# oral physiology # lecture 1 # 16 feb # done by :nurkauthar Slide 1-5 Oral Physiology is a branch of biology that dealswith thestudy

of the function of the mouth and its structure. What is a functionof the human mouth? This is important. Number one, it is the portal to Gastrointestinal Tract. It is the first part of gastrointestinal tract, so it guides the food pathway through Gastrointestinal Tract and it prepares the food for digestion. Mouth is really important for the feeding process. Also it is important in the production of speech. We use the mouth for speaking. It is a treat in human. Can animal speak? No, but they can produce sounds. Thats why humans are advanced or superior to the animalsbecause they can use their mouth for speaking. This speech process requires complicated control of many oral pharyngeal and laryngeal muscles. In order to produce speaking, we need to use our larynx, we need to use our pharynx and mouth. So, also sometimes we need the nose so thats why it is anintegrated function. Speaking needs the function of more than one structure all working together. These are 2 important functions of the mouth. We had the third function which your colleague mentioned just now; Breathing is also an important function of the mouth. We use the mouth for breathing if we have problem with nose. Usually we do not use the mouth for breathing but for people who have nasal blocks, they have to use their mouth for breathing. We have another function for mouth which usually applicable to animal which is a prehensile organ. Prehensile meansto hold an object, ya3ni animal use their mouth to hold object. So this is prehensile. But we dont actually (in human) use our mouth for prehensile purpose. So it is more evident in animal. Functions of the oral cavity are organized. We have sensory system which comprise of perception of tasting, pain,touching,temperature and smelling. So when food comes into the mouth, you need to have information about this food. For example the food is salty, so you will have the perception about the taste of this food. So you will have the information of smell of this food, the taste and the texture of this food. For example if I give a piece of

apple inside your mouth so by the texture, you know that youre chewing an apple. (Temperature)We could also know that the food is hot or cold or average in temperature. (Pain) Sometimes you can taste something thats very painful for example chili or mustard sometimes; it is painful or slightly irritating. So together, these are five characteristic of food. So, what will happen after that? Sensory information is integrated to the brain. Then, the brain will collect information about the food that you are eating through these 5 characteristics. The brain is now conscious about what you are eating. So as a result, what does the brain do? The brain actually sends signals to the salivary gland to secrete saliva because it wants to envelop this food with saliva. So after receiving the information, the brain will send a signal to the Salivary gland and the salivary gland will secrete saliva. Actually, saliva is not only important for lubrication but also important for calcification ya3ni one function of saliva is to produce calcium. Calcium is very important for maintain integrity of enamel. So, if people ask what will happen if our salivary glands do not secrete calcium, we will have very fast formation of caries .Why does this happen? Its because calcium maintains the integrity of surface enamel. Saliva is not only important for lubrication but also as a matter of fact it is important in keeping your teeth healthy. After mixing the food with saliva, I will start chewing the food. The brain, other than giving information to the salivary glands, it also gives informationfor the movement of muscle for example we use theMasseter muscle, the Temporalis muscle, the Lateral and Medial Pterygoid muscle. These muscles are the muscles of mastication. They will lead to chewing or as we call it medically mastication. Mastication is bringing teeth together in occlusion. These require neuromuscular control of muscular movement and the muscles have to be functioning in a very organized way. We call it Neuromuscular control. How can we control the movement of the muscle? We do by the brain. Brain controls the activities of these muscle. And then, this is a protection from tissue damage. For example, how many times have you bitten your tongue? So what happens to your tongue? (not that oftenit moves involuntarily). this proves that organized neuromuscular control is important to protect the tissue from damage.For example if your Neuromuscular control is disorganized, you will always bite your tongue or your cheek.

And then after the food is ready, the tounge will lead food to the next track in Gastrointestinal System by the process swallowing.So, do you see this process? We will have lectures on each of these stages. For example we will have a lecture about taste, we will have a lecture about sensation and we will have at least 3 lectures about pain. We will also have a lecture about saliva and we will have 3 lectures about mastication and control of the muscle movementand finally we will have a lecture on swallowing and speech production. So this is the oral physiology, Ivesummarized these topics in this slide. Why do we study oral physiology? Because the knowledge of normal function in mouth will help us recognize the dysfunction in mouth. Therefore if you want to know what sort of problem is present in the mouth, you need to know the normal functions first. Quote~ If you want to know about the abnormality, you need to know about the normality. Thats why we perform a diagnosis before the treatment. Because by diagnosis, we would know the abnormality so after that we could plan a treatment. Practical example of oral physiology that has an impact on industry and marketing is Dietary sweets. If you see Diet coke or Diet Pepsi for example, although its the diet form but It does contain higher sugar levels than the normal Cola. So this is a kind of a fooling system.

Slide 6-7 PAIN We will talk about pain, the first part is here. Dentistry is the beginning of quest about pain relief. Why do we have dentistry? Dentistry exists to deal with pain in mouth. If there is no pain, maybe dentistry would not have existed or would`ve but in another form. Dentistry always find patients who seeking for pain relief. The classical foundation in the dental profession is basically; we need to identify, then diagnose and eliminate that pain. Usually, most of your patients will visit you mainly due to pain. So now we will have to discuss pain. Pain is a subjective substance. What does subjective mean? We usually have objective and subjective pains. Objective pain means that we either have true or false pain or we could determine that in the form of levels. The opposite is subjective. Subjective is different from one person toanother. For example, man usually can withstand pain better than female generally. Lets talk in general though. Is there anybody who wants to oppose this statement? Who wants to

offend this statement? To describe a thing is also subjective. We will find different description between a childand an Adult. In general, we will not only rely on what this child says to us but we will rely on the response of its body. So this is a subjective. Pain is subjective. It differs from one person to another from a male to afemale, a child to an adult the old and young and so on. Also pain is a reaction that is receptive to stimulus. For example, when I tap on the tooth and its painful,the tapping is a stimulus. Some people as they drink cold water they feel pain so the cold water is a stimulus. So thats why it (pain) is a reaction that is elicited by stimulus. It may involve tissue damage: Notice that in tissue damage, what happens during introduction of pain. When you feel pain it may be caused by tissue damage for example inflammation. So thats why, a pretest must be done even if theres a small degree of tissue damage. Wanting to seek treatment: This is very important, is pain (dr. speaks to Arabs)? Because, when you feel pain, you will seek treatment. Actually, pain is a blessing and a right warning to seek treatment. Acute and chronic: What is acute pain actually? Acute pain mean very sharp, over a short period of time whereas the chronic is low pain over a long period of time. So pain can be acute or chronic. It can be spontaneous or provoked. Spontaneous is start by itself. It can be provoked. Some kind of thing produce the pain. For example when you drink cold water and you start feeling pain, so the pain is provoked by the cold water. So it can come by itself and it can provoked by another factor. Continuous or Intermittent. Continuous is you start feeling pain and until this moment you are in painful. So, this is what we call continuous. I will give you an example for continuous pain, pain that you feel on your gum and around the 3rd molar. While you are waiting for the 3rd molar to come out, during this period you will feel continuous pain.But sometimes for example you have intermittent pain. Let say you have big caries. Sometimes you will feel this pain and it disappear. Then after maybe 2 hours, the pain come again and dissappear. So this is what we call as intermittent. Intermittent is different from periodic. Periodic mean it comes and go over an equal interval of time.For example if you have pain that comes let say once daily at 9 oclock in the morning. Every day the pain comes again around the same time interval, ok. It can be recurrent. Recurrent is come, disappear and comes again. For example the eruption of 3rd molar. It comes maybe every 3 month, it comes once for 3 days and then it

disappear. After 3 month or 5 month, it comes again. So this is what we call recurrent. But if it is recurrent in the same interval of time, we call it periodic. So you can differentiate periodic and intermittent. Generally periodic referred to a long period of time. If the pain comes at morning and disappear, then it comes again on the next morning, this is not intermittent. This is what we call periodic. Periodic may take a long period of time, longer than intermittent. It may took a month or a week. It is more specific within the same period of time. If you have pain in one of your tooth, when I tap the tooth you will feel pain, you feel the pain on it, we call localized pain. For example some people say that all our teeth is sore,painful so it is generalized. It can be localized or spreading. Sometime some people come to us and suffering pain is localized and sometimes the pain is spreading to the right part of face. Sometimes it may migrate further. For example, people with coronary heart disease, sometimes he has pain in the left arm and sometime at the mandible part. This is what we call migrating. The pain migrating from heart area to area of mandible. Spreading indicates area. For example area from lower jaw to the upper jaw.From the upper jaw to the head. Migrating is for example from one organ to another organ. Referred pain is sometimes a patient come to you with head ache. Later on you discovered the pain comes from one of the tooth. But actually the tooth is not painful. We call this as referred pain. It actually not a pain in teeth but it appear as head ache. So could you differentiate between referred pain and spreading pain? When the head is painful and the tooth is painful in the same time, we call it spreading type.

Slide 8-9 Pain by definition is complex series of phenomena or can be unpleasant emotional & sensory experiences associated with actual or potential tissue damage. This is by definition. How we define pain. Mostly it is associated with actual injury. Sometimes pain may be very very small but at least they should be all the time associated with tissue damage. It need at least small tissue damage to become pain. It is unpleasant and also emotional. It also can be defined as abnormal affected state aroused by pathological activity of specific sensory.

Pain is not simply an excessive stimulation of some other sense such as touch or temperature. So,this is important. For example you put your hand in warm water that you know that this water is warm so we have the information about the temperature of the water. But when you put your hand in boiled water. Then in this state you will feel pain, you are not feeling heat. Ok, you will feel the temperature, but the pain is not come from the terminal nerve of temperature. Its not caused by temperature receptor. But when this temperature receptor is exceeded by boiling water, pain receptor will cause pain. So this is the reason why you deviate your hand quickly from the boiling water. If you put your hand into the water again you will feel pain, not temperature. It is related with tissue damage at cellular level. When we say tissue damage, we actually mean tissue damage at cellular level. This is why physiologist termed pain as noxious. Because noxious indicate tissue damage. Because of that,we need noxious receptor not pain receptor and we can actually abbreviate noxious receptor as nociceptor.(receptor of pain) Pain stimulant are caused by product of tissue damage. Tissue damage at cellular stage will produce pain stimulany. This product include Hydrogen ion, Pottasium ion, some polypeptide and prostaglandin, histamine and serotonine. These are different substances that produced by tissue damage. Aspirin is a very common medication is used to block chemical receptor. When you take aspirin, which you will take in Pharmacology next year.What happen in aspirin? Aspirin will block nociceptor so stimulant substances are not produced. Slide 10 Touch and temperature are well defined. Butnociceptor is not well defined. It is referred to nerve ending that react with stimuli that potentially produce tissue damage.So this is what we mean with nociceptor. Nociceptors may respond to very gross mechanical stimuli. Sometimes when you apply very gross mechanical stimuli for example by touching hot water,directly you react. Other stimuli may result in painful sensation when the stimulus is excessively intense. Just like what we said, when you put your hand in hot water, you will feel pain instead of temperature. The single noxious heat stimulus is said as painful ok?. Repetitive stimulation of temperature receptors with less powerful stimuli may inhibit the passage of pain.

Slide 11 Nociceptor or let say pain receptor can be classify into A delta and C fiber.Information originating in nociceptors travels over small diameter afferent nerves (A delta and C fiber). In general, the fiber that conducting pain or receiving pain is small fibre. Double nature of pain. Generally, there are two different fiber that response to the cause producing pain.Other than perceptional pain, we have double nature pain. We have double nature pain which the first pain that you feel is sharp .over short period of time,which is the response of A delta fiber which is faster producing stinging pain sharp of high intensity and this is initial pain,followed by the slower which producing agonizing intolerable, which is diffuse by C fiber second pain. But for your hand, it doesnt take that long. When you feel pain at the area which are closer to the brain, you will feel the pain produced by A delta and C fiber pain at the same time. But your foot actually is very distant, thats why there is interval about 2 seconds between the first pain and the second pain. A delta fiber is responsible for short, sharp production of pain. Thats why it is fast. Why it is fast? Because it is myelinated.Myelinated means it travel from one node of ranvier to the other. It doesnt travel along the axon. So thats why it actually producing fast pain. The myelination is about 2.5 m in diameter, conducting at 12-30 m/s, high threshold. High threshold means you need to have strong stimulus. Transmit information from nociceptors or mechanoreceptors.It also can stimulated by mechanical stimuli.Activated by intense mechanical stimulation.Involved with 1st pain which is sharp localized sensation from obvious mechanical damage. In comparison, C fiber are non-myelinated, so thats why it is smaller; it has no myelinated sheath. It conduct at slow speed, ok (o.5-2 m/s). Thats why you feel the intense pain at first because it tooks time to reach your brain. Polymodal.Polymodal means it respond to more than one stimuli. It response to more thanone type of stimulus, thus it is known as truly nociceptor in human.SO it can response to more than one different stimulus. Excited by intense mechanical, thermal &chemical .While A delta fiber, only by mechanical stimulation. In other words, if you are excited at C fiber while C fiber are responsible for thermal stimuli.Then the thermal (explanation in arab) If you kicked at table, the first pain to come from A delta fiber, the second pain is responsible by C fiber.

Also chemical stimuli is associated with C fiber. Its involved by 2nd pain which is diffuse, dull pain and follows the 1st pain. Also, it can arise by itself without presence of the 1st pain. You feel the c fibre pain without a fibre pain. It arises independently.