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Histopathology > Dental Pulp and Caries > Flashcards

Dental Pulp and Caries Flashcards

1
Q

how does dental pulp evolve

A

goes through the same stages as the rest of the tooth- goes through embryogenesis

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2
Q

what are the stages in dental pulp embryogenesis and what happens in each

A

-cap stage: dental papilla
- bell stage: primitive pulp, contains capillary development

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3
Q

what does the mature dental pulp consist of

A

loose CT

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4
Q

what is mature dental pulp derived from

A

neural crest (ectomesenchymal) cells

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5
Q

where is the density of cells in dental pulp get higher

A

towards the dentin

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6
Q

what is the odontogenic zone cell layer and is it cellular rich/dense

A

-odontoblastic cell layer
- cellular rich/dense

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7
Q

what does the odontogenic zone contain

A
  • cell-free zone of Weil
  • Cell-rich zone
  • Raschkow’s plexus
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8
Q

what cell layer makes up the pulpal core and is it cellular/dense

A

-fibroblastic layer
- not very cellular or dense

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9
Q

what does the pulpal core contain

A

-type 1 and 3 collagen
-extracellular matrix
- blood vessels
- nerve tissue

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10
Q

what are the functions of the pulp

A
  • embryonic induction (as tooth continues to develop, presence of pulp in the IEE helps to stimulate further development of the enamel organ)
  • formative: has the cells necessary to orm certain mature structures within the tooth
    -protective
    -reparative
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11
Q

what are the cells in the pulpal tissue

A

-fibroblasts
- odontoblasts
- undifferentiated mesenchymal cells
- macrophages and dendritic cells
-blood vessel related cells (endothelial and pericytes)
- neural related cells (schwann cells)
- lymphocytes (for immune response)

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12
Q

what is the majority of cells in the pulpal tissue

A

fibroblasts

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13
Q

what percentage do macrophages and dendritic cells make up in pulpal tissue

A

8%

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14
Q

what makes up the collagenous extracellular matrix of pulpal tissue

A

mostly type 3 collagen (25-32%) (and 1,4,5) via odontoblasts

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15
Q

what makes up the non-collagenous extracellular matrix of pulpal tissue

A

-proteoglycans, glycosaminoglycans, phosphoproteins, glycoproteins
-y-carboxyglutamate-containing proteins (BMP,FGF,EGF< DMP), stimulate growth and maturation of both ameloblasts and odontoblasts

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16
Q

what are most nerve endings in pulp for

A

pain
-(few for vasoconstriction/dilation)

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17
Q

what does the trigeminal nerve in the pulp give off free nerve endings as sensory afferents for

A

-pain
-mechanical (pressure)
- thermal
-tactile

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18
Q

what ganglion is for pulp

A

superior cervical ganglion

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19
Q

what makes up the superior cervical ganglion in pulp and what is their function

A

sympathetic branches, primarily vasomotor fibers to pulpal blood vessels and function most in vasoconstriction

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20
Q

what does pulp nerve tissue contain

A

myelinated and non-myelinated nerve axons

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21
Q

what do axons in pulp nervous tissue branch into

A

the subodontoblastic layer as Raschow’s plexus into the odontoblastic cell layer and some fibers enter into the dentinal tubules. forms before the full formation of roots

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22
Q

how many branches does each nerve fiber branch into the plexus

A

at least 8

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23
Q

what do most nerve fibers terminate in the plexus as

A

free nonmyelinated nerve endings (C-fibers)

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24
Q

where are schwann cells located and what do they do

A

functions in myelination in the PNS, allows for faster nerve conduction

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25
Q

describe A-delta fibers, their conduction velocity, size and function

A

-majority of myelinated pulpal nerves
-fast conducting
-diamter range of 1-6 um
- associated with sharp, localized pain

26
Q

describe A-beta fibers and size

A

-1% of myelinated pulpal nerves
-diamter range of 6-12 um

27
Q

describe C-fibers fibers and size and function

A

-nonmyelinated
-diameter range of 0,4-1.2 um (smallest)
- associated with dull,diffuse pain

28
Q

what are the neuropeptides and NTs inside the dental pulp

A
  • calcitonin gene related peptide (CGRP)
  • Substance P
  • epinephrine
  • NE
  • dopamine
    -endorphin
29
Q

what does CGRP do

A

vasodilation, stimulates fibroblast cell division

30
Q

what does substance P do

A

vasodilation, stimulates fibroblast cell division,

31
Q

what does EPI do in dental pulp

A

vasoconstriction via arteriole smooth muscles

32
Q

what does NE do in dental pulp

A

sympathetic vasoconstrictor

33
Q

what does dopamine do in dental pulp

A

vasoactive or a precursor of epinephrine

34
Q

what does endorphin do in dental pulp

A

silences of nociceptor (pain)

35
Q

what is the distribution of nerve axons and blood vessels in intratubular dentin

A

-pre-dentin will have more nerve axons

36
Q

the more mineralized you get ____

A

the less nerve axons you will have

37
Q

as you are more coronal there is more ____

A

branching and more nerve activity

38
Q

what makes up pulp horns

A

-27% pre-dentin
-11% mineralizing front
-8% dentin up to 100 um

39
Q

what makes up remaining crown

A

-14% pre-dentin
-6% mineralizing front
-2% dentin up to 100 um

40
Q

what makes up the root

A

-11% pre-dentin
-0% mineralizing front
- 0% dentin up to 100 um

41
Q

describe arterioles

A

diameter of 50-100 um, thicker

42
Q

describe venules

A

diameter of 100-150 um. thinner

43
Q

describe capillaries

A

anastomoses deep to the odontoblastic layer

44
Q

where are capillary loops dense and less dense

A

dense in the coronal and pulp horn regions and less dense in the radicular pulp

45
Q

describe changes in blood vessels due to age

A

exhibit changes like cholesterol plaque- if severe can result in pulpal hypoxia due to vessel strangulation

46
Q

describe fenestrated capillaries and what are they important in

A

with holes, allows for serum/fluid movement. important in inflammatory response and swelling: serum/tissue fluid to leaks out of capillaries (as a response) into the surrounding tissue causing the swelling

47
Q

describe continuous capillaries

A

lacking holes

48
Q

what is pulpal fibrosis and what causes it

A

-shrinking of the pulp
- occurs with increasing age or persistent low grade injury (bruxism, thermal insult, multiple restorations on single tooth)

49
Q

what are diffuse calcifications

A

irregular calcified deposits along collagen fiber bundles or within blood vessels resulting from chronic low grade inflammation/insult to the tooth

50
Q

what are pulp stones/denticles

A

classified as either free, attached (in wall) or embedded (in pulp). do not cause pain or issues, only an issue during RCT access

51
Q

what are true pulp stones

A

contain dentinal tubules

52
Q

what are false pulp stones

A

feature concentric layers of calcified tissue but are void of dentin tubules

53
Q

what is abscess

A

dense aggression of neutrophils and macrophage and other inflammatory cells within CT undergoing liquefactive necrosis (cell structure breaks down and tissue becomes liquified)

54
Q

what are vacuolated macrophages

A

consume dead tissue “clean up the mess”

55
Q

what are syncytial macrophages

A

multinucleated, resorb dentin adjacent to inflammed pulp

56
Q

what is pulpal abscess

A

active inflammatory process. will destroy soft tissue and mineralized tissue if left there

57
Q

what does pulpal abscess lead to and why

A

pulpal necrosis due to inability of pulpal tissue to swell, the increasing edema and inflammatory cell infiltration

58
Q

what is pulpal necrosis

A

inflamed pulp cuts off its own blood supply, leading to tissue death

59
Q

what are the symptoms of pulpal necrosis

A

clinically expressed with pain and periapical necrosis (seen as radiolucent near apex of root on radiographs) of the PDL and associated alveolar bone

60
Q

what is the treatment for pulpal abscess

A

incision and drainage (I and D) followed by endodontic therapy

61
Q

what is diffuse cellulitis

A

when pulpal abscess enlarges so much to where it is involving airways

Histopathology (14 decks)

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