14.

THE MOUTH AND PHARYNX

Vestibule of the mouth lies between the teeth and the cheek. Unconscious patients can be fed through this
space. Teeth are of two types – deciduous and permanent. The third molar tooth erupts around 20th Year,
when one is supposed to be wise and it is rightly called the “wisdom” tooth.

All muscles of soft palate are supplied by vagoaccessory complex except tensor veli palatini supplied by
mandibular nerve.

Collection of lymphoid tissue at the oropharyngeal junction guards the foreign bodies. Muscles of pharynx
are also supplied by vagoaccessory complex except the stylopharyngeus supplied by glossopharyngeal
nerve. Inferior constrictor of pharynx receives additional nerve supply from external and recurrent laryngeal
nerves. Auditory tube connecting the nasopharynx with the middle ear cavity equalises pressure on the two
sides of the tympanic membrane.

Identification
Identify the structures in the oral cavity. Identify the vestibule, lips, cheeks, oral cavity proper and teeth.

The Oral Cavity

The oral of mouth cavity is divided into an outer, smaller portion, the vestibule, and an inner larger part, the
oral cavity proper.

Vestibule

1. The vestibule of the mouth is narrow space bounded externally by the lips and cheeks , and
internally, by the teeth and gums.
2. It communicates : (a) With the exterior through the oral fissure ; (b) with the mouth open it
communicates freely with the oral cavity proper. Even when the teeth are occluded a small
communication remains behind the third molar tooth.
3. The poratid duct opens on the inner surface of the cheek opposite the crown of the upper second
molar tooth. Numerous labial and buccal glands (mucous) situated in the submucosa of the lips and
cheeks open into the vestibule. Four or five molar glands (mucous), situated on the buccopharyngeal
fascia also open into the vestibule.
4. Except for the teeth, the entire vestibule is lined by mucous membrane. The mucous membrane
forms median folds that pass from the lips to the gums, and are called the frenula of the lips.

Lips

1. The lips are fleshy folds lined externally by skin and internally by mucous membrane. The
mucocutaneous junctions lines the ‘edge’ of the lip : part of the mucosal surface is normally seen.
2. Each lip is composed of : (a) Skin ; (b) superficial fasica ; (c) the orbicularis oris muscle ; (d) the
submucosa, containing mucous labial glands and blood vessels; and (e) mucous membrane.
3. The lips bound the oral fissure. They meet laterally at the angles of the mouth. The inner surface of
each lip is supported by a frenulum which ties it to the gum. The outer surface of the upper lip
presents a median verticle groove, the philtrum.
4. Lymphatics of the centralpart of the lower lip drain to the submental nodes ; the lymphatics from the
rest of the lower lip pass to the submandibular nodes.
Cheeks (Buccae)

1. The cheeks are fleshy flaps, forming a large part of each side of the face. They are continuous in
front with the lips, and the junction is indicated by the nasolabial sulcus (furrow) which extends from
the side nose to the angle of the mouth.
2. Each cheek is composed of : (a)Skin : (b) superficial fascia containing some facial muscles, the
parotid duct, mucous molar glands, vessels and nerves : (c) the buccinator covered by
buccopharyngeal fascia and pierced by the parotid duct : (d) submucosa, with mucous buccal glands
: and (e) mucous membrane.
3. The buccal pad of fat is best developed in infants. It lies on the buccinator partly deep to the
masseter and partly in front of it.
4. The lymphatics of the cheek drain chiefly into the suibmandibular and preauricular nodes, and partly
also to the buccal and mandibular nodes.

Oral Cavity Proper

1. It is bounded anterolaterally by the teeth, the gums and the aveolar arches of the jaws. The roof is
formed by the hard and soft palate. The floor is occupied by the tongue posteriorly, and presents the
sublingual region anteriorly, below the tip of the tongue. Posteriorly, the cavity communicates with
the pharynx through the oropharyngeal isthmus (isthmus of fauces) which is bounded superiorly by
the soft palate, inferiorly by the tongue, and on each side by the palatoglossal arches.
2. The sublingual region presents the following features.
(a) In the median plane there is a fold of mucosa passing from the inferior aspects of the tongue
(Fig. 17.2).
(b) One each side of frenulum there is a sublingual papilla. On the summit of this papilla there is the
opening of submandibular duct.
(c) Running laterally & backwards from the sublingual papilla there is a sublingual fold which
overlies the sublingual gland. A few sublingual ducts open on the edge of this fold.
3. Lymphatics from the anterior part of the floor of the mouth pass to the submental nodes.Those from
the hard palate and soft palate pass to the retropharyngeal and upper deep cervical nodes. The
gums and the rest of the floor drain into the submandibular nodes (Fig. 14.9).

Gums (Gingivae)

The gums are the soft tissue which envelop the alveolar process of the upper and lo The fibrous tissue of
the gum is continuous with the periosteum lining the alveoli (periodontal membrane).

1. The Gums are the soft tissue which envelop the alveolar processes of the upper and lower jaws and
surround the necks of the teeth. These are composed of dense fibrous tissue covered by stratified
squamous epithelium.
2. Each gum has two parts : (a) The free part surrounds the neck of the tooth like a collar. (b) The
attatched part is firmly fixed to the alveolar arch of the jaw. The fibrous tissue of the gum is
continuous with the periosteum lining the alveoli (periodontal membrane).
3. Nerve supply: The upper gums on labial aspects are supplied by posterior, middle & anterior
superior alveolar nerves. Their lingual aspects are supplied by anterior or greater palatine &
nasopalatine nerves. The lower gums on labile aspects are supplied by buccal branch of mandibular
& incisive branch of mental nerves. Their lingual aspect is supplied by the lingual nerve.
4. Lymphatics of the upper gum pass to the submandibular nodes. The anterior part of the lower gum
drains into the submandibular nodes.
Teeth

The teeth form part of the masticatory apparatus & are fixed to the jaws. In man, the teeth are replaced only
once (diphyodont) in contrast with non-mammalian vertebrates where teeth are constantly replaced
throughout life (polyphycodont). The teeth of the first set (dentition) are known as milk, or deciduous teeth
and the second set as permanent teeth.

The deciduous are twenty in number. In each half of each jaw there are two incisors. One canine. &
two molars.

The permanent teeth are thirty two in number, and consist of two incisors, one canine, two premolars,
and three molars in each half of each jaw.

Parts of a tooth

Each tooth has three parts: (1) A crown, projecting above & below the gum; (2) a root, embedded in the jaw
beneath the gum; (3) a neck, between the crown and surrounded by the gum (Fig. 14.1).

Structure

Structurally, each tooth is composed of: (1) The pulp in the centre; (2) the dentine surrounding the pulp; (3)
the enamel covering the projecting part of dentine, or crown; (4) the cementum surrounding the embedded
part of the dentine, and (5) the periodontal membrane.

The pulp is loose fibrous tissue containing vessels, nerves and lymphatic, all of which enter the pulp
cavity through the apical foramen. The pulp is covered by a layer of tall columnar cells, known as
odontoblast which are capable of replacing dentine any time in life.

The dentine is a calcified material containing spiral tubules radiating from the pulp cavity. Each tubule
is occupied by a protoplasmic process from one of the odontoblast. The calcium and organic matter are in
the same proportion as in bone.

The enamel is the hardest substance in the body. It is made up of crystalline prisms lying roughly at
right angles to the surface of the tooth.

The cementum resembles bone in structure, but like enamel and dentine it has no blood supply, nor
any nerve supply. Over the neck, the cementum commonly overlaps the cervical end of enamel; or, less
commonly, it may just meet the enamel. Rarely, it stops short of the enamel (10%) leaving the cervical
dentine covered only by gum.

The periodontal membrane (ligament) holds the root in its socket. This membrane acts as a perioseum
to both the cementum as well as the bony socket.

Form and Function (Crowns and Roots)

01. The shape of a tooth is adapted to its function. The incisors are cutting teeth, with chisel-like crowns.
The upper and lower incisors overlap each other like the blades of a pair of scissors. The canines
are holding and tearing teeth, with conical and rugged crowns. These are better developed in
carnivores. Each premolar has two cusps and is, therefore, also called a bicuspid tooth. The molars
are grinding teeth, with square crowns, bearing four or five cusps on their crowns.
02. The incisors, canines and premolars have single roots, with the exception of the first upper premolar
which has a bifid root. The upper molars have three roots, of which two are lateral and one is medial.
The lower molars have only two roots, an anterior and a posterior.