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Adult Restorative > Dentine Caries > Flashcards

Dentine Caries Flashcards

1
Q

Describe the structure and hardness of dentine

A
  • 70% inorganic
  • 20% organic
  • 10% water
  • Harder than bone
  • Multiple close packed tubules
  • Incremental growth
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2
Q

Describe the formation of mantle dentin

A
  • Odontoblasts differentiate from cells of dental papilla
  • Signal molecules from the IEE
  • Collagen matrix secreted adjacent to IEE
  • Odontoblasts move centrally and form a process
  • Odontoblast process secretes HAP crystals that mineralise collagen matrix
  • Mantle dentine
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3
Q

Describe the formation of Primary dentine

A
  • Odontoblasts increase in size eliminating extracellular resources for matrix
  • Less collagen secreted and more organised and tightly arranged
  • Mineralised in and ordered fashion
  • Primary mineralisation - expansion and fusion of calcospherules
  • Secondary mineralisation - further expansion of globules into areas of complete fusion
  • Primary dentin
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4
Q

Describe the shape and components of dentine tubules

A
  • Minute wavy tubules within dentine
  • Contain cytoplasmic processes of odontoblasts
  • Extend from odontoblast layer at pulp to enamel dentine or cement dentin junctions
  • S shaped pattern
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5
Q

Where are the dentine tubules widest and narrowest

A
  • Widest near pulp

- Narrowest EDJ

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6
Q

Describe the features of primary dentine

A
  • Laid down in dentinogenesis

- Normal dentine-pulp complex response

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7
Q

Describe the features of secondary dentine

A
  • Laid down throughout life

- Normal dentine-pulp complex response

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8
Q

Describe the features of tertiary dentine

A
  • Laid down in response to noxious stimuli

- ‘Altered’ dentine-pulp complex response

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9
Q

Describe all the morphologic features and characteristics of early enamel caries

A
  • Plaque-acid demineralisation causes porosities within prism structure
  • Subsurface demineralisation
  • Surface zone intact
  • Inverted cone shape
  • Lesion sterile - no microbes
  • No dentine-pulp response
  • Reversible white spot lesion
  • Zones
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10
Q

What are the features of late enamel caries

A
  • Progressing lesions approach the EDJ
  • May still not have cavitated
  • Defensive dentine-pulp reactions initiated
  • May still not be symptoms
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11
Q

What characterises dentinal caries

A
  • Lesions cross the EDJ and spread into the dentine
  • Lateral spread across the hypomineralised mantle dentine
  • Increased side branching of tubules
  • Defects within tissues of EDJ
  • Penetration along dentine tubules towards pulp
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12
Q

What can occur if the dentinal caries lesion cavities

A
  • Allows micro-organisms to directly penetrate lesion
  • Acute pulpitis may develop
  • Degenerative and reparative processes occur simultaneously in different parts of the lesion
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13
Q

Describe the type of dentinal caries that require the tooth to be removed

A
  • Dark, brown, soft, wet, mushy
  • Mineral component dissolution
  • Collagen matrix denatured
  • High bacterial load
  • Dentine tubules destroyed
  • Irreversible
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14
Q

Describe the type of dentinal caries that don’t require the tooth to be removed

A
  • Sticky, scratchy, leathery
  • Mineral component dissolution (lesser degree)
  • Collagen matrix damaged by proteolysis but not denatured
  • Lower bacterial load
  • Dentine tubules remain intact
  • Reversible
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15
Q

What ways can the dentine-pulp complex respond to injury

A
  • Tubular sclerosis (tertiary dentine)
  • Reactionary dentine
  • Reparative dentine
  • Pulpal inflammation
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16
Q

Describe the dentine-pulp complex tubular sclerosis mechanism to injury

A
  • Noxious stimuli to odontoblasts
  • Peritubular dentin laid down
  • Occludes tubule
  • Protects the dentine-pulp complex from further injury
  • Dead tracts formed distal to occlusion
  • Tubular sclerosis translucent on ground section as hypermineralised
17
Q

Describe the dentine-pulp complex reactionary dentine mechanism to injury

A
  • Tertiary dentine laid down at dentine-pulp interface
  • Increases distance between dentine-pulp and stimulus
  • Low grade stimulus = slower deposition and irregular tubules formed
  • Odontoblasts survive
  • Metabolically unregulated
18
Q

Describe the dentine-pulp complex reparative dentine mechanism to injury

A
  • Tertiary dentine laid down at dentine-pulp interface
  • Increases distance between dentine-pulp and stimulus
  • Higher grade stimulus - faster deposition, atubular dentine, disorganised
  • Odontoblasts vitality compromised
  • Progenitor cells in sub-odontoblastic layer differentiate and unregulate
19
Q

Describe the dentine-pulp complex pulpal inflammation mechanism to injury

A
  • Noxious stimuli leads to inflammation of pulp - pulpitis
  • Acute or chronic
  • Toxins released from progressing carious lesions
  • If slow progressing - chronic pulpitis, cellular changes - fibrosis, vascular changes - plasma cells and lymphocytes
  • If faster progressing - acute pulpitis, vascular changes - PMNs and MO/
20
Q

Describe the features and treatment required for advanced lesions

A
  • Dentine architecture destroyed
  • Micro-organisms close to pulp
  • Sterile zone demineralisation
  • Irreversible pulpitis/pulpal necrosis
  • Endodontics required
21
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Patients may have an overlapping continuum where there are simultaneous areas of sclerotic, reactionary and reparative dentine

22
Q

Describe the carious process by bacteria

A
  • Acidogenic and proteolytic bacteria
  • Acidogenic bacteria dissolve inorganic matrix (collagen)
  • Proteolytic bacteria destroy organic matrix (collagen)
  • Streptococcus mutans and lactobacillus sp.
  • From liquefaction foci that coalesce to form transverse clefts at right angles to tubules

Adult Restorative (14 decks)

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