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Technically, the oral cavity consists of the vestibule between the lips and cheeks externally and the teeth and alveolar processes internally and the larger oral cavity proper located internal to the dental arches. In clinical practice, the whole mouth is simply referred to as the oral cavity, but ‘vestibule’ is used for the specific area defined above. For charting of teeth and similar dental procedures, the mouth is divided into quadrants—upper right and left and lower right and left with the midline and occlusal surfaces of the teeth forming the dividing lines. It is a crucial skill for dental students and practitioners to recognize the naked eye appearance of the structures in a normal healthy mouth and variations that occur; abnormal appearances can then be recognized, diagnosed, and treated successfully. Much of the macroscopical appearance is determined by the underlying gross anatomy so this must be understood too. The best way to examine the interior of the mouth is on a subject seated in a dental chair with clinical lighting and the use of a tongue spatula and a dental mirror where necessary. However, you will be able to see most of the important features by examining the inside of your own mouth in a well-lit household mirror. The following description and illustrations apply to an adult mouth with a full secondary (permanent) dentition of two incisors, one canine, two premolars, and three molars in each quadrant, making 32 teeth in total. Apart from size, the major differences in childrens’ mouths are in the dentition. The primary (deciduous) dentition erupts into the oral cavity between the age of 6 months and 2 years. It comprises two incisors, one canine, and two molars in each quadrant, giving a total of 20 teeth. Most of the teeth of the secondary dentition erupt between the ages of 6 to 12, replacing the primary teeth; a combination of primary and secondary teeth, a mixed dentition, is found between these ages. Primary incisors and canines are replaced by their permanent successors, but the deciduous molars are succeeded by the permanent premolars; the three permanent molars in each quadrant are additional teeth.

It is essential that dental students and practitioners understand the structure and function of the temporomandibular joints and the muscles of mastication and other muscle groups that move them. The infratemporal fossa and pterygopalatine fossa are deep to the mandible and its related muscles; many of the nerves and blood vessels supplying the structures of the mouth run through or close to these areas, therefore, knowledge of the anatomy of these regions and their contents is essential for understanding the dental region. The temporomandibular joints (TMJ) are the only freely movable articulations in the skull together with the joints between the ossicles of the middle ear; they are all synovial joints. The muscles of mastication move the TMJ and the suprahyoid and infrahyoid muscles also play a significant role in jaw movements. The articular surfaces of the squamous temporal bone and of the condylar head (condyle) of the mandible form each temporomandibular joint. These surfaces have been briefly described in Chapter 22 on the skull and Figure 24.1A indicates their shape. The concave mandibular fossa is the posterior articulating surface of each squamous temporal bone and houses the mandibular condyle at rest. The condyle is translated forwards on to the convex articular eminence anterior to the mandibular fossa during jaw movements. The articular surfaces of temporomandibular joints are atypical; they covered by fibrocartilage (mostly collagen with some chondrocytes) instead of hyaline cartilage found in most other synovial joints. Figures 24.1B and 24.1C show the capsule and ligaments associated with the TMJ. The tough, fibrous capsule is attached above to the anterior lip of the squamotympanic fissure and to the squamous bone around the margin of the upper articular surface and below to the neck of the mandible a short distance below the limit of the lower articular surface. The capsule is slack between the articular disc and the squamous bone, but much tighter between the disc and the neck of the mandible. Part of the lateral pterygoid muscle is inserted into the anterior surface of the capsule. As in other synovial joints, the non-load-bearing internal surfaces of the joint are covered with synovial membrane.