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BDS2 - oral biology > dentine and pulp complex > Flashcards

dentine and pulp complex Flashcards

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1
Q

what is found in dental pulp?

A
  • cells
    > odontoblasts
    > fibroblasts
    > defence cells
- extracellular components
> fibres 
~ collagen 
~ oxytalan
> matrix 
~ proteoglycans 
~ chondroitin
~ dermatan
  • nerves
    > sensory, autonomic
  • blood vessels
  • lymphatics
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2
Q

name the layers of dentine-pulp complex

A 
dentine 
predentine
odontoblasts
cell free zone
cell rich zone
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3
Q

what are the functions of the dental pulp?

A
  • nutritive (blood vessels)
  • dentine growth / physiological growth
    > primary
    > secondary
  • dentine repair
    > tertiary
  • defence
    > immune cells
    > lymphatics
  • neural
    > sensory
    ~ pain
    > control of dentinogenesis
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4
Q

what are the developmental links between dentine and pulp?

A

dentine and pulp develop from the dental papilla

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5
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 
[note there are no blood vessels in normal dentine]
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6
Q

what are haemodynamics?

A

the dynamics of blood flow

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7
Q

what are hydrodynamics?

A

the branch of science concerned with forces acting on or exerted by fluids (especially liquids)

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8
Q

where does the fluid that leaks from the pulp capillaries go?

A

interstitial space

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9
Q

what are the ways in which this fluid can leak?

A

some drains by lymphatics
some passes along dentinal tubules
{look at diagram in lecture maybe for explanation on the outward tubular fluid flow}

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10
Q

what is the dentinal fluid flow proportional to?

A

pulp pressure

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11
Q

what are the functional links between dentine and pulp?

A
  • formation of secondary dentine
  • formation of tertiary dentine in response to tooth wear
    > reactionary dentine
    > reparative dentine
  • regulate exchange of material between dentine and pulp
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12
Q

name 6 things that cause tooth wear

A
  • mastication / abrasion
  • bruxism / attrition
  • abfraction / occlusal overload
  • diet = erosion
  • caries
  • operative procedures (cavity cutting and crown prep)
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13
Q

define abrasion

A

the process of scraping or wearing something away

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14
Q

define bruxism

A

involuntary habitual grinding of the teeth, typically during sleep

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15
Q

define attrition

A

the process of reducing something’s strength or effectiveness through sustained attack or pressure

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16
Q

define abfraction

A

is the mechanical loss of tooth structure that is not caused by tooth decay, located along the gum line

17
Q

what are the 2 types of tertiary dentine

A

reactionary

reparative

18
Q

what is reactionary dentine

A

it is laid down in response to a mild stimulus

laid down by primary odontoblasts

19
Q

what is reparative dentine

A

it is laid down in response to a severe stimulus which destroys the primary odontoblasts
laid down by secondary odontoblasts

20
Q

explain the odontoblast layer as a permeability barrier

A

separates pulp and tubular space

Regulates movement of material between pulp and tubular ECF, Movement can be in either direction

21
Q

what material is exchanged from the pulp to the dentine

A
  • nutrients
  • formation of secondary and tertiary dentine
  • function of tubular nerves eg potassium for membrane potential
22
Q

what material is exchanged from the dentine to the pulp

A
  • medicaments applied to dentine
  • diffusion of toxins from bacteria
  • diffusion of components from filling materials
23
Q

what is the anatomy of pulp nerves

A

branches of alveolar nerves

  • neurovascular bundles enter pulp via apical foramen
  • pass along root canal in centre of pulp towards coronal pulp chamber
  • branches fan out in sub-odontoblastic layer = Raschow’s plexus
  • terminal branches enter odontoblast layer, some nerves enter dentinal tubules
24
Q

explain the innervation of dentine

A 
some nerves enter dentine
	- Under cusps
		○ 40% of tubules contain nerves
		○ Some axons extend around 100-200 micrometres
	- Coronal dentine
		○ Less; around 15%
	- Root dentine 
		○ As little as 4%
Few axons enter tubules, most end in pre-dentine region
25
Q

what is the hydrodynamic mechanism for activating intradental sensory nerves?

A
  1. stimulus (can be thermal, mechanical, evaporative, chemical) acts on exposed dentine - open tubules
  2. this increases the rate of dentinal fluid flow
  3. causes generation of action potentials in intra-dental nerves
  4. action potentials pass to brain to cause pain
26
Q

what generates an outward dentinal fluid flow

A
  • cooling
  • drying
  • evaporating
  • hypertonic solutions
  • decreased hydrostatic pressure
27
Q

what generates an inwards dentinal fluid flow

A
  • heating
  • mechanical
  • increased hydrostatic pressure
28
Q

is outward or inward fluid flow more effective at activating intradental nerves

A

outward - away from the pulp

rapid outward flow stretches the nerves

29
Q

what stimuli bypass the hydrodynamic mechanism and act directly on intradental nerves?

A
  • Intense heating
    • Intense cooling
    • Electrical current (vitality tests)
      • Pain producing chemicals
30
Q

what mediates normal dentinal sensitivity

A

a-beta and a-alpha fibres

Activated by hydrodynamics stimuli applied to dentine

31
Q

what mediates pain associated with pulp inflammation

A

c fibres
activated directly by stimuli, rather than hydrodynamic mechanism
They respond to most forms of intense stimulatio

32
Q

what is the blood supply to the teeth

A

branches of maxillary arteries

33
Q

what controls pulp blood flow

A
  • local factors
    > metabolites
  • nerves
    > sympathetic
    > somatic afferents
  • circulating hormones
    > adrenaline
  • drugs
    > LA preparations with vasoconstrictors
34
Q

what are the functions of pulp nerves

A
  • sensory
    > mediating pain
- control of BV
> sympathetic 
~ vasoconstrictor
> afferents 
~ vasodilator
  • promote neurogenic inflammation
    > neuropeptides
    ~ Subst P
    ~ CGRP
  • promote dentine formation
  • maybe facilitate an immune response
35
Q

explain the dentine-pulp response to injury

A 
• Immediate 
		○ Nociceptor activation = pain
	• After 1 minute or so
		○ Early inflammatory response
		○ Kinins, prostaglandins, neuropeptides
		○ Vasodilation
	• After 10 minutes or so
		○ Nociceptor sensitisation
		○ Extravasation of fluid, oedema
		○ Polymorph migration
	• After 100 minutes or so
		○ Enzyme activation; Nerve growth factor
		○ Monocyte presence
	• After 1 day or so
		○ Nerve sprouting (NGF)
		○ Increased axonal transport
		○ Altered excitability of CNS synapses
	• After 1 week or so
		○ Repair; tertiary dentine formation
	• Variable
Completion of repair and recovery
36
Q

what is pulpitis

A

acute inflammation in the dental pulp

37
Q

why is pulpitis different to inflammation in other tissues

A

the pulp cannot swell within the pulp chamber

oedema causes an increase in pulp pressure

BDS2 - oral biology (5 decks)

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