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BDS2 BAMS > BAMS revision > Flashcards

BAMS revision Flashcards

1
Q

what is the periodontium?

A

tissues surrounding and supporting the teeth

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2
Q

what is the role of the periodontium?

A
  • retain the tooth in the socker
  • resist masticatory loads
  • defensive barrier (protecting tissues against threats from the oral environment)
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3
Q

junctional epithelium

A

the physical barrier separating the body tissues from the oral environment

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4
Q

where is the only breach in epithelial attachment?

A

where the tooth passes through the epithelium

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5
Q

cementum

A
  • covers root dentine

- similar in structure to bone (collagen matrix, lamellar arrangement)

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6
Q

what are the 2 types of cementum?

A
  • cellular

- acellular

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7
Q

cellular cementum

A

contains no cells, usually adjacent to dentine, no attached fibres

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8
Q

acellular cementum

A

contains cementocytes, present in apical part of root and in furcation regions, collagen fibres from PDL (sharpey’s)

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9
Q

where is the weakest point of tooth attachment?

A

apex and furcation regions

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10
Q

what forms the inner lining of the tooth socket?

A

cortical plate

layer of compact bond that overlies the spongiosa of the alveolar process on the mandible and maxilla

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11
Q

what penetrates the alveolar bone?

A

nutrient canals (volkmans)

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12
Q

what is the inner bone of the alveolar bone like?

A

cancellous

contains marrow

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13
Q

what happens to the alveolar bone when teeth are lost?

A

the bone is resorbed

leaving a residual ridge

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14
Q

what are alveolar canals filled with?

A

blood vessels

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15
Q

what is in the connective tissue of periodontal ligament?

A 
fibroblasts
ECM
fibres
nerves
blood vessels
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16
Q

what is in the PDL matrix?

A

hyaluronate GAGs
glycoproteins = fibronectin
proteoglycans

behaves like a viscoelastic gel

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17
Q

what are the cells in the PDL?

A
  • fibroblasts
  • cementoblasts
  • osteoclasts and cementoclasts
  • epithelial cells (cell rests or debris of
    malassez)
  • defence cells
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18
Q

how are cysts formed?

A

lining of cysts created by debris of malassez

epithelial balloon filled with highly protein liquid

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19
Q

what 3 types of sensory nerve are in periodontium?

A
  • mechanoreceptors (A beta and A delta)
  • nociceptors (A delta and C)
  • autonomic (sympathetic)
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20
Q

mechanoreceptors in periodontium role

A
  • rapidly or slowly adapting
  • proprioception; chewing control

A beta and A delta fibres

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21
Q

nociceptors in periodontium role

A
  • protective reflexes
  • inhibit jaw elevator motor neurons (popcorn)

A delta and C fibres

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22
Q

autonomic (sympathetic) nerves in periodontium role

A

blood vessel control - vasocontriction

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23
Q

blood supply of the periodontium

A
  • From inferior & superior alveolar arteries, passing into PDL from alveolar bone
  • From lingual & palatine arteries supplying gingivae
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24
Q

true periodontal ligament

A

fibres connecting tooth to bone at or apical to the alveolar crest

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25
Q

‘gingival’ ligament periodontal fibres

A

Fibres mainly above the alveolar crest, including ‘free gingival’ fibres

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26
Q

purpose of PDL

A
  • Attaches tooth to jaw
  • Transmits biting forces to alveolar bone

Organised connective tissue
Width approx = 0.2 mm

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27
Q

fibres in PDL

A

Collagen = (types I & III)

  • Principal fibres - true periodontal ligament
  • Support tooth; load bearing

Oxytalan fibres
- Function uncertain

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28
Q

alveolodental fibre types (5)

A
  • Alveolar crest
  • Horizontal
  • Oblique
  • Apical
  • Interradicular (multi rooted teeth)
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29
Q

interdental fibres

A
  • Transseptal fibres
  • between the cementum of two proximal teeth
  • Interdental septum = part of alveolar bone between two teeth
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30
Q

gingival fibre groups

A
  • Dento-gingival
  • Alveologingival
  • Dento-periosteal
  • Circular
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31
Q

gingival fibre groups role

A

support the free gingiva

present in the lamina propria in marginal gingivae

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32
Q

‘gingival margin’

A

where the gingiva meets the tooth

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33
Q

muco-gingival margin

A

where the ginigiva meets the mucosa

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34
Q

junctional epithelium type

A

stratified non-keratinising epithelium

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35
Q

junctional epithelium special properties

A

2 basal laminas

  • One faces tooth (internal)
  • One faces connective tissue (external)
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36
Q

how does the junctional epithelium and epithelia attach?

A
  • Internal basal lamina & hemidesmosomes

Connects the junctional epithelium to tooth surface

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37
Q

interdental epithelium type

A

stratified squamous (keratinised)

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38
Q

what type of forces are PDL mainly subjected to?

A

intrusive forces and rarely extrusive and horizontal forces

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39
Q

cells in dental pulp

A
  • Odontoblasts
  • Fibroblasts
  • Defence cells
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40
Q

extracellular components of dental pulp

A

Fibres

  • Collagen
  • Oxytalan

Matrix

  • Proteoglycans
  • Chondroitin SO4
  • Dermatan SO4
41
Q

nerves in dental pulp

A
  • Sensory

- Autonomic (sympathetic)

42
Q

what makes up the dental pulp?

A
  • cells
  • exracellular components
  • nerves
  • blood vessels
  • lymphatics
43
Q

what is in the cell rich zone?

A

fibroblasts

44
Q

functions of dental pulp

A
  • Nutritive - blood vessels
  • Dentine growth (primary + secondary)
  • Dentine repair (tertiary)
  • Defence (immune cells; lymphatics)
  • Neural (sensory - pain… control of dentinogenesis)
45
Q

what does both the dentin and pulp develop from?

A

dental papilla

46
Q

structural links between the dentine and pulp

A

Pulpal elements extend into dentine

  • Odontoblast processes
  • Nerve terminals
  • Immune cells (dendritic cells)
  • Dentinal fluid

NB** no blood vessels in normal dentine

47
Q

primary dentine

A

rapid formation

from ADJ –> till full tooth formed

48
Q

secondary dentine

A

slower
continues to be made and laid down throughout life

reason why pulp shrinks over lifetime

49
Q

haemodynamics and hydrodynamics of pulp

A

Fluid leaks from pulp capillaries - interstitial space

  • Some drain by lymphatics
  • Some pass along dentine tubules (dentinal fluid)
50
Q

reactionary dentine

A
  • in response to mild stimulus
  • laid down by primary odontoblasts

secreted by original odontoblasts

51
Q

reparative dentine

A
  • in response to intense stimulus that destroys primary odontoblasts

formed by odontoblast-like cells (secondary odontoblasts)

52
Q

abarsion due to

A

mastication

53
Q

attrition due to

A

bruxism

54
Q

abfraction due to

A

occlusal overload (fractions and cervical lesions)

55
Q

erosion due to

A

diet, gastric reflux, vomitting

56
Q

what does the odontoblast layer act as?

A

permeability barrier

  • Separates pulp and tubular space
  • Regulates movement of material between pulp and tubular extracellular fluid
  • Movement may be in either direction
57
Q

what moves from the pulp to the dentine?

A
  • nutrients to sustain the cell
  • formation of 2 + 3 dentine
  • function of tubular nerves (e.g. K+)
58
Q

what moves from dentine to pulp?

A
  • medicaments applied to dentine

- diffusion of toxins, from bacteria, components of filling materials

59
Q

anatomy of pulp nerves

A

Branches of the alveolar nerves

Neurovascular bundles enter pulp via apical foramen and pass along root canal in centre of pulp towards the coronal pulp chamber
- Branches fan out in subodontoblastic layer; some nerves enter dentinal tubules

60
Q

innervation of dentine

A

some nerves enter tubules

  • Under cusps : 40% of tubules contain nerve
  • Some axons extend 100-200um

Tubular innervation is less in coronal dentine (15%) and root dentine (4%)
- Few axons enter tubles; most end in pulp-predentine region

61
Q

what stimuli can bypass the hydrodynamic mechanism?

A

act directly on intradental nerves

  • intense heating
  • intense cooling
  • electrical current
  • pain-producing chemicals
62
Q

how can high fillings cause dentine pain?

A

force distorts the dentine and alters the tubular fluid flow

63
Q

intradental nerves are…

A

A beta and delta (large and small myelinated)

C fibres (unmyelinated)

64
Q

What activates A beta and A delta fibres in intradental nerves?

A

hydrodynamic stimuli applied to dentine

probably mediate ‘normal’ dentinal sensitivity

65
Q

What activates C fibres in intradental nerves?

A

directly by stimulu, rather than hydrodynamic mechanism
- respond to most forms of intense stimulation

probably mediate pain associated with pulp inflamttion (e.g. caries)

66
Q

4 things that control pulpal blood flow

A

Local factors e.g. metabolites

Nerves

  • Sympathetic
  • Somatic afferents

Circulating hormones e.g. adrenaline

Drugs
- E.g. local anaesthetic preparations with vasoconstrictors

67
Q

5 functions of pulp nerves

A

Sensory - mediating pain

Control of pulp blood vessels

  • Sympathetic : vasoconstrictor
  • Afferents : vasodilator (axon reflex)

Promote neurogenic inflammation

Neuropeptides : subset P, CGRP

Promote dentine formation

68
Q

dentine-pulp first response to injury

A

immediate, nociceptor activation (pain)

69
Q

dentine-pulp response to injury after 1 min.

A
  • early inflammatory response
  • kinins, prostaglandins, neuropeptides
  • vasodilatioin
70
Q

dentine-pulp response to injury after 10 mins

A
  • nociceptor sensitisation
  • extravasation of fluid, odema
  • polymorph migration
71
Q

dentine-pulp response to injury after 100mins

A
  • enzyme activation; nerve growth factor

- monocyte presence

72
Q

dentine-pulp response to injury after 1 day

A
  • nerve spouting (NGF)
  • increased axonal transport
  • altered excitability of CNS synapses
73
Q

dentine-pulp response to injury after 1 week

A
  • repair tertiary dentine formation
74
Q

pulpitis

A

Acute inflammation in the pulp
- Pulp cannot swell as it is confined within the pulp chamber

Odema causes increase in pulp pressure
- Can have variable effects on blood flow + nerve excitability

75
Q

what enamel is more mineralised and harder?

A

surface enamel is more mineralised and harder than deeper enamel

76
Q

how does enamel hardness decrease

A

decrease in hardness from cusp tip to cervical margin

mineral structure varies too

77
Q

what is a basic unit of enamel?

A

rod/prism

78
Q

enamel rods run

A

from ADJ to surface

79
Q

enamel rod dimensions

A

5um x 2.5mm

80
Q

long parallel enamel rods are due to

A

daily growth (approx. 4um)

cross sections in rods

81
Q

brown transverse stiae are due to

A

weekly intervals

25-35um apart

82
Q

does rod orientation effect demineralisation?

A

yes

distinction in head and tail regions is cause by variations in orientations of HA in different parts of the rod

83
Q

HA content in enamel

A

95% weight

90% volume

84
Q

Water content in enamel

A

4% weight

5-10% volume

85
Q

organic matrix content in enamel

A

1% weight
(1-2% volume)

Proteins : amelogenins; enamelins; peptides; amino acids

86
Q

what does the organic compound of enamel regulate?

A

the nanomechanical properties of enamel = FLEXIBILITY

87
Q

how are crystallites deposited?

A

at right angles to the ameloblast membrane

88
Q

where are HA crystallites largest?

A

in enamel, compared to dentine, cementum and bone

89
Q

ground section of tooth shows

A

mineral present

no soft tissues

90
Q

decalcified sections of tooth shows

A

no mineral

just soft tissues

91
Q

how to enamel rods run?

A

in a sinusoidal course

92
Q

what causes banding patterns (Hunter-Schreger bands) in enamel?

A

periodic orientation

93
Q

hunter-shreger bands

A
  • Rod periodic orientation

- Absent in outer enamel

94
Q

gnarled enamel can be found at

A

cusps

95
Q

incremental lines in enamel are

A

brown striae of retzius

96
Q

enamel tufts at the ADJ are

A

hypomineralised regions due to residual matrix protein prism boundaries

97
Q

enamel lamella at ADJ are

A

incomplete maturation of groups of prims

- fault line extending through enamel thickness

98
Q

enamel spindles at ADJ are

A

odontoblast processes extending into the enamel

BDS2 BAMS (54 decks)

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