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BDS2.5 Oral Biology > Pulpal response to irritants > Flashcards

Pulpal response to irritants Flashcards

1
Q

What do the consequences of pulpal inflammation depend on?

A

if the effects are transitory or lasting

if the pulp can completely recover form the irritation

patients age

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2
Q

What happens to the size of the pulp with age?

A

smaller, less vascularised, not as high innervated

due to secondary dentine formation, reduce the size and volume of the pulp

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3
Q

How does an older pulp respond to infection?

A

not as well, it is smaller

less likley to reverse inflammatory response

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4
Q

What are signs of reversible pulpitis?

A

acute toothache and pains with momentary cold

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5
Q

What should you examine when checking a tooth?

A

if the tooth is tender to percussion

if there is tenderness in the buccal sulcus

if it is mobile

if there are signs of infection

  • associated with a necrotic pulp, hard to decipher levels of inflammation.
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6
Q

What are the 3 ways the pulp will protect itself against caries?

A
  1. a decrease in dentine permeability
  2. tertiary dentine formation
  3. inflammatory and immune reactions
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7
Q

How does the pulp decrease the permeability of dentine?

A

the pulp upregulates this secretion of intratubular dentine and direct deposition of mineral crystals into narrowed tubule lumens

this is called dentinal sclerosis and decrease dentine permeability

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8
Q

How is tertiary dentine formation initiated?

A

In early carious lesions, acidic by-products degrade dentine matrix, liberating bioactive molecules

diffuse across the dentine and signal tertiary dentine = dentinogenesis

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9
Q

What type of dentine is stimulated in a mild stimuli?

A

reactionary dentine

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10
Q

What type of dentine is produced in with a stronger stimuli?

A

reparative dentine

caused by odontoblast death and new progenitor cells are needed

tubular structure is irregular and permeable

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11
Q

What is ore impermeable, reactionary or reparative dentine?

A

reactionary, more regular tubule formation

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12
Q

What first detects the caries?

A

odontoblasts

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13
Q

What immune cells are released in response to carious lesion?

A

proinflammatory cytokines
chemokines
antimicrobial peptides

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14
Q

where do immune cells gather?

A

pulp

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15
Q

What do the afferent nerve endings beside the odontoblasts release?

A

proinflammatory neuropeptides

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16
Q

What happens as the caries progress towards the pulp?

A

the pulps immune response increases its intensity

the density of chronic infiltrate increases

accompanied by angiogenesis and capillary sprouting

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17
Q

What are the immune cells associated with a more severe immune response?

A

increase in pulpal lymphocytes, plasma cells, neutrophils, macrophages

18
Q

What can form when there is chronic inflammation in or near the pulp?

A

focal micro-abscesses can begin to form

19
Q

What cells aggregate beside the odontoblastic processes in severe inflammatory response?

A

dendritic cells, leading to a focal concentration of antibodies beneath the advancing lesion

20
Q

What happens to the pulp with the increase in inflammatory cells?

A

increase in pulpal tissue pressure and increases the outward dentinal fluid flow due to positive pulpal pressure

21
Q

What occurs when the caries get extremely close to the pulp?

A

there is an acute exacerbation of the existing chronic inflammation

involving an influx of neutrophils

22
Q

What can focal micro-abscesses cause?

A

pulpal necrosis

23
Q

When can the dentinal tubules be exposed?

A

developmental defects

disease processes

periodontal/surgical procedures

24
Q

Do the pulp and dentinal tubules communicate directly with one another?

A

yes

25
Q

If a tooth is chipped and the dentinal tubules are exposed, are the pulpal inflammatory changes transient of permanent?

A

transient

as long as the pulpal vascular supply remains intact and bacterial invasion prevented

aim to treat quickly and appropriately.

aim to seal the dentine asap

26
Q

What are factors which can influence the pulps response when placing a restoration?

A

LA
cavity depth or remaining dentine thickness (RDT)
contamination of the cavity with microbes
heat generated
desiccation/dehydration
materials used

27
Q

Does a deep preparation, have more r less effect on pulp reaction?

A

increasing severe pulpal reaction

likelihood of the pulp becoming irreversibly inflamed much greater

28
Q

What is RDT?

A

REMAINING DENTINE THICKNESS

29
Q

What is a good and bad barrier for RDT?

A

Over 2mm is good

under 2mm is bad - compromise recovery of pulp

30
Q

What happens to the permeability of the RDT over time?

A

decreases

31
Q

Why does the permeability of the RDT decrease over time?

A

most likely due to reactionary dentine and dentinal tubule necrosis

32
Q

What type of preparation leaves the pulp less protected from preparation trauma?

A

a deep cavities with small RDTs

33
Q

What is used to minimise contamination?

A

rubber dam to prevent salivary contamination

34
Q

What is microleakage?

A

leakage of ions, fluids, bacteria and bacteria by-products through the tooth-restoration interface

it occurs when there is poor seal between the tooth preparation and the restorative material

35
Q

What can microleakage lead to?

A

secondary caries
pulpal inflammation.. potentially necrosis
partial or total loss of the restoration itself

36
Q

What is said to be the greatest threat to the vitality of the pulp in restorations?

A

microleakage

37
Q

What dental material has good insulation?

A

dentine - but can damage the pulp

38
Q

What temperature can cause irreversible pulp inflammation?

A

rise of 10 d.c

39
Q

What can a rise of 20 dc pulp temperature cause?

A

pulp abscess formation

40
Q

When will a rise in pulpal temperature occur?

A

cavity preparation

crown prep

light curing

finishing/polishing a restoration

polishing teeth

curing of resins

41
Q

What are the effects of heat generation in the pulp?

A

loss of odontoblasts or their aspiration into the dentinal tubules and subsequent pulpal inflammation

42
Q

Why should you not over dry dentin?

A

results in outward fluid flow

can result in aspiration of odontoblast cell bodies into tubules
- causing pulpal inflammation

some tubules are not repopulated and become dead tracts

BDS2.5 Oral Biology (10 decks)

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