teeth


Swallowing – Episode 112

 

A young child with no shirt and light brown hair against a blue sky is swallowing gulps of orange juice from a clear plastic bottle.

The 3 Phases of Swallowing

Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios

How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don’t hurry and use the suctioning straw to remove the liquid, you’re going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you’re aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move – roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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Teeth Issues – Episode 104

teething

Teething

Teething is mostly known as the phase of babies growing their first teeth.  Eruption is when the tooth enamel shows through the gum tissue.  A baby’s first teeth grow in between 6 months and 2 years old.  Before any of the teeth show, the gums can be swollen and bumpy.  These symptoms can cause fussiness, sleeplessness, drooling, decreased appetite, excessive chewing, and overall grumpiness.  A few controversial symptoms include fever, diarrhea, and rash. A fever less than 100.4*F can be indicative of inflammation going on, which can be true for some teething babies.  Diarrhea is blamed on excessive saliva ending up in the digestive tract (eh, many things can change the consistency of a baby’s poop, especially in the early stages where they’re only drinking milk or just learning to eat new foods).  A rash is a little more questionable, but can also be a result of inflammation going on.

Treatments

Treatments for teething babies include Infant’s Tylenol or Infant’s Ibuprofen (for children older than 6 months).  Other medications that used to be recommended for teething babies were Teething Tablets and Orajel.  An active ingredient in the Teething Tablets is Belladonna.  This medication can constrict blood vessels, which is good when there’s inflammation (increased blood flow) to an area, but bad when baby’s blood vessels are already tiny and they need to get blood to very important places (i.e. the brain).   The bottom line is that Belladonna can decrease the amount of blood, and therefore oxygen to a baby’s brain, and the outcome can potentially be SIDS.

This is also true of Benzocaine, the ingredient in Orajel.  Benzocaine is a topical numbing agent.  The key word here is topical.  It is not intended to circulate in the body.  The problem comes when you use a TOPICAL product in your mouth, you can’t help but swallow some of it.  When Benzocaine is swallowed, it can cause a serious side effect that involved decreased oxygen in the blood.  Again, if oxygen doesn’t get to important places in the baby’s body, bad things can happen.

PSA: NO Belladonna and NO Benzocaine for babies!

Plaque

Your teeth are covered in a biofilm that is mostly made up of bacteria. That bacteria can compromise the seal that is formed between healthy teeth and healthy gums.  If this seal is breached by bacteria, then infection and gum disease (gingivitis) can occur.

Tartar

Plaque can harden, and when it does, it becomes known as tartar.  Mouth bacteria eat the sugars in the food that gets stuck in the crevices of your teeth.  A waste product of this process is lactic acid, and lactic acid can actually dissolve enamel of your teeth.  Minor erosion can be repaired by your body.  The problem is that saliva cannot break through the plaque.

Cavities

Tooth decay is the result of long-term enamel erosion that can’t be repaired by the body.  If the erosion is deep enough, it can expose the softer parts of the tooth to irritants and injury.  When this happens, the only way to repair and protect the tooth is to get a filling from your dentist. *womp womp*

Discoloration

Extrinsic stains are when substances change the tooth color from the outside. So this is how coffee, tea, wine, and tobacco can make the teeth yellow or brown.  Also, certain bacteria, excessive chlorophyll, or excess copper and nickel can make the teeth look green.

Intrinsic stains are when the building blocks of teeth are altered and changes the color from the inside.  Tetracycline antibiotics have been a common treatment for acne in teenagers for quite a long time.  It is well-documented that these antibiotics can bind up free calcium in the body.  Therefore, it is not recommended for pregnant women or children younger than 8 years old to use these medications.  There are many cases of developing fetuses and children with quickly-developing teeth ending up with grey or brown teeth due to this missing calcium (remember, calcium built into the enamel is what makes it white).

Injuries

A chipped tooth is when a part of the enamel breaks away.  A fractured tooth is when a crack involves the enamel and the dentin.  An abscess is an infection in the gum around the tooth or in the accessible or exposed pulp of a tooth.  Luxation is a dislocated tooth, and may or may not include injury to the periodontal ligaments or jawbones.

Dental Trauma Guidelines

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Teeth – Episode 103

Types of Teeth

Incisors: You have 4 on the top and 4 on the bottom.  Yes, it sounds like “scissors”; they are the teeth and cut and tear food (or the enemy?).  They are in the very front of your mouth.

Canines:  You have 2 on the top and 2 on the bottom.  Yes, canine, like a dog; they are sharp and pointed.  These teeth are good for gripping and tearing.  Also known as cuspids (one point).  They are located at the “corners” of your teeth arch.

Premolars: You have 4 on the top and 4 on the bottom.  These are permanent teeth only.  They have a flatter surface for crushing food.  Also known as bicuspids (two points).

Molars: You have 6 on the top and 6 on the bottom.   They have large flattish surfaces for grinding up food.  Four of these molars are also known as your wisdom teeth.

Parts of a Tooth

Outside In

Enamel: This is the part that you can see.  It is mostly made up of a crystalline structure of calcium phosphate, and that’s what makes them look white.  Enamel all by itself can be very brittle.

Dentin: This layer is made of a softer, yet still strong calcium-containing crystals.  This acts as a tough and supportive scaffold for enamel.

*These two layers together are what make your teeth so hard and strong.

Pulp: The soft connective tissue that contains the nerves and blood vessels that feed the tooth.

Top to Bottom

Crown: This is the part of the tooth that is above the gum line that you can see.  And since you can only see the outside of the tooth, when you look at your teeth, you only see enamel.

Neck:  This is the enameled part of the tooth that is below the gum line.

Root: The part of the tooth that is embedded in the jawbone and provides the openings for the nerves and blood vessels to run up into the pulp.  The roots are covered by a specialized bone structure called cementum (yes, it sounds like cement).

*The roots are actually attached to the jawbone by periodontal ligaments. (Ligaments are connective tissue that connects bone to bone).

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Mouth Parts – Episode 101

bright red lips in a slight smirk behind a window covered in droplets of water

Mouth Parts

Lips:  They are red due to blood flow.  They have lots of nerve ending so they can be very sensitive.  Our lips are used to manipulate food as we eat and make sounds as part of our speech.
* The Divot above the center of your upper lip is called the philtrum.

Gums:  They are also known as the gingiva.  Even though they are wet and look fleshy, healthy gums are quite resilient.

Teeth: They are used for chewing, and possibly as a tool.  Healthy teeth and gums seal together tightly to keep out invaders.  We will talk about teeth in a separate episode.

Tongue:  It is a muscular organ made up of many muscles and nerve endings.  It just happens to be an organ that we can voluntarily move around.  We use our tongue to manipulate food and to make sounds for speech.  And, of course, it is covered in taste buds.  We will cover all of this in a separate episode.

Hard Palate:  A flesh-covered bone that connects the upper teeth.  Our tongue will smash food against it when we eat and use to make certain sounds in speech.

Soft Palate: It is a muscle behind the hard palate and it moves up to close off the nose when we swallow and sneeze.  It also interacts with the back of the tongue to make certain sounds when we talk.

Palatoglossal arch:  It marks the front edge of the soft palate.

Palatopharyngeal arch: It makes the back edge of the soft palate and the end of the “mouth”.

Salivary Glands

Parotid glands: The largest salivary glands are located by your jaws, below your ears.
Submandibular glands: They are located under the jaw and back molars
Sublingual glands: They are located under the tongue, behind your chin.
~1000 of mini glands: They cover the buccal (cheek) tissue, soft palate, uvula, and tongue to keep everything moist.  This is what allows the inside of the mouth to be known as a mucous membrane.

Sublingual papilla: This is the folds of skin under the tongue.  This area contains many blood vessels close to the surface.  Medicine development has learned this is a great place for medication absorption directly into the bloodstream.

Palatine raphe (ray-fee): This is the seam down the middle of the hard palate.

Frenula: Plural for frenulum.  These are folds of skin that connect one place to the other.  You have three: for your upper lip, lower lip, and tongue.

Uvula: Latin for “small bunch of grapes”.  It is attached to the soft palate and contains a gag reflex trigger.  It is also involved in snoring if it dries out.

 

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