Lecture 3 (9/5) Flashcards
The primary function of dental pulp is:
formative
What describes “anything that causes movement of the fluid within the dentinal tubules & causes pain in the pulp?
Branstromm’s Hydrodynamic Theory of Pain
Uniform deposition of ____ reducing the general size of the pulp, but retaining the general form as the toot matures is known as:
secondary dentin
Most common portal of entry of microbiological irritants into the pulpal space is:
caries/leaking restorations
What is the most common etiology of pulpal inflammation?
microbiological
Central mass of a tooth consisting of soft tissue that is densely innervated by afferent (sensory) fibers, sympathetic fibers, vascular structures, lymphatics and specialized cells such as odontoblasts (characteristic cells of pulp) and fibroblasts (most common/prevalent cell type in pulp):
pulpal organ
The pulpal organ is the central mass of tooth consisting of ____ that is densely innervated by:
soft tissue; afferent (sensory) fibers, sympathetic fibers, vascular structures, lymphatics and specialized cells.
What are the specialized cells in the pulpal organ?
- odontoblasts
- fibroblasts
What cells are characteristic cells of the pulp?
odontoblasts
What cells are the most common/prevalent cell type in pulp?
fibroblasts
What are the afferent fibers that innervate the pulpal organ?
sensory fibers
In addition to the afferent (sensory) fibers that innervate the dental pulp, there are also ___ fibers.
sympathetic
The primary function of the dental pulp is formative; meaning the odontoblasts form _____ (with dental epithelium), and the ameloblasts form ____.
odontoblasts- dentin
ameloblasts - enamel
What are the secondary functions of the dental pulp?
- support
- protection
- sensation
- defense
- repair
Label the following image:
A: mantle dentin
B: tertiary dentin
C: primary dentin
D: secondary dentin
E: predentin
Label the following image:
Odontoblastic layer
Label the following image:
A) pulpal horns
B) pulp chamber
C) root canal
D) apical foramen
Fibroblasts arise from:
undifferentiated ectomesenchymal cells
_____ arise from undifferentiated ectomesenchymal cells
fibroblasts
Most prevalent cell in the pulp organ:
fibroblast
Fibroblasts elaborates ____ fibers and ground substance
type I & III collagen
Elaborates type I & III collagen fibers and ground substance:
Fibroblasts
Function in wound healing:
fibroblasts
A basic cell in connective tissue:
fibroblasts
Important in pulpal regeneration:
fibroblasts
Cell unique to the pulp:
Odontoblast
Odontoblasts are responsible for:
dentinogenesis
Odontoblasts produce ___ and ___ which becomes mineralized
collagen fiber & proteoglycan matrix
Odontoblastic processes extend into:
tubules
What nerve is the principle sensory innervation of both maxillary and mandibular pulp?
Trigeminal nerve (branches V2 & V3)
Additional innervation to the pulp may come from the ____ nerve.
mylohyoid
Due to the pulpal innervation, an IA block alone may provide:
insufficient anesthesia
Dental pulp is supplied by both ___ & ___
myelinated and non-myelinated axons
_____ fibers are classified according to diameter, velocity of conduction and function
Myelinated A fibers
Myelinated A fibers are classified according to:
- diameter
- velocity
- conduction of function
List the diameters of the following fibers:
- A alpha fibers
- A beta fibers
- A gamma fibers
- A delta fibers
(micrometers)
1. (12-20)
2. (5-12)
3. (3-6)
4. (1-5)
List the velocity of conduction of the following fibers:
- A alpha fibers
- A beta fibers
- A gamma fibers
- A delta fibers
(m/sec)
- (70-120)
- (30-70)
- (15-30)
- (6-30)
About 90% of myelinated A fibers are:
Delta A fibers
What is the diameter and conduction of velocity of unmyelinated C fibers?
diameter: 0.4-1.0 um
velocity: 0.5-2.0 m/sec
- relatively low stimulation threshold
- quicker response
A- fibers
Pain characteristics of sharp & pricking are those of:
A- fibers
- relative high stimulation threshold
- slow in onset (late)
C-fibers
Pain characteristics of dull, aching and more diffuse less bearable pain are those of:
C-fibers
Associated with early sharp pain (think ACUTE) maybe RP:
A-fibers
Associated with dull, diffuse pulpal pain (think CHRONIC damage) IP:
C-fibers
Label this image:
A: sclerosis
B: dead tracts
C: tertiary dentin by fibroblasts
Anything that causes movement of the fluid within the dentinal tubules causes pain in the pulp:
Branstromm’s “Hydrodynamic Theory”
What theory is accepted as the basis of dentinal sensitivity?
Branstromm’s “Hydrodynamic Theory”
Common etiologies of pulp irritation include: (4)
- microbiological
- mechanical
- chemical
- trauma
The pulp is amazingly resilient if covered by:
at least 0.5mm of healthy dentin
Reasonable pulpal trauma can be survived if bacteria are:
minimized or eliminated
Many etiologies of pulpal damage are:
Iatrogenic
What can be seen in this image? What is the significance?
Pulp Polyp (hyperplastic pulpitis)
Doesn’t Hurt- can’t heal
Trauma to the pulp can be both:
external & internal
Label the following images:
Image 1: Young pulp
A: primary dentin
B: pulp
C: cementum
Image 2: Aged pulp
A: primary dentin
B: pulp
C: secondary dentin
D: cementum
____ dentin reduces the general size of the pulp but retains the general form as the tooth matures:
secondary dentin
Compared to young pulp, what is additionally present in aged pulp?
Secondary dentin
How is secondary dentin arranged?
uniformly
Calcific metamorphosis is also known as: (2)
- Pulp Sclerosis
- Dystrophic Calcification
Probably a combination of secondary and tertiary dentin formation in response to extensive and chronic injuries before the pulp become necrotic:
Calcific metamorphosis
Calcific metamorphosis is probably a combination of ____ formation in response to extensive and chronic injuries before the pulp became necrotic (no deposition unless the pulp is vital):
secondary & tertiary dentin
Calcific Metamorphosis will not occur unless:
the pulp is vital
Remember: The FUNCTION of ____ is to create tooth
odontoblasts
The deposition of primary dentin occurs during the:
development of the root in a young patient (6-9 years old)
May also be called pulp sclerosis or dystrophic calcification:
calcific metamorphosis
Typically when calcific metamorphosis is observed , what should you do as a provider?
refer
The #1 cause of pulpal injury is of ____ origin.
The #1 threat to health of the dental pulp is:
microbiological
dental caries
_____ exposed pulps of germ free and convention rats to their own flora. The gnotobiotic rats did not develop pulpal or periradicular lesions
Kakehashi
Kakehashi exposed pulps of germ free and convention rats to their own flora. What was the outcome of the rats?
They did not develop pulpal or periradicular lesions
(basically he fucked w the pulp but kept that shit CLEAN, and the mice were okay)
Size of bacteria compared to the size of tubules:
bacteria: 0.2-5um
tubules: 50um
List some common portals of access for microbiological irritants: (6)
- cracked or fractured tooth
- cemental defect @ CEJ
- open dental tubules
- perio invasion into apex
- pulpal invasion in P/A
- lateral or accessory canals
One of the most common causes of microbiological irritants gaining a portal of access into the pulp is:
caries/leaking restoration
The central goal of RCT obturation is to:
Seal ALL portals of access (entry or exit)
Most operative procedures are accompanied by significant opportunity for ___ and ____ to the pulp.
iatrogenic and irreversible damage
Cutting with insufficient coolant causes: (3)
- aspiration of odontoblasts into tubules
- “cooking of pulp in its own juices”
- ultimately “pulpal necrosis”
Pulpal necrosis can occur at what temperature (when cutting with insufficient coolant):
10 degrees celcius
Excessive air drying of exposed dentin:
aspiration
List some common mechanical irritants of the pulp (4):
- aspiration (air drying excessively)
- desiccants (alcohol, chloroform, Cavit, etc.)
- polishing
- use of laser
______ is deposited over time in the immediate area of the injury by fibroblasts in an attempt to repair, protect or insulate the pulp from further injury
Tertiary (Reparative dentin)
Tertiary dentin may also be called:
reparative dentin
Where is tertiary dentin deposited and by what?
in the immediate area of injury, by fibroblasts
Tertiary dentin attempts to:
- repair
- protect
- insulate
When tertiary dentin is deposited, the general form of the pulp is:
altered
Common causes of external trauma to the pulp include:
falls & sports accidents
Common causes of internal trauma to the pulp include:
Para-normal habits (bruxism)
Application of any irritating or toxic element to the pulp or dentinal tubules may cause:
pulpal injury
List some examples of irritating or toxic elements commonly used that may cause pulpal injury: (4)
- Direct or indirect pulp cap (CaOH has a pH of 12)
- Disinfecting agents
- Acidic preparations
- Composites
