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BDS2 BAMS > Dentine and Pulp > Flashcards

Dentine and Pulp Flashcards

1
Q

what is the dental pulp?

A

connective tissue ‘core’ of the tooth

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2
Q

what is 5 things are present in pulp?

A
  • cells
  • extracellular components
  • nerves
  • blood vessels
  • lymphatics
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3
Q

what cells are present in pulp?

A
  • odontoblasts
  • fibroblasts
  • defence cells
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4
Q

what are the extracellular components of pulp?

A

fibres
- collagen and oxytalan
matrix
- proteoglycans, chondroitin SO4, dermatin SO4

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5
Q

5 functions of the dental pulp

A
  • nutritive (blood vessels)
  • dentine growth
  • dentine repair (tertiary)
  • defence (immune cells and lymphatics)
  • neural (sensory pain response)
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6
Q

what are the close links between dentine and pulp/

A
  • developmental links
  • structural links
  • functional links

dentine-pulp complex

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7
Q

what are the structural links between dentine and pulp?

A

pulpal elements extend into dentine

  • odontoblast processes
  • nerve terminals
  • immune cells (dendritic cells)
  • dentinal fluid
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8
Q

pulp haemodynamics and hydrodynamics

A
  • Fluid leaks from pulp capillaries –>interstitial space
  • Some drains by lymphatic
  • Some passes along dentinal tubules (dentinal fluid)
  • Flow proportional to pulp pressure

Defence role
• To protect tissue avoid microorganism entering pulp as drive force

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9
Q

functional links between dentine and pulp

A
  • formation of secondary and tertiary dentine

- regulates exchange of material between dentine and pulp

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10
Q

types of tooth wear and possible causes

A
  • mastication
  • bruxism –> attrition
  • abfraction (occlusal overload –> fractures & cervical lesions)
  • abrasion - loss due to mechanical actions (not teeth)
  • diet (erosion)
  • caries
  • operative procedures
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11
Q

what is the role of tertiary dentine?

A

reactionary dentine

  • in response to mild stimulus
  • laid down by primary odontoblasts

reparative dentine

  • in response to intense/harsher stimulus that destroy primary odontoblasts
  • laid by secondary odontoblasts
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12
Q

what separates pulp and tubular space?

A

odontoblast layer

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13
Q

what is the role of the odontoblast layer which separates pulp and tubular space?

A

permeability barrier

  • regulates movement of material between pulp and tubular ECF
  • movement may be in either direction
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14
Q

what materials move from pulp to dentine?

A
  • nutrients to sustain cells,
  • formation of secondary and tertiary dentine,
  • for tubular nerve function (e.g. K=)
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15
Q

what materials move from dentine to pulp?

A
  • medicaments applied to dentine

- diffusion of ‘toxins’ from bacteria, components of filling materials

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16
Q

what nerve supplies most teeth?

A

branches of alveolar nerve

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17
Q

where do neurovascular bundles enter the pulp?

A

via apical foramen

18
Q

what is the passage of neurovascular bundles?

A
  • enter pulp via apical foramen
  • pass along root canal in centre of pulp towards coronal pulp chamber
  • branches fan out in sub-odontoblastic layer
  • terminal branches enter odontoblast layer (some enter dentinal tubules)
19
Q

what is Raschow’s Plexus?

A

branches of alveolar nerve which fan out in sub-odontoblastic layer in pulp

20
Q

what is the spread of dentine innervation?

A
  • 40% under cusps
  • 15% coronal dentine
  • 4% root dentine
    few axons enter tubules; most end in pulp-predentine region
21
Q

what causes outward dentinal fluid flow?

A 
cooling
drying 
evaporation 
hypertonic solutions
decreased hydrostatic pressure
22
Q

what causes inward dentinal fluid flow?

A

heating
mechanical
increased hydrostatic pressure (e.g. syringe)

23
Q

what dentinal fluid flow is more effective at activating intradental nerves?

A

outwards dentinal fluid flow
(away from pulp)

RAPID OUTWARD FLOW STRETCHES THE NERVE

24
Q

4 stimuli that act directly on intradental nerves

A
  • intense heating
  • intense cooling
  • electrical current
  • pain-producing chemicals
25
Q

what is the most common ways for a restoration to cause dental pain?

A

distortion onto dentine and creates movement in dentinal fluid flow

‘high’ fillings

26
Q

A beta and delta fibres in intradental nerves are activated by

A

hydro-dynamic stimuli applied to dentine

27
Q

A beta and delta fibres cause what type of pain response in intradental nerves?

A

likely mediate ‘normal’ general dentinal sensitivity response

28
Q

C fibres in intradental nerves are activated by

A

stimuli directly (rather than hydrodynamic mechanism)

respond to most forms of intense stimulation

29
Q

C fibres cause what type of pain response in intradental nerves?

A

likely mediate pain associated with pulp inflammtion (e.g. caries)

30
Q

what is the blood supply to teeth?

A

branches of maxillary artery

31
Q

what are the 5 branches of the maxillary artery?

A
  • deep auricular artery
  • anterior tympanic artery
  • medial meningeal artery
  • accessory meningeal artery
  • inferior alveolar artery
32
Q

4 factors on pulp blood flow control

A
  • local factors e.g. metabolites
  • nerves (sympathetic, somatic afferents)
  • circulating hormones e.g. adrenaline
  • drugs e.g. LA with vasoconstrictors
33
Q

what does increase in pulp pressure do to dentinal fluid movement?

A

causes increase in outward flow in dentinal tubules (increase in nutrients)

34
Q

4 functions of pulp nerves

A
  • sensory (mediate pain)
  • control of pulp blood vessels (sympathetic: vasoconstrictor; afferents: vasodilator)
  • promote neurogenic inflammation (neuropeptides, subst P, CGRP)
  • promote dentine formation
35
Q

immediate dentine-pulp response to injury

A

nociceptor activation - pain

36
Q

after approx. 1 min dentine-pulp response to injury

A

early inflammatory response
- kinins, prostaglandins, neuropeptides

vasodilation - swelling

37
Q

after approx. 10 mins dentine-pulp response to injury

A

nociceptor sensitisation e.g. sorer when biting

extravasation of fluid, oedema

polymorph migration - recruitment of cells, presence of agents of cell inflammatory response

38
Q

after approx 100 mins dentine-pulp response to injury

A

enzyme activation; nerve growth factor

monocyte presence

39
Q

after approx. 1 day dentine-pulp response to injury

A

nerve sprouting (NGF)

increased axonal transport

altered excitability of CNS synapses
- small local sensitisation of response; become more later - small lesions can cause large response to pain

40
Q

after approx. 1 week dentine-pulp response to injury

A

repair - tertiary dentine formation

variable completion and repair/recovery

41
Q

what is pulpitis?

A

toothache
acute inflammation in the dental pulp is similar to other tissues except pulp cannot swell as it is confined in pulp chamber
oedema causes increase in pulp pressure
- variable effects on blood flow and nerve excitability

BDS2 BAMS (54 decks)

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