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Oral Biology > bds2 pulp morphology and biology > Flashcards

bds2 pulp morphology and biology Flashcards

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1
Q

list the components of the dental pulp

A

connective tissue

cells:
- odontoblasts
- fibroblasts
- defence cells

extracellular components
- collagen and oxytalan fibres
- matrix composed of proteoglycans, chondroitin sulphate and derma tan sulphate

nerves
- sensory
- sympathetic

blood vessels and lymphatics

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2
Q

functions of the dental pulp

A

nutrition via blood vessels
dentine growth
dentine repair
defence via immune cells and lymphatics
neural via sensory and control of dentinogenesis

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3
Q

which pulpal elements extend into the dentine

A

odontoblast process
nerve terminals
immune cells
dentinal fluids

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4
Q

describe the haemodynamics and hydrodynamics of the pulp

A

fluid leaks form the pulp capillaries to the interstitial space
some drain via lymphatics and some pass along the dentinal tubules

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5
Q

what are the functional links between dentine and pulp

A

formation of secondary dentine
formation of tertiary dentine in response to tooth wear including reactionary and reparative dentine
regulate exchange of material between dentine and pulp

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6
Q

what are the causes of tooth wear for enamel and dentine

A

mastication
bruxism
abfraction
diet
caries
operative procedures

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7
Q

what type of wear is mastication

A

abrasion

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8
Q

what type of wear is bruxism

A

attrition

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9
Q

what is abfraction

A

occlusal overload leading to fractures and cervical lesions

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10
Q

what are operative procedures that can lead to tooth wear

A

occlusal equilibration
cavity cutting and crown preparation

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11
Q

what is reactionary dentine

A

tertiary dentine formed in response to mild stimulus and laid down by primary odontoblasts

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12
Q

what is reparative dentine

A

tertiary dentine formed in response to intense stimulus that destroys the primary odontoblasts
laid down by secondary odontoblasts

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13
Q

what is the function of the odontoblast layer of the pulp periphery

A

separate the pulp and the tubular space
regulate the movement of material between pulp and tubular extracellular fluid

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14
Q

explain the material exchanged from the pulp to the dentine

A

nutrients to sustain cells
formation of secondary and tertiary dentine
function of tubular nerves eg potassium ions

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15
Q

explain the material exchanged from the dentine to the pulp

A

medicaments applied to dentine
diffusion of toxins from bacteria and components of filling materials

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16
Q

describe the anatomy of pulp nerves

A

branches of alveolar nerves
neuromuscular bundles enter the pulp via the apical foramen and pass along the root canal in the centre of pulp toward coronal pulp chamber
the branches then fan out in the sub odontoblastic layer to form raschows plexus
the terminal branches enter the odontoblast layer and some nerves will enter the dentinal tubules

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17
Q

what is raschows plexus

A

when nerves enter the pulp via the apical foramen and branch out in the subodontoblastic layer, this plexus is formed

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18
Q

describe the innervation of the dental tubules

A

some nerves can enter the tubules but not all

under the cusps, 40% of tubules have nerves

tubular innervation is less in coronal dentine and root dentine

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19
Q

how innervated is coronal dentine

A

15%

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20
Q

how innervated is root dentine

A

4%

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21
Q

where do most axons end in the dentine pulp complex

A

pulp-predestine region

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22
Q

describe the hydrodynamic mechanism for activating intradental sensory nerves

A

stimulus acts on exposed dentine with open tubules which increases the rate of dentinal fluid flow
this generates action potential in intradental nerves
these action potentials pass to the brain to cause pain

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23
Q

what are the effects of outward dentinal fluid flow

A

drying
evaporation
hypertonic solutions
decreased hydrostatic pressure

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24
Q

what are the effects of inward dentinal fluid flow

A

heating
mechanical
increased hydrostatic pressure

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25
which direction of dentinal fluid flow is more effective in activating intradental nerves and why
outward, away from the pulp because the rapid flow stretches the nerves
26
what are stimuli that can bypass the hydrodynamic mechanism
intense heating intense cooling electrical current pain producing chemicals
27
why do high fillings cause dentinal pain
the force distorts the dentine and alters the tubular fluid flow
28
describe the properties of the a beta and a delta fibres in the pulp
these are large and small, myelinated nerves they are activated by hydro dynamic stimuli applied to dentine they mediate normal dentinal sensitivity
29
which nerve fibres mediate normal dentinal sensitivity
a beta and a delta
30
which nerve fibres in the pulp are unmyelinated
c fibres
31
describe the features of the C fibres in the pulp
active directly by stimuli instead of hydrodynamic mechanism and respond to most forms of intense stimuli mediate pain associated with pulp inflammation such as caries
32
branches from which blood vessel provide the pulp
maxillary artery
33
describe the control of pulp blood flow
- local factors like metabolites - sympathetic nerves - somatic afferent nerves - circulating hormones like adrenaline - drugs including LA with vasoconstrictors
34
why do burs need to be cooled
they can damage the pulp if used with a high speed motor
35
list the functions of pulp nerves
sensory function to mediate pain control pulp blood vessels via sympathetic for vasoconstriction and afferents for vasodilation promote neurogenic inflammation promote dentine formation facilitate the immune response
36
what is the immediate response to dental pulp injury
nociceptor activation ie pain
37
what is the dentine pulp response to injury after one minute
early inflammatory response including kinins, prostaglandins, neuropeptides and then vasodilation
38
what is the dentine pulp response to injury after 10 minutes
nociceptor sensitisation extravasation of fluid causing oedema polymorph migration
39
what is the dentine pulp response to injury after 100 minutes
enzyme activation, nerve growth factor and monocyte presence
40
what is the dentine pulp response to injury after one day
nerve sprouting, increasing axonal transport and altered excitability of the central nervous synapses
41
what is the dentine pulp response to injury after a week
repair - tertiary dentine formation
42
when is the dentine pulp response to injury completely repaired and recovered
this time is variable so there is no real answer but usually over a week
43
describe pulpitis
acute inflammation in the dental pulp is similar to that in other tissues except that the pulp cannot swell as it is confined within the pulp chamber oedema causes an increase in pulp pressure this can have variable effects on blood flow and nerve excitability
44
what forms the core of the tooth
the dental pulp complex
45
main function of the pulp is
to produce dentine
46
what elements of the pulp provide the characteristic gel elastic behaviour
the matrix and the fibres
47
why is blood supply and lymphatic drainage important for the pulp
anything that impacts these characteristics will impair the function of the pulp
48
where does the pulp open to the external environment
at the apex
49
why is nutrition important for the pulp
allows dentine to grow and produce both the primary and secondary dentine
50
what is the developmental link between pulp and dentine
they originate from the dental papilla
51
what is the name of the cells that migrate from the neural crest to create the dental papilla
ectomesenchymal cells
52
are there blood vessels in normal dentine
no
53
what is the origin of the dentinal fluid
the extracellular fluid or better from the leakage of pulp capillaries into the interstitial space
54
what is the flow of dentinal fluid proportional to
pressure inside the pulp
55
what is the difference between primary and secondary dentine
one is formed during tooth formation and the other starts when the tooth is completely formed, including the root and apex primary dentine is formed quickly following the pace of the tooth development when the tooth is complete, the pace of dentine formation is slowed, and this is secondary dentine which is formed throughout your lifetime
56
what are the two types of tertiary dentine
reactionary dentine, produced by the original odontoblasts faced with aggression. when this aggression is powerful enough to damage these cells the dormant non differentiated stem cells are recruited to differentiate into odontoblasts and produce the reparative dentine
57
what is the difference between reactionary and reparative dentine described as and why is this
academic difference because they cannot be clinically identified as their origin is not something we can tell by looking at the dentine
58
what are some instances that cause aggression to the pulp
abrasion caused by masticatory function functional damage caused by bruxism attrition occlusal overload causing fractures of enamel in the cervical region (abfraction) acidic diet causing erosion aries operative procedures
59
what is occlusal equilibration therapy
used to correct the bite surface of the teeth causing tmp disorders. drill occlusal surface of healthy teeth to fix the tmp only used in rare and specific cases by a few professionals
60
what is the most common cause of tooth wear in operative procedures
cutting cavities and preparation of the tooth to receive crowns and bridges
61
damage can be caused to the pulp even without extending the tooth cutting to dentine. why is this
you can still cause damage to the pulp because of the heat generated during preparation - this is why water is always used
62
what is reactionary dentine a consequence of
mild stimulus triggering the primary original odontoblasts to produced dentine
63
what is reparative dentine a consequence of
when stimulus is intense and the primary odontoblasts are destroyed, leading to secondary odontoblasts recruited and laying down reparative dentine
64
where do secondary odontoblasts originate from
sub odontoblastic layer called hoehls layer this contains stem cells
65
what is the name given to the subodontoblastic layer where the stem cells are found
hoehls layer
66
does tertiary dentine have dentinal tubules
no
67
function of tertiary dentine
a plug to seal tubules from access to the pulp and protect the vital tissue from the exterior threat
68
what other function do odontoblasts have aside from forming dentine
they form a permeability barrier between pulp and the dentinal tubules to regulate the exchange of materials between pulp and the tubular extracellular fluid this exchanging movement happens in both directions
69
describe the route of innervation for the pulp
trigeminal nerve - maxillary and mandibular branches - alveolar branches - enter pulp at apical foramen pass along root canal at the centre of the pulp toward the coronal chamber fan out toward the sub odontoblastic layer and form the plexus of raschow these terminal branches enter the odontoblastic layer and some of these nerves will enter the dentinal tubules
70
what is the difference between the nerves entering the tubules at the cusp, coronal portion of the crown and the root
under the cusps, 40% of the tubules have nerves coronal dentine has 15% tubular innervation root dentine has 4%. most axons do not enter the tubes and end in the pulp in the predentine region
71
why are axons in the pulp relevant to think about
stimulus like thermal, mechanical, chemical etc on the surface of exposed tubules can act on them and increase rate of dentinal fluid flow this generates action potentials in the intradental nerve and passes to the brain as pain this is the hydrodynamic mechanism to activate the intradental sensorial nerves and generate pain
72
what is the consequence of the hydrodynamic mechanism in dentine that generates pain
dentinal fluid can flow outward or inward. stimuli type will determine the different flows.
73
which stimuli result in the dentinal fluid being driven outward
cooling drying evaporating hypertonic solutions reduction of hydrostatic pressure
74
which stimuli result in the dentinal fluid being driven inward
heating mechanical pressure increased hydrostatic pressure
75
which flow of dentinal fluid causes greater stimuli
outward flow as it is rapid and stretches the nerve
76
is all stimuli due to the movement of dentinal fluid
no, intense temperature changes can affect the intradental nerves directly electrical current and pain producing chemicals can also affect the nerves
77
dentinal fluid is associated with pain for many reasons. one is due to fillings. explain this
high fillings such as inlay and inlay restorations will be distorted by occlusal forces and generate pressure to alter the flow of the fluids
78
what activates the a beta and a delta myelinated fibres
hydrodynamic stimuli applied to dentine
79
which nerve fibres are responsible for normal dentine sensitivity
a beta and a delta myelinated fibres
80
what activates the unmyelinated C fibres in dentine
direct stimuli
81
which fibres are responsible for intense stimulation in the dentinal tubules
c fibres
82
which fibres are most likely to be associated with pain mediated by pulp inflammation including carious lesions
c fibres
83
blood supply to the teeth branches from which artery
maxillary artery
84
does cavity preparation and inflammatory response change the vascular permeability of the pulp
yes it is increases it
85
what controls pulpal blood flow
local factors like metabolites which will have to be removed and affect blood flow in other tissue not many details on how this works in the pulp but it is known there are changes in blood flow for instance after exercise innervation - sympathetic controls blood flow by changing the diameter of the blood vessels - generates vasoconstriction to reduce blood flow afferent somatic fibres means there are sensorial fibres that when receiving stimulation release peptides which produce vasodilation and increase blood flow effect of hormones like adrenaline will promote vasoconstriction vasoconstrictors like adrenaline and fenylpressin are used in anaesthetics
86
why are uncooled burs problematic
they reduce the blood flow to the pulp
87
what is the function of pulp nerves
sensory to mediate pain control of pulp blood flow afferents generate vasodilation via peptidergic activity aka axon reflex neuropeptides released in axon reflex promote neurogenic inflammation so the neuropeptides release by the afferent nerves like substance P induce inflammatory responses neurogenic response also promotes dentine formation
88
what stimulates the afferent sensorial fibres
changes in dentinal fluid flow
89
describe the axon reflex mechanism
change in dentinal fluid flow from stimulus - axon reflex triggered to release vasoactive peptides like substance P and CGRP these peptides will promote vasodilation to increase permeability pulp tissue pressure increases tubular fluid flow increases
90
what does the time of full pulpal repair depend on
size of the lesion host response ability to recognise repair with radiographs
91
why does the confinement of the pulp chamber impact when there is inflammation
it does not allow swelling so the oedema will increase the pressure, affecting blood flow and nerve excitability this incapacitates the tissue to perform its function

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