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BDS stage 2 > CTB theme 2 > Flashcards

CTB theme 2 Flashcards

1
Q

What are the 3 phases of tooth development ?

A

initiation
morphogenesis
histogenesis

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2
Q

What is initiation ?

A

appearance of tooth germs

this stage determines the tooth position

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3
Q

What is morphogenesis ?

A

cell proliferation and movement

determines the tooth shape and type

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4
Q

What is histogenesis ?

A

cell differentation and specialisation

leads to the formation of dental tissues

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5
Q

What are the 3 stages in the initiation phase of tooth development ?

A

formation of the priamary epithelial band
condensation of mesenchymal cells
formation of the dental and vestibular lamina

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6
Q

What happens during the formation of the primary epithelial band ?

A

6 weeks in utero
a continuous band of odontogenic epithelium forms around the mouth in the upper and lower jaws
each band corresponds with the dental arches

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7
Q

Why does the primary epithelial band form ?

A

as a result of a change in the cleavage plane of dividing cells

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8
Q

What happens when mesenchymal cells condense ?

A

epithelial band grows into ectomesenchyme

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9
Q

What is ectomesenchyme ?

A

neural crest derived mesenchyme

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10
Q

What happens in the formation of the dental and vestibular lamina ?

A

7 weeks in utero

primary epithelial band divides into the dental and vestibular lamina which grow into the ectomesenchyme

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11
Q

What eventually happens to the dental lamina ?

A

it continues to proliferate lingually leading to the development of 20 epithelial outgrowths - tooth germs

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12
Q

How is the vestibule formed ?

A

epithelial cells proliferate and the central cells enlarge and degenerate to produce the vestibule

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13
Q

What are the stages of the morphogenesis phase ?

A

formation of a tooth bud
early cap stage
late cap stage
early bell stage

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14
Q

What happens in the formation of a tooth bud ?

A

elongation of the dental lamina leads to localised swellings- proliferates rapidly
ecomesenchymal cells condense

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15
Q

What happens at the early cap stage ?

A

11 weeks

epithelial outgrowth resembles a cap which sits on condensed ectomesenchyme

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16
Q

What is the condensed ectomesenchyme called ?

A

the enamel organ

it will eventually form the enamel of the tooth

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17
Q

What happens in the late cap stage ?

A

a group of non dividing cells form the enamel knot
the condensed ectomsenchyme cells under the enamel organ from the dental papilla
the condensed ectomesenchyme surrounding the enamel organ forms the dental follicle

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18
Q

What is the enamel knot ?

A

a transient molecular signalling centre

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19
Q

What does the dental papilla form ?

A

the dentine and pulp

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20
Q

What does the dental follicle form ?

A

periodontal tissues

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21
Q

What happens in the early bell stage ?

A

cells on the periphery of the enamel organ become cuboidal and form the outer enamel epithelium

cells bordering the dental papilla have a columnar shape - inner epithelium

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22
Q

What is in the middle of the enamel organ?

A

stellae reticulum

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23
Q

What is the stellae reticulum characterised by ?

A

star shaped cells
cells are connected by desmosomes
intracellular spaces filled with GAGs

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24
Q

What do GAGs act as ?

A

shock absorbers

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25
Q

What is the stellae intermedium ?

A

in the bell stage some epithelial cells between stellae reticulum and the IEE diffferentiate into the stellae intermedium

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26
Q

What are characteristics of stellae intermedium ?

A

2-3 cell layers thick
high activity of alkaline phosphatase
involved in protein synthesis and substance transport to and from the IEE
supports ameloblasts.

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27
Q

What is the role of the dental papilla ?

A

generates fibroblasts and ectomesencymal stem cells of the pulp
produce odontoblasts

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28
Q

What is the role of the dental follicle ?

A

support the enamel organ with nutrients

supports the generation of tooth forming tissues

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29
Q

What is the inner layer of the dental follicle like ?

A

condensed and vascularised and in contact with the OEE

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30
Q

What is the outer layer of the dental follicle like ?

A

loose and vascularised and contacts the developing alveoalr bone

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31
Q

What are the stages of the tooth histogenesis phase ?

A

late bell stage
reciprocal tissue interactions in crown formation
protection of the crown after completion

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32
Q

What happens in the late bell stage ?

A

odontoblasts and amelobalsts secrete predentine and preenamel
stellae reticulum moves downwards
breakdown of the dental lamina
enamel organ looses contact with the oral epithelium

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33
Q

Why does the stellae reticulum move downwards ?

A

protect the cellular area of the tooth

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34
Q

What is the cervical loop ?

A

growing end of the enamel organ
located where the IEE and OEE meet
involved in root formation

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35
Q

What does stratum intemedium do in the late bell stage ?

A

produces alkaline phosphatase which leads to enamel mineralisation

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36
Q

What does stellae reticulum do ?

A

protects and maintains tooth shape

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37
Q

What does the OEE do ?

A

maintains tooth shape and exchanges substances with the dental follicle

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38
Q

What are odontoblasts ?

A

dental papilla cells

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39
Q

What are ameloblasts ?

A

IEE cells

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40
Q

How is the IEE separated from the dental papilla ?

A

cell free zone

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41
Q

What happens when the IEE cells elongate ?

A

they become preameloblasts which secrete signalling molecules that induce odontoblast differentiation of dental papilla cells

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42
Q

What happens once the odontoblasts start secreting predentine ?

A

they align and release signals that induce differentiation of preameloblasts into ameloblasts- produce pre enamel

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43
Q

When is the protective epithelium for the crown formed ?

A

when the crown is formed

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44
Q

How is the REE formed ?

A

flattened ameloblasts and remnants of the enamel organ

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45
Q

What is the purpose of the REE ?

A

it covers the crown and stops enamel of the erupting tooth being attacked by osteoclasts in resorption

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46
Q

Which teeth need successive tooth germs ?

A

incisors, canines and premolars

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47
Q

How are successional tooth germs formed ?

A

they bud off lingually from the dental lamina at 5 months in utero

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48
Q

What do successional tooth germs do ?

A

they remain dormant until their development is initiated

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49
Q

How does molar development occur ?

A

dental lamina grows posteriorly

backward extension gives rise to epithelial outgrowths that form molar tooth germs

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50
Q

What are ectodermal appendages ?

A

epithelium and mesenchyme cross over

in organ development

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51
Q

What is the origin of ameloblasts ?

A

epithelial

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52
Q

What is the origin of odontoblasts ?

A

mesenchymal

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53
Q

How is the interaction between epithelium and mesenchyme mediated ?

A

cell signalling molecules

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54
Q

What is the enamel knot ?

A

signalling centre

determines the cuspation of the tooth

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55
Q

What happens to the enamel knot in the early bell stage ?

A

it divides depending on how many cusps the tooth has
eg. premolars- divide into 2
number of knots is number of cusps

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56
Q

What does the 1st pharyngeal arch divide into ?

A

mandibular and maxillary arch

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57
Q

What is the odontogenic potential ?

A

capacity to form teeth

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58
Q

What can potentially happen within 2 days ?

A

dental epithelium can loose its odontogenic potential

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59
Q

How does the odontogenic potential switch ?

A

from epithelial to mesenchyme

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60
Q

What type of signalling is there in the initiation stage ?

A

epithelial signallig which turns epithelium into dental mesenchyme

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61
Q

What type of signalling is there in the bud stage ?

A

mesenchymal signalling as epithelium looses its odontogenic potential

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62
Q

What do combinations of transcription factors do ?

A

regulate expression of signalling molecules

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63
Q

What is paracrine signalling ?

A

signalling molecules are secreted and act on nearby receptors

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64
Q

Give some examples of signalling molecules ?

A

Wnt family
Fgf- fibroblast growth factors
BMP- bone morphogenic proteins

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65
Q

What do transcription factors do ?

A

alter gene expression

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66
Q

Give some examples of transcription factors ?

A

Pax

Msx

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67
Q

What happens in the initiation stage signalling wise ?

A

competence to make tooth in the epithelium
FGF and BMP signals transmitted
expression of PAX9/MASX1 transcription factors
TFs lead to cells identifying as mesenchymal cells

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68
Q

What i the outcome of the initiation stage ?

A

tooth position

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69
Q

What happens in the bud stage signalling wise ?

A

odontogenic potential shifts to mesenchyme
mesenchyme secretes FGF and BMP
PAX9/MSX1 transcription factors made

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70
Q

How is the enamel knot formed ?

A

cells in the centre become arrested and dont divide

this happens in cap stage when BMP is secreted

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71
Q

What happens in the cap stage signalling wise ?

A

enamel knot secretes BMP arrests cell division
FGF induces cell proliferation in surrounding border cells - leads to downwards movement of enamel knot and formation of a 3D structure

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72
Q

What does the cap stage determine ?

A

tooth shape

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73
Q

How are signalling molecules used repeatedly ?

A

BMP and FGF are always present in tissue
they in turn stimulate MSX1 and PAX9 transcription factors
again stimulates BMP and FGF

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74
Q

What are genetic modules ?

A

they are reused to regulate subsequential development steps

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75
Q

Mutations in genetic regulators lead to what ?

A

arrest tooth development at an early stage

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76
Q

What do EDA1/EDAR mutations lead to ?

A

ectodermal dysplasia

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77
Q

What do PAX9/MSX1 mutations lead to ?

A

hypodontia

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78
Q

How does variable Shh expression lead to domains that determine tooth development ?

A

at the lamina stage shh expression can varied in different regions
leads to domains of cells that form a special structure
domains divide to determine tooth shape- primary enamel knot
further subdivision leads to secondary enamel knot to determine cusps

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79
Q

Which transcription factors code for the incisor region ?

A

MSX1/2

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80
Q

Which transcription factors code for the molar region ?

A

Dlx 1/2- maxillary molars
Dlx 5/6- mandibular molars
Barx

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81
Q

What would happen in an absence of Dlx1/2 ?

A

loss of maxillary molars

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82
Q

What would happen with an overexpression of barx-1 ?

A

in the incisor region the incisors would be transformed into molars

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83
Q

Defects in the initiation stage lead to ?

A

defects affect tooth number and identity

ectodermal dysplasia and hyperdontia

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84
Q

Defects in the morphogenesis stage lead to ?

A

defects in number, shape and size

hypodontia

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85
Q

Defects in the histogenesis stage leads to ?

A

hard tissue formation

amelogenesis imperfecta etc

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86
Q

What are syndromic defects ?

A

they occur in combination with other effects

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87
Q

What are non-syndromic defects ?

A

defects not associated with another abnormalities

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88
Q

What is hypodontia ?

A

less than 6 missing teeth excluding 8s

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89
Q

Which mutation leads to hypodontia ?

A

MSX1 mutation

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90
Q

What are common features of hypodontia ?

A

missing lower 5s
retained primary molars
missing lower 2s
incisors are peg shaped

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91
Q

What is oligodontia ?

A

more than 6 missing teeth excluding 8s

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92
Q

Which mutation leads to oligodontia ?

A

pax9 mutation

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93
Q

What are common features of oligodontia ?

A

missing 4s
missing 5s
missing molars

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94
Q

What is anodontia ?

A

no teeth

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95
Q

What are syndromes associated with oligodontia ?

A

hypohidrotic ectodermal dysplasia
rieger syndrome
oligodontia- colorectal cance syndrome

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96
Q

Which mutation leads to hypohidrotic ectodermal dysplasia ?

A

Eda1

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97
Q

Which mutation leads to rieger syndrome ?

A

Pitx2

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98
Q

Which mutation leads to oligodontia- colorectal cancer syndrome ?

A

Axin 2

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99
Q

How can we manage hypodontia ?

A

open spaces for bridges and implants

close spaces with orthodontic devices

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100
Q

Give an example of hyperdontia ?

A

cleidocranial dysplasia

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101
Q

Which mutation leads to cleidocranial dysplasia ?

A

RUNX2

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102
Q

What is cleidocranial dysplasia ?

A

bone defects in the clavicle
multiple teeth due to duplication of the dental lamina
enamel hypoplasia
delayed eruption

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103
Q

What are dentigerous cysts ?

A

radiolucency caused by a fluid filled space between REE and the tooth crown

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104
Q

Incomplete breakdown and removal of the dental lamina can lead to what ?

A

supernumerary teeth
eruption cysts
odontomes

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105
Q

What are eruption cysts ?

A

form when teeth try to erupt and hit epithelial remnants leading to pearls of serres

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106
Q

What is the gubernacular canal ?

A

canal filled with connective tissue that connects the dental follicle to the oral epithelium

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107
Q

What are the 3 types of amelogenesis imperfcta ?

A

hypoplasia
hypomineralisation
hypomaturation

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108
Q

What is hypoplasia ?

A

affects enamel matrix formation

reduced enamel thickness

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109
Q

What is hypomineralisation ?

A

normal enamel thickness but reduced mineral content

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110
Q

What is hypomaturation ?

A

normal enamel thickness but softer

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111
Q

Which gene is mutated in amelogenesis imperfecta ?

A

AMELX and ENAM

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112
Q

What is dentinogenesis imperfecta ?

A

defects in dentine formation
blue, gray, opalascent teeth
softer dentine leads to enamel chipping and tooth wear down
bulbous crowns

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113
Q

Which genes are mutated in dentinogenesis imperfecta ?

A

DSPP

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114
Q

How can dentine be classified ?

A

by location and time of development

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115
Q

What is predentine ?

A

unmineralised dentine matrix

forms between the layer of odontoblasts and the mineralising front

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116
Q

What is primary dentine ?

A

forms during tooth development

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117
Q

What is secondary dentine ?

A

forms after root completion

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118
Q

What is tertiary dentine ?

A

in response to stimuli

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119
Q

What is coronal dentine ?

A

in the crown

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120
Q

What are the 2 types of coronal dentine ?

A

circumpulpal and mantle

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121
Q

What is mantle dentine ?

A

outermost layer that forms first

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122
Q

What is circumpulpal dentine ?

A

bulk of the crown

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123
Q

What are the 2 types of root dentine ?

A

hyaline layer- outermost

granular layer of tomes

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124
Q

What is the composition of dentine ?

A

70% inorganic
20% orgaic
10% water

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125
Q

What is the inorganic component of dentine ?

A

calcium hydroxyapatite crystals

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126
Q

Where are the hydroxyapatite crystals located in dentine ?

A

between the type I collagen fibrils

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127
Q

What are the components of the organic matrix of dentine ?

A 
type I collagen fibrils and some type III networks 
proteoglycans 
glycoproteins 
phosphoproteins 
growth factors
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128
Q

What are proteoglycans what do they do ?

A

they are GAGs with proteins attached

they regulate the mineralisation process

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129
Q

What are glycoproteins ?

A

osteonectin
osteopontin
dentine sialoprotein

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130
Q

What are phosphoproteins ?

A

dentine phosphoprotein

unique to dentine

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131
Q

What are growth factors ?

A

BMPs

transforming growth factors

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132
Q

What are the physical properties of dentine ?

A 
softer than enamel 
higher tensile strength than enamel
porous 
sensitive 
reactive
less radiopaque than enamel
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133
Q

Why does dentine have a higher tensile strength than enamel ?

A

collagen fibrils resist shearing forces

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134
Q

Why is dentine sensitive ?

A

it is innervated by the pulp

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135
Q

Why is dentine reactive ?

A

tertiary dentine can be made in response to external stimuli

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136
Q

When does dentine formation begin ?

A

at the cusps in the late bell stage

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137
Q

Where do odontoblasts differentiate ?

A

in the cervical loop region from dental papilla cells

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138
Q

When do odontolasts differentiate ?

A

when signals from pre-ameloblasts induce differentation of dental papilla cells into odontoblasts and subodontoblasts

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139
Q

What happens when odontoblasts differentiate ?

A

they become columnar and secrete predentine

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140
Q

What are the steps of dentinogenesis ?

A
  1. odontoblasts secrete predentine
  2. Large type III collagen fibrils form perpendicular to the EDJ
  3. secretion of smaller type I fibrils parallel to the EDJ
  4. in mantle dentine- vesicles are secreted by odontoblasts- contain calcium phosphate
  5. odontoblasts develop cell processes
  6. initiation of mineralisation
  7. crystallites burst out from vesicles- for,m the mineralising front
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141
Q

What are von Korffs fibres ?

A

type III collagen fibrils that form perpendicular to the EDJ

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142
Q

How does mineralisation happen ?

A

via matrix vesicles

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143
Q

What are matrix vesicles ?

A

small membrane covered vesicles secreted by odontoblasts

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144
Q

What do matrix vesicles contain ?

A

Phospholipids that bind to calcium
Alkaline Phosphatase which increases phosphate concentration by destroying the inhiibtor of mineralisation- pyrophosphate

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145
Q

In which dentine are matrix vesicles only observed ?

A

mantle dentine

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146
Q

Where is predentine mineralised ?

A

at the mineralising front

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147
Q

Why does the thickness of predentine remain constant ?

A

the amount calcified is balanced by the addition of new unmineralised matrix

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148
Q

What are the 2 types of dentine mineralisation ?

A

linear and globular depending on speed

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149
Q

Which type of mineralisation happens in mantle dentine ?

A

globular

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150
Q

Which type of mineralisation happens in circumpulpal dentine ?

A

both linear and globular

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151
Q

Which mineralisation happens with fast dentine deposition ?

A

globular

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152
Q

Which mineralisation happens with slow dentine deposition ?

A

linear

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153
Q

What happens in globular calcification ?

A

calcospherites form in the matrix and fuse to form a single calcified mass

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154
Q

What are calcospherites ?

A

globular masses of mineralised matrix

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155
Q

What happens if calcification is exceptionally fast ?

A

the calcospherites dont fuse - leading to interglobular dentine

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156
Q

Where is interglobular dentine found ?

A

in the upper third of circumpulpal dentine

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157
Q

Why is the EDJ scalloped ?

A

increasing the SA and the attachment of enamel to dentine

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158
Q

What are enamel spindles ?

A

overshot odontoblast processes that enter the enamel and become trapped once the enamel mineralises

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159
Q

What is significant about dentine tubules in mantle dentine ?

A

they are highly branched increasing the sensitivity of dentine

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160
Q

What are the 2 types of dentine tubule curvature ?

A

S-shaped

Linear shaped

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161
Q

What are S-shaped dentine tubules ?

A

in the coronal region

crowding of odontoblasts means they are pushed apically

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162
Q

What are linear shaped tubules ?

A

in the cervical region and root dentine

little or no crowding of odnotoblasts

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163
Q

What is secondary curvature of dentine tubules ?

A

change in the direction of dentine tubules during dentien deposition

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164
Q

What are contour lines of owen and how are they formed ?

A

when secondary curvature coincides with adjacent tubules leads to an owen line
forms due to metabolic stress

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165
Q

What type of line is a contour line of owen ?

A

accentuated incremental growth lines

hypomineralised

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166
Q

What are von ebner lines ?

A

daily short period lines
they showcase daily dentine deposition - daily activity of odontoblasts
closely spaces

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167
Q

What are andresen lines ?

A

more spaced out than von ebner lines
long period
sharply defined

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168
Q

What is the most prominent growth line ?

A

neonatal line

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169
Q

Why does the neonatal line form ?

A

disturbance at birth in dentine deposition

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170
Q

What are the types of circumpulpal dentine ?

A

intetglobular
intertubular
intratubular
sclerotic

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171
Q

What is intertubular dentine ?

A

dentine between tubules

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172
Q

What is intratubular dentine ?

A

dentine inside tubules

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173
Q

What is sclerotic dentine ?

A

caused by obliteration of dentine tubules

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174
Q

What is reactionary dentine ?

A

original odontoblasts secrete dentine
less tubules
in response to weak stimuli

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175
Q

What is repairative dentine ?

A

newly recruited odontoblast like cells - original die
deposit dentine that is less structured
strong stimulus- fast repsonse

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176
Q

What is secondary dentine and where is it found ?

A

forms throughout life
reduces the size of the pulp chamber
found on roof and floor of pulp chamber

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177
Q

What are the features of intratubular dentine ?

A

lines the inside of dentine tubules

hypomineralised

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178
Q

What does continual formation of intratubular dentine lead to ?

A

obliteration of dentine tubules

dentine is now sclerotic

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179
Q

What are dead tracts ?

A

retraction of odontoblast processes and odontoblast cell death means that tubules become air filled and are visible as dark lines

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180
Q

How does sclerotic dentine increase ?

A

age
attrition
caries

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181
Q

The formation of sclerotic dentine is a mechanism for what ?

A

protection against microorganisms

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182
Q

What are the 2 different types of root dentine ?

A

tomes granualr layer

hyaline layer

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183
Q

What is the hyaline layer ?

A

non tubular
first layer formed
bonds dentine to cemnetum
hypomineralised

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184
Q

What is tomes granular layer ?

A

globules

incomplete fusion of calcospherites

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185
Q

How do ameloblasts form ?

A

odontoblasts send signals to IEE cells which induces differentaition to ameloblasts

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186
Q

What are the 3 phases of amelogenesis ?

A

presecretory phase
secretory phase
maturation phase

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187
Q

What are the 2 stages in the presecretory phase ?

A

morphogenetic stage

histodifferentation stage

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188
Q

What is the initial enamel layer like ?

A

aprismatic

30% mineralised

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189
Q

What are the 2 stages in the secretory phase ?

A

initial secretory sage

secretory stage

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190
Q

What happens in the morphogenetic stage ?

A

IEE cells are cuboidal

basal lamina made which separates the IEE cells from the dental papilla - differentiation to pre-ameloblasts

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191
Q

What happens in the histodifferentiation stage ?

A

differentiation of pre-ameloblasts to ameloblasts
cells are columnar, cell polarity and nucleus moves proximally
basal lamina removed
enamel proteins made

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192
Q

What is the purpose of tomes process ?

A

to orientate crystals

align prisms

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193
Q

What happens in the initial secretory stage ?

A

tomes process is absent
ameloblasts enlongate
and secrete the initial aprismatic layer of enamel

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194
Q

What happens in the secretory stage ?

A

tomes process is present
the proximal part develops before the distal part
proximal part produces interprismatic enamel
distal part produces prismatic enamel

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195
Q

Where is the distal portion of tomes process located ?

A

between the prismatic and interprismatic layer of the enamel

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196
Q

What happens when the outermost enamel layer is formed ?

A

the ameloblasts become shorter and loose the distal portion of tomes process
form thin aprismatic enamel

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197
Q

What are the 2 types of enamel proteins ?

A

amelogenins and non-amelogenin proteins

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198
Q

What are amelogenins ?

A

90% matrix content
hydrophilic- regulate growth and thickness of enamel
form nanospheres- collate between crystals to prevent them widening
scaffold for enamel structure

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199
Q

How are amelogenins removed ?

A

proteolytically cleaved selectively

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200
Q

What do mutations in enamelysin lead to ?

A

amelogenesis imperfecta

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201
Q

What are non-amelogenin proteins ?

A

first matrix component secreted but removed proteolytically

10% matrix contnet

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202
Q

What happens if non-amelogenin proteins arent removed ?

A

they form the enamel sheath at the periphery of prisms

only remaining organic material

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203
Q

What are 3 examples of non-amelogenin proteins ?

A

ameloblastin
enamelin
amelotin

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204
Q

What is ameloblastin ?

A

adhesion of ameloblasts to enamel matrix

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205
Q

What is enamelin ?

A

promotes and guides formation of enamel prisms

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206
Q

What is amelotin ?

A

basal lamina protein

adhesion of enamel to junctional epithelium

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207
Q

What are the 2 stages of the maturation phase ?

A

transitional stage

maturation proper

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208
Q

What happens in the transitional phase ?

A

enamel full formed

ameloblasts decrease in volume and 50% die by apoptosis

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209
Q

What happens in the maturation proper stage ?

A

increase in mineral content
water and proteins removed
increase in ion transport

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210
Q

Ameloblasts in the maturation phase are cyclically modulated between which 2 types ?

A

smooth ended

ruffle ended

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211
Q

What are ruffle ended ameloblasts ?

A

selectively transport calcium ions to the enamel layer

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212
Q

What type of junctions are in ameloblasts ?

A

leaky junctions at the basal end

tight jucntions at the enamel end to prevent fluid passage

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213
Q

What are smooth ended ameloblasts ?

A

leaky junctions at enamel end
allows water and enamel proteins to leave
IF travels between ameloblasts to neutrlaise increase in protons
deliver trace elements like fluoride to enamel layer

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214
Q

Which surface has the most mineralised layer of enamel ?

A

occlusal surface

degree of mineralisation decreases towards the EDJ

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215
Q

Why are primary teeth less mineralised ?

A

smaller maturation phase

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216
Q

How is mature enamel in a chemica equilibrium ?

A

acid leads to mineral loss

saliva acts as a buffer and is a permanent remineralising agent

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217
Q

What happens in the protective stage of amelogenesis ?

A

REE forms inactive cuboidal cells

cover crown and prevent crown from being resorbed

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218
Q

What does water fluoridation do ?

A

leads to fluoride incorporation

enamel becomes resistant and reduces dental caries

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219
Q

What does long term excessive consumption of fluoride lead to ?

A

fluorosis

mottled enamel

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220
Q

What are the features of enamel in fluorosis ?

A

faint white opacities
pitting
high porosity in outer third- bacteria can enter

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221
Q

What does acid etching do ?

A

makes it more adhesive for dental restorative materials

removes a thin layer of enamel to increase SA- better bonding surface

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222
Q

What are white spot lesions ?

A

loclaised demineralisation

can be arrested or progress to caries

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223
Q

What does tetracycline do?

A

disturb amelogenesis and can be incorporated into tissues - brown pigmentation

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224
Q

What is enamel hypomineralisation ?

A

smooth surface but abnormal colour

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225
Q

What is molar incisor hypomineralisation ?

A

affects teeth that form in first year of life

6s and incisors

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226
Q

What is the origin of enamel ?

A

epithelial origin

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227
Q

What is the composition of enamel ?

A

96% inorganic

4% organic

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228
Q

Where is enamel the thickest and thinnest ?

A

Thickest at cusps and thinnest at cervical region

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229
Q

How does enamel thickness increase in molars ?

A

increases in thickness from 1st to 3rd molar

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230
Q

What are the mechanical properties of enamel ?

A

hard
brittle
low tensile strength

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231
Q

What do HA crystallites combine to form ?

A

prisms

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232
Q

What are prisms separated by ?

A

interprismatic region

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233
Q

How is prismatic and interprismatic eamel different ?

A

they are similar in structuure but diverge in orientation

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234
Q

What are the 3 types of enamel prism patterns ?

A

circular
stacked
keyhole

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235
Q

Which pattern is found in humans ?

A

keyhole

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236
Q

What is the circular enamel pattern ?

A

discrete rods surrounded by interprismatic enamel

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237
Q

What is the stacked enamel pattern ?

A

rods in vertical rows

interrow sheets

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238
Q

What is the keyhole enamel pattern ?

A

head and tail

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239
Q

How many ameloblasts form each keyhole rod ?

A

5

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240
Q

What is the enamel prism sheath ?

A

boundary between prisms and interprismatic enamel

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241
Q

What material does the enamel sheath contain ?

A

ameloblastin

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242
Q

What is the direction of enamel prisms in primary teeth ?

A

orientated towards the oral cavity

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243
Q

What is the direction of enamel prisms in permanent teeth ?

A

towards the alveolar crest

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244
Q

What is prism decussation ?

A

enamel prisms follw a sinusoidal path

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245
Q

What is the purpose of enamel decussation ?

A

strengthen enamel structure

preventing cracks

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246
Q

What are hunter-schreger bands ?

A

alternating light and dark bands
due to prism decussation
longitudinally-parazones - light
transversally- diazones- dark

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247
Q

What is gnarled enamel ?

A

exaggerated prism decussation

rapid enamel formation

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248
Q

What are cross sriations?

A

result of daily variation

in ameloblast secretory rate

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249
Q

What are striae of retzius ?

A

result of ameloblast position at various points in development
long weekly lines
extend from the EDJ to the outer surface and externally as perikymata

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250
Q

What is linear enamel hypoplasia ?

A

disruption to enamel formation causes deep grooves on outer surface due to stressful development

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251
Q

What are enamel tufts ?

A

hypomineralised voids
located at the EDJ- project outwards
contain tuffelin
if they stretch into enamel theyre lamellae

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252
Q

What is erosion ?

A

dissolution of enamel by acids that arent of bacterial origin- can be intrinsic ot extrinsic
irreversible tooth loss

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253
Q

Removal of carbonate and phosphate ions leads to which type of structure ?

A

honeycomb - prisms dissolved

interprismatic enamel more prominent

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254
Q

Where is the pulp derived from ?

A

mesenchymal cells of the dental papilla

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255
Q

What is the pulp divided into ?

A

coronal

radicular

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256
Q

What does the pulp open into ?

A

The PDL via the apical foramen

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257
Q

What is transmitted by the apical foramen ?

A

blood vessels
nerves
lymphatic vessels

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258
Q

What is the pulp made of ?

A

ECM
blood vessels and lymph vessels
cells

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259
Q

What is the composition of pulp ?

A

75% water

25% organic

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260
Q

What are the histological zones of pulp ?

A 
predentine- unmineralised
odontoblast layer
cell free zone - ECM and nerve endings 
cell rich zone - fibroblasts 
pulp core - nerve endings and blood vessels
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261
Q

Why are their tight junctions and desmosomes between odontoblasts ?

A

maintain spatial relationships

stop substances from the pulp entering the dentine

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262
Q

Why are their gap junctions between odontoblasts ?

A

cell to cell communication

exchange of small molecules

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263
Q

What is the most abundant cell type in the pulp ?

A

fibroblaasts

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264
Q

What do fibroblasts do ?

A

prodcue collagen and ground substance

can also degrade collagen to remodel tissues

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265
Q

What are fibroblasts like in young pulp ?

A

large

centrally located nucleus

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266
Q

What are fibroblasts like in old pulp ?

A

spindle shaped

smaller

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267
Q

What are the types of cell in the pulp ?

A

fibroblasts
undifferentiated mesenchymal cells
immune cells
dental pulp stem cells

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268
Q

What ca undifferentiated mesenchymal cells do ?

A

differentiate into odontoblast lie cells and fibroblasts

number reduces with age and this reduces the repairative potential

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269
Q

Which immune cells are present in the pulp ?

A

macrophages
T and B lymphocytes
Neutrophls and eosinophils
dendritic cells

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270
Q

What is the role of pulp macrophages ?

A

patrol pulp and remove dead cells and bacteria

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271
Q

What is role of T and B lymphocytes ?

A

adaptive immunity from antibodies

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272
Q

What do neutrophils and eosinophils do ?

A

respond to infection

mediate inflammation

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273
Q

What do dendritic cells do ?

A

present foregin antigens to T cells

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274
Q

What does the ECM of the pulp contain ?

A

type I and III collagen fibres

ground substnace

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275
Q

What is the purpose of collagen in the pulp ?

A

forms a scaffold

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276
Q

What is the ground substance of the pulp ?

A

non protein fibrous matrix
GAGs, Proteoglycans, Glycoproteins and water medium for transport
reservoir for growth factors

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277
Q

Why does the ground substance contain hydrophilic molecules ?

A

swell when hydrated

hydrogel made that fill extracellular spaces

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278
Q

Where do blood vessels in the pulp originate from ?

A

PDL

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279
Q

Why are there lymphatic vessels in the dental pulp ?

A

drainage of tissue fluid

have thin walls and no RBCs

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280
Q

What are the 2 types of nerve s in the pulp ?

A

myelinated afferent

unmyelinated C fibres

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281
Q

What is the role of unmyelinated afferent fibres ?

A

from v2/v3
transmit pain sensation to the CNS
cell bodies in the trigeminal ganglion

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282
Q

What is the role of unmyelinated C fibres ?

A

afferent- terminate in odontoblast layer and transmit noxious timuli
efferent- to smooth muscle in arterioels to control capillary flow

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283
Q

What is the plexus of raschkow ?

A

a nerve plexus that terminates at the cell free zone

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284
Q

What is the function of the pulp ?

A

provide vitality to the tooth
nourishment of odontoblasts
sensation
barrier

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285
Q

What is the pulp chamber like for young teeth ?

A

large pulp chamber

thin dentine so pulp easily exposed

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286
Q

What is the pulp chamber like in young teeth ?

A

narrow pulp chamber

challenge for RCT

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287
Q

How can caries spread ?

A

from the pulp to the periodontal tissues leading to periodontal abcesses

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288
Q

How can periodontal disease spread ?

A

from the periodontal tissues to the pulp via accessroy root canals

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289
Q

What is a pulpectomy ?

A

partial RCT

access pulp chamber and remove pulp tissue

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290
Q

What is RCT ?

A

pulpectomy
cleaning and shaping
disnfectant
sealing material

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291
Q

Why do pulp stones form ?

A

age

caries - chronic stimulus

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292
Q

What are false pulp stones ?

A

calcifying blood vessels

contain bone like material

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293
Q

What are true pulp stones ?

A

detatched odontoblasts

contain dentine

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294
Q

What are the 3 theories of dentine sensitivity ?

A

neural theoery- dentine directly innervated
receptors- odontoblasts are receptors
hydrodynamic theory- fluid movement in dentine tubules is sensed directly

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295
Q

When does root formation happen ?

A

After crown completion

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296
Q

After crown completion has occurred what happens to the epithelial cells of the OEE and the IEE ?

A

they proliferate from the cervical loop of the enamel organ to form a double layer of cells- Hertzwigs epithelial root sheath

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297
Q

What does HERTS do ?

A

extends around and encloses the pulp and determines the future shape of the root.

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298
Q

What is different between the cervical loop and the HERS ?

A

no stratum intermedium or stelale reticulum

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299
Q

What epithelial signalling occurs in the HERS ?

A

transient enamel proteins

signalling the dental follicle to make osteoblasts that resorb bone and allow tooth eruption

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300
Q

What mesenchymal signalling occurs in the HERS ?

A

cementoblast differentiation and periodontal regeneration

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301
Q

What does the IEE of the HERS induce ?

A

odontoblast differentiation

odontoblasts secrete predentine which is mineralised to root dentine - single root tooth made

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302
Q

What is the curved end of HERS ?

A

epithelial diaphragm

outlines the primary apical foramen

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303
Q

Growth of the dentine layer does what do HERS ?

A

HERS is stetched and the epithelial cells degenerate

HERS has a network appearance

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304
Q

What happens during root completion ?

A

growth of HERS
odontoblast differentiation
dentine formation

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305
Q

Why does HERS remain stationary ?

A

the epithelial cells dont grow downwards

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306
Q

What happens if HERS is stationary ?

A

root dentine is formed and the root is pushed upwards

however disproven as rootless teeth can erupt

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307
Q

How else are roots erupted ?

A

collagen fibres rearranged - pull tooth up

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308
Q

What is different about root dentine compared to coronal dentine ?

A

root dentine has collagen fibres that are parallel to the ECJ
less mineralised due to less dentine phosphoprotein

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309
Q

What does dentine phosphoprotein do ?

A

binds to calcium and regulates dentine mineralisation

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310
Q

Where is HERS ?

A

skirt hanging from the enamel organ

encloses the primary apical foramen

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311
Q

How does the secondary apical foramena form ?

A

primary apical foramen divides by fusion of epithelial cells

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312
Q

How can 3 roots form ?

A

triangular HERS fusion

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313
Q

At the end of eruption how long is the root ?

A

65% of the final length

wide, open and root apex

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314
Q

How long do primary teeth take to complete their roots ?

A

1.5 years

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315
Q

How long do permanent teeth take to complete their roots ?

A

3 years

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316
Q

What happens to the apical foramen when the roots are complete ?

A

the foramen is narrow and blood vessels and nerves pass through

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317
Q

What happens in cemntogenesis ?

A

odontoblasts differentiate and produce dentine
HERS stretches and is disintegrated
differentiation of dental follicle cells into
osteoblasts
fibroblasts
cementoblasts

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318
Q

What do fibroblasts do ?

A

produce colalgen for the PDL

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319
Q

What do osteoblasts do ?

A

resorb bone for eruption

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320
Q

What are the 2 theories of cementoblast differentiation ?

A
  1. undifferenitated dental follicle cells migrate through gaps in disintegrating HERS - receive inductive signals
  2. HERS cells undergo epithelial- mesenchymal transition
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321
Q

What is cementum ?

A

avascular connective tissue covering roots

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322
Q

What is the function of cementum ?

A

attaches the root dentine to the PDL

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323
Q

What is the chemical composition of cementum ?

A

45-50% hydroxyapatite

gives resistance to root resorption

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324
Q

What are the types of collagen in cementum ?

A

type I III

XII

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325
Q

Which non collagen proteins does cementum contain ?

A

bone sialoprotein

Alkaline phosphatase

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326
Q

How do we classify cementum ?

A

acellular- primary

cellular- secondary

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327
Q

What are the types of relationship between enamel and cementum at the CEJ ?

A

cementum overlaps enamel - 60%
cememtum meets enamel- 30%
cementum and enamel dont meet- 10%

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328
Q

What is acellular cementum ?

A

covers the part of the root adjacent to the dentine- it provides attachment to the PDL

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329
Q

What is cellular cementum ?

A 
founs apically and in interradicualr areas 
for adaptation and repair
thickness increases with age 
fast rate of development 
incremental lines are far apart
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330
Q

Why do cementoblasts processes face the PDL ?

A

to nourish the cementoblasts

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331
Q

How is early acellular cementum made ?

A

cementoblasts align along the hyaline layer
extension of the cell processes into predentine
deposition of collagen fibres - intemingling of predentine
form fibrous fringe
some of the collagen fibres extend and stitch to the fringe
mineralisation of the dentine- processes are trapped

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332
Q

What is the singnificance of cementoblast processes being trapped ?

A

they strengthen the attachment of dentine and cementum

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333
Q

What are the lines of salter ?

A

incremental growth lines in cementum

show daily activity of cementoblasts

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334
Q

What are cementricles ?

A

groups of cementoblasts that are separated and sit in the PDL
acellualr and have concentric rings

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335
Q

What are epithelial cells of malassez ?

A

HERS is stretched

degenerates by apoptosis leaving behind groups of cells in the PDL

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336
Q

What are enamel pearls ?

A

epithelial rests can form enamel pearls

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337
Q

What are the 2 theories of enamel pearl formation ?

A

cell rests attach to predentine in the absence of cementoblasts
root bifurcates and molecular signals induce ameloblast differentiation

HERS development is initiated and stratum intermedium and stratum reticulum become trapped in the ECRs

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338
Q

What is concresence ?

A

union of 2 teeth in eruption
due to fusion of cementum surfaces
usually 7s and 8s

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339
Q

Why does concresence come about ?

A

trauma

crowding

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340
Q

What are dilacerated roots ?

A

curved and bent roots
due to developmental trauma
extraction is difficult

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341
Q

Why do multiple roots and canals form ?

A

abnormal folding of HERS

disturbances in the closure of primary apical foramina

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342
Q

What needs to be considered when treating teeth with excess canals ?

A

need to be aware of extra canal- if not cleaned can be a source of recurrent infection

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343
Q

What is the mechanism of lateral root canal formation ?

A

HERS disrupted
blood capillary forms between dental papilla and follicle
odontoblast formation- dentine made for new canal

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344
Q

Where are accessory root canals mostly found ?

A

in the apex

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345
Q

What is hypercementosis ?

A

abnormal production of cellular secondary cementum

can be due to trauma or age related

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346
Q

What are the implications of hypercementosis ?

A

increased distance from the CEJ to the root apex

endodontical implications

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347
Q

Which teeth would the neonatal line be present in ?

A

all primary teeth and the 6s

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348
Q

What would be the position of the neonatal line in the D and E ?

A

in the D- neonatal line further away from the EDJ- more development time
in the E- neonatal line closer to the EDJ- less development

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349
Q

Why do we need to know prism decussation ?

A

clinically for restorations

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350
Q

Why does the neonatal line form ?

A

birth shuts down ameloblasts- ameloblasts freeze- shows position at birth

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351
Q

How do dental follicle cells differentiate ?

A

the dental follicle cells migrate through gaps in the disintegrating HERS-attach to the predentine and get signals to initiate odontoblast differentation.

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352
Q

Why does the stellate reticulum move downwards in the late bell stage ?

A

protect the pulp

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353
Q

What happens in coordinated root and PDL development ?

A

odontoblast induction and dentine formation
stretching and disintegration of HERS
Differentiation of dental follicle cells

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354
Q

What do the dental follicle cells differentiate into ?

A

cementoblasts- cementum
fibroblasts- collagen
osteoblasts- bone

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355
Q

What are the genetic factors regulating periodontal development ?

A

FGFs carry out cell proliferation
BMPs carry out bone formation and cell differentiation
GFs stimulate periodontal regeneration

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356
Q

What are the functions of the PDL ?

A 
tooth attachment 
withstand masticatory forces
sensory receptor 
remodelling 
nutritive fucntion
357
Q

What does the PDL do with tooth attachment ?

A

PDL fibres insert into the cementum and the alveolar bone to form a fibrous gomphosis joint with no movement

358
Q

How does the PDL withstand masticatory forces ?

A

acts as a shock absorber

359
Q

How can the PDL act as a sensory receptor ?

A

can sense pain tension and compression

360
Q

What does the PDL do in remodelling ?

A

during tooth eruption - high turnover of ECM and collagen fibres-

361
Q

What does the PDL do with nutritive function ?

A

hughly vascularised tissue

connected to dental arteries to get nutrients

362
Q

What happens in PDL development in the initiation stage ?

A

ligament space between cementum and and bone consists of unorganised tissue

363
Q

What are short fibre bundles ?

A

formed near the cementum and bone and extend only a little bit into the ligament space

364
Q

What are fine brush fibres ?

A

emerge from the cementum and only a few fibres emerges from the bone into the ligament space

365
Q

How is an interconnected meshwork formed in the PDL space ?

A

fibroblasts produce more collagen fibrils that assemble as fibres and gradually conenct on both sides to form an interconnected meshwork

366
Q

What are the fibres like on the alveolar bone side ?

A

thick and wide spread

367
Q

What are the fibres like on the cementum side ?

A

thin and closely spaced

368
Q

What are alveolar rest fibres ?

A

formed first at the CEJ

initially oblique then horizontal and the oblique again

369
Q

When is the PDL constantly modified ?

A

in tooth movements and occlusion

370
Q

What are the principle fibre groups ?

A 
alveolar crest group 
horizontal group 
oblique group 
apical group 
interradicular group
371
Q

What is the alveolar crest group ?

A

below CEJ
rim of alveolus
resits extrusive forces

372
Q

What is the horizontal group ?

A

below the alveolar crest group
at right angle to the tooth axis
resist horizontal forces that could make the tooth tip

373
Q

What is the oblique group ?

A

most abundant fibre group

resists intrusive mastication

374
Q

What is the apical group ?

A

radiate from the root apecx
form the bone of the socket
resist extrusive forces

375
Q

What is the interradicular group ?

A

only in multi rooted teeth
connects to the crest of the interradicular septum
resist extrusive forces

376
Q

What does each collagen fibre look like ?

A

spliced rope of individual fibrils that are continuously individual fibrils are remodelled whilst the overall fibre remains in place

377
Q

What are the elastic fibres in the PDL ?

A

oxtytalan fibres that contain fibrillin and are perpendicular to collagen fibres in cervical region

378
Q

What do the elastic fibres do ?

A

associated with NV bundles

form 3D meshwork surrounding the root

379
Q

What are sharpeys fibres ?

A

mineralised PDL fibres in the alveoalr bone and cementum

380
Q

What is the main function of finroblasts ?

A

produce collagen fibrils that turn into fibres and the ECM

381
Q

What are the types of fibroblasts ?

A

perivascular and endosteal (bone)

382
Q

What do fibroblasts do ?

A

secrete GFs and cytokines

high amount of collagen

383
Q

Do fibroblasts have a high or low turnover ?

A

high

384
Q

Which junctions are in fibroblasts ?

A

adherens junctions

gap junctions

385
Q

What does the cytoskeleton in fibroblasts allow them to do ?

A

migration and motility

386
Q

How are fibroblasts contractile ?

A

bind to the ECM via integrins

387
Q

How is fibroblast activity induced ?

A

mechanical and masticatory forces

388
Q

What is the dual function of fibroblasts ?

A

synthesis

degradation- of ECM and collagen

389
Q

Which enzymes are responsible for high collagen turnover in periodontal disease ?

A

matrix metalloproteases

390
Q

What are osteoclasts and osteoblasts invovled in ?

A

bone remodelling of alveolar bone

391
Q

Which immune cells are present in the PDL ?

A

eosinophils
mast cells
macrophages

392
Q

What are other cell types in the PDL ?

A

cementoblasts
rests of mallasez
undifferentiated mesenchymal cells
endothelial cells

393
Q

How do the superior and inferior alveolar arteries enter the pulp ?

A

the apex

394
Q

Which arteries supply the PDL ?

A

superior and inferior alveolar arteries
interalveoalr arteries
lingual and palatine arteries

395
Q

What are the interalveoalr arteries ?

A

pass through the alveolar bone

known as perforating arteries

396
Q

What do perforating arteries do ?

A

form interstitial areas with the PDL

enable the PDL to function after endodontic treatment

397
Q

`What are the perforating arteries ?

A

part of the NV bundle that passes through the alveolar bone and form interstitial areas with the PDL

398
Q

What are interstitial areas ?

A

located closer to the alveolar bone and contain NV bundles

399
Q

What do blood vessels do around the root ?

A

form a circular capillary plexus around the root surface a and a postcapillary plexus from which venules pass to the bone

400
Q

Which direction do blood vessels run ?

A

apical occlusal direction and form anteriovenous anastamoses

401
Q

What is the crevicular plexus ?

A

surrounds the tooth in the region beneath the gingival crevice

402
Q

Why are capillaries fenestrated in the PDL ?

A

fenestrations are pores in the endothelial cells

increase diffusion capacity needed for high metabolic rate in PDL

403
Q

What do perforating nerve fibres divide into ?

A

gingival and apical branch

404
Q

Which teeth have a higher PDL innervation than molars ?

A

upper incisors

405
Q

What are the 2 types of nerve fibres in the PDL ?

A

sensory and automatic

406
Q

What do sensory PDL fibres do ?

A

detect pain
mechanically respond to pressure
alter tongue and neck muscles

407
Q

What do autonomic PDL fibres do ?

A

regulate blood flow through constriction and dilation of blood vessels

408
Q

What are the types of nerve endings ?

A

free endings
ruffini corpsucles
colied type
encapsualted spindle type

409
Q

What do free endings do ?

A

tree like
unmyekinated
extend to cementoblasts
sense pain and pressure

410
Q

What do ruffini corpuscles do ?

A

found in the PDL root apex
myelinated
dendritic endings
sense pressure

411
Q

Where are coiled type nerve endings found ?

A

middle third of PDL

412
Q

What are encapsulated spindle type endings ?

A

found in the PDL root apex

surrounded by a fibrous capsule

413
Q

Where is the PDL thinnest ?

A

middle third of the root

414
Q

How does PDL thickness change ?

A

decreases with age

415
Q

What doe mastication induce ?

A

periodontal remodelling
increased PDL with
increased alveolar bone size

416
Q

Where is the PDL thicker ?

A

in areas of tension than compresssion

417
Q

What does a decreased use of PDL lead to ?

A

reduction in the periodontal tissues

418
Q

What can strong orthodontic forces lead to ?

A

lead to PDL necrosis

419
Q

How can a damaged PDL be repaired ?

A

cells

420
Q

What does failure to repair the PDL lead to ?

A

localised resorption

tooth ankylosis

421
Q

What is tooth ankylosis ?

A

fusion of the tooth to the bone

422
Q

How can the PDL be a target for periodontal surgery ?

A

prevent undesirable wound healing

GFs, cytokines, stem cells stimulate PDL regenration

423
Q

What is the composition of the PDL ?

A

60% ground substance

collagen fibrils blood vessels and nerves

424
Q

What is the composition of the fibres in the PDL ?

A

90% collagen

10% oxytalan

425
Q

Which types of collagen are dominant ?

A

type I

type III

426
Q

What is oxytalan ?

A

fibrillin molecules without elastin

427
Q

What does collagen type III form ?

A

reticular fibre meshwork

428
Q

What does collagen type XII form ?

A

present after development and link collagens together

429
Q

Does collagen composition change with age ?

A

no

430
Q

What is the ground substane known as ?

A

ECM

431
Q

What does the ECM contain ?

A

GAGs
proteoglycans
glycoproteins

432
Q

What are some examples of GAGs ?

A

hyaluronic acid

dermatan sulfate

433
Q

What are the functions of the ground substance ?

A

act as a shock absorber
orientate collagen fibrils
increase hydration
increase collagen strength

434
Q

What does fibronectin do ?

A

mediates collagen fibril attachment to cells via integrin dimers
influence cell differentiation and migration

435
Q

What does the ECM bind ?

A

GFs and cytokines

436
Q

What are lines of salter ?

A

daily activity of cementoblasts - incremental growth lines

437
Q

How do odontoblasts come about in root formation ?

A

IEE of the HERS induces odontoblast differentiation

438
Q

What does acellular cementum do ?

A

covers the root and attaches to the PDL

439
Q

How does a cellular cementum form ?

A

cementoblasts align to the hyaline layer and their process extend into the dentine - collagen fibrils are secreted and become trapped when mineralisation happens

440
Q

What do capillaries in the dental follicle supply ?

A

supply nutrients to the SI and ameloblasts

441
Q

What happens in initial enamel secretion ?

A

secretion of a thin aprismatic layer
30% mineralised
tomes process is absent

442
Q

Why does stellate reticulum moves downwards in late bell stage ?

A

protect developing areas that arent mineralised

443
Q

Which lines are accentuated ?

A

in dentine- contour lines of owen

in enamel- striae of retzius

444
Q

Why does the granular layer of tomes form ?

A

incomplete fusion of calcospherites
extensive branching of odontoblasts
hypomineralised

445
Q

Why does peritubular (intratubular) dentine form ?

A

increasing age. mild attrition

446
Q

Is peritubular dentine hypomineralised or hypermineralised ?

A

hypermineralised

447
Q

Where is the position of the neonatal line in the D ?

A

further away from the EDJ as more tissue formation

448
Q

Where is the position of the neonatal line in the E ?

A

closer to the EDJ - less hard tissue

449
Q

How can epithelial rests of malassex contribute to PDL and cementoblast formation ?

A

EMT

450
Q

What is the primary curvature of dentine tubules ?

A

sigmoid route of dentine tubules

451
Q

What is secondary curvature of dentine tubules ?

A

meandering at high magnification

452
Q

What are the functions of the Stratum intermedium ?

A

alkaline phosphatase- enamel mineralisation
removaal of waste products
support ameloblasts

453
Q

What does the stellate reticulum contain ?

A

GAGs for protection

454
Q

What is the shape and function of OEE ?

A

cuboidal

tooth shape and exchange

455
Q

What is the EDJ like in primary teeth ?

A

less scalloped as it forms faster

456
Q

What is the clinical significance of enamel prism orientation ?

A

need to know direction so you dont undercut them - can release restorations

457
Q

Which direction do primary enamel prisms orientate in ?

A

occlusally

458
Q

Which direction do permanent enamel prisms orientate in ?

A

apically

459
Q

Are prisms straighter or more curved in primary teeht ?

A

straighter

460
Q

What does the distal portion of tomes process secrete ?

A

prismatic

461
Q

What does the proximal portion of tomes process secrete ?

A

interprismatic

462
Q

How does mantle dentine form ?

A

matrix vesicles- globular calcification

463
Q

What in unique about mantle dentine ?

A

no dentine phosphoprotein
loosely packed with von korff fibres
highly branched dentine prevent crack propagation

464
Q

What does amelobalstin do ?

A

adhesion of ameloblasts to enamel

465
Q

What does enamelin do ?

A

guide formation of enamel crystals

466
Q

What does amelotin do ?

A

adhesion of enamel to the junctional epithelium

467
Q

What does the neonatal line signify in enamel and dentine ?

A

enamel- position of ameloblasts at birth

dentine- position of mineralising front

468
Q

When is the first histological appearance of enamel and dentine ?

A

late bell stage

469
Q

When are calcium ions actively transported during maturation stage ?

A

maturation stage with ruffle ended ameloblasts

470
Q

Which gene family encodes transcription factors ?

A

MSX

471
Q

Where are accessory root canals mostly found ?

A

apex

472
Q

Which teeth are mostly affected by a PAX9 gene mutation ?

A

permanent molars

473
Q

What percentage of people have cementum overlapping the enamel ?

A

60%

474
Q

What percentage of people have cementum meeting enamel ?

A

30%

475
Q

What percentage of people dont have cementum meeting the enamel ?

A

10%

476
Q

What is secondary dentine ?

A

develops after the root is complete

reduces the size of the pulp chamber and root canals

477
Q

How can we see secondary dentine ?

A

visible change in dentine tubule direction

found on roof and floor of pulp chamber

478
Q

What does secondary dentine do ?

A

it forms throughout life by odontoblasts that line the pulp cavity

479
Q

What does the alveolar process of the mandible form ?

A

tooth sockets

480
Q

What are the mechanisms of bone formation ?

A

endochondral ossfication
intramembranous osssification
sutural ossification

481
Q

What is endochondral ossification ?

A

chondrocytes produce cartilage
bone is made from the cartilage
osteoblasts replace cartilage with osteoid

482
Q

What is intramembranous ossification ?

A

bones made from osteoblasts that differentiated from mesenchymal stem cells

483
Q

What is sutural ossification ?

A

similar to intramembranous

fibrous connection providing stability during growth

484
Q

What is the chemical composition of bone ?

A

67% inorganic hydroxyapatrtite between collagen I fibris

33% organic

485
Q

What are the non collageneous proteins present in bone ?

A

bone sialoprotein
osteocalcin
osteonectin
osteopontin

486
Q

What is the role of non collagenous proteins in bone ?

A

they bind to calciuim and control mineralisation

487
Q

What are the functions of bone ?

A

support
protection
locomotion
mineral reservoir of calcium and phosphate

488
Q

What does PTH do to bone ?

A

decrease bone formation

489
Q

What does calcitonin do to bone ?

A

increase bone formation

490
Q

What does vitamin D do to bone ?

A

increases bone formation

491
Q

What does oestrogen do to bone formation ?

A

increase bone formation

492
Q

What do glucocorticoids do to bone formation ?

A

decrease bone formation

493
Q

What does leptin do to bone formation ?

A

increase bone formation

494
Q

What is woven bone ?

A

forms during development
randomly orientated colalgen fibrils
remodelled into lamellar bone

495
Q

What are the components of adult bone ?

A

compact bone

trabecular bone

496
Q

What is compact bone ?

A

dense outer area of bone

497
Q

What is trabecular bone ?

A

canceollous
spongy cavity filled with bone marrow
network of bone platees

498
Q

What are the types of bone lamellae ?

A

cicumferetnial
concentric
interstitial

499
Q

What are circumferential lamellae ?

A

enclose entire outer and inner perimeter of the bone

500
Q

What are the concentric (haversain) lamellae ?

A

form basic unit of bone

make up bulk of compact bone

501
Q

What is the structure of concentric lamellae ?

A

concentric rings with blood vessel in the middle

502
Q

What is the basic unit of bone ?

A

osteon

503
Q

What is an osteon ?

A

cylinder of bone that has a central canal which includes blood capilalreis used by osteoblasts

504
Q

What is the periosteum ?

A

external connective tissue membrane consisiting of 2 layers
outer fibrous layer- dense collagen fibrils
inner fibrous layer- osteoblasts

505
Q

What is the endosteum ?

A

loose connective tissue
separates bone surface from the bone marrow
not that active in bone formation

506
Q

What are osteoblasts ?

A

bone forming cells

507
Q

What is the morphology of osteoblasts ?

A

active- cuboidal

inactive- flat

508
Q

What are osteoblats derived from ?

A

mesenchymal stem cells

509
Q

What are the fucntions of osteoblasts ?

A

synthesis alkaline phosphatase
synthesis bone matrix
produce growth factors

510
Q

What is the role of alkaline phosphatase in tooth development ?

A

cleaves inorganic phosphate to initiate and promote mineralisation

511
Q

Which growth factors do osteoblasts produce ?

A

IGF1
TGF-
PDGF

512
Q

What is the role of PDGF ?

A

increases bone repair and used in periodontal therapy

513
Q

What are osteocytes ?

A

osteoblasts that are trapped in the bone amtrix

become smaller in size and produce a lacunae space

514
Q

What do osteocytes produce ?

A

network of cellular processes that connect osteocytes- canaliculi

515
Q

What is the fucntion of osteocytes ?

A

form sensors of the changing bone environment

form signalling centres to maintain bone integrity

516
Q

What are osteoclasts ?

A

bone resorbing cells
produce howships lacunae
produce acid phosphatase and lysozymes

517
Q

What is the morphology of osteoclasts ?

A

large and multinucleated

518
Q

What are howships lacunae ?

A

resorption bays

519
Q

What is the resorption sequence ?

A

osteoclasts attach to bone
create an acid environment
degrade exposed matrix
endocytosis of degradation products

520
Q

What is intramembranous ossification ?

A

mesenchymal cells of the cellular periosteum - osteoblasts produce woven bone
remodelled to lamellar bone
formation of osteons by osteoblasts
continued bone replacement produces orgnaised mature bone with develope osteons and circumferential lamellae

521
Q

What are the steps in the development of the alveolar process ?

A

1) mandible forms a trough under the inf alveoalr nerve and the alveoalr pocess grows towards the tooth germ
2) alveolar process surrounds the tooth germ and the inf alveoalr nerve is now in a bony canal
3) to accomodate the growing tooth germ and stellate reticulum the bone must be resorbed on the inner wall and deposited on outer wall

522
Q

What are bone lining cells ?

A

flat cells
form an area of bone inactivity
area protected from resorption
source of progenitor cells

523
Q

What are the stags of bone remodelling ?

A

resorption
reversal
formation
cessation

524
Q

What happens in resorption ?

A

recruitment

migration and activation of osteoclasts

525
Q

What happens in reversal ?

A

cessation of resorption

osteoclasts disappear- apoptosis and migration

526
Q

What happens in formation ?

A

recruitment and migration of osteoblasts

527
Q

What happens in resting ?

A

cessation of bone formation

surface covered by bone lining cells

528
Q

What are the structural lines in bone ?

A

resting and reversal lines

529
Q

What are resting lines ?

A

osteoblasts stop bone formation
lines form showing pauses in deposition
parallel

530
Q

What are reversal lines ?

A

scalloped

change from resorption to formation

531
Q

What are the plates in the tooth sockets ?

A

buccal cortical plate
lingual cortical plate
alveolar cibriform plate

532
Q

What is the alveolar cribriform plate ?

A

has peroforations for blood vessels and nerves

533
Q

What is the interdental septum ?

A

alveolar spetum between 2 teeth

534
Q

What is the interradicular seprum ?

A

between 2 roots

535
Q

What are the 3 parts of the alveolar process ?

A

cortical plate
spongiosa
alveolar plate

536
Q

What is the cortical plate ?

A

surface layer or lamellar bone supported by osteons

thinner in maxilla than amndible

537
Q

Where is the cortical plate the thickest ?

A

buccal aspect of the 4s and 5s lower

538
Q

What is the spongiosa ?

A

trabecular bone
bone marrow spaces rich in adipose tissue
absent in anterior teeth as the alveolar and cortical plate is fused

539
Q

What is the alveoalr plate ?

A

made of lamellar and bundle bone

contains sharpeys fibres

540
Q

What is bundle bone ?

A

innermost layer of alveolar plate

contains collagen fibres of the PDL- sharpeys

541
Q

What is the purpose of the bundle bone ?

A

provides attachment for the PDL fibres

542
Q

What happens in the process of tooth drift ?

A
  1. resoprtion on the right side of alveolar bone- creates space for the tooth to move into
  2. bone must be formed on the cortical plate to compensate
  3. bone depostion on the cortical side
  4. excess bone must be resorped on the cortical side
543
Q

Why is there no bone displacement ?

A

alveolar bone remodelling proceeds at same time

544
Q

What is the concept of mesial drift ?

A

unworn teeth have few contact points
attrition causes loss of interproximal and occlusal surfaces
increase in interproximal distance made up for by mesial drift
leads to broader interproximal contact points

545
Q

What is the link between abrasive diets and eruption of the 8 ?

A

in the past abrasive diets led to attrition and mesial drift
creating space for the 8 to erupt
softer diets in modern populations mean higher incidence of 8 impaction

546
Q

What is ankylosis and what causes it ?

A

dental trauma or infection can lead to fusion of the totoh to the bone
prevents exfoliation
impaction of the successor

547
Q

Which teeth are likely to be ankylosed ?

A

D and E

4 and 5 imapcted

548
Q

What does further growth and submergence lead to ?

A

submergence of an ankylosed tooth- infraocclusion

549
Q

What is the alveolar plate referred to on radiographs ?

A

lamina dura

550
Q

Why is the alveolar plate radioplaque ?

A

thick cortical plate

551
Q

What does an interrupted dark lamina dura indicate ?

A

periapical abscess

552
Q

What can happen to the alveolar bone following extraction and periodontitis ?

A

resorption
dental implants hard to place
ability to make removable prostheses decreases

553
Q

Which roots are in close proximity to the maxillary sinus ?

A

4 and 5 roots

554
Q

What can happen during extraction to the maxilalry sinus ?

A

bone can fracture leading to a fistula

555
Q

What happens in the tooth socket after extraction ?

A

fills with blood forming a blood clot

556
Q

What can happen when the blood clot detaches ?

A

dry socket
alveolar ostelitis
alveolar plate exposed
painful bone inflammation

557
Q

What is the gingiva ?

A

part of the oral mucosa that surrounds the teeth and the alveolar bone

558
Q

What happens during tooth eruption to establish the dgj ?

A

the REE fuses with the oral epithelium to establish the DGJ

559
Q

What does the junctional epithelium do ?

A

attaches tooth to gingiva

560
Q

What happens when the DGJ is formed ?

A

tooth approaches oral epithelium and only a thin connective tissue layer separates the REE from the OE
fusion of the OE and the RR- degeneration of central epithelilal cells
DGJ is formed

561
Q

What type of epithelium is the REE ?

A

simple epithelium

562
Q

What type of epithelium is the OE ?

A

stratified squamous

563
Q

Why is there no bleeding in eruption ?

A

epithelial continuity ensures no bleeding

564
Q

What is the first stage of DGJ formation ?

A

immediately after tooth eruption
junctional epithelium is entirely REE
not keratinised and attaches firmly to enamel

565
Q

What is the second stage in DGJ formation ?

A

gingival epithelium in the upper region overgrows the REE
create gingival sulcus made of sulcualr epithelium
junctional epithelium in the lower region is simple, non keratinised and appears like REE

566
Q

What are the characteristics of gingival epithelium ?

A

stratifed

keratnised

567
Q

What are the characteristics of sulcar epithelium ?

A

stratified

non keratnised

568
Q

How is the base of the sulcus determined ?

A

masticatory forces

569
Q

What is the external landmark of the base of the sulcus ?

A

free gingival groove

570
Q

What is the third stage of eruption ?

A

gingival epithelium completely replaces the REE

small epithelial tag develops from the REE- Nasmyths membrane

571
Q

What are the components of nasmyths membrane ?

A

primary enamel cuticle and cell remnants

572
Q

What do molecular markers dictate about junctional epithelial and gingival epithelial cells ?

A

they are different

573
Q

What is the immunohistochemical evidence behind the difference in junctional and gingival epithelial cells ?

A

staining for amelotin
amelotin normally expressed in ameloblasts but found in junctional epithelial and internal basal lamina
suggests junctional epithelium is derived from REE

574
Q

What are the histological characteristics of attached gingiva ?

A

lamina propia- long papillae with dense collagen fibres
has a mucoperiosteum
no submucosa

575
Q

What is the mucoperisoteum ?

A

fibrous connective tissue to the bone for stability
dense collagen fibres directly joint to to the periosteum of the bone
in the masticatory mucosa
difficult to inject- doesnt require sutures

576
Q

What is the alveoalr submucosa ?

A

lose and mobile connectve tissue with few colalgen fibres

lamina propia is cellular

577
Q

Which gingival fibres are visble in the buccal view ?

A

transseptal fibre group

578
Q

What is the transspetal fibre group ?

A

runs interdentally from the CEJ of one tooth over the alveoalr crest to the CEJ of the neigbouring tooth
connects all teeth in the jaw and controls mesial and distal spacing

579
Q

What is post retention relapse ?

A

in retetnion phase of orthodontic treatment the fibres are not remodelled quickly enough so the teeth move into original position

580
Q

What do epithelial cells attach to which connects to the enamel proteins ?

A

epithelial cells secrete primary enamel cuticle - internal basal lamina onto the enamel - binds to to enamel proteins

581
Q

How do epithelial cells attach to the primary enamel cuticle ?

A

via hemidesmosomes

582
Q

What is the external basal lamina ?

A

attaches to the lamina propia - conenctive tissue

583
Q

Why is the junctional epithelium permeable ?

A

reduced number of desmosomes and large intracellular spaces

584
Q

What do large spaces in the junctional epithelium allow fo ?

A

GCF passage

585
Q

What does GCF contain ?

A 
immunoglobulin molecules 
complement factors 
macrophages 
exfoliated sulcar and junctional epithelial clls 
cytokines and metalloproteases
586
Q

What is the purpose of the GCF ?

A

defence agaisnt bacteria
remove inflammed tissue
overproduction leads to tisseu degradation and periodontitis

587
Q

What is the GCF indicative of ?

A

periodontal health

588
Q

What is the attached gingiva ?

A

tightly attached to tooth and alveolar bone

589
Q

What is the alveolar mucosa ?

A

loosely attached to the alveoalr bone and has sub mucosa

590
Q

What is the free gingiva ?

A

not bound to other tissue

591
Q

What is the free gignival groove ?

A

mark position of the gingival sulcus

592
Q

What is the mucogingival junction ?

A

boundary between alveolar mucosa and attahced gingiva

593
Q

What are the characteristics of the alveoalr mucosa ?

A 
lining 
non keratinseid 
dark pink
translucent 
thin - can see blood vessels
594
Q

What are the characteristics of attached gingiva ?

A

part of masticatory mucosa
parakeratinised/ partially otho
light pink
stippled

595
Q

What is the dentogingival fibre group ?

A

connects cervical cementum to lamina propia of free and attached gingiva

596
Q

What is the alveogingival group ?

A

connects bone of alveolar crest to lamina propia of free and attached gingiva

597
Q

What is the dentoperiosteal group ?

A

run from cementum outer surface to alveolar process or mylohyoid

598
Q

What is the circular group ?

A

band around neck of tooth and interlaces with other fibres in free gingiva
binds free gingiva to tooth

599
Q

What is the dental col ?

A

in the gingiva between the teeth- not attached to enamel

600
Q

What is gingivitis ?

A

mild periodontal inflammation
dental plaque accumulation causes inflammatory response
70% collagen fibres destroyed in 3-4 days
treatment stops spread to PDL and alveolar bone

601
Q

What does chronic inflammation lead to ?

A

destruction of connective tissue by inflammatory cells
apical migration of junctional epithelium
formation of gingival pocket
loss of PDL and alveolar bone

602
Q

How can we prevent junctional peithelium migration ?

A

insertion of membrane

forms a fibrin clot against root surface and allows tissue regeneration

603
Q

What is guided tissue regeneration ?

A

membrane inserted and when removed shows damged epitelium, mild inflammation and healthy fibrous tossue apically

604
Q

What is the size of healthy periodontal pockets ?

A

0.5-2 mm

605
Q

What is the size of diseased pockets ?

A

3 mm +

606
Q

What is the oral mucosa ?

A

forms a continuim with the gingiva and tooth attachment tissues

607
Q

What are the oral epithelium and epidermis derived from ?

A

embryonic ectoderm

608
Q

What is the buccopharyngeal membrane ?

A

where the ectoderm and endoderm meet

609
Q

What is the oral vestibule ?

A

space between lips, cheek, bone and teeth

610
Q

What is the vestibular fornix ?

A

trough formed through the vestibule

611
Q

What is the upper labial frenulum ?

A

fold of alveolar mucosa that attaches to the labial mucosa

612
Q

Which 2 frenulum are present in the mouth ?

A

frenulum near the maxilalr molars

upper labial frenulum

613
Q

What is the midline diastema ?

A

large labial frenulum attaches to the alveoalr crest
creates a diastema between maxillary 1s
affects the stability of dentures

614
Q

What is the oral cavity proper ?

A

separated from the vestibule by the teeth

615
Q

What is the anterior pillar of fauces ?

A

palatoglossal fold

616
Q

What is the posterior pillar of fauces ?

A

palatopharyngeal fold

617
Q

What is the palatine tonsil ?

A

lymphoid tissue tonsils

618
Q

What is the uvula ?

A

midline projection from soft palate

619
Q

What is the soft palate ?

A

muscular extension of the hard palate

is mobile and not attached to bone- used for swallowing, taste and speech

620
Q

What are the 2 components of the oral mucosa ?

A

epithelial and mesenhcymal component

621
Q

What are the functions of the oral mucosa ?

A

mechanical protection - protection from masticatory forces
barrier from microorganisms
immunological defence
lubrication and buffering - saliva
sensation - touch, pain, taste and proprioception

622
Q

What is the lining mucosa ?

A 
60% 
alveolar mucosa
soft palate
lip 
buccal mucosa 
floor of mouth
underside of tongue
623
Q

What is the masticatory mucosa ?

A

25%

gingiva and hard palate

624
Q

What is different about masticatory mucosa ?

A

it has a mucoperiosteum

lamina propia more fibrous and directly attached to the mucoperiosteum of the bone

625
Q

What is the specialised mucosa ?

A

15%

tongue

626
Q

What are the 3 components of the oral mucosa ?

A

oral epithelium
lamina propia
submucosa

627
Q

What are the chracteristics of the oral epithelium ?

A

stratified squamous epithelium
epithelial ridges- pegs
keratinocytes

628
Q

What are the characteristics of the lamina propia?

A 
connective tissue
papillae
fibroblasts - collagen I and III
macrophages and lymphoutes 
elastin fibres
629
Q

What are the characteristics of the submucosa ?

A 
loose connective tissue 
larger blood vessels and nerves 
fat deposits 
cheeks, lips and lateral palate
acts as a cushion
630
Q

How long does it take skin to regenerate ?

A

27 days

631
Q

How long does it take oral mucosa to regenerate ?

A

9-14 days

high tissue turonver

632
Q

What happens in oral mucosa regeneration ?

A

cells are made in the basal lamina
dividing basal cells
replace cells in the top
self renewal and terminally differentiated cells

633
Q

What are the layers of the stratified squamous epithelium of the oral mucosa ?

A

Basal layer- basale
prickle layer - spinosum
granular- granulosom
Keratinised layer- corneum

634
Q

What is stratum basale ?

A 
cuboidal cells 
single proliferating layer 
attached to lamina propia 
keratin 5 and 14 
stem cells
635
Q

What is stratum spinosum ?

A

round spiny cells
desmosomes
keratin 1 and 10
cociin and involucrin

636
Q

What is stratum granulosum ?

A 
larger flatter cells 
several layers 
loss of cell organelles 
cytoplasm with keratohyaline granules
profilaggrin
637
Q

What is stratum corneum ?

A

very flat cells
filaggrin binds keratin filaments
involucrin networks
cornified envelope

638
Q

What are the types of keratinisation status ?

A

parakeratinised
orthokeratinised
non keratinised

639
Q

What is parakeratinisation ?

A

cornified cell layer with dead cells
cell nuclei present
gingiva

640
Q

What is orthokeratinisation ?

A

dead cells with no nuclei - cornified layer
flat cells
present in specialised tongue mucosa

641
Q

What is non keratinised ?

A

superficial layer with live cells in coreneum layer
no kerathyalin molecules
in lining mucosa

642
Q

What are other cell types in the oral mucosa ?

A

melanocytes- in basal layer, make melanin and transfter to kaeratinocytes via dendritic processes
merkel cells- basal layer, sensory receptor cells, sense light touch
langerhans cells- suprabasal, dendritic cells - antigen processing
lymphocytes- inflammatory response

643
Q

What type of mucosa does the hard palate have ?

A

masticatroy mucosa

644
Q

What is the incisive papilla ?

A

prominence overlying the nasopalatine foramen

need to relieve in denture fitting

645
Q

What is the nasopalatine foramen ?

A

blood vessels and nerves to supply the hard palate

646
Q

What is the palatine raphe ?

A

midline epithelial ridge joined to the bone

647
Q

What is the palatine rugae ?

A

unique epithelial folds

648
Q

What is fovea palatini ?

A

openign ducts of the minor salivary glands

posterior border of the upper denture

649
Q

What type of mucosa is present at the border of the alveoalr bone and the lateral hard palate ?

A

submucosa

650
Q

What is the keratinisation staus of masticatory mucosa ?

A

ortho and para

651
Q

What is the buccal mucosa bounded by ?

A

upper and lower vestibular fornices

652
Q

What are fordyces spots ?

A

ectopic sebaceous glands without hair follicles

produce sebum to lubricate lips

653
Q

What is the parotid papilla ?

A

opening of the parotid gland opposite the 2nd maxillary molar

654
Q

What is the linea alba ?

A

parakeratinisation at the level of the molar occlusal plane

655
Q

What type of mucosa is on the floor of the mouth ?

A

movable

lining mucosa above mylohyoid

656
Q

What is the lingual frenulum ?

A

attached to the underside of the tongue to floor of mouth

657
Q

What is ankyglossia ?

A

lingual frenulum to short

658
Q

What is the sublingual papilla ?

A

opening of the submandibular salivary ducts

659
Q

What is the sublingual folds ?

A

opening of the sublingual salivary ducts

660
Q

What are fimbriated folds ?

A

remnants of tongue development

661
Q

What is the histological properties of the labial and buccal mucosa ?

A

thick epithelium non keratinised
long and slender papilale in the lamina propia
submucosa attached to muscle
motility and stability

662
Q

What ar the histological properties of the floor of the mouth and tongue ?

A

thin epithelium non jeratinised
thin short papillae in the lamina propia
thin submucosa
motility

663
Q

What is the vermillon zone ?

A

lining mucosa
keratinised
between skin and labial mucosa

664
Q

What is the labial mucosa ?

A

a lining mucosa

non keratinised

665
Q

What is the alveolar mucosa ?

A

lining mucosa

non keratinised

666
Q

What is the gingiva ?

A

masicatory mucosa

para and ortho keratinised

667
Q

What is the mucogingival junction ?

A

junction between the alveolar mucosa and the gingiva

668
Q

What are the fucntions of the tongue ?

A

swallowing
speech
taste
immune function

669
Q

What are the parts of the tongue ?

A

anterior two thirds- palatal part - epeithelium from ectoderm
posterior one third- pharyngeal part- epithelium from endoderm

670
Q

What are the cicumvallate papillae ?

A

big
taste
between the anterior 2/3 and posterior 1/3

671
Q

What are the lingual follicles ?

A

lymphoid function

672
Q

What are the foliate papillae ?

A

slits on the side of the tongue
taster
anterior 2/3

673
Q

What are the fungiform papillae ?

A

red mushroom shaped
taste
anterior 2/3

674
Q

What are the filiform papillae ?

A

masticatory function

white spots

675
Q

What is the epithelium of the tongue like ?

A

thick
orthokeratinised in filiform papillae
non keratinised in taste and interpapilalry regions

676
Q

What is the lamina propia like in the tongue ?

A

long papillae

minor salivary glands

677
Q

Is there a submucosa in the tongue ?

A

no the lamina propia directly attaches to the tongue

678
Q

What is the function of the specialised mucosa ?

A

taste

679
Q

What is atrophy of oral mucosa ?

A 
smoother and dryer surface 
loss of epithelial ridges 
fibrosis 
decreased cellularity in the lamina propa 
increased fordyces spots
680
Q

What are the causes of atrophy of the oral mucosa ?

A

systemic disease

medication that reduces saliva flow

681
Q

What are age changes in the tongue ?

A 
epithelial atrophy 
loss of filiform papillae 
fissured surface 
varicoase veins 
burning sensations
682
Q

What could lead to age related changes in the tongue ?

A

nutritional deficiencies

medication

683
Q

What is black hairy tongue ?

A

hypertrophy of the filiform papillae

accumulation of food debris and microorganisms

684
Q

What is geographic tongue ?

A

bening migratory glossitis
atrophy of filiform papillae
migration of depapilaled white border patches

685
Q

What is recurrent aphtous stoamtitis ?

A

recurrent mouth ulcers

genetic and stars in childhood

686
Q

Which diseaeses can also cause mouth ulcers ?

A

virus- HPV
Iron and Vit B deficiency
Crohns disease

687
Q

What is lichen planus ?

A

autoimmune disease

reticular patches

688
Q

What is white sponge naevus ?

A

keratin 13/14 mutation

689
Q

What is leukoplakia ?

A

white patches formed by hyperkeratosis
potentially malignant
OPMD

690
Q

What are risk factors for oral cancer ?

A

p53 protein mutations

tobacco alcohol HPV

691
Q

What is the mechanism of oral cancer ?

A 
over expression of protoncogenees 
inactivation of tumour supressors 
increased cell proliferation 
genome instability 
cell mobility 
evasion
692
Q

What are 90% of oral cancers ?

A

squamous cell carcinoma

693
Q

What is the progresssion of oral cancer ?

A 
hyperplasia 
dysplasia
carcinoma i situ
inasvie carcinoma 
metastasis
694
Q

What are the most common pre malignant lesions ?

A

leukoplakia

eryhtroplakia

695
Q

What is regenerative medicine ?

A

aims to develop novel therapies to repair or regenerate tissues and organs that have been damaged by injury, cancer and disease.

696
Q

What is repair ?

A

restoration of tissue function but with impaired tissue architecture

697
Q

What is regeneration ?

A

complete restoration of tissue architecture and fucntion

698
Q

Do humans have full regenrative cacpacity ?

A

no

699
Q

What is the current function with restoration ?

A

we are limited to incomplete restoration of original tissue function

700
Q

What are the 2 routes in regenrative medicine ?

A

cellular therapy- use exogenous or own progenitro cells

tissue engineering- using biomaterial like collagen

701
Q

What are stem cells ?

A

unspecialised cells that can self renew and differentiate into other cell type
development and regeneration
1 is precursor other is self renewal

702
Q

What are totipotent stem cells ?

A

can differentiate into all cell types

eg. fertilised egg cell

703
Q

What are pluropotent stem cells ?

A

can differentiate into cells of the embryonic germ layers

embryonic stem cells

704
Q

What are multipotent stem cells ?

A

can differentiate into many cell types

haemopoietic stem cells

705
Q

What are oligopotent stem cells ?

A

can differentiate into a few cell types

myeloid precursors

706
Q

What are unipotent stem cells ?

A

can differentiate into 1 cell type

mast cell prescursors

707
Q

What are quadripotent stem cells ?

A 
can differentiate into 4 cell types 
mesenchymal
cartialge
stroma 
fat
708
Q

What are the problems with stem cells ?

A

not fully understood
genetic control is difficult
in niches- hard to find

709
Q

What are the 4 mechanisms of tissue regeneration ?

A

stem cell mediated regeneration
epimorphosis
morphollaxis
compensatory regualtion

710
Q

What is stem cell mediated regernation ?

A

repalcement of lost tissue by stem cell activity

eg. blood replacement by haemopoietic stem cells

711
Q

What is epimorphosis ?

A

dedifferentiation of cells at wound site and formation
of undifferentiated cells
redifferentate to form lost structure
amputation of amphibian limbs

712
Q

What is morphollaxis ?

A

depatterning of existing tissue with little or new growth

713
Q

What is compensatory regulation ?

A

differentiated cells divide and maintain fucntions

liver regeneration

714
Q

What are the 4 stages of wound healing in oral mucosa ?

A

haemostasis
inflammatory response
epithelial response
connective tissue repair

715
Q

What is haemostasis ?

A

cessation of blood loss

716
Q

What happens in haemostasis ?

A

vascular damage means blood leaks into a wound
clot formation via coagulation, fibrin and platelets
barrier that unites wound margins
protects exposed tissue

717
Q

What does haemostasis provide ?

A

provisional scaffold for subsequent colonisation by repairative cells

718
Q

What happens in the inflammatory response ?

A

toxins enter triggering the inflammatory response
leakage of plasma proteins by vasodilation
cytokines and GFs released
these stimulate leukocyte migration to the wound - chemotaxis
neutrophils appear and become activated

719
Q

What do monocytes de in the inflammatory response ?

A

they become macrophaes

remove debris via phagocytosis

720
Q

What do lymphocytes do ?

A

humoral immune system response

721
Q

What do mast cells do ?

A

promote inflammation

722
Q

What happens in the reparative epithelial response ?

A

mobilisation of cells- widening intercellular spaces
increased basal cell proliferation
epithelial cells adjacent to wound migratte under clot
epithelial sheet formation
reach opposing margin and stop
stratification

723
Q

What is the reparative connective tissue response ?

A

fibroblasts proliferate and migrate to connective tissue
deposit collagen in disorganised manner
angiogenesis at wound margin
new ECM - fibronectin, laminin and collagen - scaffold
collagen deposition accelerated - scar tissue formation

724
Q

What is angiogenesis ?

A

production of new blood vessels from exiting ones

725
Q

What is the exception that the oral mucosa can do with scar tissue ?

A

oral mucosa is able to remodel scar tissue removing it

original collagen formation- looks the same

726
Q

What are the first fibroblasts that enter the wound site ?

A

contractile myofibroblasts

727
Q

What is the origin of contractile myofibroblasts ?

A

pericytes

728
Q

What do contractile myofibroblats do ?

A

form connections with each other and collagen fibrils

draw wound together in contraction

729
Q

What is the compromise between time and tissue integrity ?

A

to prevent further damage

quick wound healing but reduced tissue integrity

730
Q

What leads to immobilisation and rigidity of repair site ?

A

disorganised collagen

731
Q

What prevents scar formation is the oral mucosa ?

A

remodelling of collagen fibres

732
Q

What is the procedure for wound healing after tooth extraction ?

A

socket fills with clot
proliferation and migration of epithelial cells
epithelialisation of socket
osteogenic precursor cells migrate to clot
osteoblasts differentiate and bone is deposited

733
Q

What is the procedure for wound healing at DGJ ?

A

colonisation of wound by epithelial cells - make a junctional epithelium
ODAm expressed
JE grows downwards
new DGJ

734
Q

What must happen when restoring the periodontium ?

A

resotre a unit

cementum , PDL, alveolar bone and gingiva

735
Q

What do fibroblasts do in periodontal regenration ?

A

remodel collagen fibres in periodontal regeneration

736
Q

What do endothelial cells do in periodontal regeration ?

A

for new blood vessels from exiting blood vessles

angiogenesis

737
Q

Where do cementoblasts originate from in periodontal regernation ?

A

epithelial rest cells of malassez

738
Q

Where do osteoblasts in periodontal regernation originate from ?

A

mesenchymal progenitor cells

periosteum

739
Q

Do normal tooth movements require an inflammtroy response ?

A

no

740
Q

Why do we need the inflammatory response in infection and repair ?

A

to combat infection

741
Q

What does chronic inflammation do ?

A

inhibits stem cells activation
cell recruitment
proliferation
differentation

742
Q

What are the molecular approaches to tooth repair ?

A

FGF
PDGF
TGF-
apply growth factor cocktails to root surfaces

743
Q

Which enamel matrix protein stimulates repair ?

A

emdogain

744
Q

Why cant we regenerate enamel ?

A

ameloblasts die at the end of development

745
Q

Which aspects of enamel repair can we control ?

A

physico chemical properties of remineralisation
calcium
phosphate
fluoride

746
Q

How are early carious lesions reversible ?

A

if the surface enamel is intact and acid abcteria are removed

747
Q

Is dentine living ?

A

yes

748
Q

What does the dentine reparative process depend on ?

A

extent and duration of caries
structural variation - tubules occlude dor not
age of tooth - size of pulp chamber

749
Q

What happens to dentine with a slow and prolonged insult ?

A

occlusion of dentine tubules by collagen plug or sclerotic dentine
reactionary dentine formed by existing odontoblasts

750
Q

What happens to dentine with a rapid and severe insult ?

A

reactionary dentine possibly if some cells survive
reparative denime fomred by differentiated odontoblast like cells
dentine is less tubular

751
Q

What does repair of the dentine pulp complex involve ?

A

inflammation but no epithelial response

752
Q

What are sources of stem cells for dental regeneration ?

A

dental pulp
exfoliated primary teeth
from PDL

753
Q

What are tissue engineering regenerative methods ?

A

biodegradable scaffolds
cell seeding
implants with bioactive surface for regenration

754
Q

What is the pattern of cementum relating to age ?

A

young- more acellular cementum- less mechanical exposure

old- occlusal wear, induces cellular cementum in apical and interradicular areas

755
Q

What is the clinical significance of enamel and cementum not meeting at the CEJ ?

A

root dentine is exposed
lead to dentine sensitivity
10% cases

756
Q

What is the keratinisation status of the gingival epithelium ?

A

para and ortho

masticatory function

757
Q

What is the keratinisation status of the sulucular epithelium ?

A

non keratinised

758
Q

What are the components of nasmyths membrane ?

A

epithelial tag

primary enamel cuticle and REE remnants

759
Q

How does the junctional epithelium attach to enamel ?

A

hemidesmosomes and IBL

760
Q

Why is there no bleeding when a tooth erupts ?

A

epithelial continuity as REE and oral epithelium fuse

761
Q

What happens to the surface cells of the junctional epithelium ?

A

they are sloughed off and enter the GCF

762
Q

What is the appearance of the cells in the deepest aprt if the JE ?

A

JE similar to REE

763
Q

How can we identify inflammation histologically ?

A

dark blue staining

inflammatory cells- neutrophils, monocytes and lymphocytes

764
Q

What effect does inflammation have on the sulcular epithelium ?

A

sulcular epithelium moves downwards and form long processes - project into lamina propia

765
Q

What happens to the basal lamina when inflammed ?

A

more penetrable for microbes and toxins

766
Q

What is the function of keratin in mucosa ?

A

resist abrasion and masticatory mucosa

767
Q

What are the tissues that comprise the submucosa ?

A

adipose tissue
larger vessels and nerves
loose connective tissue
minor salivary glands

768
Q

What is the significance of inter digitation of epithelial and connective tissue interface ?

A

inter digitation of epithelial ridges increases surface area and increases stability

769
Q

Which collagen is predominant in gigniva and hard palate ?

A

strong fibres that provide tensile strength and resist shearing forces

770
Q

What is the physiological response of the periodontal tissues after application of a light orthodontic response ?

A

metabolic response

771
Q

Which type of bone forms the cortical plate of the alveoalr bone ?

A

bundle bone

772
Q

What is the size of the orthodontic force applied to achieve movements of the teeth ?

A

100-150g

773
Q

Which nerve endings are evenly distributed in the PDL and serving pain and pressure ?

A

free ending tree like

774
Q

What is the aim of guided regeneration of the gingiva ?

A

prevention of undesirable wound healing

775
Q

Which structure is not involved in taste ?

A

foliate papilla

776
Q

What is the function of the REE ?

A

forms the DGJ

777
Q

Which type of collagen is present in the PDL after tooth eruption ?

A

collagen XII

778
Q

What are the 2 types of tooth movement ?

A

natural

forced

779
Q

What is the pathway of force transmission in a tooth?

A

crown
cementum
PDL
bone

780
Q

What is the origin of osteoblasts ?

A

undifferenetiated mesenchymal cells

781
Q

What is the origin of osteoclasts ?

A

blood monocytes

782
Q

What are the origins of osteocytes ?

A

osteoblasts

783
Q

What do the undifferentiated mesenchymal cells in the PDL differentiate into ?

A

osteoblasts

fibroblasts

784
Q

What happens when a force of 1 second is applied to teeth ?

A

PDL doesnt have time to become compressed
alveolar bone gives way
creates piezzoelectirc signal

785
Q

What is a piezoelectric signal ?

A

mechanical force to a crystaline structure which creates a movement of electrons - short current

786
Q

What happens to teeth with a longer force of 1-2 seconds ?

A

PDL fluid expressed

tooth moves in socket

787
Q

What happens to teeth with a force of 3-5 seconds ?

A

PDL fluid redistributed

tissues compressed leading to pain

788
Q

What happens to teeth with long term orthodontic forces ?

A

tooth movement in the socket

bony changes occur

789
Q

What causes bony changes with long orthodontic forces ?

A

piezoelectric effect

streaming potential

790
Q

What is the streaming potential ?

A

longer forces leading to movement of ground substance

potential difference leading to cell permeability

791
Q

What is the pressure tension theory ?

A

causes bony changes in long duration

when the PDL has a force applied - one side is compressed and one side is tension

792
Q

What happens when then PDL is stretched ?

A

blood flow increased

tension is made

793
Q

What happens when the PDL is squashed ?

A

blood flow decreased

pressure is made

794
Q

What can squashing bone lead to ?

A

hyalinisation

microfractures

795
Q

What is the cellular response and systemic response in long term force ?

A

cellular response- prostaglandins, IL1

systemic response- PTH, vitamin D and calcitonin

796
Q

What is the effect of the force on teeth dependent on ?

A

size and duration of force

797
Q

What does applying a force to a tooth do ?

A

force transmitted through PDL and bone

biological electricity and pressure-tension theory leading to changes in blood flow

798
Q

Which areas are osteoblasts recruited in ?

A

areas of tension- increased bone flow

799
Q

Which areas are osteoclasts recruited in ?

A

areas of pressure - decreased bone flow

800
Q

What happens in the heavy forces ?

A

blood vessels on squashed side are occluded within seconds
blood flow cut off to the compressed PDL- minutes
cell death in compressed layer
adjacent bone forms hyaline layer
cells beneath the hyaline layer are differentiated into osteoclasts
undermining resorption removes lamina dura

801
Q

What happens in heavy forces to allow tooth movement ?

A

undermining resorption

802
Q

What happens in light forces ?

A

blood vessels on the pressure side are partially occluded
dilated on the tension side
leads to an alteration in blood flow on the pressure side
allows metabolic changes to occur
cell differentiation in PDL - osteoclasts for pressure side and osteoblasts for tension side

803
Q

What causes tooth movement in light forces ?

A

tooth remodelling

804
Q

What are the 5 types of tooth movements ?

A 
tipping 
extrusion
intrusion 
translation 
rotation
805
Q

What is tipping ?

A

simple movement
around centre of resistance= third distance from the apex
forces are greatest further away from the apex
100-150 g

806
Q

What is rotation ?

A

tipping can be due to excessive compression of PDL

50-100 g

807
Q

What is translation ?

A

bodily movement though bone
PDL uniformly loaded
100-150 g

808
Q

What is extrusion ?

A

produces tension in PDL fibres
too much can loose vitality
50-100 g

809
Q

What is intrusion ?

A

forces concentrated on the root apex
excess damage leads to cementum damage - osteoclasts get access to dentine
root resorption
15-25

810
Q

What are the adverse effects of orthodontic appliances on roots ?

A 
root resorption - 1-2 mm of root length 
increased in dilacerated roots
thin roots
excess force
tooth can be made mobile - accelerated in periodontal disease
811
Q

What are the effects of orthodontic appliances on bone ?

A

loose about 0.5-1 mm of alveolar crest

812
Q

What are the adverse effects of orthodontics on PDL ?

A

maintenance of excessive force leads to damage

important in relapse

813
Q

What is the response of pulp to orthodontics ?

A

transient inflammatory response

814
Q

What is infraocclusion ?

A

tooth below the occlusal plane

815
Q

What is the aetiology of infra occlusion ?

A

ankylosis

816
Q

What is ankylosis ?

A

tooth fused to the bone

817
Q

How does ankylosis occur ?

A

PDL lost- link between tooth and bone made

818
Q

What are the causes of ankylosis ?

A

trauma

819
Q

Why is their a risk of decalcification with orthodontics ?

A

poor PH

820
Q

Why do teeth erupt ?

A

to maintain contact in occlusion

821
Q

Why does class II div 2 have a deep overbite ?

A

lower incisors have nothing to erupt agaisnt

822
Q

What can retained primary teeth cause with opposite teeth ?

A

over eruption of opposite

823
Q

What can overuption lead to ?

A

gingival trauma

occlusal problems

824
Q

What is mesial drift ?

A

natural tendency of teeth to drift forward

825
Q

When does mesial drift happen ?

A

early loss of primary teeth

if E lost early 6 will move into space and prevent 5 from erupting

826
Q

How can we stop mesial drift ?

A

hold the space

827
Q

How can mesial drift be useful ?

A

loose 6 early

7 drifts into space

828
Q

What is late lower incisor crowding ?

A

old age

pressure from 8s

829
Q

What is ageing ?

A

progressive decline in the ability to respond effectively to stresses of the environment

830
Q

Why do teeth discolour with age ?

A

thinning of the enamel

thickening of the dentine- shines through translucent enamel

831
Q

How do teeth become stained ?

A

stains and food particles become trapped in microscopic pores that are remineralised - trapped

832
Q

What are strains visible as microscopically ?

A

dark areas under the surface

more prominent striae of retzius

833
Q

How do whitening agents work ?

A

produce oxygen free radicals from hydrogen peroxide which penetrates enamel and reduces larger molecules into smaller molecules
smaller molecules can diffuse out the pores

834
Q

What is the action of fluoride ?

A

fluoride replaces hydroxide groups in hydroxyapatite

leads to a more mineralised fluorapatite

835
Q

Why are old people more resistant to caries ?

A

fluorapatite is harder than hydroxyapatite

836
Q

What is the first step in caries ?

A

chalk white early white lesion

837
Q

Are white spot lesions always due to caries ?

A

no can be developmental if they are shiny

838
Q

Are White spot lesions reversible and if so how ?

A

they are reversible if the enamel is intact and the biofilm removed

839
Q

Does secondary or primary dentine form faster ?

A

primary forms faster

840
Q

What happens to the pulp chamber in age ?

A

size of the pulp chamber reduces

root canals very narrow

841
Q

What are secondary dentine tubules like ?

A

they are continuous with primary dentine tubules
less secondary tubules
show a change in direction between primary and secondary
leads to contour line of owen

842
Q

Where does peritubular dentine begin to form ?

A

on the outter dentine where the stresses are felt the most

843
Q

What happens to form peritubular dentine ?

A

precipitation of calcium phosphate ions

844
Q

Is peritubular dentine hypo or hyper mineralised ?

A

hypermineralised - 90%

845
Q

What are the characteristics of peritubular dentine ?

A

doesnt contain collagen

tubule is completely occluded - sclerotic dentine made

846
Q

What is sclerotic dentine ?

A

complete occlusion of dentinal tubules by peritubular dentine
leads to dentine becoming transparent

847
Q

What are the 2 methods of sclerotic dentine formation ?

A

physiological - ageing- seen in the roots

pathological - in response to caries- between carious lesion and the pulp

848
Q

What is reactionary dentine ?

A

slow response - slow attrition
existing odontoblasts lining the pulp make reactionary dentine
inferior quality of dentine - less tubules

849
Q

What is repairative dentine ?

A

quick rapid response
odontoblast like cells (recruited from the pulp) make repairative dentine as original odontoblasts cells have been killed by the stimulus
repairative dentine has less tubules and is less mineralised

850
Q

What does natural attrition of the crown stimulate ?

A

peritubular dentine

dentine is less sensitive and less permeable

851
Q

What happens to compensate for tissue loss in attrition ?

A

reactionary dentine

852
Q

What does repairative dentine form in response to ?

A

strong stimulus- caries

853
Q

What do dead tracts form in response to ?

A

attrition and caries
repairative dentine forms to seal off the pulp from microorganisms
empty dentine tubules as odontoblast processes (dead) retract
dark appearance

854
Q

What are age changes in the pulp ?

A

less cells
narrow pulp chamber
calcified stones

855
Q

What are the types of calcified structures that form in the pulp ?

A

false pulp stones
true pulp stones
diffuse calcifications

856
Q

What are false pulp stones ?

A

not made by odontoblasts
concentric layers of calcified tissue
degenerated pulp tissue in pulp

857
Q

What are true pulp stones ?

A

denticles
contain organic tissue and dentinal tubules
made by odontoblasts

858
Q

What are diffuse calcifications ?

A

blood vessels associated with collagen fibres

become calcified as the blood vessels are calcified

859
Q

What happens to cementum with age ?

A

increases in thickness

not known of the pattern if thickness

860
Q

When is cellular cementum formed ?

A

in response to attrition it forms at the apex to lift the tooth up

861
Q

What are the age changes in the PDL ?

A

decreased cell numbers
fibroblasts have shorter lifespans , diminished collagen synthesis and degradation activity
thicker bundles
irregular organisation of sharpeys fibres
less remofelling of PDL- older teeth are less mobile

862
Q

What are the age changes the oral mucosa ?

A

thinning of tongue epithelium
reduced taste sensation
increased susceptibility to cancerous lesions

863
Q

What happens to the alveolar bone when there is a loss of teeth ?

A

alveoalr bone receeds

864
Q

What are the age changes to the salivary glands ?

A

decrease in the amount of salivary glands
increase in fibrotic tissue
xerostomia- medication use

865
Q

What is physiological attrition ?

A

mastication and contact with food
affects interproximal and occlusal surfaces
reactionary dentine forms in response
block off dentine tubules and leads to dead tracts

866
Q

What is pathological attrition ?

A

chewing - habitual and abnormal
bruxism
flat occlusal plane
dentine exposed- hypersensitivity

867
Q

What is abrasion ?

A

tooth wear comes into contact with foreign objects
pipe smoking
abrasive toothpastes and brushing

868
Q

What is erosion ?

A

progressive loss of hard tissues due to chemical dissolution
acid of non bacterial origin
extrinsic- diet
intrinsic- acid reflux / bulimia

869
Q

Why doesnt enamel dissolve at ph7 ?

A

pH7 the saliva is super saturated

enamel wont dissolve the calcium phosphate

870
Q

What happens below pH6 to enamel ?

A

saliva is unsaturated
pulls out ions
acidic dissolution initiates erosion

871
Q

What is the development process for a lesion ?

A

subsurface translucent zone
development of a dark zone
typical zoned structure of early white spot lesion
cavitation and spread along EDJ

872
Q

How can we arreest non cavitated lesions ?

A

removal of plaque

seal and hold

873
Q

What is secondary dentine ?

A

normal continuation of dentine after root development
odontoblasts lining the pulp
reduce the size of the pulp chamber and root canals
found on the roof and floor of the pulp chamber

874
Q

What is reactionary dentine ?

A

in response to mild stimuli like attrition
odontoblast cells lining the pulo
irregular structure with few tubules

875
Q

What is repairative dentine ?

A

in response to strong stimuli

original odontoblasts killed so need to use odontoblast like cells

876
Q

What is the progression of pulpal pain ?

A 
dentine hypersensitivity 
reversible pulpits
irreversible pulpitis
apical periodontitis 
peri apical abscess
877
Q

What is dentine hypersensitivity ?

A

short sharp pain arising from exposed dentine in response to stimuli

878
Q

What are the stimuli that can trigger dentine hypersensitivity ?

A 
thermal 
evaporative 
tactile 
osmotic 
chemical
879
Q

How can be dentin ebe exposed ?

A

by gingival recession or lack of enamel

880
Q

What are the causes of pulpal inflamIs tehre amation ?

A

caries
defective restorations
trauma
dens invaginations - infolding of enamel into the dentine

881
Q

Is there always a correlation of inflamed pulp and pain ?

A

no- an inflamed pulp can be painless

882
Q

What is reversible pulpitis ?

A

short pain in duration
pain disappears when stimulus removed
poorly localised

883
Q

How can we manage reversible pulpitis ?

A

remove irritant and restore

884
Q

What is irreversible pulpitis ?

A

pain longer in duration
pain PERSISTS when stimulus removed
spontaneous

885
Q

How can we manage irreversible pulpitis ?

A

pulpotemy
pulpectomy
extraction
NOT ANTIBIOTICS

886
Q

What is symptomatic apical periodontitis ?

A

pain
apical inflammation
still respond to nerve tests

887
Q

What is asymptomatic chronicl apical periodontitis ?

A

no TTP
no response to nerve tests
no pain
apical radiolucency

888
Q

What is apical acute abscess ?

A

non responsive
swelling
febrile

889
Q

What is a chronic apical abscess ?

A

draining sinus

asymptomatic

BDS stage 2 (28 decks)

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