Pulp I Flashcards
1
Q
Origin of the pulp?
A
Ectomesenchymal from the dental pailla
2
Q
What is the pulp?
A
Lax connective tissue surrounded by dentin
3
Q
What are the 2 areas of pulp?
A
- Cameral pulp
- Radicular pulp
4
Q
What do you find in the pulp? (5)
A
- Fibroblasts and defensive cells (macrophages, eosinophils…)
- Odontoblasts
- Intercellular substance
- Fibers
- Ectomesenchymal cells
5
Q
Pulp histology: 4 different areas. From the outer surface towards the core we find…
A
- Odontoblastic zone in the periphery
- Cell-free zone of Weil
- Cell-rich zone
- Deep pulp cavity or Central zone
6
Q
Most external area of pulp?
A
Odontoblastic zone in periphery
7
Q
Where is the odontoblsatic zone located?
A
Immediately underneath the dentin
8
Q
What is the odontoblastic zone composed of? (3)
A
- Body of the odontoblasts
- Blood capillaries
- Nervous fibers
9
Q
Where is the cell-free zone of weil in the pulp located?
A
very narrow area under the odontoblasts
10
Q
Characteristics of the cell-free zone of weil? (4)
A
- Relatively free of cells
- Crossed by blood vessels, amyelinic nervous fibers and thin fibroblast processes
11
Q
Pulp: Cell-free zone of Weil may not be clear in: (2)
A
- Young pulps that form quickly dentin
* Old pulps that produce reparative dentin
12
Q
Where is the cell-rich zone of the pulp?
A
at the subodontoblastic area
13
Q
The cell-rich zone of the pulp presents?
A
High levels of fibroblasts
14
Q
The cell-rich zone of the pulp includes? (3)
A
- macrophages
- lymphocytes
- plasmatic cells
15
Q
The cell-rich zone of the pulp formed as a result of?
A
Peripheral migration of the cells that reach the central
areas of the pulp. It starts at the moment of the
dental eruption
16
Q
The deep pulp cavity or central zone of the pulp is where what has the bigger diameter? (2)
A
Nervous fibers and blood vessels
17
Q
The deep pulp cavity or central zone of the pulp is a system of connective tissue formed by…?
A
Fibroblasts that create the fundamental matrix
(collagen and reticulin), that is a basis to fibrous
complex
18
Q
Pulp properly said? (whatever that means)
A
Deep pulp cavity or central zone
19
Q
Functions of the pulp? (4)
A
- Formation of the dentin
- Nutrition
- Sensorial
- Defensive
20
Q
Formation of dentin occurs _____ ? what does it produce? (2)
A
- continuously
- modifications in pulp chamber and canals
21
Q
Dentin formation in primary vs permanent dentition?
A
More intense process in primary dentition than in permanent
22
Q
What happens when there is aggression in young permanent dentition?
A
Acceleration of the dentin
production and of the closure of the apical foramen
23
Q
What happens when there is aggression in primary dentition?
A
Accelerates the root reabsorption
24
Q
What are the types of dentin? (2)
A
Physiological and non-physiological
25
What are the types of physiological dentin?
* Primary dentin
| * Secondary dentin
26
What are the types of non-physiological dentin? (3)
* Esclerotic dentin
* Tertiary dentin
* Reparative dentin
27
What is primary dentin? (3)
- Physiological dentin
- extends from limit with the enamel or cement
- includes all the formation of the tooth (first crown then the root)
28
What is secondary dentin? (3)
- physiological dentin
- After tooth is formed, deposit of dentin the rest of the life
- Pulp chamber and root canals decrease in size
29
Which physiologic dentin has a slower deposit?
Secondary dentin
30
Secondary dentin has the same structure as ....
Primary dentine but LESS MINERALIZED
31
What is sclerotic dentin? (4)
- Non-physiological dentin
| - Mild stimuli on the dentin
32
Mechanism of action of sclerotic dentin?
- The odontoblasts become shorter, leaving free the dentine tubules
- This dentin tubules will become mineralized forming peritubular dentin
33
Sclerotic dentin forms _____?
Peritubular dentin
34
Aim with sclerotic dentin and caries?
The aim is to try to slow down the advance of the caries by decreasing the permeability of the dentin
35
What is tertiary dentin?
- Non-physiological dentin
- Reactive
- created as a response to moderate external aggressions that don't destroy the odontoblastic barrier
36
External aggressions that don't destroy the odontoblastic barrier? (2)
- slow advance of caries
| - abrasions
37
Formation of tertiary dentin? (3)
- fast
- disorganized
- deforming the shape of the pulp chamber
38
What is reparative dentin? (3)
- Severe aggression with odontoblastic destruction
- The undifferentiated mesenchematic cells replace the lost odontoblasts, forming a dentin barrier that
deforms the pulp chamber.
- The neodentin has an irregular shape, with a mínimum quantity of dentin tubules (atubular characteristic)
39
Apart from creating non-physiological dentin, the pulp presents...
inflammatory and
| immunological reactions as a defense system against aggressions
40
Do primary or permanent teeth pulp respond faster to the dental caries?
Primary
41
Before the appearance of inflammatory changes of the pulp there is ...
a general reduction
| of it and the quantity of odontoblasts
42
What is young pulp?
Rich in cells and poor in fundamental matrix
43
What is old pulp?
It increases the number of fibers and decreases the number of cells
44
How does young pulp change into old pulp? (3)
- time + mastication
- The higher the number of
aggressions, the faster the
change.
- Higher capacity of response in a Young tooth
45
How many stages of pulp evolution exist?
3
46
First stage of pulp evolution?
Since eruption to complete formation of the root: Higher vascularization and big
activity of dentinogenesis
47
Second stage of pulp evolution?
Since the root is complete to the beginning of root reabsorption: Pulp
characteristics similar to those onYoung permanent eeth, good reparative capacity.
48
Third stage of pulp evolution?
Since root reabsorption starts: The pulp becomes old and there is a decrease of the
reparative capacity.
49
To do a correct diagnosis and treatment plan, we have to consider: (3)
1. General factors
2. Regional factors
3. Local factors
50
Diagnosis of pulp pathology: In immature, non-collaborative children with long treatments
(That need sedation or general anesthesia) ....
extractions may be
| considered (specially in medically compromised patients).
51
Diagnosis of pulp pathology: In what types of patients is the chosen treatment extraction + antibiotc coverage? (3)
- Congenital cardiopathies, (risk of bacterial endocarditis)
- immunosuppressed patients
(leukemya, idiopathic cyclic neutropenia, transplanted
patients …)
- patients with poor general health
(solid tumors)
52
Diagnosis of pulp pathology: In cases of bleeding and blood clotting alterations ...?
We will try to keep the tooth
| avoiding the risk of an extraction
53
We will only do pulp treatments in children with poor general health after we have done: (3)
* Meticulousstudy of the child and the general state
* Study of the pulp treatment
* Evaluation of the relative importance of keeping the affected tooth
54
Regional factors for diagnosis of pulp pathology? (7)
* Oral condition of the patient.
* Evaluation of the risk factors
* Dental age
* Presence of malocclusions
* Strategic importance of the dental organ in the arch
* Associated phenomenons (cellulitis, adenopathies,…)
* Possibilities to reconstruct the tooth
55
Local factors for diagnosis of pulp pathology? (3)
* History of pain
* Clinical exam
* Radiographic exam
56
Local factors for diagnosis of pulp pathology: history of pain?
- In primary dentition, in many occasions, the pain is due to food impactation, so we have to consider this in our evaluation.
-There is usually no response to painful stimuli
(hot, cold,…)
57
Local factors for diagnosis of pulp pathology: history of pain - Reversible pulpitis?
Pain caused by heat, cold, sweet, mastication or other stimulus that when are
eliminated, the pain disappears or diminishes
58
Local factors for diagnosis of pulp pathology: history of pain - irreversible pulpitis?
Spontaneous, continuous pain that appears in moments of inactivity such as sleep.
59
Local factors for diagnosis of pulp pathology: history of pain - necrosis?
History of various episodes of pain along the time.
60
Local factors for diagnosis of pulp pathology: Clinical exam of the soft tissues? (3)
* Changes on the mucosa color
* Swelling, abscess
* Fistulas
61
Local factors for diagnosis of pulp pathology: dental clinical exam ? (7)
§ Evaluation of the depth and extensión of the caries or trauma
§ Pulp exposures: evaluate the kind and amount of bleeding, the size of the
exposure, and the aspect of the pulp.
§ Polips
§ Possibilities of rubberdamisolation and tooth
recosntruction
§ Dental mobility (differentiate between pathological and
physiological mobility)
§ Sensitivity to percussion and presion.
§ Pulp vitality tests, both termal and electric (Little utility
in primary dentition, they do not have reliable results)
62
Local factors for diagnosis of pulp pathology: radiographic exam? (9)
- Time remaining in the arch of the tooth
- State of the permanent tooth in formation
- Tooth anatomy
- Relationship between the roof and floor of the pulp chamber.
- Depth of the lesion and its proximity to the pulp chamber
- Previous treatments
- Pathological reabsorption: internal and/or external
- Presence of pulpar calculus
- Perforation of the pulp chamber ceiling
- DO NOT confuse normal anatomical
situations with pathological changes. (open ápex)
63
Local factors for diagnosis of pulp pathology: radiographic exam Parulis abscess? (3)
- Typical in primary molars.
- Because of thin pulp chamber floor with accessory conducts makes the interradicular osteolysis more frequent than the periapical.
- If there is pathological root reabsorption or affectation of the permanent tooth follicle, we will extract the primary tooth. If we do not do the extraction, there is risk of hypoplasya of the
permanent tooth or deviation of its eruptive path.
64
What are the 3 pulp conditions?
* Reversible pulpitis
* Irreversible pulpitis
* Necrosis
65
Pain in reversible pulpitis? (2)
- Caused by heat, cold, sweet, mastication or stimuli that when withdrawn, pain decreases or disappears.
- Absence of spontaneous or persitent pain
- No sensitivity to percussion or palpation
66
Mobility in reversible pulpitis?
Absence of pathological mobility
67
Radiographical signs in reversible pulpitis?
Absence of radiographical signs
68
Pulp color/bleeding/histology in reversible pulpitis? (2)
- Pulp with red color and controlable bleeding
| - Histologically it corresponds to a chronic pulpitis of the cameral pulp (partial chronic pupitis)
69
Pain in irreversible pulpitis?
* Persistant and spontaneous pain
| * Hypersensitivity to percussion and palpation
70
Mobility in irreversible pulpitis?
Absence of pathological mobility
71
Radiographical signs in irreversible pulpitis?
Absence of radiographical signs
72
Pulp color/bleeding/histology in irreversible pulpitis? (2)
• Pulp with dark red color and abundant bleeding
• Histologically it corresponds to a complete chronic pulpitis (both cameral and radicular
pulp are affected)
73
Pain in pulp necrosis?
History of several episodes of pain repeated through time
74
Clear signs of pulp degeneration?
abscess, fistulas
75
Radiographical lesions in pulp necrosis?
Clear radiographical lesions.
76
Mobility in pulp necrosis?
Pathological mobility
77
Pulp bleeding / smell in pulp necrosis?
* Absence of pulp bleeding.
| * Possible bad smell
78
EVOLUTION OF THE PULP CONDITION AGAINST AND EXTERNAL AGGRESSION THAT
IS NOT TREATED?
1. Aggression
2. Formation of non-physiological dentin
3. Pulpar inflammation
4. Reversible pulpitis (chronic partial pulpitis)
5. Irreversible pulpitis (total chronic pulpitis)
6. Necrosis
