Pulpal Pathophysiology Flashcards
susceptibility of the pulp to irreversible injury
yes
- low compliance system
- poor collateral circulation
- pulpal degeneration
- abundant oral bacteria
pulpal response to a carious lesion why?
direct communicaton between dentin and the pulp
pulp reacts to carie before it is infected with bacteria
pulp reacts to carie before it is infected with bacteria?
yes because of
- bacterial products
- endotoxins
- immune complexes
slcerotic dentin?
a response to a carious lesion
- peri-tubular dentin
- highly mieralized
- initial defense against a low grade lesion
initial defense against a low grade lesion?
scleortic dentin
describe dead tracts
Acute carious lesion
death of odontoblasts
loss of odontoblastic processes
open pathway for infection of pulp by oral bacteria
describe reparative dentin
Tertiary form of dentin
less tubular / more permeable than primary dentin
produced by replacement odontoblasts
‘calciotraumatic line’
‘calciotraumatic line’ represented by?
reparative dentin
initial response is what type in pulpal inflammation?
desscribe what happens
intital response is a chronic one
- lymphocytes / plasma cells/ macrophages
- deposition of collagen
- proliferation of blood vessels
formation of microabscesses?
yes - a pulpal response to inflammation
it is AN ATTEMPT TO WALL OFF INFECTION
Circumferential spread of inflammation?
continued tissue destruction
- continued increase in intra-pulpal pressure
VENULAR COLLAPSE
ISCHEMIC NECORIS
c- fibers may still be vital in necrosis?
Yes
Classificaiotn of Pulpal Pathosis
3
- reversible pulpitis
- ireversible pulpitis
- pulp necrosis
reversible pulpitis
Localized inflammation
localized increase in intra-pulpal pressure
threshold for stimulation of A-delta nerve fibers is lowered
- Hyperalgesia
EXAGGERATED but non-lingering response to stimuli (thermal)
no permanent pulpal damage
hyperalgesia definition
associated with
reversible pulpitis–
EXAGGERATED but non-lingering response to stimuli (thermal)
no permanent pulpal damage
describe irreversible pulpitis
deep throbbing pain, unstimulated pain
circumferential spread of inflammation
threshold for both A-delta and C fibers is lowered
-lingering pain after thermal stimulation
spontaneous, dull, aching pain
IRREVERSIBLE
describe pulp necorsis
COMPELTE NECROSIS OF A-DELTA FIBERS
- no response to vitality tests
C-fibers may still be viable
may or may not be symptomatic
Periradicular tissue
describe
Direct communication with pulp tissue
inflammation ersponse precedes infection
collateral ciculation presnt
cancellous bone allows for drainage of edematous fluids
proprioceptive fibers present
calciotraumatic line from?
reparative dentin
intitial defense against low grade carious lesion
sclerotic dentin
- highly mineralized
what is the major way bacteria can go through after an acute carious lesion?
dead tract – loss of odontoblastic processes and death of odontoblast
describe tertiary dentin in terms of permeability and tubules?
Less tubular and more permeable than primary dentin
describe the pulp in an acute inflammatory reaction
vascular changes – vasodilation and increased permeability
- PMNs and leukocytes
- increased intrapulpal fluid (edea)
- increased intrapulpal pressure
- stimulation of C fibers
hyperalgesia represents?
reversible pulpitis
when threshold for stimualtion of A delta nerve fibers is lowered
- hyperalgesia
circumferential spread of inflammation is represented by?
irreversible pulpitits
collateral circulation present where?
in the peri-radicular areas – NOT PULPAL
Implication of cancellous bone in peri-radicualr tissues
allows for drainage of edematous fluids
main two reasons we see symptomatic apical perio and main feature
- pulpal pathosis
- occlusal trauma
PERCUSSION / PALPATION SENSITIVE
radiographic ferature in apical perio
widened PDL - break in lamina dura
Feature of acute apical abscess
SWELLING
Radiolucency associated with Asympotmatic apical perio? describe
yes – peri-radicular granuloma or cyst
describe periradicualr granuloma
granulomatous tissue
- macriphage, lymphocytes, plasma cells
- fibrous tissue capsule
- increased vascularity
bay cyst vs true cyst
bay cyst –> opening in the lining - opening in the canal to the apex
true cyst – completely lined with epithelium
lumen may / may not communicate with apical foramen
- if it does – bay cyst – of if does not – true cyst
describe peri-radicular cyst
associated with AAP
- stimulation of epithelial rests of Malassez within in the granuloma
3D epithelial lined cavity filled with fluid
lumen may/ may not communicate with apical foramen
radiographic feature of focal scelorosing osteomyeltits
histologically?
increased bone density/ trabeculation
histologically
- mild inflammatory response with increased bone deposition
it is a response to low grade pulpal inflammation
