Pulp E Flashcards
List the types of pulp dentin insults.
- microbial
- traumatic
- Iatrogenic
- chemical
- others
What is the main cause of pulp pathosis?
- bacteria -> travels readily within dentinal tubules and toxins pass through dentin ahead of bacteria themselves
- direct exposure to bacteria is NOT a pre-requisite for pulp pathosis
- pulp inflammatory response is to the toxin and not the bacteria itself.
What are the routes of bacterial infection?
- caries
- dental anomalies: dens invaginatus & deep palatal grooves
- cracks
- marginal breakdowns of restorations
- fractures - tooth, restoration
- trauman - luxation
- periodontal disease - exposed lateral canals, damaged cementum.
Explain the process of forming caries
- periods of activity alternating with periods of quiescence
- progress quickly through demineralised enamel
- progress slowly in dentine
How does bacterial toxins cause pulp inflammation?
- Released or formed on the death of bacteria
- Diffuse along dentinal tubules
- Rate determined by:
a) Variation in composition & thickness of enamel/dentine
b) Patency of dentinal tubules
c) Outward flow of dentinal fluid
What types of bacterial toxins exists?
A) Acids
B) Proteinases
- both dissolve/digest enamel & dentine
C) Lipopolysaccharide (LPS)
- Endotoxin
- Breakdown of the walls of Gram -ve bacteria
- Primary toxin in carious lesion
D) Lipotechoic acid LTA
- Breakdown of walls of Gram +ve bacteria
What types of trauma can occur to teeth?
1) Accidental
- cracks/ fractures
- concussion
- luxation
- avulsion
- traumatic occlusion
2) Physiological
- attrition (grinding)
- abrasion
- traumatic occlusion
Lists types of iatrogenic dental insults.
1) Cavity preparation
- heat, dehydration, deep cavity, pulp exposure
2) Restoration procedures
- insertion, cementing, polishing
3) Prosthetic manipulation
- fixed & removable prosthodontics
4) Orthodontics
- tooth movement
5) Radiation
6) GA, LA
- trauma
7) Surgery
8) Smoking
- reduced blood flow
List types of chemical dental insults.
1) Restorative materials
- Material toxicity
2) Erosion
- Various acids, foods, bulimia
How does ageing affect dentition?
- reduces arteriole & venules
- terminal capillary network are less pronounced.
What disease can affect dentition?
- sickle cell anaemia
- hereditary hypophosphataemia
What is the pulp & dentine’s response to insults?
1) Innate immunity
2) Adaptive immunity
3) Local modifying factors
4) Deposition of calcified barrier
What types of dentin is deposited in response to insults?
- Dentine response -> deposition of calcified barrier
1) Dentine sclerosis: - Occlusion of tubules
- Increased collagen deposition by OB process
2) Tertiary dentine: - Odontoblast survives – reactionary dentine
- Odontoblast dies – reparative dentine
- Dentine bridge at site of pulp exposure
3) Radiopacities: - Within demineralised dentine
- Rim of hypermineralised dentine towards pulp
What factors affect dentine’s response to injury?
1) Extent & duration of stimulus
- Attrition: low progressing/gentle insult
- Cavity preparation: immediate crisis
2) Dentine permeability
3) Age of tooth
- Dentine forms throughout life
- Smaller chamber
- Decreased cellularity
- Increased collagens
- Diminished neurovascular supply
4) Immune response
