Anatomy and Physiology

LEARNING OBJECTIVES
1. Pronounce, define, and spell the key terms.
2. Name and describe the terms used to designate directions in the body, as well as the planes and
sections of the body.
3. List and describe the organizational levels of the human body.
4. Name each body system, and identify its major function.
5. Discuss the structures of the head and neck, and explain why a dental assistant should be
familiar with these structures.
6. Identify the major muscles of mastication and facial expression, and state the function of each.
7. Name and locate the landmarks of the face and oral cavity.

KEY TERMS
ala of the nose
alveolar socket
anatomy
angle of the mandible
anterior
anterior naris
attached gingivae
buccal
canthus
cells
distal
frontal plane
glabella
inferior
innervation
lateral
lingual
mandibular
masticatory mucosa
maxillary
medial
mental protuberance
midsagittal plane
mucogingival junction
mucous membrane
nasion

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organs
palate
philtrum
physiology
posterior
proximal
sagittal plane
septum
superior
tissues
tragus
transverse plane
trigeminal nerve
zygomatic arch
The human body is an incredible living creation. It has 11 body systems that function together more
smoothly than the world's greatest computers. Having a basic understanding of the study of
anatomy (study of the structure of the human body) and physiology (study of how the human
body functions) is important for the dental assistant. This knowledge will also help you keep your
own body healthy, communicate with medical personnel, and understand treatments or
medications that may be prescribed for you. This chapter also introduces you to the basic terms and
definitions that you need to communicate effectively as a dental health care professional.

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Directions and Body Planes
Directions in the Body
Directional terms are used to describe the relative position of one part of the body to another. Note
that the pairs of directional terms in Table 3-1 are opposites (e.g., left and right, up and down,
forward and back).

TABLE 3-1
Directional Terms for the Body

Term Example Term Example

Anterior The heart is anterior to the Posterior The ear is posterior to the nose.
Toward the front of the body spinal column. Toward the back of the body
Medial The nose is medial to the Lateral The ears are lateral to the nose.
Toward, or nearer to, the midline of ears. Toward the side; away from
the body the midline
Proximal The elbow is proximal to Distal The fingers are distal to the wrist. In dentistry, the surface of a tooth that is farthest
Part closer to the trunk of the body or the wrist. Part farther away from the from the midline is the distal surface.
point of attachment midline of the body
Superior The nose is superior to the Inferior The nose is inferior to the eyes.
Above or higher mouth. Below or under

Planes and Sections of the Body

Three imaginary planes are used to help visualize the spatial relationships of internal body parts.
These planes are used to describe the location of an organ or a problem (Figure 3-1).

1. The sagittal plane refers to a lengthwise cut that divides the body into right and left portions. If
the cut passes through the midline of the body, then it is called a midsagittal plane.

2. The transverse plane, also known as the horizontal plane, is any vertical plane at right angles to
the sagittal plane that horizontally cuts across the body, dividing the body into anterior (front) and
posterior (back) portions. This type of view is sometimes called a cross section.

3. The frontal plane divides the body into anterior and posterior sections and is perpendicular to
both the sagittal plane and the transverse plane. The frontal plane is sometimes called a coronal
plane.

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FIGURE 3-1 Body in anatomic position. (Modified from Abrahams PH, Boon J, Spratt J: McMinn's clinical atlas of human
anatomy, ed 6, St. Louis, 2008, Mosby.)

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Organizational Levels of the Body
The human body has four organizational levels or units. From the simplest to the most complex,
they include cells, tissues, organs, and body systems (Figure 3-2).

FIGURE 3-2 Organizational levels of the body.

Cells
Cells are the smallest units in the human body. A variety of cell types are known, and each type has
its own special functions. The structure of a particular cell is based on the function of that cell. For
example, blood cells have a very different function from heart cells. Cells do not function alone.
Approximately 75 to 100 trillion cells join together to form special groups known as tissues.

Tissues
Four primary types of tissues are found in the human body: epithelial, connective, muscle, and
nervous. Similar to cells, each type of tissue is designed to perform a specific function (Table 3-2).
Related tissue types join together to form organs. For example, heart muscles function together to
keep the heart beating.

TABLE 3-2
Tissue Types and Functions

Tissue Function Examples

Epithelial Forms the covering of all body surfaces, and lines body cavities
and hollow organs.
Connective Binds structures together.
Forms the framework and support for organs and the entire
body.
Stores fat, transports substances, and helps repair tissue damage.
Muscle Produces movement of body parts.
Nervous Is found in the brain, spinal cord, and nerves.
Coordinates and controls many body activities.
Skin, intestines, lungs, tubes of the reproductive system, and lining of the oral cavity
Fat, tendons and ligaments, cartilage, blood, and bone
Body movements, pumping action of the heart, food movement through the digestive process, and urine
movement through the bladder
Stimulates muscle contraction.
Creates awareness of the environment.
Plays a major role in emotions, memory, and reasoning.

Organs
Organs work together as a team to keep each body system functioning. The heart, skin, ear,
stomach, and liver are examples of organs.

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Body Systems
Body systems are made up of organs. Occasionally, the same organ belongs to more than one
system. For example, ovaries and testes clearly belong to the reproductive system, but because one
of their functions is to produce hormones, they are also part of the endocrine system. Body systems
do not function independently. For example, when you exercise hard, your muscular system needs
extra oxygen. Your respiratory system meets this need by supplying additional oxygen.

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Systems of the Body
Eleven major systems are present in the human body (Figure 3-3). Although each system has its
own specific functions, all systems work together as a team to support life (Table 3-3).

FIGURE 3-3 The eleven body systems.

TABLE 3-3
Major Body Systems

Body System Components Major Functions

Skeletal 206 bones Protection, support, and shape; hematopoietic; storage of certain minerals
Muscular Striated, smooth, and cardiac muscle Holding body erect, locomotion, movement of body fluids, production of body heat,
communication
Cardiovascular Heart, arteries, veins, and blood Respiratory, nutritive, excretory
Lymphatic and White blood cells; lymph fluid, vessels, and nodes; spleen and tonsils Defense against disease, conservation of plasma proteins and fluid, lipid absorption
immune
Nervous Central and peripheral nervous systems, special sense organs Reception of stimuli, transmission of messages, coordinating mechanism
Respiratory Nose, paranasal sinuses, pharynx, epiglottis, larynx, trachea, bronchi, Transportation of oxygen to cells, excretion of carbon dioxide and some water wastes
and lungs
Digestive system Mouth, pharynx, esophagus, stomach, intestines, and accessory organs Digestion of food, absorption of nutrients, elimination of solid wastes
Urinary system Kidneys, ureters, bladder, and urethra Formation and elimination of urine, maintenance of homeostasis
Integumentary Skin, hair, nails, sweat glands, and sebaceous glands Protection of body, regulation of body temperature
system
Endocrine system Adrenals, gonads, pancreas, parathyroids, pineal, pituitary, thymus, and Integration of body functions, control of growth, maintenance of homeostasis
thyroid
Reproductive system Male: testes and penis Production of new life
Female: ovaries, fallopian tubes, uterus, and vagina

Digestive System
The digestive system is composed of the mouth, teeth, tongue, pharynx, esophagus, stomach,
intestines, and glands such as the salivary glands, pancreas, and liver. The functions of the
digestive system are to ingest food, process it into molecules that can be used by the body, and then
eliminate the residue.

Nervous System
The nervous system causes muscles to contract, stimulates glands to secrete, and regulates many
other systems of the body. The nervous system also allows sensations such as pain, pressure, and

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touch to be perceived. The two primary divisions of the nervous system are the central nervous
system, which consists of the spinal cord and brain, and the peripheral nervous system, which
consists of the cranial and spinal nerves.

Cardiovascular System
The cardiovascular system includes the heart, blood vessels, and blood. The functions of the
cardiovascular system are to circulate blood, carry oxygen and nutrients to all areas of the body,
and filter and eliminate wastes. The two major subdivisions of this system are the pulmonary
circulation and the systemic circulation. Pulmonary circulation includes the flow of blood from the
heart, through the lungs (where it receives oxygen), and back to the heart. Systemic circulation
includes blood flow to all parts of the body except to the lungs.

Endocrine System
The endocrine system consists of glands that produce hormones that regulate the rate of
metabolism, growth, and sexual development and functioning. Hormones are directly secreted into
the bloodstream (not through a duct). The endocrine glands include the thyroid and parathyroid
glands, ovaries, testes, pituitary gland, pancreas, and adrenal medulla.

Respiratory System
The respiratory system is responsible for carrying oxygen from the air to the bloodstream and for
expelling the waste product carbon dioxide. The respiratory system comprises the nose, paranasal
sinuses, pharynx, epiglottis, larynx, trachea, alveoli, and lungs.

Lymphatic System
The lymphatic system is part of the immune system and plays important roles in the defense of the
body against infection and disease and also in the absorption of fats from the intestine. The
lymphatic system includes the thymus, spleen, tonsils, lymph vessels, lymph nodes, and
lymphatic nodules located in the digestive system.

Muscular System
The muscular system consists of three basic types of muscles: striated (striped), smooth, and
cardiac. These types of muscle are described according to their appearance and function (Figure 3-
4).

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 FIGURE 3-4 Types of muscle. (From Thibodeau GA, Patton KT: The human body in health and disease, ed 5, St. Louis, 2010,
Mosby.)

Types of Muscle
Striated muscles are known as the skeletal or voluntary muscles. Skeletal muscles attach to the
bones of the skeleton and make bodily motions possible.
Smooth muscle fibers move the internal organs, such as the digestive tract, blood vessels, and
secretory ducts leading from the glands.
Cardiac muscle forms most of the wall of the heart and is the contraction of the muscle that
causes the heart to beat.

Skeletal System
The skeletal system consists of 206 bones. It provides the framework for the attached muscles and
plays an indispensable role in movement and in supporting the brain and spinal cord, which are
encased in the skull and spine.

Urinary System
The urinary system consists of the kidneys, in which urine is formed to carry away waste materials
from the blood; the ureters, which transport urine from the kidney; the bladder, where the urine is
stored until it can be disposed; and the urethra, through which the bladder is emptied to the
outside through the process of urination. The kidneys require a large blood supply and are close to
the primary artery of the body—the aorta. More than 2 pints of blood pass through the kidneys
every minute.

Integumentary or Skin System

The integumentary (skin) system has many important functions. It helps regulate body
temperature, keeps bacteria from entering the body, excretes liquids and salts, and provides
sensitivity to touch. The skin also absorbs ultraviolet rays from the sun and uses them to convert
chemicals into vitamin D, which is necessary for the absorption of calcium.

Reproductive System
The female reproductive system consists of the ovaries, fallopian tubes, uterus, and vagina.
Fertility begins at puberty (the onset of menstruation) and ceases at the time of menopause. The

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male reproductive system includes the testes, prostate, and seminal vesicles.

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 Structures of the Head and Neck
As a dental assistant, your knowledge and understanding of the structures of the head and neck
will be useful for almost every task you perform. (See Procedure 3-1: Identify the Major Landmarks
and Structures of the Face.)

Procedure 3-1
Identify the Major Landmarks and Structures of the Face
Goal
To identify the major landmarks and structures of the face correctly.

1. Ala of the nose.

2. Inner canthus and outer canthus of the eye.

3. Commissure of the lips.

4. Location of the frontal sinuses.

5. Location of the maxillary sinuses.

6. Location of the parotid glands.

7. Philtrum.

8. Tragus of the ear.

9. Vermilion border.

10. Zygomatic arch.

Types of Bone
Bone is the hard connective tissue that makes up most of the human skeleton. There are two types
of bone (Figure 3-5).

FIGURE 3-5 Structure of bone.

Compact bone, also known as cortical bone, is hard, dense, and very strong. It forms the outer
layer of bones where it is needed for strength. For example, the outer layer of the mandible (lower
jaw) is made of compact bone (Figure 3-6, A).

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 FIGURE 3-6 A, Cortical bone appears hard and dense. B, Cancellous bone appears spongy. (From Haring
JI, Lind LJ: Radiographic interpretation for the dental hygienist, Philadelphia, 1993, Saunders.)

Cancellous bone, also known as spongy bone, is found in the interior of bones and is lighter in
weight and not as strong as compact bone. For example, the inner layer of the maxillary bones
(upper jaw) is made of cancellous bone (Figure 3-6, B).
The periosteum is the specialized connective tissue covering of all bones in the body.

Anatomy of the Skull

The human skull is made up of the bones of the cranium and the face. (The cranium forms the bony
protection for the brain.) The bones of the skull are summarized in Table 3-4.

TABLE 3-4
Bones of the Skull

Bone Number Location

Eight Bones of the Cranium
Frontal 1 Forms the forehead, most of the orbital roof, and the anterior cranial floor.
Parietal 2 Form most of the roof and upper sides of the cranium.
Occipital 1 Forms the back and base of the cranium.
Temporal 2 Form the sides and base of the cranium.
Sphenoid 1 Forms part of the anterior base of the skull and part of the walls of the orbit.
Ethmoid 1 Forms part of the orbit and the floor of the cranium.
Fourteen Bones of the Face
Zygomatic 2 Form the prominence of the cheeks and part of the orbit.
Maxillary 2 Form the upper jaw.
Palatine 2 Form the posterior part of the hard palate and the floor of the nose.
Nasal 2 Form the bridge of the nose.
Lacrimal 2 Form part of the orbit at the inner angle of the eye.
Vomer 1 Forms the base for the nasal septum.
Inferior conchae 2 Form part of the interior of the nose.
Mandible 1 Forms the lower jaw.
Six Auditory Ossicles
Malleus, incus, stapes 6 Are the bones of the middle ear.

The dental assistant should know the anatomic landmarks of the skull. These landmarks are
illustrated in Figures 3-7 through 3-13.

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FIGURE 3-7 Frontal view of the skull. (From Applegate E: The anatomy and physiology learning system, ed 4, St. Louis,
2011, Saunders.)

FIGURE 3-8 Lateral view of the skull. (From Applegate E: The anatomy and physiology learning system, ed 4, St. Louis,
2011, Saunders.)

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FIGURE 3-9 Base of the skull. (From Applegate E: The anatomy and physiology learning system, ed 4, St. Louis, 2011,
Saunders.)

FIGURE 3-10 Midsagittal view of the skull. (From Applegate E: The anatomy and physiology learning system, ed 4, St.
Louis, 2011, Saunders.)

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FIGURE 3-11 Bones and landmarks of the hard palate.

FIGURE 3-12 Topical view of the mandible.

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 FIGURE 3-13 Views of the mandible. A, From the front. B, From behind and above. C, From the left and
front. D, Internal view from the left. (From Malamed SF: Handbook of local anesthesia, ed 6, St. Louis, 2013, Mosby. Data from
Abrahams PH, Boon J, Spratt J: McMinn's clinical atlas of human anatomy, ed 6, St. Louis, 2008, Mosby.)

Paranasal Sinuses
The paranasal sinuses are spaces that contain air within the bones of the skull. Their functions
include providing mucus, making the bones of the skull lighter, and helping to produce sound
(Figure 3-14). These sinuses are named for the bones in which they are located (Table 3-5).

FIGURE 3-14 The paranasal sinuses.

TABLE 3-5

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The Paranasal Sinuses

Sinuses Location Significance of Sinuses

Maxillary Are located in the maxillary bones and are the largest sinuses. Infection in any of the maxillary sinuses may cause pain in the maxillary teeth.
The symptoms of sinusitis (inflamed sinuses) are headache, foul-smelling
discharge, fever, and weakness.
Infection in one sinus can travel through the nasal cavity to the other sinuses,
leading to serious complications for the patient.
Frontal Are located in the frontal bone, within the forehead, just above the eyes.
Ethmoid Are located in the ethmoid bone and are irregularly shaped air cells separated from the
orbital (eye) cavity by a very thin layer of bone.
Sphenoid Are located in the sphenoid and close to the optic nerves. Infection in these sinuses may damage vision or the brain or both.
sinuses

Temporomandibular Joint
A joint is the junction between two or more bones. The temporomandibular joint (TMJ) is located on
each side of the head where the temporal bone and the mandible join (Figure 3-15). The TMJ makes
it possible for the lower jaw to move so that we can speak and chew. A patient may have a disorder
with one or both of their TMJs. The dental professional must have an understanding of the anatomy
of the TMJ, the normal movements of the joint, and any possible disorders of the joint (Figure 3-16).

FIGURE 3-15 Lateral view of the skull showing the mandible and the temporomandibular joint. (From
Fehrenbach M, Herring S: Illustrated anatomy of the head and neck, ed 4, St. Louis, 2012, Saunders.)

FIGURE 3-16 Palpation of the patient during movements of both temporomandibular joints.

Capsular Ligament
The capsular ligament is a dense fibrous capsule that completely surrounds the TMJ. It is attached

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to the neck of the condyle and to the nearby surfaces of the temporal bone. The ligaments of the
TMJ attach the mandible to the cranium (Figure 3-17).

FIGURE 3-17 Lateral view of the joint capsule of the temporomandibular joint and its lateral
temporomandibular ligament. (From Fehrenbach M, Herring S: Illustrated anatomy of the head and neck, ed 4, St. Louis, 2012,
Saunders.)

Articular Space
The articular space is the area between the capsular ligament and the surfaces of the glenoid fossa
and the condyle. The articular disc, also known as the meniscus, is a cushion of dense connective
tissue that divides the articular space into fluid-filled upper and lower compartments. The structure
of these compartments and the presence of fluid make smooth movement of the joint possible.

Movements of the Temporomandibular Joint

The TMJs are constructed for specialized hinge-and-glide movements, which allow the mouth to
open and close (Figure 3-18).

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 FIGURE 3-18 Hinge-and-gliding actions of the temporomandibular joint.

Hinge Action
The hinge action is the first phase in opening the mouth. During this movement, the body of the
mandible drops downward and backward.

Gliding Action
Gliding action is the second phase in opening the mouth. This phase consists of a gliding movement
by the condyle and articular disc forward and downward along the articular eminence. This
movement occurs during the forward movement (protrusion) of the mandible. The backward
movement is called retrusion.

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Major Muscles of Mastication and Facial Expression
The muscles of mastication are responsible for closing the jaws, bringing the lower jaw forward and
backward, and shifting the lower jaw from side to side. The muscles of mastication work with the
TMJ to accomplish these movements (Table 3-6).

TABLE 3-6
Muscles of Mastication and Facial Expression

Muscle Function
Buccinator Compresses the cheeks and holds food in contact with the teeth.
External (lateral) pterygoid Depresses, protrudes, and moves the mandible from side to side.
Internal (medial) pterygoid Closes and aids in sideways movement.
Masseter Raises the mandible, closes the jaws, and occludes the teeth.
Mentalis Raises and wrinkles the skin of the chin and pushes up the lower lip.
Orbicularis oris Closes and puckers the lips and aids in chewing by pushing the food against the teeth.
Temporal Raises the mandible, closes the jaw, and occludes the teeth.
Zygomatic major Draws the angles of the mouth upward and backward, as in laughing.

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Blood Supply to the Face and Mouth
Arteries carry oxygenated blood away from the heart to all parts of the body with a pulsing motion.
Veins carry blood back to the heart. The major arteries and veins of the face and mouth are shown
in Figure 3-19 and listed in Table 3-7.

FIGURE 3-19 Major arteries and veins of the face and oral cavity.

TABLE 3-7
Major Arteries to the Face and Mouth

Structure Blood Supply

Muscles of facial expression Branches and small arteries from maxillary, facial, and ophthalmic arteries
Maxilla Anterior, middle, and posterior alveolar arteries
Maxillary teeth Anterior, middle, and posterior alveolar arteries
Mandible Inferior alveolar arteries
Mandibular teeth Inferior alveolar arteries
Tongue Lingual artery
Muscles of mastication Facial arteries

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Lymph Nodes
Lymph nodes are small round or oval structures located in lymph vessels. With some infections and
immune disorders, the lymph nodes become swollen and tender. During the examination, the
dentist examines the nodes of the neck to detect signs of swelling or tenderness. The lymph nodes
of the face and neck are shown in Figure 3-20.

FIGURE 3-20 A, Superficial lymph nodes of the head and associated structures. B, Deep cervical lymph
nodes and associated structures. (From Fehrenbach M, Herring S: Illustrated anatomy of the head and neck, ed 4, St. Louis,
2012, Saunders.)

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Nerve Supply to the Mouth
The trigeminal nerve, which is a branch of the fifth cranial nerve, is the primary source of the nerve
supply for the mouth. Innervation is another term for nerve supply. The trigeminal nerve divides
into maxillary and mandibular branches to serve the mouth (Figures 3-21 and 3-22).

FIGURE 3-21 Maxillary and mandibular innervation.

FIGURE 3-22 Palatal, lingual, and buccal innervation.

Maxillary Innervation
The maxillary division of the trigeminal nerve supplies the maxillary (upper) teeth, periosteum,
mucous membrane, maxillary sinuses, and soft palate. The mucous membrane is the specialized
tissue that lines the inside of the mouth.
The maxillary division further subdivides to provide the following routes of the nerve supply:
• The nasopalatine nerve, which passes through the incisive foramen, supplies the tissue palatal to
the maxillary anterior teeth. (Anterior means toward the front. A foramen is an opening in a bone

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 through which blood vessels, nerves, and ligaments pass.)
• The anterior palatine nerve, which passes through the posterior palatine foramen and forward
over the palate, supplies the mucoperiosteum (mucoperiosteum is periosteum that has a mucous
membrane surface).
The anterior superior alveolar nerve supplies the maxillary central, lateral, and cuspid teeth plus
their periodontal membrane and gingivae. This nerve also supplies the maxillary sinus.
• The middle superior alveolar nerve supplies the maxillary first and second premolars, the
mesiobuccal root of the maxillary first molar, and the maxillary sinus.
• The posterior superior alveolar nerve supplies the other roots of the maxillary first molar and the
maxillary second and third molars. This nerve also branches forward to serve the lateral wall of
the maxillary sinus.
• The buccal nerve supplies branches to the buccal mucous membrane and to the mucoperiosteum
of the maxillary and mandibular molar teeth. (Buccal means pertaining to or directed toward the
cheek.)

Mandibular Innervation
The mandibular division of the trigeminal nerve subdivides into the buccal, lingual, and inferior
alveolar nerves.
• The buccal nerve supplies branches to the buccal mucous membrane and to the mucoperiosteum
of the maxillary and mandibular molar teeth.
• The lingual nerve supplies the anterior two thirds of the tongue and gives off branches to supply
the lingual mucous membrane and mucoperiosteum. (Lingual means of, or pertaining to, the
tongue.)
• The inferior alveolar nerve subdivides into the following:
• The mylohyoid nerve supplies the mylohyoid muscles and the anterior belly of the digastric
muscle.
• The small dental nerves supply the molar teeth and premolar teeth, alveolar process, and
periosteum of the mandible.
• The mental nerve moves outward through the mental foramen and supplies the chin and mucous
membrane of the lower lip.
• The incisive nerve continues interiorly and gives off small branches to supply the cuspid, lateral,
and central teeth.

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 Structures of the Face and Oral Cavity
Before beginning more advanced procedures, such as exposing dental radiographs or assisting with
intraoral procedures, you must learn the terms and locations of various structures of the face and
oral cavity. See Procedure 3-2: Identify the Major Landmarks, Structures, and Normal Tissues of the
Mouth.

Procedure 3-2
Identify the Major Landmarks, Structures, and Normal
Tissues of the Mouth
Goal
To identify and locate correctly the major landmarks, structures, and normal tissues of the mouth.

1. Locate the dorsum of the tongue.

2. Locate the area of the gag reflex.

3. Identify the hard and soft palates.

4. Identify the gingival margin.

5. Locate the incisive papilla.

6. Identify the mandibular labial frenum.

7. Identify the maxillary labial frenum.

8. Locate the sublingual frenum.

9. Identify the vestibule of the mouth.

10. Locate Wharton duct.

Landmarks of the Face

The face is defined as the part of the head visible in a frontal view that is anterior to the ears and
that lies between the hairline and the chin.

Regions of the Face

The facial region can be subdivided into nine areas (Figure 3-23):

1. Forehead, extending from the eyebrows to the hairline

2. Temples, or temporal area posterior to the eyes

3. Orbital area, containing the eye and covered by the eyelids

4. External nose

5. Zygomatic (malar) area, the prominence of the cheek

6. Mouth and lips

7. Cheeks

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8. Chin

9. External ear

FIGURE 3-23 A and B, Regions of the face.

Features of the Face

The dental assistant should be able to identify the following important facial landmarks (Figure 3-
24):

1. Outer canthus of the eye: Fold of tissue at the outer corner of the eyelids

2. Inner canthus of the eye: Fold of tissue at the inner corner of the eyelids

3. Ala of the nose: Winglike tip on the outer side of each nostril

4. Philtrum: Rectangular area between the two ridges running from under the nose to the midline
of the upper lip

5. Tragus of the ear: Cartilaginous projection anterior to the external opening of the ear

6. Nasion: Midpoint between the eyes just below the eyebrows; on the skull, the point where the
two nasal bones and frontal bone join

7. Glabella: Smooth surface of the frontal bone; also the anatomic area directly above the root of the
nose

8. Root: Commonly called the bridge of the nose

9. Septum: Tissue that divides the nasal cavity into two nasal fossae

10. Anterior naris: Nostril

11. Mental protuberance: Part of the mandible that forms the chin

12. Angle of the mandible: Lower posterior of the ramus

13. Zygomatic arch: Prominence of the cheek

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 FIGURE 3-24 Features of the face.

Oral Cavity
The entire oral cavity is lined with mucous membrane tissue. This type of tissue is moist and is
adapted to meet the needs of the area it covers.
The oral cavity consists of the following two areas:

1. Vestibule: Space between the teeth and the inner mucosal lining of the lips and cheeks

2. Oral cavity proper: Space on the tongue side within the upper and lower dental arches

Tongue
The tongue is primarily made up of muscles. It is covered on top with a thick layer of mucous
membrane and thousands of tiny projections called papillae. Inside the papillae are the sensory
organs and the nerves for both taste and touch. On a healthy tongue, the papillae are usually
pinkish-white and velvety smooth.
The tongue is one of the body's most versatile organs and is responsible for a number of
functions: (1) speaking, (2) positioning food while eating, (3) tasting and tactile sensations, (4)
swallowing, and (5) cleansing the oral cavity. After eating, notice how your tongue moves from
crevice to crevice, seeking out and removing bits of retained food in your mouth.
The anterior two thirds of the tongue, called the body, is found in the oral cavity. The root of the
tongue is the posterior part that turns vertically downward to the pharynx. The dorsum consists of
the superior (upper) and posterior roughened aspects of the tongue and is covered with small
papillae of various shapes and colors (Figure 3-25).

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 FIGURE 3-25 Dorsum of the tongue. (From Liebgott B: The anatomical basis of dentistry, ed 3, St. Louis, 2010, Mosby.)

The sublingual surface of the tongue is covered with thin, smooth, transparent mucosa through
which many underlying vessels can be seen (Figure 3-26). Two small papillae are present on either
side of the lingual frenulum (frenum) just behind the central incisors. Through these papillae into
the mouth are the openings of the submandibular ducts. The saliva enters the oral cavity through
these ducts. On either side of the lingual surface are two smaller fimbriated folds. The lingual
frenum is the thin fold of mucous membrane that extends from the floor of the mouth to the
underside of the tongue.

FIGURE 3-26 Sublingual aspect of the tongue. (From Liebgott B: The anatomical basis of dentistry, ed 3, St. Louis, 2010,
Mosby.)

Frenum
A frenum is a narrow band of tissue that connects two structures. The maxillary labial frenum
passes from the oral mucosa at the midline of the maxillary arch to the midline of the inner surface
of the upper lip. The mandibular labial frenum passes from the oral mucosa at the midline of the
mandibular arch to the midline of the inner surface of the lower lip (Figure 3-27).

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 FIGURE 3-27 View of the gingivae and associated anatomic structures.

In the area of the first maxillary permanent molar, the buccal frenum passes from the oral mucosa
of the outer surface of the maxillary arch to the inner surface of the cheek. The lingual frenum
passes from the floor of the mouth to the midline of the ventral border of the tongue.

Salivary Glands
The salivary glands produce saliva that lubricates and cleans the oral cavity and helps with
digestion. The nervous system controls these glands. The salivary glands have ducts (openings) to
help drain the saliva directly into the oral cavity where the saliva is used. The salivary glands may
become enlarged, tender, and possibly firm as the result of various disease processes. Certain
medications or disease processes may result in decreased or increased production of saliva by these
glands (Table 3-8 and Figure 3-28).

TABLE 3-8
Three Pairs of Salivary Glands and Ducts

Gland Location Associated Duct

Parotid Is the largest pair of glands; located under the skin just in front of and below each ear. The parotid Saliva enters through Stensen duct, located in the cheek opposite
glands can be felt by gently touching that area. the maxillary second molar.
Sublingual This gland is present on each side underneath the tongue. Saliva enters through the sublingual duct through the sublingual
caruncle.
Submandibular Is the second largest pair of salivary glands; they lie beneath the mandible in the submandibular fossa, Saliva enters through Wharton duct.
posterior to the sublingual salivary gland.

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 FIGURE 3-28 Major salivary glands. A, Parotid salivary glands. B, Submandibular salivary gland. C,
Sublingual salivary gland. Note the elevated tongue and the tissues sectioned in the highlighted
area. (From Fehrenbach M, Herring S: Illustrated anatomy of the head and neck, ed 4, St. Louis, 2012, Saunders.)

Hard and Soft Palates

The hard and soft palates serve as the roof of the mouth, and they separate the mouth from the
nasal cavity (Table 3-9 and Figure 3-29).

TABLE 3-9
Structures of the Hard and Soft Palates

Structure Location
Hard palate Bony anterior portion covered with masticatory mucosa
Palatine rugae Irregular ridges or folds in the mucosa on the palate just behind the maxillary central incisors
Incisive papilla (a small or nipple-shaped pad of Pear-shaped pad of tissue located directly behind the maxillary central incisors
tissue)
Soft palate Flexible posterior portion of the palate that can be lifted upward and backward to block the entrance to the throat during swallowing
and speech
The uvula hangs from the posterior soft palate.

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 FIGURE 3-29 A, Surface features of the hard palate. B, Surface features of the soft palate. (From Liebgott
B: The anatomical basis of dentistry, ed 3, St. Louis, 2010, Mosby.)

Gag Reflex
The gag reflex is an involuntary protective mechanism located in the posterior region of the mouth.
This very sensitive area includes the soft palate, the uvula, the surrounding tissue, and the posterior
portion of the tongue.
Contact of a foreign body with the membranes of this area causes gagging, retching, or vomiting
when placing impression trays or working in the mouth. It is extremely important to avoid
stimulating the gag reflex.

Alveolar Process
The alveolar process is the extension of the bones that form the mandible and the maxilla. The teeth
are firmly held in place within the bone of the alveolar process.

Cortical Plate
The cortical plate, also known as the cribriform plate, is the dense outer layer of bone covering the
alveolar process that provides strength and protection. The cortical plate of the mandible is dense
with few openings. The cortical plate of the maxilla is not as dense.

The Alveolar Crest

The alveolar crest is the highest point of the alveolar ridge. In an unhealthy mouth, the alveolar
crest can be destroyed.

Alveolar Socket
The alveolar socket is the space within the alveolar process in which the root of a tooth is held in
place by the periodontal ligament (Figure 3-30).

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 FIGURE 3-30 The alveolar crest (arrows) as it appears on a radiograph. (From Haring JI, Lind LJ: Radiographic
interpretation for the dental hygienist, Philadelphia, 1993, Saunders.)

Oral Mucosa
The entire mouth is lined with mucous membrane tissue (Figure 3-31). Two types of oral mucosa
are known as:
• The lining mucosa, which covers the inside of the cheeks, vestibule, lips, ventral surface of the
tongue, and soft palate, is delicate, thin, and easily injured.
• The masticatory mucosa, which covers the gingivae (gums), hard palate, and dorsum of the
tongue, is firmly attached to the bone, is very dense, and designed to withstand the vigorous
activity of chewing and swallowing food.

FIGURE 3-31 A, Dense masticatory mucosa makes up the gingiva. B, Delicate lining mucosa covers the
vestibule.

Gingivae
The gingivae are the tissues that surround the teeth (Table 3-10 and see Figure 3-27).

TABLE 3-10
Gingivae

Structure Location
Epithelial The epithelial attachment is healthy gingiva that covers the alveolar bone and attaches to the teeth on the enamel surface just above the neck of the tooth.
attachment
Free gingiva The free gingiva extends from the base of the gingival sulcus to the gingival margin. It is not attached to the surface of the tooth.
Gingival sulcus The gingival sulcus is the space between the free gingiva and the tooth. A normal, healthy gingival sulcus is 3 mm or less in depth.
Gingival margin The gingival margin is the upper edge of the gingiva. Its shape follows the curvatures of the cervical line of the tooth.
Free gingival groove The free gingival groove is a shallow groove that extends from the base of the sulcus to the mucogingival junction. It is a stippled, dense tissue that is firmly bound to
the underlying bone.
Attached gingivae The attached gingivae extend from the base of the sulcus to the mucogingival junction.
Mucogingival The mucogingival junction is the line that separates the attached gingivae from the alveolar mucosa.
junction

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 The gingiva (plural, gingivae), commonly referred to as the gums, is masticatory mucosa that
covers the alveolar processes of the jaws and surrounds the necks of the teeth.

Epithelial Attachment
Healthy gingivae cover the alveolar bone and attach to the teeth on the enamel surface just above
the neck of the tooth. This structure is known as the epithelial attachment.

Free Gingivae
The free gingivae are the parts of the gingiva that extend higher than the epithelial attachment.
They are made up of tissue from the gingival margin to the base of the gingival sulcus and are
normally light pink and coral in color in light-skinned people. The gingival sulcus is the space
between the free gingivae and the tooth.

Teeth
The types of teeth, their structures, and their tissues are discussed in Chapter 4.

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Chapter Exercises
Multiple Choice
Circle the letter next to the correct answer.
1. The simplest organizational level in the human body is the __________.
a. cell
b. organ
c. tissue
d. body system
2. The body system that causes muscles to contract and stimulates glands to secrete is the
__________ system.
a. digestive
b. nervous
c. cardiovascular
d. endocrine
3. The thymus, spleen, and tonsils are components of the _________ system.
a. respiratory
b. muscular
c. lymphatic
d. nervous
4. The type of movements made by the TMJ is __________.
a. hinge
b. glide
c. hinge and glide
5. The nerve that supplies the maxillary first and second premolars and the mesiobuccal root of the
maxillary first molar is the __________ nerve.
a. anterior superior alveolar
b. middle superior alveolar
c. posterior superior alveolar
d. buccal
6. The structures that carry blood back to the heart are the __________.
a. arteries
b. lymph nodes
c. veins
d. trigeminal nerve
7. The top of the tongue is called the __________ surface.
a. lateral
b. ventral
c. dorsal
d. facial
8. Which of the following is(are) functions of the salivary glands?
a. Provide lubrication.
b. Clean the oral cavity.
c. Aid in digestion.
d. All of the above are functions.

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9. Which type of oral mucosa covers the inside of the cheeks, vestibules, lips, and ventral surface of
the tongue?
a. Lining mucosa
b. Masticatory mucosa
c. Gingiva
d. Epithelial attachment
10. The __________ is the cavity within the alveolar process that holds the tooth.
a. alveolar crest
b. alveolar socket
c. cortical plate
d. periodontal ligament

Apply Your Knowledge

1. A patient comes into your office complaining that when he bit into a hot piece of pizza, he
“burned the bump of skin in the front part” of the roof of his mouth. Which oral landmark was
most likely injured?
2. The dentist asks you to place a cotton roll over the Stensen duct to help control the flow of saliva.
Where would you place the cotton roll?
3. To perform a restorative procedure on the mandibular teeth, which nerve must be anesthetized?
4. When placing x-ray film in the maxillary posterior regions of the mouth, care must be taken to
avoid stimulating a certain response from the patient. What is this involuntary response?

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