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Endo > physiology > Flashcards

physiology Flashcards

1
Q

Percentage of A and C fibers in the dental pulp. Difference between them.

A

20% A fibers: myelinated

80% C fibers: unmyelinated, do not fire til injury

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2
Q

Two different kinds of A fibers:

A 
A delta (90%)
A beta (10%)
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3
Q

What is dentin, by weight?

A

70% inorganic, 20% organic, 10%water

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4
Q

Main inorganic component of dentin?

A

calcium hydroxyapatite

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5
Q

Most common type of collagen in dentin?

A

type 1 collagen (there’s a minor component of type V)

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6
Q

Types of dentin and descriptions:

A

Primary (before tooth eruption): Regular in structure, dentin tubules are S-shaped, the majority of dentin in a tooth.
Secondary: After eruption, less structured, deposited for rest of tooth’s life at slow rate
Tertiary: Deposited as a result of a pathologic process-disorganized in structure

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7
Q

What is mantle dentin? Where is it?

A

The first layer of primary dentin to be deposited. It’s adjacent to the enamel in a crown. Less mineralized (softer). 150 micrometers thick

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8
Q

What dentin constitutes the major part of primary and secondary dentin?

A

Circumpulpal dentin.

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9
Q

What is predentin?
How thick is it?
Where is it?

A

15-20 micrometer unmineralized organic matrix layer of dentin situated between the odontoblast layer and the mineralized dentin.

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10
Q

What type of collagen is in predentin?

A

Types 1 and 2

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11
Q

Is dentin permeability higher or lower near the pulp?Why?

A

Higher near the pulp, because the tubules occupy a greater percentage of the space (larger tubules).

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12
Q

What is intertubular dentin?

A

Located between the dentin tubules and constitutes the bulk of dentin. Has lots of collagen.

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13
Q

What is intratubular dentin?

A

Dentin lining the walls of tubules (also called peritubular). Fewer collagen fibrils, more sulfated proteoglycans and mineral.

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14
Q

Which dentin is more easily dissolved by etch and why?

A

Peritubular (intratubular)-more mineral and less collagen. So when etch or EDTA is used, the peritubular dentin is removed and the tubules are enlarged.

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15
Q

Is radicular dentin more or less permeable than coronal dentin? Why?

A

Radicular dentin is much less permeable, due to a decrease in the density of dental tubules (42,000/mm2 in cervical dentin, and 8000/mm2 in radicular dentin)

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16
Q

Who said the functional diameter of tubules is only about 5-10% of the actual anatomic diameter b/c of odontoblast processes, collagen fibers etc.?

A

Michelich 1978

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17
Q

Michelich 1978

Dentin tubules?

A

the functional diameter of tubules is only about 5-10% of the actual anatomic diameter b/c of odontoblast processes, collagen fibers etc.

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18
Q

Who said an inflammatory reaction develops in the pulp long before the pulp actually becomes infected with microorganisms?

A

Trowbridge 1978

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19
Q

What is the outermost stratum of cells in a healthy pulp? What does it lie beneath?

A

The odontoblast layer. Lies beneath the predentin.

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20
Q

What lies right below the odontoblast layer?

A

The cell poor zone (cell free layer of Weil). Has lots of capillaries, unmyelinated nerve fibers, and cytoplasmic processes of fibroblasts.

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21
Q

What lies beneath the cell poor zone?

A

The cell rich zone (lots of fibroblasts, and also immune cells like macrophages and dendritic cells, and also undifferentiated mesenchymal stem cells)

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22
Q

Primary purpose of the pulp?

A

To grow the tooth–odontoblasts form dentin–most important function!

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23
Q

What is dentin primarily composed of? What is its primary function?

A

Fibroblasts, odontoblasts

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24
Q

What immune cell is present in the highest number in the pulp?

A

Dendritic cells (8%) (Antigen Presenting cells)

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25
Q

How are c fibers different from A fibers?

A

C fibers produce a dull aching pain, and have a higher threshold of excitation.

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26
Q

Pain pathway for a mandibular molar (three nerves and where they end?

A

Inferior alveolar nerve – trigeminal nucleus
Secondary nerve–thalamus
Tertiary nerve–cortex

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27
Q

Arterial blood supply for all teeth:

A 
r. atrium, r. ventricle, pulpmonary a., l. atrium, l. ventricle, aorta, common carotid, external carotid, maxillary artery then...
max post: pterygopalatine, PSA
max ant: pterygopalatine, PSA, ASA
mand post: mand a., IA a.
mand ant. mand a., IA a., incisive a.
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28
Q

Venous blood supply for all teeth

A

maxillary v., pterygoid venous plexus, retromandibular v., internal jugular v., brachiocephalic v., superior vena cava, heart
all mand: IA v., then above
max ant: infraorbital, then above
max post: above

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29
Q

Nerve supply to teeth

A

Brain stem- trigeminal nerve-
max teeth: V2-PSA-MSA-ASA
mand teeth: V3-IAN-incisive brances

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30
Q

What three spaces are involved in Ludwig’s Angina?

A

Submental, submandibular, sublingual

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31
Q

Why is Ludwigs angina so dangerous

A

Life threatening cellulitis which can advance to pharyngeal and cervical spaces–airway obstruction

32
Q

Difference between sublingual, submental and submandibular space infections?

A

All break through lingual plate
Above mylohyoid: sublingual
Ant below mylohyoid: submental
Post below mylohyoid: submandibular

33
Q

For a buccal vestibule infection, the MAND apices must lie above the?

A

buccinator or mentalis muscle attachment

34
Q

Laskin-which way do apices of teeth point?

A

Usually facial, except max laterals (50%) and mand molars (1st ?, 2nd 50%, 3rd usually)

35
Q

For a buccal vestibule infection, the MAX apices must lie below the?

A

buccinator muscle attachment

36
Q

For a buccal space infection where must apices lie?

A

max-above the buccinator, mans-below the buccinator

37
Q

Difference between buccal vestibule infection and buccal space infection?

A

buccinator muscle attachment (for a space infection, max teeth must be above it, and mand teeth below it)

38
Q

What is infection around the eye called?

A

Periorbital (spread from canine or buccal space infections)

39
Q

Why are infections of the mid face dangerous?

A

Cavernous sinus thrombosis

40
Q

Do cysts heal following NSRCT? Says whom?

A

Pocket cysts, yes. True cysts less likely. Nair

41
Q

What is the difference between a true cyst and pocket cyst. Who defined them?

A

True cyst: completely enclosed by epithelial lining. Bay/pocket cyst: lined with epithelium, but communicates with root canal
Simon

42
Q

Eliasson 1984- condensing osteitis?

A

73% of condensing osteitis healed completely with NSRCT, it did not progress in any cases.

43
Q

Who showed that 73% of condensing osteitis healed completely with NSRCT, it did not progress in any cases?

A

Eliasson 1984

44
Q

Bone is resorbed by osteoclasts. What are the two signaling molecules that act on the osteoclasts and osteoblasts to regulate the amount of bone to be resorbed?

A

RANKL: stimulates osteoclast formation
OPG: inihibits osteoclas formation

45
Q

What is the dental papilla? What type of cells is it made of?

A

The tissue inside the “bell” that becomes the pulp. Ectomesenchymal cells from the dental papilla mingled with local mesenchymal cells.

46
Q

Mesenchymal cells become…

A

the dental papilla

47
Q

What is the dental lamina made of?

A

Epithelial cells (it invaginates from the oral epithelium). Bud–> Cap –> Bell

48
Q

The inner layer of the enamel organ (the internal dental epithelium) differentiates into what?

A

ameloblasts

49
Q

what controls how much enamel and dentin get laid down?

A

The interactions between the ectomesenchymal cells and the epithelial cells

50
Q

first layer of dentin to be laid down?

A

The mantle dentin

51
Q

What is Hertwig’s epithelial root sheath made of?

A

The meeting of two fused epithelial layers (inner dental epithelia and outer dental epithelia)

52
Q

How do multiple roots form?

A

Hertwig’s epithelial root sheath proliferates not just in a vertical direction, but a horizontal direction.

53
Q

What does the hyaline layer of Hopewell-Smith do?

A

binds newly formed cementum to dentin

54
Q

What causes radicular cysts?

A

The remnants of Hertwig’s Epithelial Root Sheath stay in the PDL (called the epithelial Rests of Malassez) sometimes proliferate with inflammation and give rise to radicular cysts

55
Q

How does cementum form

A

Once the root sheath breaks down, the mesenchymal cells of the follicle differentiate into cementoblasts that lay down cementum on top of the hyaline layer

56
Q

What are Sharpey’s fibers?

A

Bundles of collagen laid down by mesenchymal cells of the follicle that have differentiated into fibroblasts.

57
Q

What do Sharpey’s fibers do?

A

Become embedded in the forming cementum and become the principal fibers of the PDL.

58
Q

Five functions of dental pulp?

A
  1. Induction of enamel formation
  2. Lay down dentin
  3. nutrition
  4. defense (lay down tertiary dentin)
  5. sensation
59
Q

Shape and configuration of odontoblasts?

A

Single layer of columnar cells.

60
Q

what two molecules stimulate undifferentiated mesenchymal stem cells to differentiate into odontoblasts

A 
BMP (bone morphogenic protein)
TGF beta (Transforming growth factor beta)
61
Q

What is the most common cell type in the pulp?

A

Fibroblasts

62
Q

Largest blood vessels in the pulp:

A

Arterioles, venules (slightly bigger)

63
Q

Arterioles in pulp are branches of what three arteries?

A

Inferior alveolar artery
superior posterior alveolar artery
infraorbital artery

64
Q

Venules in pulp drain what two ways?

A

Into maxillary vein thru pterygoid plexus

anteriorly into facial vein

65
Q

Where do lymphatics of pulp drain?

A

Into submental, submandibular, or cervical before emptying into subclavian and internal jugular veins

66
Q

What is harder, cementum or bone?

A

cementum

67
Q

Who said that necrosis extends gradually from upper portion of pulp to apical portions?

A

Yamasaki

68
Q

Current data suggests that what is responsible for increased blood flow in pulpal inflammation?

A

CGRP

69
Q

What do kinins do?

A

Cause many signs and symptoms of acute inflammation

70
Q

What kind of pulps have Mast cells?

A

Inflamed pulps (they are no present in healthy pulps)

71
Q

Difference between a cyst and granuloma?

A

A cyst is lined by stratified squamous epithelium, surrounded by connective tissue

72
Q

What is condensing osteitis often confused with?

A

Enostatsis (sclerotic bone in the posterior mandible that is a non-pathologic entity)

73
Q

Dendritic cells make up what percentage of the pulp?

A

8%

74
Q

fastest conducting nerve fibers in the pulp?

A

A beta

75
Q

what is CRP? What is it produced in response to?

A

C-reactive protein, produced in response to IL-6, and prototype component of acute-phase proteins.

Endo (20 decks)

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