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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
what is the most common ways for a restoration to cause dental pain?
distortion onto dentine and creates movement in dentinal fluid flow 'high' fillings
26
A beta and delta fibres in intradental nerves are activated by
hydro-dynamic stimuli applied to dentine
27
A beta and delta fibres cause what type of pain response in intradental nerves?
likely mediate 'normal' general dentinal sensitivity response
28
C fibres in intradental nerves are activated by
stimuli directly (rather than hydrodynamic mechanism) respond to most forms of intense stimulation
29
C fibres cause what type of pain response in intradental nerves?
likely mediate pain associated with pulp inflammtion (e.g. caries)
30
what is the blood supply to teeth?
branches of maxillary artery
31
what are the 5 branches of the maxillary artery?
- deep auricular artery - anterior tympanic artery - medial meningeal artery - accessory meningeal artery - inferior alveolar artery
32
4 factors on pulp blood flow control
- local factors e.g. metabolites - nerves (sympathetic, somatic afferents) - circulating hormones e.g. adrenaline - drugs e.g. LA with vasoconstrictors
33
what does increase in pulp pressure do to dentinal fluid movement?
causes increase in outward flow in dentinal tubules (increase in nutrients)
34
4 functions of pulp nerves
- sensory (mediate pain) - control of pulp blood vessels (sympathetic: vasoconstrictor; afferents: vasodilator) - promote neurogenic inflammation (neuropeptides, subst P, CGRP) - promote dentine formation
35
immediate dentine-pulp response to injury
nociceptor activation - pain
36
after approx. 1 min dentine-pulp response to injury
early inflammatory response - kinins, prostaglandins, neuropeptides vasodilation - swelling
37
after approx. 10 mins dentine-pulp response to injury
nociceptor sensitisation e.g. sorer when biting extravasation of fluid, oedema polymorph migration - recruitment of cells, presence of agents of cell inflammatory response
38
after approx 100 mins dentine-pulp response to injury
enzyme activation; nerve growth factor | monocyte presence
39
after approx. 1 day dentine-pulp response to injury
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
after approx. 1 week dentine-pulp response to injury
repair - tertiary dentine formation variable completion and repair/recovery
41
what is pulpitis?
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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