Pulpal response to irritants Flashcards
What do the consequences of pulpal inflammation depend on?
if the effects are transitory or lasting
if the pulp can completely recover form the irritation
patients age
What happens to the size of the pulp with age?
smaller, less vascularised, not as high innervated
due to secondary dentine formation, reduce the size and volume of the pulp
How does an older pulp respond to infection?
not as well, it is smaller
less likley to reverse inflammatory response
What are signs of reversible pulpitis?
acute toothache and pains with momentary cold
What should you examine when checking a tooth?
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.
What are the 3 ways the pulp will protect itself against caries?
- a decrease in dentine permeability
- tertiary dentine formation
- inflammatory and immune reactions
How does the pulp decrease the permeability of dentine?
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
How is tertiary dentine formation initiated?
In early carious lesions, acidic by-products degrade dentine matrix, liberating bioactive molecules
diffuse across the dentine and signal tertiary dentine = dentinogenesis
What type of dentine is stimulated in a mild stimuli?
reactionary dentine
What type of dentine is produced in with a stronger stimuli?
reparative dentine
caused by odontoblast death and new progenitor cells are needed
tubular structure is irregular and permeable
What is ore impermeable, reactionary or reparative dentine?
reactionary, more regular tubule formation
What first detects the caries?
odontoblasts
What immune cells are released in response to carious lesion?
proinflammatory cytokines
chemokines
antimicrobial peptides
where do immune cells gather?
pulp
What do the afferent nerve endings beside the odontoblasts release?
proinflammatory neuropeptides
What happens as the caries progress towards the pulp?
the pulps immune response increases its intensity
the density of chronic infiltrate increases
accompanied by angiogenesis and capillary sprouting
What are the immune cells associated with a more severe immune response?
increase in pulpal lymphocytes, plasma cells, neutrophils, macrophages
What can form when there is chronic inflammation in or near the pulp?
focal micro-abscesses can begin to form
What cells aggregate beside the odontoblastic processes in severe inflammatory response?
dendritic cells, leading to a focal concentration of antibodies beneath the advancing lesion
What happens to the pulp with the increase in inflammatory cells?
increase in pulpal tissue pressure and increases the outward dentinal fluid flow due to positive pulpal pressure
What occurs when the caries get extremely close to the pulp?
there is an acute exacerbation of the existing chronic inflammation
involving an influx of neutrophils
What can focal micro-abscesses cause?
pulpal necrosis
When can the dentinal tubules be exposed?
developmental defects
disease processes
periodontal/surgical procedures
Do the pulp and dentinal tubules communicate directly with one another?
yes
