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2 - Oral Biology (Head And Neck Anatomy) > Pulp Morphology > Flashcards

Pulp Morphology Flashcards

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1
Q

What tissue is the pulp?

A

Connective tissue

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2
Q

What cells are present in the pulp?

A

Odontoblasts, fibroblasts, defence cells

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3
Q

What are the extra cellular components (fibres/matrix) of the pulp that make up the ECM?

A

Fibres - oxytalan, collagen
Matrix - proteoglycans, chondroitin SO4, dermatan SO4

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4
Q

What is present in the pulp?

A

Cells
Extracellular components
Nerves (autonomic (sympathetic))
Lymphatics
Blood vessels

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5
Q

Where does pulp open up to the external environment?

A

At the apex of the root

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6
Q

What is non-mineralised dentine called?

A

Pre-dentine

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7
Q

What type of dentine is closest to the pulp?

A

Pre-dentine

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8
Q

What are the functions of the pulp?

A

Nutrition (blood vessels)
Dentine growth (primary/secondary)
Dentine repair (tertiary)
Defence (immune cells, lymphatics)
Neural (sensory-pain, control of dentinogenesis)

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9
Q

What are the type of links between dentine and pulp?

A

Developmental
Structural
Functional

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10
Q

What are the developmental links between dentine and pulp?

A

Both dentine and pulp develop from the dental papilla which originates from ectomesenchyme cells

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11
Q

What are the structural links between dentine and pulp?

A

Elements from the pulp extend into dentine such as:
Odontoblast processes
Nerve terminals
Immune cells (dendritic cells)
Dentinal fluid

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12
Q

What is never found in normal dentine?

A

Blood vessels

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13
Q

Where is the origin of fluid in the pulp from?

A

Fluid leaks from the pulp blood capillaries into the interstitial space

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14
Q

What are the systems that controls the flow of fluid within vessels?

A

Haemodynamics
Hydrodynamics

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15
Q

Where does the fluid in the interstitial space go?

A

Some drained by lymphatics in the pulp
Some passes along the dentinal tubules (dentinal fluid)

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16
Q

What is the flow of the fluid proportional to?

A

Proportional to the pressure inside the pulp

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17
Q

What are the functional links between dentine and pulp?

A

Formation of secondary dentine
Formation of tertiary dentine in response to trauma
Exchange of material between the pulp and dentine

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18
Q

What are the types of tertiary dentine?

A

Reactionary dentine
Reparative dentine

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19
Q

What is the difference between the two types of tertiary dentine?

A

Reactionary dentine is laid down in response to mild stimulus by primary odontoblasts

Reparative dentine is laid down - in response to intense stimulus that destroys the primary odontoblasts - by secondary odontoblasts

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20
Q

Which type of dentine is formed slower?

A

Secondary throughout life

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21
Q

What can cause tooth wear?

A

Mastication (abrasion)
Bruxism (attrition)
Abfraction (caused by occlusal overload)
Diet (erosion)
Operative procedures (cavity cutting, crown preparation)

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22
Q

Where does abfraction cause tooth-wear?

A

Fractures in the cervical region of enamel

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23
Q

Besides producing dentine, what do odontoblasts form?

A

A permeable barrier between pulp and dentinal tubules - to regulate exchange of materials between pulp and tubular extracellular fluid

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24
Q

How does the movement occur between the pulp and dentinal tubules?

A

In both directions

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25
Q

What does the pulp pass to the dentine?

A

Nutrients (to sustain cells)
Formation of secondary and tertiary dentine (mineralisation)
Ions for nerve terminals (K+, Na+)

26
Q

What does the dentine pass to the pulp?

A

Medicaments applied to dentine (for treatment)
Toxins from bacteria, and components of filling materials

27
Q

What cranial nerve supplies the teeth?

A

Trigeminal 5

28
Q

Where do the alveolar nerves come from and where do they enter?

A

Branches of the alveolar nerves come from the maxillary and mandibular branches of the trigeminal. They enter the pulp of the tooth via the apical foramen

29
Q

How do the alveolar nerves pass?

A

Via the root canal in the centre of the pulp towards the coronal pulp chamber

30
Q

Where do the alveolar nerves fan out?

A

Fan out in the sub-odontoblastic layer and form the plexus of raschow

31
Q

What plexus do the branches of the alveolar nerves form?

A

Plexus of Raschow

32
Q

After the plexus, where do the branches enter?

A

Terminal branches enter the odontoblast layer and some will enter the dentinal tubules

33
Q

How many tubules contain nerves under the cusp?

A

40%

34
Q

How long can the axons extend? (Circa)

A

100-200 micrometers

35
Q

What percentage of coronal dentine is tubularly innervated?

A

15%

36
Q

What percentage of root dentine is tubularly innervated?

A

4%

37
Q

Where do most axons end up?

A

Pulp-predentine region

38
Q

What are the types of possible stimulus that can affect dentine and therefore the pulp?

A

Thermal
Mechanical
Evaporative
Chemical

39
Q

What are the steps of the hydrodynamic mechanism? (For activating interdental sensory nerves)

A

Stimulus applied to open tubules (exposed dentine)

Rate of dentinal fluid flow increased

Generation of AP in intra-dentinal nerves

APs passed to brain and cause pain

40
Q

What type of stimulus produces an outward flow of dentinal fluid?

A

decreased hydrostatic pressure

cooling, drying, evaporation, hypertonic solutions

41
Q

What type of stimulus produces an inward flow of dentinal fluid?

A

increased hydrostatic pressure

heating, mechanical

42
Q

What direction of flow causes a greater neural stimulus?

A

Outwards (away from the pulp)

43
Q

What stimuli bypass the hydrodynamic mechanism and have a direct effect on intradental nerves?

A

Intense heating/ cooling
Electrical current
Pain-producing chemicals

44
Q

What iatrogenic factor can cause dentinal pain and how?

A

High fillings
Distorted by occlusal forces therefore generating pressure to alter flow of fluid

45
Q

What nerve fibres are responsible for normal dentinal sensitivity?

A

A-beta and A-delta myelinated fibres

46
Q

What are these fibres activated by? (normal dentinal sensitivity)

A

Activated by hydrodynamic stimuli applied to dentine

47
Q

What are the type of fibres that mediate pain associated with pain inflammation?

A

C fibres (unmyelinated)

48
Q

What are c-fibres activated by?

A

By direct intense stimuli, rather than hydrodynamic mechanism

49
Q

Where does blood supply of the teeth come from?

A

Branches of the maxillary artery

50
Q

What does cavity preparation without cooling increase?

A

Inflammation therefore vascular permeability (increased hydrodynamic mechanism)

51
Q

What is the methods of control of pulp blood flow?

A

Local factors (metabolites)
Nerves (sympathetic, somatic afferents peptidergic - release peptides while receiving stimulation)
Circulating hormones (adrenaline)
Drugs (vasoconstrictors in LA)

52
Q

What is the function of pulp nerves?

A

Sensory - mediates pain
Control of blood vessels
Promote neurogenic inflammation -neuropeptides, subst P, CGRP
Promote dentine formation
(MAYBE) Facilitate immune response

53
Q

How does the neurogenic effect of inflammation occur?

A

Afferent sensorial fibres are stimulated by changes in fluid flow (hydrodynamic),
Triggers axon reflex which releases vasoactive peptides (substance P and CGRP)
Peptides promote vasodilation and vascular permeability which increase pulp tissue pressure
The pressure further increases tubular fluid flow

54
Q

What are the pulp responses to injury from immediate to 10 minutes?

A

Immediate - nociceptor activation (pain)
After 1 minute - early inflammatory response
After 10 minutes - nociceptor sensitisation (increased activity)

55
Q

What happens in the early inflammatory response (1 minute)?

A

Kinins, prostaglandins, neuropeptides,
Vasodilation

56
Q

What happens during nociceptor sensitisation (10 minutes)?

A

Extravasating of fluid (Oedema)
Polymorphonuclear cell migration (leukocytes)

57
Q

What happens after 100 minutes?

A

Enzyme activation (nerve growth factor, initial phases of dentinogenesis)
Monocyte presence

58
Q

What happens after 24 hours?

A

Nerve sprouting (response to growth factor)
Increased axonal transport
Altered excitability of CNS synapses

59
Q

What happens after a week?

A

Repair; tertiary dentine formation through dentinogenesis

60
Q

What happens long term?

A

Variable rate of repair and recovery depending on size of lesion, host response,

61
Q

What is pulpitis?

A

Acute inflammation of the dental pulp

62
Q

Why does pulpitis differ from other inflammation?

A

Pulp cannot swell as it is confined within the pulp chamber which causes increase in pulp pressure. Which has an effect on blood flow and nerve excitability.

2 - Oral Biology (Head And Neck Anatomy) (13 decks)

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