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OCB02 > Dentin-Pulpal Complex > Flashcards

Dentin-Pulpal Complex Flashcards

1
Q

Why is the pulp often referred to as the pulpal-dentin complex?

A

Odontoblast processes extend at least one-third into the dentin tubules

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2
Q

What are the functions of the pulp? (4)

A

Formation of dentin

Eruption of tooth/root formation

Dentin repair

Defence against infection and systemic dissemination

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3
Q

What covers dentin externally?

A

Enamel and cementum

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4
Q

What colour is deciduous and permanent dentin?

A

Light yellow = deciduous

Pale yellow = permanent and becomes darker with age

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5
Q

Why might thicker or hypomineralised enamel appear whiter?

A

Does not transmit light as readily

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6
Q

How does the hardness of dentin compare to enamel, cementum and bone?

A

Less hard than enamel (1/5th of enamel hardness)

Harder than bone and cementum

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7
Q

How does the hardness of dentin vary?

A

3 times harder at EDJ than near pulp

Varies between crown and root, and between different teeth

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8
Q

Why does dentin get harder with age?

A

Increased mineral content

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9
Q

Why is dentin more radiolucent than enamel?

A

Less mineral

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10
Q

Why is dentin highly permeable?

A

Presence of tubules

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11
Q

How does permeability of dentin change with age and why?

A

Decreases

Formation of intratubular dentin

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12
Q

What are the components of dentin by weight and volume?

A

Inorganic - 70% w. 50% v.

Organic - 20% w. 30% v.

Water - 10% w. 20% v.

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13
Q

What does the inorganic component of dentin mainly comprise of?

A

Hydroxyapatite

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14
Q

What does the organic component of dentin comprise of?

A

90% type I collagen (traces of type III and V)

8% non-collagenous proteins

2% lipid

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15
Q

How can you separate the organic and inorganic components of dentin?

A

Decalcification (to get organic)

Incineration (to get inorganic)

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16
Q

Where is the primary curvature less pronounced?

A

Root dentin (cervical third)

Beneath cusps/incisal edge

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17
Q

Where is the diameter of the dentinal tubules largest?

A

Near pulp cavity (3-4um)

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18
Q

What is the density of dentinal tubules near the pulp?

A

50,000-90,000 tubules/mm^2

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19
Q

What is the ratio of dentinal tubules per unit area in the crown compared to the root?

A

4:1

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20
Q

What are canaliculi/microtubules in dentin?

A

Lateral branches throughout dentin every 1-2um

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21
Q

What are enamel spindles?

A

Dentin tubules which extend into enamel for several mm

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22
Q

Which of intertubular or intratubular dentin is more mineralised?

A

Intratubular (by 15%)

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23
Q

What is the lamina limitans?

A

Inner organic lining of calcified tubule wall

24
Q

Describe intertubular dentin. (3)

A

Between zones of intratubular dentin

Half its volume is organic matrix, especially randomly orientated collagen fibres

100nm long hydroxyapatite crystals form along collagen with long axes parallel to fibre

25
Q

How wide is the predentin layer?

A

2-6um depending on odontoblast activity

26
Q

What is the dental pulp comprised of generally? (4)

A

Cells

Fibres

Ground substance

Vessels

27
Q

What cells are present in the pulp? (5)

A

Odontoblasts

Stem/mesenchymal cells

Fibroblasts

Schwann cells

Defence cells

28
Q

What fibres are present in pulp?

A

Collagen I and III

29
Q

What secretes the ground substance of the pulp?

A

Fibroblasts

30
Q

What is the pulpal ground substance comprised of?

A

GAGs

Proteoglycans

Glycoproteins

31
Q

What vessels are present in the pulp?

A

Arterioles, venules, capillaries

AV shunts

Lymph vessels

32
Q

Why are capillaries more abundant in the odontoblastic layer?

A

Supplies nutrients for dentinogenesis

33
Q

What is the value of pulpal blood flow?

A

20-60ml/min per 100g of tissue

34
Q

Where are lateral canals very frequently found?

A

Molar furcations

35
Q

What are the main causes of pulpitis? (5)

A

Dental caries

Dental trauma

Dental materials

Bacterial leakages at tooth-restoration interface

Dentin exposure

36
Q

What does rubor mean?

A

Redness

37
Q

What does dolor mean?

A

Pain

38
Q

What does functio laesa mean?

A

Loss of function

39
Q

Describe the vascular reactions of inflamed pulp. (3)

A

Vasodilatation of arterioles = increased capillary blood flow and pressure = increased venous pressure

Increased capillary permeability and tissue colloid osmotic pressure = increased net filtration = increased tissue hydrostatic pressure = increased venous pressure

Net capillary absorption in non-inflamed areas and increased lymph flow

40
Q

What are the steps in forming a diagnosis?

A

History

Examination

Special and experimental tests

Differential diagnosis

41
Q

What do you take a history of?

A

Chief/presenting complaint

Dental

Medical

42
Q

What are the two types of clinical examinations?

A

Intraoral (IO)

Extraoral (EO)

43
Q

What special tests can be carried out for pulp? (3)

A

Vitality testing

Thermal tests - endofrost

Electric pulp tester

44
Q

How can an endofrost indicate abnormal pulp? (3)

A

Lack of response

Lingering response of painful sensation after removal of stimulus

Immediate excruciating pain

45
Q

What experimental tests can be carried out for pulp?

A

Laser doppler flowmetry

Pulse oximetry

46
Q

What does laser doppler flowmetry do?

A

Assesses blood flow as light beam is frequently shifted by RBCs

47
Q

What is pulse oximetry?

A

Determines pulpal blood flow by measuring oxygen concentration of blood and pulse rate

48
Q

What are possible non-odontogenic examples of pain? (4)

A

Musculoskeletal pain - TMJ

Neuropathic pain - trigeminal CNV neuroglia

Neurovascular pain - migraine, headache

Autonomic pain - atypical facial pain

49
Q

How can you treat pulpitis?

A

Vital pulp therapy

Root canal treatment

50
Q

What is vital pulp therapy?

A

Method of treating pulpitis which aims to preserve and maintain pulp tissue

Involves a pulp cap and permanent restoration seal

51
Q

What equipment is involved in root canal treatments?

A

Long-cone periapical x-rays or master apical cone x-rays

Working length determined with apex locator

52
Q

Where should a RCT end?

A

Apical constriction

53
Q

What causes complete mineralisation of pulp?

A

Traumatic injury which is insufficient to kill pulp over a period of one year

54
Q

What are the characteristics of type II dentinogenesis imperfecta? (3)

A

Narrow spindly root

Rapid sclerosis of pulp chamber and root canals

Bulbous crowns

55
Q

What is a characteristic of coronal (type II) dentin dysplasia?

A

Permanent teeth demonstrate apical extension of pulp chamber - thistle-tube/flame shape

OCB02 (19 decks)

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