Bio and Histo of Pulp

Question 1

What is the pulpal organ?

Answer 1

Central mass of a tooth consisting of soft tissue that is densely innervated by afferent (sensory) fibers, sympathetic fibers, vascular structures, lymphatics and specialized cells such as odontoblasts (characteristic cells of pulp) and fibroblasts (most common/prevalent cell type in pulp)

Question 2

Answer 2

dental lamina

Question 3

Answer 3

bud stage

Question 4

Answer 4

bell stage

Question 5

Answer 5

cap stage
- arrow points to dental papilla

Question 6

Answer 6

Question 7

What does the cell-free zone (of Weil) do?

Answer 7

reduces the metabolic activity of the pulp

Question 8

What is the function of odontoblast?

Answer 8

• Responsible for DENTINOGENESIS
• Important in amelogenesis

Question 9

Primary Dentin secreted ________ root formation

Answer 9

before

Question 10

Secondary Dentin formed ______ root formation

Answer 10

after

Question 11

What do odontoblasts produce?

Answer 11

• Produces collagen fiber and proteoglycan matrix which becomes mineralized . Pre-Dentin

Question 12

Where do odontoblast processes extend into?

Answer 12

tubules

Question 13

Answer 13

odontoblasts

Question 14

Answer 14

odontoblasts

Question 15

What do fibroblasts arise from?

Answer 15

arises from undifferentiated ectomesenchymal cell

Question 16

What do fibroblasts do?

Answer 16

WOUND HEALING- FORMS TERTIARY DENTIN

• Elaborates Type I & III Collagen fibers and ground susbtance (important for pulp regeneration)
• tertiary dentin is layered pulpally by fibroblasts

Question 17

What is the most prevalent cell in the pulp organ?

Answer 17

fibroblasts

Question 18

Answer 18

fibroblasts

Question 19

Answer 19

Question 20

What are the primary functions of the pulp?

Answer 20

*INDUCTION
*FORMATIVE

Question 21

What are the secondary functions of the pulp?

Answer 21

*PROTECTION
*DEFENSE AND REPAIR
*NUTRITION

Question 22

What are the principle sensory innervations of the pulp in max and mand?

Answer 22

Trigeminal nerve (V2 and V3)

Question 23

Additional premolar innervation comes from what nerve (especially in premolar area)?

Answer 23

mylohyoid nerve

Question 24

Sympathetic (motor) innervation for the pulp is from…

Answer 24

T1 and T2 via superior ganglion

Question 25

Why might you have to anesthetize the pulp?

Answer 25

IA block alone may provide insufficient anesthesia

Question 26

The dental pulp is supplied by both...

Answer 26

myelinated and non-myelinated n. axons

Question 27

What are the characteristics of A fibers?

Answer 27

sharp, pricking

Question 28

What are the characteristics of C fibers?

Answer 28

dull, aching and more diffuse less bearable pain

Question 29

Which fibers have relatively high stimulation threshold, slow in onset (late)?

Answer 29

C fibers

Question 30

Which fibers have relatively low stimulation threshold, quicker response, pain?

Answer 30

A fibers

Question 31

Which fibers are associated with early sharp pain (acute)?

Answer 31

A fibers

Question 32

Which fibers are associated with dull, diffuse pulpal pain (chronic)?

Answer 32

C fibers

Question 33

What type of fibers are associated with reversible pulpitis?

Answer 33

A fibers

Question 34

What type of fibers are associated with irreversible pulpitis?

Answer 34

C fibers

Question 35

About 90% of the fibers are...

Answer 35

A delta fibers

Question 36

What is Branstromm’s “Hydrodynamic Theory”?

Answer 36

Anything that causes movement of the fluid w/in the dentinal tubules causes pain inthe pulp

Question 37

Many of the etiologies of pulpal damage are...

Answer 37

IATROGENIC

Question 38

The pulp amazingly resilient if covered by at least _____ mm of healthy dentin

Answer 38

.5mm *reasonable trauma can be survived if bacteria are minimized or eliminated

Question 39

What are the common etiologies of pulp irritation?

Answer 39

* Microbiological * Mechanical * Chemical * Trauma

Question 40

What are the portals of acess of microbiological irritants to the pulp?

Answer 40

- Cracked or fractured tooth - Cemental defect @ CEJ - Open dental tubules - Perio invasion into apex - Pulpal invasion in P/A - Lateral or Accessory Canal

Question 41

What is the most common cause of access of microbiological irritants to the pulp?

Answer 41

caries/leaking restoration

Question 42

How big are bacteria compared to the tubules?

Answer 42

Bacteria are 0.2 to 5 um Tubules are 50 um

Question 43

What is the central goal of RCT?

Answer 43

to SEAL ALL PORTALS of ACCESS

Question 44

The #1 threat to health of the dental Pulp is...

Answer 44

DENTAL CARIES

Question 45

Without microbes & their products, LEOs (Lesions of Endodontic Origin)...

Answer 45

do NOT occur

Question 46

What is this?

Answer 46

pulp polyp (hyperplastic pulpitis) *doesn't hurt- can't heal

Question 47

Most operative procedures are accompanied by significant opportunity for...

Answer 47

iatrogenic and irreversible damage to the pulp

Question 48

What does cutting with insufficient coolant cause?

Answer 48

Aspiration of odontoblasts into tubules

Question 49

What is the hottest temp that the pulp can get before it is beyond repair?

Answer 49

42 C

Question 50

What happens if the pulp gets damaged beyond repair by a mechanical irritant?

Answer 50

Pulp Necrosis

Question 51

What are different types of mechanical irritants to the pulp?

Answer 51

- Excessive air drying of exposed dentin: aspiration - Application of desiccants: alcohol, chloroform, Cavit, etc. - Polishing - Use of laser

Question 52

What is the response of the dental pulp to injury in the immediate area of the injury?

Answer 52

fibroblasts lay down tertiary (reparative) dentin - general form of the pulp is altered

Question 53

What is a chemical irritant?

Answer 53

Application of any irritating or toxic element to the pulp or dentinal tubules may cause pulpal injury

Question 54

What are the different chemical irritants for the pulp?

Answer 54

- Direct Pulp Cap or Indirect Pulp Cap (CaOH has pH of 12) - Disinfecting agents - Acidic preparations - Composites

Question 55

What are types of external trauma to the pulp?

Answer 55

Falls & Sports Accidents

Question 56

What are types of internal trauma to the pulp?

Answer 56

Para-Normal Habits (Bruxism)

Question 57

What is calcific metamorphosis?

Answer 57

- Pulp sclerosis or Dystrophic calcification - Probably a combination of 2ndary and Tertiary dentin formation in response to extensive and chronic injuries before the pulp became necrotic. (no deposition unless pulp is vital) *also comes with age

Question 58

When is calcified material is deposited?

Answer 58

only when the pulp is vital

Question 59

What is the typical response of the Dental Pulp to Aging & Injury?

Answer 59

Calcific Metamorphosis

Question 60

The uniform deposition of ___________ __________ reducing the general size of the pulp but retaining the general form as the tooth matures

Answer 60

SECONDARY DENTIN

Question 61

What is the function of odontoblasts?

Answer 61

create tooth structure