Clinical Relevance of Pulp Flashcards
Pulp is protected by intact ________,________ and _________.
Dentin
Enamel
Periodontum
The pulp horn is the _______ and the chamber is the _______.
Top of the pulp
body of pulp
What is another term for root area?
Radicular Area
Where do nerves and blood vessels enter the tooth?
Apical Foramen
What are lateral canals?
Canals smaller than the apical foramen that enter the tooth
If pulp swells there is no where for the interior contents to grow because pulp is surrounded by _________.
Lots of hard tissue including dentin and enamel
The top most part of the apical area is made of _________ which contains _______ and ________ tissue.
transitional tissue which contains perio and endodontic (pulp) tissue
Endodontist’s work up until they reach the _________ tissue
Periapical tissue
We do not want to touch the periodontal tissue.
________ line the apical root up until they reach the area where the ___________.
Odontoblasts
fibers for periodontum attach to cementum
Pulp is a __________ tissue.
The primary role of pulp is to _________ that produce ________.
______ protects pulp.
specialized connective tissue
create odontoblasts for dentin formation
Secondary Dentin
From the interior of the pulp to the exterior of the tooth, describe the features of the dentin-pulp complex
Cell-rich Zone
Cell Free Zone
Odontoblasts
Predentin
Dentin
Dentin is a living tissue.
True or False?
True
Dentin is formed by _________ which have processes located in the ________. The tubules widen as they approach ______.
Odontoblasts, dentinal tubules
the pulp
Primary Dentin is formed __________.
Secondary Dentin is formed __________. What do its tubules look like?
before tooth eruption
After root is fully developed. LESS regular
Dentin is made of _______%inorganic material.
______% Water
_______ % organic material of which a majority is ________.
70%- Hydroxyapatite
10%
20% , collagen
The dentinal tubules will contain __________ and __________ processes.
Nerve and Odontoblastic processes
The pulp chamber can ______ as we age and builds up _______.
reduce , dentin
Predentin is __________ , _________ matrix between ________ and _______.
Unmineralized ORGANIC matrix between Mineralized Dentin and the Odontoblasts
In NORMAL pulp,
the odontoblast layer will be the __________ and ________ to predentin.
This layer contains the _________ of _________.
outermost layer and subadjacent to PREDENTIN
cell bodies of odontoblasts.
The odontoblastic layer has more cells in the ____________ than the _________ pulp area.
coronal pulp area, radicular pulp area
Coronal odontoblastic cells are more __________ than those in _________.
columnar, radicular pulp
Right _____ the odontoblastic layer is a ___________ zone that is more prominent in the ________pulp
What does it contain?
There is also a __________ zone with high ______.
What does it contain?
Below, cell-free zone that is more prominent in the coronal pulp
- Plexus of capillaries
- Nerve Plexus of Raschow
3.Ground Substance
Cell-RICH Zone, high cell dentisy
- Fibroblasts (1 and 3)
- Collagen Fibers (1 and 2)
- Undifferentiated Mesenchymal Cells
- Macrophages
Pulp Proper
What is the predominant cell?
What is the pulp matrix made of?
- Fibroblasts which are connective tissue cells
- Ground Substance and Collagen Fibers
What cells are responsible for immunosurveillance of the pulp?
Dentritic Cells and Lymphocytes
What cells are chronically found in inflamed pulp?
Mast Cells
All cells in pulp include
Fibroblasts
Odontoblasts
Macrophages
Dentritic Cells
Lymphocytes
Mesenchymal Cells
Osteoclasts
The central mass of pulp contains _______.
Blood vessels and nerves
Mesenchymal cells of pulp differentiate into __________.
- Fibroblasts
- Odontoblasts
- Osteoclasts
- Macrophages
Nerves enter the ________ as a ____________ and divide as they go into the ___________.
apical foramen as a bundle and divide as they go into the coronal part of the tooth.
Describe what the nerves in a tooth would look like from the apical to the coronal part of the tooth.
They will start out collectively in the apical region, branch out as they approach the coronal portion and congregate all along the coronal area
The coronal area will appear dark while the apical area will have visible branching of nerve fibers.
In the coronal pulp area, what kind of nerve fibers are most common and what are they responsible for?
Location as layers
A Delta Fibers
It transmits the first sharp pain you experience
Odontoblastic and subodontoblastic layer
In the body proper pulp area, what kind of nerve fibers are most common and what are they responsible for?
C fibers
They are responsible for the throbbing pain associated with tissue damage.
This one requires a LOT of damage
What are autonomic nerve fibers?
Modulates microcirculation of blood vessels.
What are the 3 main nerve fibers found in pulp?
C-fibers -Body Proper
A-Fibers - Coronal
Autonomic - Blood Vessels
What is the hydrodynamic theory?
When the fluid in dentinal tubules move due the activation of exposed dentin by cold.
The movement of fluid causes odontoblastic processes to deform which are attached to nerve fibers.
The deformation of odontoblastic processes causes a distortion of tissue with nerve endings at the pulp dentin border causing pain.
This is due to a small cracks in enamel and dentin.
What is hyperalgesia?
Extra pain sensitivity
Acutely inflamed pulp can cause ________ in dentin because _________.
sensitivity
inflammatory agent can reach tubules
As we age, there are ________ in the pulp. This is why we can do some procedures in _________ and not in ______ patients.
less cells
Younger Patients / Older Patients
What are the 3 main pulpal CALCIFICATIONS?
Free Stones that surround pulp tissue
Attached stones that are continuous with dentin
Embedded Stones surrounded by TERTIARY dentin
Coronal pulp stones are often shaped _________.
Radicular pulp stones are often ___________ if formed near _____.
Concentrically
diffused(irregular), if formed near apex
What is Pulp Atrophy?
What are some causes of it?
- Continued deposition of secondary dentin from age or response to stimuli
- Narrowing of pulp chamber and canals
- Recession of pulp chamber
Patients with pulp atrophy may have _______ with pulp appearing _______ on radiographs.
Yellower
Obliterated
Pulp atrophy is always treated.
NO!
If patient is asymptomatic, no need to treat.
Patients with pulp atrophy have yellower teeth.
Why doesn’t bleaching work? What is the alternative?
Too much dentin!
Veneers or crowns !
Fibrosis is a reduction in size of _______ pulp due to __________.
Radicular Pulp
and INCREASE in collagen fibers and a decrease in ground substance and regular cells such as fibroblasts.
Fibrotic teeth may appear ______ on the radiograph.
Calcified
What is dentinal sclerosis?
Partial or complete OBTURATION of dentinal tubules due to attrition or caries OR aging
Peritubular dentin formation increases and appears in apical third of root as a function of age.
In dentinal sclerosis, what exactly is happening to the dentin as a factor of AGING?
Peritubular dentin is growing so fast it reaches the apical third of root
What is pathological sclerosis?
Dentinal tubules blocked by precipitation of hydroxyapatite and whitlockite crystals.
Internal root resorption occurs as a result of __________ of _________ due to ________.
The ______ and _____ thirds of canals are affected.
Progressive destruction of intraradicular dentin due to clastic activity
middle and apical
Roots destruction can either mean more _________ or _______.
Calcified or resorption
In internal root resorption ,a ________ forms in the _________ around the __________ that has started breaking down ________.
___________ around the ________. indicates inflammation
lacunae
dentin around the odontoclast that has started breaking down dentin
Granulation tissue around the odontoclast indicates inflammation
The only way to stop internal root resorption is to __________.
Remove granulation tissue
(Or block of vital tissue to apical root)
Replace Resorption is when there is damage of ___________ cells.
There is replacement of ______ and _____ with ________ rather than _____ or ______.
There is fusion of _______ with _____.
PDL
PDL cells and tooth substance with BONE rather than cementum or dentin
Alveolar bone with root surface
Describe how replacement resorption appears on a radiograph.
Lack of PDL
Root will look moth eaten and irregular
Teeth that have replacement resorption have a ______ sound when percussed compared to regular teeth.
Metallic
External inflammatory root resorption occurs as result of ________ in the ________ part of the root.
trauma in the CERVICAL part of the root
In external inflammatory root resorption, ________ will collect in _______ and _________ may appear ________.
Is there invasion of pulp?
granulation , dentin , area near CEJ will appear pink
NO
How does external inflammatory root resorption appear on a radiograph?
Radiotranslucent area near CEJ
Can enamel irritation cause a reaction in pulp?
YES
External root resorption can extend ______.
Apically
If dentin is exposed to bacteria what occurs?
Inflammatory cells such as neutrophils in dentinal tubules can prevent dissemination of bacterial elements to the pulp
_______ in _______ can prevent dissemination of bacterial elements to the pulp.
Neutrophils in dentin tubules
pulp
Can pulp repair itself?
Yes
Calcific Metamorphosis occurs as a result of ___________ where calcification of _______ can take anywhere from ______ to _______.
_____ tissue looks like ________ or _________ so teeth will appear _______ to the eye and __________ radiographically
trauma, root, months to years
Mineralized tissue looks like cementum or dentin so teeth will appear yellow and lack a canal radiographically.
Is partial root obliteration possible?
Yes
Tertiary dentin is irregular because it is made in response to _______.
irregular , a need for repair.
Hyperplastic pulpitis is often found in ____________ patients due to _______.
______ is exposed to the oral environment and gets lined by _______. It has massive __________.
Patients are often symptomatic/asymptomatic.
young, severe caries
Pulp tissue, oral mucosa , inflammatory infiltrate
Asymptomatic
In hyperplastic pulpitis, the exposed pulp gets covered by ________ which becomes _________.
oral mucosa, keratinized
Necrotic pulp is when ______ in _______ cause infection of _________.
bacteria in dentinal tubules cause an infection of canals
Necrotic pulp is defined as the loss of all _________ and the presence of ____, ______ and ______.
vital tissue
bacteria, dead cells, empty space
Necrotic pulp treatment requires ________ because bacteria can penetrate _________ micrometers into the dentinal tubules.
medicament
10-150 micrometers
If bacteria attaches to the walls of canals, it is called a________.
biofilm. This makes bacteria very adhesive to the dentin
Biofilm can occur on the exterior of root.
True or False
True
Confocal Microscopes can show us if bacteria are ___________.
Light green indicates :
Orange indicates:
Alive or Dead
Alive bacteria
Dead/Membrane damaged bacteria
Cementum is bone-like and made from the ___________ of _______ which differentiate into _________ to produce cementum
mesenchymal cells of dental follicle
Cementoblasts to produce cementum
Cementum is deposited first against ______ and forms the ______. The ______ portion is found in the _________.
The _____ portion is found in the _____ of the root and contains _______.
the dentin and forms the CDJ. Acellular portion is found in the cervical and middle thirds of the root
The cellular portion is found in the apical third of the root and contains cementocytes.
In endodontics there are two diagnoses. What are they?
- Inside the root
- Outside the root
Apical Periodontitis is _________ at _____ and will appear ________ because _________ is being ________ as well as ___________..
inflammation at apices and will appear radiolucent because cortical bone is being resorbed as well as dentin,cementum and bone
Apical Periodontitis will result in patients that are asymptomatic.
True or False
FALSE
Mastication will definitely cause pain
Periapical Cysts are lined with ________ and formed within a __________.
The lumen is filled with _________.
Stratified Squamous Epithelium and formed within a granuloma
The lumen is filled with cholesterol crystals.
What is an acute apical abscess?
This occurs if apical periodontis isn’t treated and the cyst escapes bone and fines soft tissue
Intraoral and sometimes extraoral swelling that can be diffused or localized, indurated or flucuant
There will be pain to biting, pressure and tooth will be mobile.
_______ cysts can be drained.
Fluctuant
Chronic Apical Abscesses
Cyst can interact with sinus tract and patients are able to pop this.
This can occur on chin, cheek.
Chronic Apical Abscesses are asymptomatic while Acute Apical Abscesses are symptomatic.
True or False
TRUE
Condensing Osteitis
Localized bony reaction to a low-grade inflammatory stimulus associated with pulpal damage, inflammation and possibly necrosis.
Marrow spaces and cancellous bone are replaced by Dense COMPACT bone. Reduced medullary spaces and fatty marrow is replaced by fibrous tissue.
In condensing osteitis, ________ and _______ is replaced by ___________.
Reduced __________ spaces and _____-______ is replaced by ______ tissue.
marrow spaces and cancellous bone is replaced by dense compact bone
medullary spaces and fatty marrow is replaced by fibrous tissue
Radiographically, condensing osteitis appears _____________.
as concentric radiopacity around apex
Root fractures in a _______ usually cannot be saved.
Vertical
Not using water when drilling teeth can result in _________, severe _____________ of ______ and displacement of ______ into _________.
burned dentin
inflammation of pulp
displacement of odontoblasts into dentinal tubules
Pulp capping is often done with ___________ which has a pH of _________ at the ______ part of the tooth.
Why is this done?
Calcium hydroxide, 12 at the coronal part of tooth
Makes fibroblasts differentiate into odontoblasts to initiate mineralization.
________ pH substances promote tooth healing.
Alkaline
A pulpotomy extends ___________.
It was done with ________ which was found to be __________-.
PAST the coronal portion of the root.
It was done with formocresol which was found to be carcinogenic.
NO mineralization takes place
Is formocresol or calcium hydroxide better for pulp medication?
Calcium Hydroxide
A smear layer which is ________________, can be removed via ____________ called ________.
dentinal particles covering dentin tubules after some sort of treatment such as filing can be removed via a CHELATING agent called EDTA
Dentinal tubules will open up!
Pulp caps create ________ bridges.
Dentin bridge
Regeneration in Endodontics
Using stem cells in young teeth to initiate growth into dentinal areas aka Zombie Teeth
Pulp tissue is often not uniform and there may be some calcification
