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Oral Biology > bds2 pulp morphology and biology > Flashcards

bds2 pulp morphology and biology Flashcards

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1
Q

list the components of the dental pulp

A

connective tissue

cells:
- odontoblasts
- fibroblasts
- defence cells

extracellular components
- collagen and oxytalan fibres
- matrix composed of proteoglycans, chondroitin sulphate and derma tan sulphate

nerves
- sensory
- sympathetic

blood vessels and lymphatics

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2
Q

functions of the dental pulp

A

nutrition via blood vessels
dentine growth
dentine repair
defence via immune cells and lymphatics
neural via sensory and control of dentinogenesis

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3
Q

which pulpal elements extend into the dentine

A

odontoblast process
nerve terminals
immune cells
dentinal fluids

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4
Q

describe the haemodynamics and hydrodynamics of the pulp

A

fluid leaks form the pulp capillaries to the interstitial space
some drain via lymphatics and some pass along the dentinal tubules

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5
Q

what are the functional links between dentine and pulp

A

formation of secondary dentine
formation of tertiary dentine in response to tooth wear including reactionary and reparative dentine
regulate exchange of material between dentine and pulp

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6
Q

what are the causes of tooth wear for enamel and dentine

A

mastication
bruxism
abfraction
diet
caries
operative procedures

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7
Q

what type of wear is mastication

A

abrasion

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8
Q

what type of wear is bruxism

A

attrition

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9
Q

what is abfraction

A

occlusal overload leading to fractures and cervical lesions

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10
Q

what are operative procedures that can lead to tooth wear

A

occlusal equilibration
cavity cutting and crown preparation

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11
Q

what is reactionary dentine

A

tertiary dentine formed in response to mild stimulus and laid down by primary odontoblasts

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12
Q

what is reparative dentine

A

tertiary dentine formed in response to intense stimulus that destroys the primary odontoblasts
laid down by secondary odontoblasts

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13
Q

what is the function of the odontoblast layer of the pulp periphery

A

separate the pulp and the tubular space
regulate the movement of material between pulp and tubular extracellular fluid

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14
Q

explain the material exchanged from the pulp to the dentine

A

nutrients to sustain cells
formation of secondary and tertiary dentine
function of tubular nerves eg potassium ions

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15
Q

explain the material exchanged from the dentine to the pulp

A

medicaments applied to dentine
diffusion of toxins from bacteria and components of filling materials

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16
Q

describe the anatomy of pulp nerves

A

branches of alveolar nerves
neuromuscular bundles enter the pulp via the apical foramen and pass along the root canal in the centre of pulp toward coronal pulp chamber
the branches then fan out in the sub odontoblastic layer to form raschows plexus
the terminal branches enter the odontoblast layer and some nerves will enter the dentinal tubules

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17
Q

what is raschows plexus

A

when nerves enter the pulp via the apical foramen and branch out in the subodontoblastic layer, this plexus is formed

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18
Q

describe the innervation of the dental tubules

A

some nerves can enter the tubules but not all

under the cusps, 40% of tubules have nerves

tubular innervation is less in coronal dentine and root dentine

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19
Q

how innervated is coronal dentine

A

15%

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20
Q

how innervated is root dentine

A

4%

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21
Q

where do most axons end in the dentine pulp complex

A

pulp-predestine region

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22
Q

describe the hydrodynamic mechanism for activating intradental sensory nerves

A

stimulus acts on exposed dentine with open tubules which increases the rate of dentinal fluid flow
this generates action potential in intradental nerves
these action potentials pass to the brain to cause pain

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23
Q

what are the effects of outward dentinal fluid flow

A

drying
evaporation
hypertonic solutions
decreased hydrostatic pressure

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24
Q

what are the effects of inward dentinal fluid flow

A

heating
mechanical
increased hydrostatic pressure

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25
Q

which direction of dentinal fluid flow is more effective in activating intradental nerves and why

A

outward, away from the pulp because the rapid flow stretches the nerves

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26
Q

what are stimuli that can bypass the hydrodynamic mechanism

A

intense heating
intense cooling
electrical current
pain producing chemicals

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27
Q

why do high fillings cause dentinal pain

A

the force distorts the dentine and alters the tubular fluid flow

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28
Q

describe the properties of the a beta and a delta fibres in the pulp

A

these are large and small, myelinated nerves
they are activated by hydro dynamic stimuli applied to dentine
they mediate normal dentinal sensitivity

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29
Q

which nerve fibres mediate normal dentinal sensitivity

A

a beta and a delta

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30
Q

which nerve fibres in the pulp are unmyelinated

A

c fibres

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31
Q

describe the features of the C fibres in the pulp

A

active directly by stimuli instead of hydrodynamic mechanism and respond to most forms of intense stimuli
mediate pain associated with pulp inflammation such as caries

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32
Q

branches from which blood vessel provide the pulp

A

maxillary artery

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33
Q

describe the control of pulp blood flow

A
  • local factors like metabolites
  • sympathetic nerves
  • somatic afferent nerves
  • circulating hormones like adrenaline
  • drugs including LA with vasoconstrictors
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34
Q

why do burs need to be cooled

A

they can damage the pulp if used with a high speed motor

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35
Q

list the functions of pulp nerves

A

sensory function to mediate pain

control pulp blood vessels via sympathetic for vasoconstriction and afferents for vasodilation

promote neurogenic inflammation

promote dentine formation

facilitate the immune response

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36
Q

what is the immediate response to dental pulp injury

A

nociceptor activation ie pain

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37
Q

what is the dentine pulp response to injury after one minute

A

early inflammatory response including kinins, prostaglandins, neuropeptides and then vasodilation

38
Q

what is the dentine pulp response to injury after 10 minutes

A

nociceptor sensitisation
extravasation of fluid causing oedema
polymorph migration

39
Q

what is the dentine pulp response to injury after 100 minutes

A

enzyme activation, nerve growth factor and monocyte presence

40
Q

what is the dentine pulp response to injury after one day

A

nerve sprouting, increasing axonal transport and altered excitability of the central nervous synapses

41
Q

what is the dentine pulp response to injury after a week

A

repair - tertiary dentine formation

42
Q

when is the dentine pulp response to injury completely repaired and recovered

A

this time is variable so there is no real answer but usually over a week

43
Q

describe pulpitis

A

acute inflammation in the dental pulp is similar to that in other tissues except that the pulp cannot swell as it is confined within the pulp chamber
oedema causes an increase in pulp pressure
this can have variable effects on blood flow and nerve excitability

44
Q

what forms the core of the tooth

A

the dental pulp complex

45
Q

main function of the pulp is

A

to produce dentine

46
Q

what elements of the pulp provide the characteristic gel elastic behaviour

A

the matrix and the fibres

47
Q

why is blood supply and lymphatic drainage important for the pulp

A

anything that impacts these characteristics will impair the function of the pulp

48
Q

where does the pulp open to the external environment

A

at the apex

49
Q

why is nutrition important for the pulp

A

allows dentine to grow and produce both the primary and secondary dentine

50
Q

what is the developmental link between pulp and dentine

A

they originate from the dental papilla

51
Q

what is the name of the cells that migrate from the neural crest to create the dental papilla

A

ectomesenchymal cells

52
Q

are there blood vessels in normal dentine

A

no

53
Q

what is the origin of the dentinal fluid

A

the extracellular fluid or better from the leakage of pulp capillaries into the interstitial space

54
Q

what is the flow of dentinal fluid proportional to

A

pressure inside the pulp

55
Q

what is the difference between primary and secondary dentine

A

one is formed during tooth formation and the other starts when the tooth is completely formed, including the root and apex

primary dentine is formed quickly following the pace of the tooth development

when the tooth is complete, the pace of dentine formation is slowed, and this is secondary dentine which is formed throughout your lifetime

56
Q

what are the two types of tertiary dentine

A

reactionary dentine, produced by the original odontoblasts faced with aggression. when this aggression is powerful enough to damage these cells the dormant non differentiated stem cells are recruited to differentiate into odontoblasts and produce the reparative dentine

57
Q

what is the difference between reactionary and reparative dentine described as and why is this

A

academic difference because they cannot be clinically identified as their origin is not something we can tell by looking at the dentine

58
Q

what are some instances that cause aggression to the pulp

A

abrasion caused by masticatory function
functional damage caused by bruxism attrition
occlusal overload causing fractures of enamel in the cervical region (abfraction)
acidic diet causing erosion
aries
operative procedures

59
Q

what is occlusal equilibration therapy

A

used to correct the bite surface of the teeth causing tmp disorders.
drill occlusal surface of healthy teeth to fix the tmp
only used in rare and specific cases by a few professionals

60
Q

what is the most common cause of tooth wear in operative procedures

A

cutting cavities and preparation of the tooth to receive crowns and bridges

61
Q

damage can be caused to the pulp even without extending the tooth cutting to dentine. why is this

A

you can still cause damage to the pulp because of the heat generated during preparation - this is why water is always used

62
Q

what is reactionary dentine a consequence of

A

mild stimulus triggering the primary original odontoblasts to produced dentine

63
Q

what is reparative dentine a consequence of

A

when stimulus is intense and the primary odontoblasts are destroyed, leading to secondary odontoblasts recruited and laying down reparative dentine

64
Q

where do secondary odontoblasts originate from

A

sub odontoblastic layer called hoehls layer
this contains stem cells

65
Q

what is the name given to the subodontoblastic layer where the stem cells are found

A

hoehls layer

66
Q

does tertiary dentine have dentinal tubules

A

no

67
Q

function of tertiary dentine

A

a plug to seal tubules from access to the pulp and protect the vital tissue from the exterior threat

68
Q

what other function do odontoblasts have aside from forming dentine

A

they form a permeability barrier between pulp and the dentinal tubules to regulate the exchange of materials between pulp and the tubular extracellular fluid
this exchanging movement happens in both directions

69
Q

describe the route of innervation for the pulp

A

trigeminal nerve - maxillary and mandibular branches - alveolar branches - enter pulp at apical foramen

pass along root canal at the centre of the pulp toward the coronal chamber

fan out toward the sub odontoblastic layer and form the plexus of raschow

these terminal branches enter the odontoblastic layer and some of these nerves will enter the dentinal tubules

70
Q

what is the difference between the nerves entering the tubules at the cusp, coronal portion of the crown and the root

A

under the cusps, 40% of the tubules have nerves

coronal dentine has 15% tubular innervation

root dentine has 4%.

most axons do not enter the tubes and end in the pulp in the predentine region

71
Q

why are axons in the pulp relevant to think about

A

stimulus like thermal, mechanical, chemical etc on the surface of exposed tubules can act on them and increase rate of dentinal fluid flow

this generates action potentials in the intradental nerve and passes to the brain as pain

this is the hydrodynamic mechanism to activate the intradental sensorial nerves and generate pain

72
Q

what is the consequence of the hydrodynamic mechanism in dentine that generates pain

A

dentinal fluid can flow outward or inward. stimuli type will determine the different flows.

73
Q

which stimuli result in the dentinal fluid being driven outward

A

cooling
drying
evaporating
hypertonic solutions
reduction of hydrostatic pressure

74
Q

which stimuli result in the dentinal fluid being driven inward

A

heating
mechanical pressure
increased hydrostatic pressure

75
Q

which flow of dentinal fluid causes greater stimuli

A

outward flow as it is rapid and stretches the nerve

76
Q

is all stimuli due to the movement of dentinal fluid

A

no, intense temperature changes can affect the intradental nerves directly

electrical current and pain producing chemicals can also affect the nerves

77
Q

dentinal fluid is associated with pain for many reasons. one is due to fillings. explain this

A

high fillings such as inlay and inlay restorations will be distorted by occlusal forces and generate pressure to alter the flow of the fluids

78
Q

what activates the a beta and a delta myelinated fibres

A

hydrodynamic stimuli applied to dentine

79
Q

which nerve fibres are responsible for normal dentine sensitivity

A

a beta and a delta myelinated fibres

80
Q

what activates the unmyelinated C fibres in dentine

A

direct stimuli

81
Q

which fibres are responsible for intense stimulation in the dentinal tubules

A

c fibres

82
Q

which fibres are most likely to be associated with pain mediated by pulp inflammation including carious lesions

A

c fibres

83
Q

blood supply to the teeth branches from which artery

A

maxillary artery

84
Q

does cavity preparation and inflammatory response change the vascular permeability of the pulp

A

yes it is increases it

85
Q

what controls pulpal blood flow

A

local factors like metabolites which will have to be removed and affect blood flow in other tissue

not many details on how this works in the pulp but it is known there are changes in blood flow for instance after exercise

innervation - sympathetic controls blood flow by changing the diameter of the blood vessels - generates vasoconstriction to reduce blood flow

afferent somatic fibres means there are sensorial fibres that when receiving stimulation release peptides which produce vasodilation and increase blood flow

effect of hormones like adrenaline will promote vasoconstriction

vasoconstrictors like adrenaline and fenylpressin are used in anaesthetics

86
Q

why are uncooled burs problematic

A

they reduce the blood flow to the pulp

87
Q

what is the function of pulp nerves

A

sensory to mediate pain

control of pulp blood flow

afferents generate vasodilation via peptidergic activity aka axon reflex

neuropeptides released in axon reflex promote neurogenic inflammation so the neuropeptides release by the afferent nerves like substance P induce inflammatory responses

neurogenic response also promotes dentine formation

88
Q

what stimulates the afferent sensorial fibres

A

changes in dentinal fluid flow

89
Q

describe the axon reflex mechanism

A

axon reflex triggered to release vasoactive peptides like substance P and CGRP

these peptides will promote vasodilation to increase permeability

pulp tissue pressure increases

tubular fluid flow increases

90
Q

what does the time of full pulpal repair depend on

A

size of the lesion

host response

ability to recognise repair with radiographs

91
Q

why does the confinement of the pulp chamber impact when there is inflammation

A

it does not allow swelling so the oedema will increase the pressure, affecting blood flow and nerve excitability

this incapacitates the tissue to perform its function

Oral Biology (27 decks)

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