortable for patients and often result in inaccuracies. Intraoral scanners provide a quick, comfortable, and highly accurate alternative, ensuring that the aligners fit perfectly and function as intended.


In conclusion, the examination of the role of technology in enhancing diagnostic accuracy and treatment planning in orthodontics reveals a landscape that is rapidly evolving. Digital imaging, software applications, artificial intelligence, and innovative treatment modalities like clear aligners are all contributing to a more personalized approach to orthodontic care. As these technologies continue to advance, they promise to make orthodontic treatment more precise, efficient, and tailored to the individual needs of each patient.

Explanation of the role of orthodontic imaging in monitoring treatment progress and evaluating treatment outcomes

In the evolving field of orthodontics, the integration of diagnostic findings into personalized treatment plans has revolutionized the way we approach dental care for children. This tailored approach not only enhances treatment outcomes but also improves patient satisfaction and compliance. Let's explore a couple of case studies that vividly illustrate the successful application of diagnostic findings in personalized orthodontic treatment for kids.


Case Study 1: Early Intervention for a Growing Smile
Meet Emily, a vibrant 8-year-old with a developing overbite and crowded front teeth. During her routine dental check-up, Dr. Smith, her orthodontist, utilized a combination of diagnostic tools including panoramic X-rays, 3D scans, and a thorough clinical examination to assess her dental development. The diagnostic findings revealed that Emily was in the early mixed dentition stage, a critical period for orthodontic intervention.


Understanding the significance of this developmental stage, Dr. Smith crafted a personalized treatment plan for Emily. The plan included the use of a removable orthodontic appliance designed to guide the eruption of her permanent teeth and correct her overbite. Regular follow-up appointments allowed Dr. Smith to monitor Emily's progress closely, making adjustments to the appliance as needed. Within a year, Emily's overbite had significantly improved, and her permanent teeth were erupting in a more aligned position, setting the stage for a beautiful, healthy smile in the future.


Case Study 2: Addressing Unique Challenges with Precision
Then there's Jake, a 10-year-old with a rare genetic condition that affects his jaw development, leading to an underbite. Recognizing the complexity of Jake's case, Dr. Lee, his orthodontist, employed advanced diagnostic techniques including genetic testing, alongside traditional orthodontic assessments, to gain a comprehensive understanding of Jake's condition.


The diagnostic findings played a crucial role in developing Jake's personalized treatment plan. Dr. Lee opted for a combination of orthodontic appliances and specialized therapy to address both the dental and genetic aspects of Jake's underbite. The treatment plan was meticulously tailored to Jake's unique needs, incorporating regular adjustments and monitoring to ensure optimal outcomes. Over time, Jake's underbite improved, and his jaw development aligned more closely with typical growth patterns, significantly enhancing his facial aesthetics and bite function.


These case studies underscore the profound impact of leveraging diagnostic findings in the creation of personalized orthodontic treatment plans for children. By carefully analyzing each patient's unique dental and genetic makeup, orthodontists can develop targeted interventions that not only correct dental issues but also contribute to the overall well-being and confidence of young patients. As we continue to advance in diagnostic technologies and treatment methodologies, the potential for personalized orthodontic care to transform smiles and lives becomes ever more promising.

Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

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Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

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An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

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An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

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Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

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An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

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Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

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Unilateral posterior crossbite

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Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

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A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

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Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

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  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

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  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
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Tooth
A chimpanzee displaying his teeth
Details
Identifiers
Latin dens
MeSH D014070
FMA 12516
Anatomical terminology
[edit on Wikidata]

A tooth (pl.: teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, tearing food, for defensive purposes, to intimidate other animals often including their own, or to carry prey or their young. The roots of teeth are covered by gums. Teeth are not made of bone, but rather of multiple tissues of varying density and hardness that originate from the outermost embryonic germ layer, the ectoderm.

The general structure of teeth is similar across the vertebrates, although there is considerable variation in their form and position. The teeth of mammals have deep roots, and this pattern is also found in some fish, and in crocodilians. In most teleost fish, however, the teeth are attached to the outer surface of the bone, while in lizards they are attached to the inner surface of the jaw by one side. In cartilaginous fish, such as sharks, the teeth are attached by tough ligaments to the hoops of cartilage that form the jaw.[1]

Monophyodonts are animals that develop only one set of teeth, while diphyodonts grow an early set of deciduous teeth and a later set of permanent or "adult" teeth. Polyphyodonts grow many sets of teeth. For example, sharks, grow a new set of teeth every two weeks to replace worn teeth. Most extant mammals including humans are diphyodonts, but there are exceptions including elephants, kangaroos, and manatees, all of which are polyphyodonts.

Rodent incisors grow and wear away continually through gnawing, which helps maintain relatively constant length. The industry of the beaver is due in part to this qualification. Some rodents, such as voles and guinea pigs (but not mice), as well as lagomorpha (rabbits, hares and pikas), have continuously growing molars in addition to incisors.[2][3] Also, tusks (in tusked mammals) grow almost throughout life.[4]

Teeth are not always attached to the jaw, as they are in mammals. In many reptiles and fish, teeth are attached to the palate or to the floor of the mouth, forming additional rows inside those on the jaws proper. Some teleosts even have teeth in the pharynx. While not true teeth in the usual sense, the dermal denticles of sharks are almost identical in structure and are likely to have the same evolutionary origin. Indeed, teeth appear to have first evolved in sharks, and are not found in the more primitive jawless fish – while lampreys do have tooth-like structures on the tongue, these are in fact, composed of keratin, not of dentine or enamel, and bear no relationship to true teeth.[1] Though "modern" teeth-like structures with dentine and enamel have been found in late conodonts, they are now supposed to have evolved independently of later vertebrates' teeth.[5][6]

Living amphibians typically have small teeth, or none at all, since they commonly feed only on soft foods. In reptiles, teeth are generally simple and conical in shape, although there is some variation between species, most notably the venom-injecting fangs of snakes. The pattern of incisors, canines, premolars and molars is found only in mammals, and to varying extents, in their evolutionary ancestors. The numbers of these types of teeth vary greatly between species; zoologists use a standardised dental formula to describe the precise pattern in any given group.[1]

Etymology

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The word tooth comes from Proto-Germanic *tanþs, derived from the Proto-Indo-European *h₁dent-, which was composed of the root *h₁ed- 'to eat' plus the active participle suffix *-nt, therefore literally meaning 'that which eats'.[7]

The irregular plural form teeth is the result of Germanic umlaut whereby vowels immediately preceding a high vocalic in the following syllable were raised. As the nominative plural ending of the Proto-Germanic consonant stems (to which *tanþs belonged) was *-iz, the root vowel in the plural form *tanþiz (changed by this point to *tÄ…Ì„þi via unrelated phonological processes) was raised to /œË/, and later unrounded to /eː/, resulting in the tōþ/tÄ“þ alternation attested from Old English. Cf. also Old English bōc/bÄ“Ä‹ 'book/books' and 'mÅ«s/mȳs' 'mouse/mice', from Proto-Germanic *bōks/bōkiz and *mÅ«s/mÅ«siz respectively.

Cognate with Latin dÄ“ns, Greek á½€δούς (odous), and Sanskrit dát.

Origin

[edit]

Teeth are assumed to have evolved either from ectoderm denticles (scales, much like those on the skin of sharks) that folded and integrated into the mouth (called the "outside–in" theory), or from endoderm pharyngeal teeth (primarily formed in the pharynx of jawless vertebrates) (the "inside–out" theory). In addition, there is another theory stating that neural crest gene regulatory network, and neural crest-derived ectomesenchyme are the key to generate teeth (with any epithelium, either ectoderm or endoderm).[4][8]

The genes governing tooth development in mammals are homologous to those involved in the development of fish scales.[9] Study of a tooth plate of a fossil of the extinct fish Romundina stellina showed that the teeth and scales were made of the same tissues, also found in mammal teeth, lending support to the theory that teeth evolved as a modification of scales.[10]

Mammals

[edit]

Teeth are among the most distinctive (and long-lasting) features of mammal species. Paleontologists use teeth to identify fossil species and determine their relationships. The shape of the animal's teeth are related to its diet. For example, plant matter is hard to digest, so herbivores have many molars for chewing and grinding. Carnivores, on the other hand, have canine teeth to kill prey and to tear meat.

Mammals, in general, are diphyodont, meaning that they develop two sets of teeth. In humans, the first set (the "baby", "milk", "primary" or "deciduous" set) normally starts to appear at about six months of age, although some babies are born with one or more visible teeth, known as neonatal teeth. Normal tooth eruption at about six months is known as teething and can be painful. Kangaroos, elephants, and manatees are unusual among mammals because they are polyphyodonts.

Aardvark

[edit]

In aardvarks, teeth lack enamel and have many pulp tubules, hence the name of the order Tubulidentata.[11]

Canines

[edit]

In dogs, the teeth are less likely than humans to form dental cavities because of the very high pH of dog saliva, which prevents enamel from demineralizing.[12] Sometimes called cuspids, these teeth are shaped like points (cusps) and are used for tearing and grasping food.[13]

Cetaceans

[edit]

Like human teeth, whale teeth have polyp-like protrusions located on the root surface of the tooth. These polyps are made of cementum in both species, but in human teeth, the protrusions are located on the outside of the root, while in whales the nodule is located on the inside of the pulp chamber. While the roots of human teeth are made of cementum on the outer surface, whales have cementum on the entire surface of the tooth with a very small layer of enamel at the tip. This small enamel layer is only seen in older whales where the cementum has been worn away to show the underlying enamel.[14]

The toothed whale is a parvorder of the cetaceans characterized by having teeth. The teeth differ considerably among the species. They may be numerous, with some dolphins bearing over 100 teeth in their jaws. On the other hand, the narwhals have a giant unicorn-like tusk, which is a tooth containing millions of sensory pathways and used for sensing during feeding, navigation, and mating. It is the most neurologically complex tooth known. Beaked whales are almost toothless, with only bizarre teeth found in males. These teeth may be used for feeding but also for demonstrating aggression and showmanship.

Primates

[edit]

In humans (and most other primates), there are usually 20 primary (also "baby" or "milk") teeth, and later up to 32 permanent teeth. Four of these 32 may be third molars or wisdom teeth, although these are not present in all adults, and may be removed surgically later in life.[15]

Among primary teeth, 10 of them are usually found in the maxilla (i.e. upper jaw) and the other 10 in the mandible (i.e. lower jaw). Among permanent teeth, 16 are found in the maxilla and the other 16 in the mandible. Most of the teeth have uniquely distinguishing features.

Horse

[edit]

An adult horse has between 36 and 44 teeth. The enamel and dentin layers of horse teeth are intertwined.[16] All horses have 12 premolars, 12 molars, and 12 incisors.[17] Generally, all male equines also have four canine teeth (called tushes) between the molars and incisors. However, few female horses (less than 28%) have canines, and those that do usually have only one or two, which many times are only partially erupted.[18] A few horses have one to four wolf teeth, which are vestigial premolars, with most of those having only one or two. They are equally common in male and female horses and much more likely to be on the upper jaw. If present these can cause problems as they can interfere with the horse's bit contact. Therefore, wolf teeth are commonly removed.[17]

Horse teeth can be used to estimate the animal's age. Between birth and five years, age can be closely estimated by observing the eruption pattern on milk teeth and then permanent teeth. By age five, all permanent teeth have usually erupted. The horse is then said to have a "full" mouth. After the age of five, age can only be conjectured by studying the wear patterns on the incisors, shape, the angle at which the incisors meet, and other factors. The wear of teeth may also be affected by diet, natural abnormalities, and cribbing. Two horses of the same age may have different wear patterns.

A horse's incisors, premolars, and molars, once fully developed, continue to erupt as the grinding surface is worn down through chewing. A young adult horse will have teeth, which are 110–130 mm (4.5–5 inches) long, with the majority of the crown remaining below the gumline in the dental socket. The rest of the tooth will slowly emerge from the jaw, erupting about 3 mm (18 in) each year, as the horse ages. When the animal reaches old age, the crowns of the teeth are very short and the teeth are often lost altogether. Very old horses, if lacking molars, may need to have their fodder ground up and soaked in water to create a soft mush for them to eat in order to obtain adequate nutrition.

Proboscideans

[edit]
Section through the ivory tusk of a mammoth

Elephants' tusks are specialized incisors for digging food up and fighting. Some elephant teeth are similar to those in manatees, and elephants are believed to have undergone an aquatic phase in their evolution.

At birth, elephants have a total of 28 molar plate-like grinding teeth not including the tusks. These are organized into four sets of seven successively larger teeth which the elephant will slowly wear through during its lifetime of chewing rough plant material. Only four teeth are used for chewing at a given time, and as each tooth wears out, another tooth moves forward to take its place in a process similar to a conveyor belt. The last and largest of these teeth usually becomes exposed when the animal is around 40 years of age, and will often last for an additional 20 years. When the last of these teeth has fallen out, regardless of the elephant's age, the animal will no longer be able to chew food and will die of starvation.[19][20]

Rabbit

[edit]

Rabbits and other lagomorphs usually shed their deciduous teeth before (or very shortly after) their birth, and are usually born with their permanent teeth.[21] The teeth of rabbits complement their diet, which consists of a wide range of vegetation. Since many of the foods are abrasive enough to cause attrition, rabbit teeth grow continuously throughout life.[22] Rabbits have a total of six incisors, three upper premolars, three upper molars, two lower premolars, and two lower molars on each side. There are no canines. Dental formula is 2.0.3.31.0.2.3 = 28. Three to four millimeters of the tooth is worn away by incisors every week, whereas the cheek teeth require a month to wear away the same amount.[23]

The incisors and cheek teeth of rabbits are called aradicular hypsodont teeth. This is sometimes referred to as an elodent dentition. These teeth grow or erupt continuously. The growth or eruption is held in balance by dental abrasion from chewing a diet high in fiber.

Buccal view of top incisor from Rattus rattus. Top incisor outlined in yellow. Molars circled in blue.
Buccal view of the lower incisor from the right dentary of a Rattus rattus
Lingual view of the lower incisor from the right dentary of a Rattus rattus
Midsagittal view of top incisor from Rattus rattus. Top incisor outlined in yellow. Molars circled in blue.

Rodents

[edit]

Rodents have upper and lower hypselodont incisors that can continuously grow enamel throughout its life without having properly formed roots.[24] These teeth are also known as aradicular teeth, and unlike humans whose ameloblasts die after tooth development, rodents continually produce enamel, they must wear down their teeth by gnawing on various materials.[25] Enamel and dentin are produced by the enamel organ, and growth is dependent on the presence of stem cells, cellular amplification, and cellular maturation structures in the odontogenic region.[26] Rodent incisors are used for cutting wood, biting through the skin of fruit, or for defense. This allows for the rate of wear and tooth growth to be at equilibrium.[24] The microstructure of rodent incisor enamel has shown to be useful in studying the phylogeny and systematics of rodents because of its independent evolution from the other dental traits. The enamel on rodent incisors are composed of two layers: the inner portio interna (PI) with Hunter-Schreger bands (HSB) and an outer portio externa (PE) with radial enamel (RE).[27] It usually involves the differential regulation of the epithelial stem cell niche in the tooth of two rodent species, such as guinea pigs.[28][29]

Lingual view of top incisor from Rattus rattus. Top incisor outlined in yellow. Molars circled in blue.

The teeth have enamel on the outside and exposed dentin on the inside, so they self-sharpen during gnawing. On the other hand, continually growing molars are found in some rodent species, such as the sibling vole and the guinea pig.[28][29] There is variation in the dentition of the rodents, but generally, rodents lack canines and premolars, and have a space between their incisors and molars, called the diastema region.

Manatee

[edit]

Manatees are polyphyodont with mandibular molars developing separately from the jaw and are encased in a bony shell separated by soft tissue.[30][31]

Walrus

[edit]

Walrus tusks are canine teeth that grow continuously throughout life.[32]

Fish

[edit]
Teeth of a great white shark

Fish, such as sharks, may go through many teeth in their lifetime. The replacement of multiple teeth is known as polyphyodontia.

A class of prehistoric shark are called cladodonts for their strange forked teeth.

Unlike the continuous shedding of functional teeth seen in modern sharks,[33][34] the majority of stem chondrichthyan lineages retained all tooth generations developed throughout the life of the animal.[35] This replacement mechanism is exemplified by the tooth whorl-based dentitions of acanthodians,[36] which include the oldest known toothed vertebrate, Qianodus duplicis[37].

Amphibians

[edit]

All amphibians have pedicellate teeth, which are modified to be flexible due to connective tissue and uncalcified dentine that separates the crown from the base of the tooth.[38]

Most amphibians exhibit teeth that have a slight attachment to the jaw or acrodont teeth. Acrodont teeth exhibit limited connection to the dentary and have little enervation.[39] This is ideal for organisms who mostly use their teeth for grasping, but not for crushing and allows for rapid regeneration of teeth at a low energy cost. Teeth are usually lost in the course of feeding if the prey is struggling. Additionally, amphibians that undergo a metamorphosis develop bicuspid shaped teeth.[40]

Reptiles

[edit]

The teeth of reptiles are replaced constantly throughout their lives. Crocodilian juveniles replace teeth with larger ones at a rate as high as one new tooth per socket every month. Once mature, tooth replacement rates can slow to two years and even longer. Overall, crocodilians may use 3,000 teeth from birth to death. New teeth are created within old teeth.[41]

Birds

[edit]

A skull of Ichthyornis discovered in 2014 suggests that the beak of birds may have evolved from teeth to allow chicks to escape their shells earlier, and thus avoid predators and also to penetrate protective covers such as hard earth to access underlying food.[42][43]

Invertebrates

[edit]
The European medicinal leech has three jaws with numerous sharp teeth which function like little saws for incising a host.

True teeth are unique to vertebrates,[44] although many invertebrates have analogous structures often referred to as teeth. The organisms with the simplest genome bearing such tooth-like structures are perhaps the parasitic worms of the family Ancylostomatidae.[45] For example, the hookworm Necator americanus has two dorsal and two ventral cutting plates or teeth around the anterior margin of the buccal capsule. It also has a pair of subdorsal and a pair of subventral teeth located close to the rear.[46]

Historically, the European medicinal leech, another invertebrate parasite, has been used in medicine to remove blood from patients.[47] They have three jaws (tripartite) that resemble saws in both appearance and function, and on them are about 100 sharp teeth used to incise the host. The incision leaves a mark that is an inverted Y inside of a circle. After piercing the skin and injecting anticoagulants (hirudin) and anaesthetics, they suck out blood, consuming up to ten times their body weight in a single meal.[48]

In some species of Bryozoa, the first part of the stomach forms a muscular gizzard lined with chitinous teeth that crush armoured prey such as diatoms. Wave-like peristaltic contractions then move the food through the stomach for digestion.[49]

The limpet rasps algae from rocks using teeth with the strongest known tensile strength of any biological material.

Molluscs have a structure called a radula, which bears a ribbon of chitinous teeth. However, these teeth are histologically and developmentally different from vertebrate teeth and are unlikely to be homologous. For example, vertebrate teeth develop from a neural crest mesenchyme-derived dental papilla, and the neural crest is specific to vertebrates, as are tissues such as enamel.[44]

The radula is used by molluscs for feeding and is sometimes compared rather inaccurately to a tongue. It is a minutely toothed, chitinous ribbon, typically used for scraping or cutting food before the food enters the oesophagus. The radula is unique to molluscs, and is found in every class of mollusc apart from bivalves.

Within the gastropods, the radula is used in feeding by both herbivorous and carnivorous snails and slugs. The arrangement of teeth (also known as denticles) on the radula ribbon varies considerably from one group to another as shown in the diagram on the left.

Predatory marine snails such as the Naticidae use the radula plus an acidic secretion to bore through the shell of other molluscs. Other predatory marine snails, such as the Conidae, use a specialized radula tooth as a poisoned harpoon. Predatory pulmonate land slugs, such as the ghost slug, use elongated razor-sharp teeth on the radula to seize and devour earthworms. Predatory cephalopods, such as squid, use the radula for cutting prey.

In most of the more ancient lineages of gastropods, the radula is used to graze by scraping diatoms and other microscopic algae off rock surfaces and other substrates. Limpets scrape algae from rocks using radula equipped with exceptionally hard rasping teeth.[50] These teeth have the strongest known tensile strength of any biological material, outperforming spider silk.[50] The mineral protein of the limpet teeth can withstand a tensile stress of 4.9 GPa, compared to 4 GPa of spider silk and 0.5 GPa of human teeth.[51]

 

Fossilization and taphonomy

[edit]

Because teeth are very resistant, often preserved when bones are not,[52] and reflect the diet of the host organism, they are very valuable to archaeologists and palaeontologists.[53] Early fish such as the thelodonts had scales composed of dentine and an enamel-like compound, suggesting that the origin of teeth was from scales which were retained in the mouth. Fish as early as the late Cambrian had dentine in their exoskeletons, which may have functioned in defense or for sensing their environments.[54] Dentine can be as hard as the rest of teeth and is composed of collagen fibres, reinforced with hydroxyapatite.[54]

Though teeth are very resistant, they also can be brittle and highly susceptible to cracking.[55] However, cracking of the tooth can be used as a diagnostic tool for predicting bite force. Additionally, enamel fractures can also give valuable insight into the diet and behaviour of archaeological and fossil samples.

Decalcification removes the enamel from teeth and leaves only the organic interior intact, which comprises dentine and cementine.[56] Enamel is quickly decalcified in acids,[57] perhaps by dissolution by plant acids or via diagenetic solutions, or in the stomachs of vertebrate predators.[56] Enamel can be lost by abrasion or spalling,[56] and is lost before dentine or bone are destroyed by the fossilisation process.[57] In such a case, the 'skeleton' of the teeth would consist of the dentine, with a hollow pulp cavity.[56] The organic part of dentine, conversely, is destroyed by alkalis.[57]

See also

[edit]
  • Animal tooth development
  • Dragon's teeth (mythology)

References

[edit]
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Sources

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  • Shoshani, Jeheskel (2002). "Tubulidentata". In Robertson, Sarah (ed.). Encyclopedia of Life Sciences. Vol. 18: Svedberg, Theodor to Two-hybrid and Related Systems. London, UK: Nature Publishing Group. ISBN 978-1-56159-274-6.
[edit]
  • Beach, Chandler B., ed. (1914). "Teeth" . The New Student's Reference Work . Chicago: F. E. Compton and Co.