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121 Histology & Embryology > Pulp > Flashcards

Pulp Flashcards

1
Q

Young pulp

A

Contains high quantities of cells and fine collagen fibrils

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2
Q

Older pulp

A

Opposite of young pulp

May contain calcified structures (pulp stones/ diffuse calcifications)

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3
Q

General characteristics of pulp

A

Limited regenerative capabilites- does contain viable cells

Pulp size decreases w/ age due to continuous dentin formation

Foramen size decreases w/ age due to continuous cementum formation & causes offset position and/or obliteration

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4
Q

Embryonic origin of pulp

A

Ectomesenchyme/mesenchyme- neuroectoderm

Neural crest cells of the head give rise to the dental papilla

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5
Q

Cells that comprise pulp

A 
Fibroblasts
Odontoblasts
Mesenchymal cells
Pericytes/Rouget cells
Dendritic cells
Macrophages
Extravasated WBC's
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6
Q

Fibroblasts

A

Synthesize collagen and amorphous/ground substance

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7
Q

Odontoblasts

A

Synthesize dentin (collagen, ground substance, calcium hydroxyapatite)

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8
Q

Mesenchymal cells

A

Differentiate into collagen, ground substance and calcium hydroxyapatite

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9
Q

Pericytes/Rouget cells

A

Associated w/ capillaries (contractile capabilities)

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10
Q

Dendritic cells

A

Phagocytize antigens, transfer these to macrophages

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11
Q

Macrophages

A

Complete antigen elimination process

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12
Q

Extravasated WBC’s

A

Leukocytes- neutrophils, eosinophils, basophils

Lymphocytes- B-cells, t-cells, NK cells

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13
Q

Intercellular substance in pulp

A

Gelatinous matrix- collagen fibers & some reticular fibers

Ground substance- glycoproteins, proteoglycans, H2O

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14
Q

Formative/Inductive functions of pulp

A

Dentinogenesis- primary, secondary, tertiary dentin (reparative/reactive)

Induces enamel formation and determines type/morphology of the tooth

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15
Q

Nutritive functions of pulp

A

Nourishes odontoblasts and dentin via pulpal blood supply

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16
Q

Sensory functions of pulp

A

Nerve fibers mediate pain (sensory/afferent)

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17
Q

Protective functions of pulp

A

Responds to irritations causing pain (mechanical, thermal, chemical, bacterial)

Pulpal reactions: tertiary dentin formation, inflammatory response—>

Acute= increased leukocytes (PMNs)
Chronic= Increased lymphocytes & plasma cells
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18
Q

Composition of pulp

A 
Cells
Intercellular substance
Tissue fluid (ECF)
Blood vessels
Lymphatic vessels
Nerve tissue
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19
Q

1st Pulp zone/ Odontoblastic layer

A

Peripheral layer- one cell layer- lines pulp chamber/canals

Function: Formative (primary/secondary), protective (tertiary), sensory (pain)

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20
Q

2nd Pulp Zone- Cell Free Zone/Cell Free Layer of Weil

A

Fewer cells
During dentinogenesis, increased # of mesenchymal cells present

Function: sensory & nutritive
Contains: Nerve fibers, capillaries, collagen fibers & ground substance

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21
Q

3rd Pulp Zone- Cell Rich Zone

A

Increased cell content: fibroblasts, mesenchyme cells (migrate through cell free zone)

Decreased # of cells with age

Function: Formative, sensory, nutritive
Contains: Nerve fibrils & capillaries

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22
Q

Nerve and vascular plexus- Deep to cell rich zone

A

Raschkow’s plexus/parietal plexus of nerves

Vascular plexus of blood vessels (capillary network is more extensive during dentinogenesis)

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23
Q

4th Pulp Zone- Pulp Core

A

Bulk of pulp
Function: Formative, sensory, nutritive
Composition: All cells and intercellular substance

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24
Q

Vasculature of pulp

A

Maxillary Artery: Superior (max) and inferior (mand) alveolar arteries

Dental and alveolar arteries supply PDL & pulp. Pulpal BV branch off PDL vessels

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25
Q

Pulpal blood vessels

A

Coronal pulp: capillary loops form “vascular plexus”

Radicular pulp: Arterioles pass to subodontoblastic region

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26
Q

Arteriovenous Anastomoses

A

Drains the capillary beds in subodontoblastic region and exit by apex

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27
Q

Pericytes/Rouget cells

A

Myofibril in nature, contractile capabilities assist capillaries

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28
Q

Where do lymphatics run?

A

Same course as blood vessels (branch from PDL lymphatic vessels)

29
Q

Which teeth do the submental nodes drain?

A

Mandibular incisors

30
Q

Which teeth are drained by the superior deep cervical nodes?

A

Maxillary 3rd molars

31
Q

Which teeth are drained by the submandibular nodes?

A

All maxillary and mandibular teeth besides the mandibular incisors and maxillary 3rd molars

32
Q

Where does the maxillary division/superior alveolar nerve pass through?

A

Foramen rotundum

33
Q

What area is targeted by the anterior superior alveolar block?

A

Incisors and canines

34
Q

What area is targeted by the Middle superior alveolar block?

A

Premolars and MB root of the maxillary 1st molar

35
Q

What area is targeted by the Posterior superior alveolar block?

A

DB root and pa;atal root of 1st molars, 2nd and 3rd molars

36
Q

Where does the mandibular division/inferior alveolar nerve pass through?

A

Foramen Ovale

37
Q

What area does the inferior alveolar block & lingual nerve block target?

A

All mandibular teeth and lingual gingiva

38
Q

What are does the long buccal/buccal block target?

A

Posterior buccal gingiva

39
Q

What are does the mental incisive block target?

A

Mandibular anteriors, premolars and associated buccal gingiva

40
Q

Types of nerves

A

Sensory

Autonomic

41
Q

Sensory- myelinated

A

Raschkow’s plexus- terminate between the odontoblastic cell bodies; may enter dentin tubules w/ odontoblastic process

42
Q

Autonomic- unmyelinated

A

Regulate lumen of blood vessels

43
Q

What are dystrophic calcifications?

A

Diffuse

Responsible for calcifications in root canals
Diffuse calcifications of collagen fibers surrounding nerve fibers & BV
Increase in size with age/ caries, restorations and/or trauma

44
Q

Pulp stones/ Denticles

A

Calcified bodies, irregular to round shape
Vary in size, increased size with age
May lodge in or over root canal

45
Q

Structural classifications of denticles

A

True denticle

False denticle

46
Q

What are true denticles?

A

Rare- found only in RADICULAR pulp

Formed by odontoblasts- induced by HERS
Contain: dentin tubules, odontoblastic processes and odontoblasts

47
Q

What are false denticles?

A

Concentric calcifications formed around foci of dead cells or collagen bundles

No odontoblasts, odontoblastic processes or dentin tubules

48
Q

Location classifications of denticles

A

3 types- free, attached and interstitial

Found in coronal and radicular pulp (mostly radicular)

49
Q

What are free denticles

A

Free floating in the pulp

50
Q

WHat are attached denticles

A

On wall of pulp chambers (dentin) & protrude into pulp chamber

51
Q

What are interstitial denticles

A

Completely embedded in the wall of the pulp chamber (dentin)

52
Q

Mechanical pulpal irritations

A

Operative high speed drill

53
Q

Thermal pulpal irritations

A

Heat produced by operative procedures

Hot and cold in general can affect irritated pulp

54
Q

Chemical pulpal irritations

A

Restorative materials such as zinc phosphate or eugenol

-sweet or sour

55
Q

Bacterial pulpal irritations

A

Caries invasion

Periodontal pocket, involving the apical region

56
Q

Unnatural forces pulpal irritation

A

Stress fractures in enamel
High restorations
Changes in air pressure if pulp tissue is inflammed

57
Q

What is focal reversible pulpitis

A

Earliest form of pulpitis- pulpal hyperemia

Localized to pulp of irritated dentin tubules
Cause: caries and defective restorations
Reversible if treated early
Tooth sensitive to cold and biting

58
Q

What is acute pulpitis?

A 
Caries that have reached the pulp
Extensive acute inflammation
PMN's very prominent; pus formation
Heat and biting cause pain
Notreversible
Tx: RCT pulpectomy (permanent) pr pulpotomy (deciduous)

Comes at night, goes away in the morning

59
Q

What is chronic pulpitis

A 
Symptoms are milder
Cause caries- dull ache
Little response to thermal change
Lymphocytes and plasma cells present
Tx: RCT
60
Q

What is chronic hyperplastic pulpitis

A

Deciduous teeth only

Chronic pulpal disease
Caused by caries
Pulp expands out of lesion and bleeds easily
Heat causes pain
Tx: pulpotomy
61
Q

What are periapical abscesses?

A

Acute or chronic tissue breakdown at apical region
Cause: caries and/or trauma
Acute: PMN’s- very painful
Chronic: Lymphocytes & plasma cells- no pain
Radiolucent on radiographs

62
Q

Periapical granuloma- caries or trauma

A

Localized granulation tissue due to infection
Tissue contained in a capsule, separates it from bone
Tx: RCT and possible apioectomy
Apical radiolucency

63
Q

Periapical cysts

A

True cysts
Lined with epithelium- fluid filled
Develop from granulomas and associated with cell rests of Malassez (remnants of HERS)
Usually asymptomatic

64
Q

Hallmark signs of cellulitis

A 
Diffuse inflammation of the deep connective tissue
Infection spreads from localized area
Severe swelling of face and/or neck
Area tissue become hard/rubbery
Skin may appear red
fever and malaise
PMNs prominent
65
Q

Serious cellulitis infection

A

May spread to floor of mouth and close the airway
May spread to cavernous sinus of the brain
Either may result in death

66
Q

Internal root resorption

A

Starts within vital pulp tissue

Cause: unknown, trauma is suspected
Clastic cells (monocytes)- resorb root from inside canal
Tx: RCT- if diagnosed early

67
Q

Dental pulp stem cells

A

Cells derived from embryonic mesenchyme

68
Q

Location of dental pulp stem cells

A

Most abundant in primary teeth

Fewer in permanent teeth

69
Q

Dental significance of dental pulp stem cells

A

Signals tissue formation and repair in the dentin-pulp complex

121 Histology & Embryology (15 decks)

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