Coronal and radicular pulp
Apical foramen
Accessory canal
Functions of dental pulp
Components of dental pulp
Functions of pulpal extracellular matrix
Organization of cells in the pulp
The principle cells of the pulp
The pathways of collagen synthesis
Matrix and ground substances
Vasculature and lymphatic supply
Innervation of Dentin- pulp complex
Disorders of the dental pulp
Advances in pulp vitality testing
I prepared this presentation during the first year of my MDS. This will give you a basic idea and necessary information about the pulp of the teeth and its histology. Hope you guys find it useful.
I prepared this presentation during the first year of my MDS. This will give you a basic idea and necessary information about the pulp of the teeth and its histology. Hope you guys find it useful.
It is a presentation in detail about the strongest structure of the oral cavity "ENAMEL". It is a simple topic but people find it difficult to learn about it. I hope my presentation is a simple method to learn about it. I would like to thank my professors for assign me this project and i learn't a lot from it and still learning my basics daily.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
https://userupload.net/3ppacneii1wj
Toxicologic Pathology (Second Edition), 2010
INTRODUCTION
The oral mucosa is, in many ways, similar to the skin in its architecture, function, and reaction patterns. This section only emphasizes those characteristics of the oral mucosa that influence or result in a distinct group of pathologic entities.
Because of its location at the entrance of the digestive and respiratory tracts and its proximity to the teeth, the oral mucosa is subjected to numerous natural and man-made xenobiotics. The peculiar architecture and absorption characteristics of the oral mucosa, especially in areas of extreme thinness, coupled with the rich microorganism flora of the mouth, makes the oral mucosa a peculiar site deserving separate discussion.
Radiographic Assessment of the Prevalence of Pulp Stones in Malaysians
Kannan et al.
JOE — Volume 41, Number 3, March 2015
Pulp stones are discrete calcified bodies found in the dental pulp.
They have calcium phosphorous ratios similar to dentin and can be seen in healthy, diseased, or even unerupted teeth
Radiographically, pulp stones appear as radiopaque structures in the pulp space that frequently act as an impediment during endodontic treatment
Amelogenesis is the formation of enamel. During amelogenesis, the ameloblast (enamel-forming cells) undergo various stages i.e the life cycle of ameloblast.
For more content check out my blog: www.rkharitha.wordpress.com "a little about everything dental"
PHYSICAL PROPERTIES
CHEMICAL PROPERTIES
STRUCTURE OF ENAMEL
DEVELOPMENT OF ENAMEL
EPITHELIAL ENAMEL ORGAN
AMELOGENESIS
LIFE CYCLE OF AMELOBLASTS
AGE CHANGES IN ENAMEL
DEFECTS OF AMELOGENESIS
CLINICAL IMPLICATIONS
It is a presentation in detail about the strongest structure of the oral cavity "ENAMEL". It is a simple topic but people find it difficult to learn about it. I hope my presentation is a simple method to learn about it. I would like to thank my professors for assign me this project and i learn't a lot from it and still learning my basics daily.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
https://userupload.net/3ppacneii1wj
Toxicologic Pathology (Second Edition), 2010
INTRODUCTION
The oral mucosa is, in many ways, similar to the skin in its architecture, function, and reaction patterns. This section only emphasizes those characteristics of the oral mucosa that influence or result in a distinct group of pathologic entities.
Because of its location at the entrance of the digestive and respiratory tracts and its proximity to the teeth, the oral mucosa is subjected to numerous natural and man-made xenobiotics. The peculiar architecture and absorption characteristics of the oral mucosa, especially in areas of extreme thinness, coupled with the rich microorganism flora of the mouth, makes the oral mucosa a peculiar site deserving separate discussion.
Radiographic Assessment of the Prevalence of Pulp Stones in Malaysians
Kannan et al.
JOE — Volume 41, Number 3, March 2015
Pulp stones are discrete calcified bodies found in the dental pulp.
They have calcium phosphorous ratios similar to dentin and can be seen in healthy, diseased, or even unerupted teeth
Radiographically, pulp stones appear as radiopaque structures in the pulp space that frequently act as an impediment during endodontic treatment
Amelogenesis is the formation of enamel. During amelogenesis, the ameloblast (enamel-forming cells) undergo various stages i.e the life cycle of ameloblast.
For more content check out my blog: www.rkharitha.wordpress.com "a little about everything dental"
PHYSICAL PROPERTIES
CHEMICAL PROPERTIES
STRUCTURE OF ENAMEL
DEVELOPMENT OF ENAMEL
EPITHELIAL ENAMEL ORGAN
AMELOGENESIS
LIFE CYCLE OF AMELOBLASTS
AGE CHANGES IN ENAMEL
DEFECTS OF AMELOGENESIS
CLINICAL IMPLICATIONS
Dental pulp / rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Dental pulp /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
MSX1 Polymorphism in an Eastern Nepalese Non Syndromic cleft lip/palate patie...Ashok Ayer
This study was carried out to evaluate the role of MSX1 799 G >T gene polymorphism with non Syndromic cleft lip/palate in Eastern Nepalese patient population. For the study, whole blood samples (2 ml) were obtained from 40 subjects and controls. Genomic DNA was extracted from the blood of the subjects by using ethanol, chloroform treatment. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to check for the presence of polymorphism. The results indicated that a patient has MSX1 799 G>T variant. The
patient was a male aged 24 years was a complete unilateral left sided cleft lip/palate involving alveolus, hard and soft palate. He had normal development and no associated anomaly. There was no family history of cleft lip/palate and no history of any teratogenic exposure during embryonic life as revealed by his mother. This may be a case of sporadic polymorphism. It may be concluded that ,although we detected the presence of a MSX1 799 G>T polymorphism in one patient, a further investigation with large sample size, including many SNP’s on families must be performed to get conclusive results.
Salvation of severely fractured anterior tooth: An orthodontic approachAshok Ayer
Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.
Dens evaginatus- a problem based approachAshok Ayer
Dens evaginatus is an uncommon developmental anomaly of human dentition characterized by the presence of tubercle on the occlusal surface of mandibular premolars and lingual surface of anterior teeth.Due to occlusal trauma, this tubercle tends to fracture thus exposing the pathway to the pulp chamber of teeth. This case report is about the presentation of dens evaginatus in mandibular premolars bilaterally; among them, tooth 44 was associated with chronic apical periodontitis. Fractured tubercle of three premolars was sealed with composite resin. Root canal treatment was performed with tooth 44. Routine endodontic treatment did not result in remission of infection.Therefore, culture and sensitivity tests were performed to identify the cause and modify treatment plan accordingly. The triple antibiotic paste was used as an intracanal medicament to disinfect the root canal that resulted in remission of infection.
Microbiology of Endodontic Infection.Mechanisms of MicrobialPathogenicity and Virulence Factors
Biofilm and Community-Based Microbial Pathogenesis
Biofilm and Bacterial Interactions
Biofilm Community Lifestyle
Quorum Sensing—Bacterial Intercommunication
Methods for Microbial Identification
Diversity of the Endodontic Microbiota
Primary Intraradicular Infection
Spatial Distribution of the Microbiota
Microbial Ecology and the Root Canal Ecosystem
Secondary/Persistent Infectionsand Treatment Failure
Operative instruments in Conservative Dentistry & EndodonticsAshok Ayer
Operative Instruments in Endodontics including hand and power driven instruments. Recent advances in instruments in conservative dentistry and endodontics.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Dr. Ashok Ayer
Assistant Professor
Department of Conservative Dentistry & Endodontics
B.P.Koirala Institute of Health Sciences, Dharan, Nepal
2. Contents:
Introduction
Coronal and radicular pulp
Apical foramen
Accessory canal
Functions of dental pulp
Components of dental pulp
Functions of pulpal extracellular matrix
Organization of cells in the pulp
The principle cells of the pulp
The pathways of collagen synthesis
Matrix and ground substances
Vasculature and lymphatic supply
Innervation of Dentin- pulp complex
Disorders of the dental pulp
Advances in pulp vitality testing
Conclusion
3. Dental Pulp
Occupies the center of each tooth.
Soft connective tissue that supports the dentin.
Total 52 pulp organs; 32: Permanent, 20: Primary
Total Volume of all permanent teeth pulp organs is
0.38 cc.
Mean volume of a single adult human pulp is 0.02 cc.
4. Maxillary
(Cubic Centimeter)
Mandibular
(Cubic Centimeter)
Central Incisor 0.012 0.006
Lateral Incisor 0.011 0.007
Canine 0.015 0.014
First Premolar 0.018 0.015
Second Premolar 0.017 0.015
First Molar 0.068 0.053
Second Molar 0.044 0.032
Third Molar 0.023 0.031
Orban’s Oral histology & embryology: Pulp; Department of Oral Surgery,
Newcastle - Tyne, England
6. Radicular Pulp:
The radicular portion of the pulp organs are
continuous with the periapical connective tissue
through the apical foramen or foramina.
As growth proceeds, more dentin is formed, so that
when the root of teeth are matured the radicular pulp
is narrower.
The apical pulp canal becomes smaller also because of
apical cementum deposition.
7. Apical foramen:
Average size of apical foramen of the maxillary teeth
in the adult is 0.4 mm
Mandibular teeth 0.3 mm
Sometimes it is found on the lateral side of the apex
although the root itself is not curved.
Frequently there are two or more foramina separated
by a portion of dentin and cementum or by cementum
only.
8. Accessory canal:
Leading from the radicular pulp laterally through the
root dentin to the periodontal tissue.
May be seen anywhere along the root but are most
numerous in the apical third of the root.
Clinically significant in spread of infection, either
from the pulp to the periodontal ligament or vice
versa.
9. Occur in areas where there is premature loss of root
sheath cells; these cells induce the formation of
odontoblasts which form dentin.
May also occur where the developing root encounters
a blood vessel.
11. Inductive:
Interact with the oral epithelial cells
Differentiation of the dental lamina and enamel
organ formation.
Cells of pulp + blood vessels & nerves
provides the tooth vitality
12. Formative:
Produces dentin that surrounds and protects the pulp.
Pulpal odontoblasts develop the organic matrix and
function in its calcification.
13. Nutritive:
Blood vascular system of the pulp; nourishes dentin
through the odontoblasts and their processes.
Protective:
Sensory nerve respond to pain
Nerves initiate reflexes that control circulation in the
pulp.
14. Defensive or reparative:
First line of defense to injuries and infection of
dentine
Tertiary dentine
Immuno-competent
Clearance of toxic substances
16. Components of dental pulp
CELLS (odontoblast, fibroblast,
undifferentiated cell, macrophage,
dendritic cell)
FIBERS AND GLYCOPROTEIN (collagen
type I, III, no elastic fiber, fibronectin)
GROUND SUBSTANCES
(glycosaminoglycans, chondroitin sulfate
proteoglycan)
BLOOD VESSELS, NERVES, LYMPH
VESSELS
17. Maintain tissue’s physical properties and integrity
Control of growth and development and repairs
Control of cell migration
Control of diffusion of macromolecules
Functions of pulpal extracellular matrix
18. Collagen in dental pulp
Concentration varies from species to species, 32% in human
pulp.
Higher content in the middle and apical pulp.
Total collagen decreases with age.
Interestingly high level of collagen type III. (43%) : vascular
content, tissue extensibility (cf. Elastin)
Absence of elastin (except in b.v.).
19. Adhesive glycoproteins in dental pulp
Fibronectin found in
predentine NOT mature
dentine.
Fibronectin present in
pulp and dental papilla.
Fibroblasts synthesize
pulpal fibronectin.
Fibronectin is expressed
during reparative
dentinogenesis.
Immunoreactive fibronectin molecules detected
along the border of predentine and between
odontoblast (Yoshiba et al., 1994)
20. Glycosaminoglycans in dental pulp
Chondroitin sulfate, dermatan sulfate, hyaluronic
acid present
Amount of uronic acid decreases with age
Total GAG decreases with reduced dentinogenic
activity
Decorin may involve in mineral nucleation at the
mineralization front
22. Four distinct zones:
1. The odontoblastic zone at the pulp periphery
2. A cell free zone of Weil beneath the odontoblast;
prominent in the coronal pulp
3. A cell rich zone; high cell density
4. The pulp core; major vessels and nerves
23.
24. The principle cells of the pulp:
Odontoblasts
Fibroblast
Undifferentiated mesenchymal cells
Macrophages
Immunocompetent cells
25. Odontoblasts:
The most distinctive cells of the dental pulp
Form a layer lining the periphery of the pulp and have
a process extending into the dentin
Arranged in palisade pattern of three to five cells deep
59,000 to 76,000 per square milimeter in coronal
dentin, with a lesser number in root dentin.
26. Active cells:
Elongated, basal nucleus, much basophilic cytoplasm,
promonent golgi zone.
Resting cell:
Stubby, little cytoplasm, more hematoxophilic nucleus.
27. Odontoblast process begins at the neck of the cells
just above the apical junctional complex where the cell
gradually begins to narrow as it enters predentin.
The process is devoid of major organelles but does
display an abundance of microtubules and filaments
arranged in a linear pattern along its length.
28. The pathways of collagen synthesis:
The spherical distensions contain free polypeptides
that assemble as a triple helix in the cylindrical
distensions to form the procollagen molecule.
The cylindrical distension bud off as secretory
granules.
Secretory granules that are transported toward the
odontoblast process, where their content is released.
30. Some types (of 15) of known collagen
Type Molecular Tissue distribution
Fibril-forming I [a1(I)]2 a2(I) bone, skin, tendon, ligaments
(90%) of body collagen
II [a1(II)]3
cartilage, intervertebral disc,
notochord, vitreous humor of eye
III [a1(III)]3 skin, blood vessels, internal organs
V [a1(V]2 a2(V) as type I
XI [a1(XI] a2(XI) a3(XI) as type II
Fibril-associated IX [a1(IX] a2(IX) a3(IX) cartilage (with type II)
XII [a1(XII)]3 tendon, ligaments (with some type I)
Network-forming IV [a1(IV)]2 a2(IV) basal laminae
VII [a1(VII)]3 anchoring fibrils beneath stratified
squmous epithelia
33. Aggrecan mechanical support
(cartilage)
Betaglycan binds TGF-beta
(cell surface*, matrix)
Decorin binds type I and (CNT)
TGF-beta
Perlecan basal laminae
(basal laminae)
Syndecan-1 binds FGF
(cell surface*)
* = Integral membrane proteoglycan
Some known proteoglycans:
34. Junctions occur between adjacent odontoblasts
involving
Gap junctions
Occluding zones (Tight junctions)
Desmosomes
The actin filaments inserting into the adherent
junction are prominent and form a terminal cell web.
35. This junctional complex does not form a zonula,
completely encircling the cell, as occurs in epithelia;
(it is focal, and there is some debate whether it can
restrict the passage of molecules and ions from the
pulp into the dentin layer)
Serum proteins seem to pass freely between
odontoblasts and are found in dentin
36. Fibroblasts:
Greatest number in the pulp
Numerous in coronal pulp where they form the cell-
rich zone.
The function is to form and maintain pulp matrix.
37. Undifferentiated Ectomesenchymal Cells:
Represents the pool from which the connective tissues
of the pulp are derived.
Depending upon the stimulus these cells may give rise
to odontoblasts and fibroblasts.
In older pulp they diminish, thereby reducing the
regenerative potential of the pulp.
38. Macrophages
Located throughout the pulp center.
Involved in the elimination of dead cells, the presence
of which indicates that turnover of dental pulp
fibroblast occurs.
40. Dendritic Cells
Bone marrow derived, antigen presenting dendritic
cells.
Beneath the odontoblast layer.
They capture and present foreign antigen to the T
cells.
41. Cells participate in immunosurvillance and increase
in number in carious teeth.
Infiltrate odontoblast and project their processes into
the tubules.
8% of total cell population.
42. Matrix and Ground Substance
Principally Type I and Type III collagen.
Composed of glycosaminoglycans, glycoproteins, and
water.
Overall collagen content increases with age.
43. The greatest concentration of collagen generally
occurs in the most apical portion of the pulp.
Significance:
During pulpectomy; Engaging the pulp with a barbed
broach in the region of apex affords a better
opportunity to remove the tissue intact.
44. Vasculature and Lymphatic Supply
Circulation establishes the tissue fluid pressure.
One or sometimes two vessels of arteriolar size
(about 150µm) enter the apical foramen with the
sensory and sympathetic nerve bundles.
Smaller vessels, without any accompanying nerve
bundle, enter the pulp through the minor foramina.
46. The arterioles occupy a central position within the
pulp and, as they pass through the radicular portion of
pulp, give off smaller lateral branches.
Occasionally U- looping of pulpal arterioles is seen,
and this anatomic configuration is thought to be
related to the regulation of blood flow.
47. Pulp tissue is highlyvascularized.
40-50 ml/min/100g
(Kim, 1985)
48. Some terminal capillary loops extend upward between
the odontoblasts to abut the predentin if
dentinogenesis is occurring.
Located on the periphery of the capillaries at random
intervals are pericytes.
Pericytes are contractile cells capable of reducing
the size of the vessel lumen.
49. Anastomosis are point of direct communication
between the arterial and venous sides of the
circulation.
Lymphatic vessels also occur in the pulp tissue, they
exit via one or two large vessels through the apical
foramen.
50. Sympathetic adrenergic nerves terminate in relation
to the smooth muscle cells of the arteriolar walls.
Afferent free nerve endings terminate in relation to
arterioles, capillaries and veins and serve as effectors
by releasing various neuropeptides that exert an
effect on the vascular system.
51. Dental pulp interstitial fluid (ISF) and exchange of substances between plasma
and ISF. (* values from Tonder and Kvinnsland, 1983; Ciucchi et al., 1995)
(5.5-10.3 mm Hg*)
(43 mm Hg)
(20 mm Hg)
(35 mm Hg)
Hydrostatic pressure
in dental pulp
52. Innervation of Dentin- Pulp Complex
Nerve enter the pulp through
apical foramen, along the
afferent blood veessels, and
together from the
neurovascular bundle.
Each nerve fiber has been
estimated to provide at least
eight terminal branches.
53. These branches ultimately contribute to an
extensive plexus of nerves in the cell free
zone just below the cell bodies of the
odontoblasts in the crown portion of the
tooth.
55. This plexus of nerves, which is called the
subodontoblastic plexus of Raschkow, occupies the
cell- free zone of Weil and can be demonstrated in
silver nitrate stained sections under the light
microscope or by immunocytochemical techniques.
56. The nerve bundles that enter the tooth pulp consist
principally of :
Sensory afferent nerves of the trigeminal
nerve
and
Sympathetic branches from the superior
cervical ganglion.
57. As the nerve bundle ascends coronally;
The myelinated axons gradually loose their
mylein coating,
So that a proportional increase in the number
of unmyelinated axons occurs in the more
coronal aspect of the tooth.
58. A-delta fibers
Conduction velocity 2-30 m/s
Lower threshold
Involved in fast, sharp pain
Stimulated by hydrodynamic
stimuli
Sensitive to ischemia
Sharp pain
C fibers
Conduction velocity 0-2 m/s
Higher threshold
Involved in slow, dull pain
Stimulated by direct pulp damage
Sensitive to anesthetics
Dull pain
Types and properties of pulpal sensory nerve fibers
A-beta fibers
Conduction velocity 30-70 m/s
Very low threshold, non-noxious
sensation
50% of myelinated fibers in pulp
Functions not fully known
Non-myelinated sympathetic
fibers
Conduction velocity 0-2 m/s
Post-ganglionic fibers of superior
cervical ganglion
Vasoconstriction
59. A small number of axons pass between the
odontoblast cell bodies to enter the dentinal tubules
in proximity to the odontoblast process.
60.
61. Possible mechanisms of dentine sensitivity
Hydrodynamic mechanism
(Gysi, 1900; Brannstrom, 1963)
62. Pulp venules
STIMULATION
Increased pulp
interstitial fluid
Increased pulp
pressure
Increased tubular
fluid flow
Release of
inflammatory
agents?
Increased blood
viscosity and rbc
congestion in capillary
bed
Increased A-V shunt
blood flow
Outward dentinal
fluid flow and
aspiration of
odontoblasts
CNS, Pain, Reflexes
Vasodilation, Increased permeability
Pulpal axonal reflex due to dentine stimulation
Without infection,
Vascular changes could
be resolved.
Axon
reflex
SP, CGRP
Dentine
64. Pulp Stones
Pulp stones, or denticles, frequently are found in pulp
tissue.
Discrete calcified masses that have calcium phosphorus
ratios comparable to that of dentin.
More frequently at the orifice of the pulp chamber or
within the root canal.
65. Concentric layers of mineralized tissue formed by
surface accretion around blood thrombi, dying or
dead cells, or collagen fibers.
Occasionally a pulp stone may contain tubules and
be surrounded by cells resembling odontoblasts.
66. Such stones are rare and, if seen, occur close to the
apex of the tooth. Such stones are referred to as ‘true’
pulp stones as opposed to ‘false’ stones having no cells
associated with them.
67. If during the formation of a pulp stone, union occurs
between it and the dentin wall, or if secondary dentin
deposition surrounds the stone, the pulp stone is
called an attached stone.
68. The presence of pulp stones is significant in that
They reduce the overall number of cells within
the pulp
and
Act as an impediment to debridement and
enlargement of the root canal system during
endodontic treatment.
69.
70. Age Changes
Decrease in the volume of pulp chamber and root
canal brought about by continued dentin deposition.
On occasion can appear to be obliterated almost
completely.
From about the age of 20 years, cells gradually
decrease in number until age 70, when the cell density
has decreased by about half.
71. Fibrosis is due to aging & Injury.
Increase in collagen fibers’
bundles which becomes more
evident with the decrease in pulp
size
72. Lose and a degeneration of myelinated and
unmyelinated axons that correlate with an age-
related reduction in sensitivity.
Irregular areas of dystrophic calcification,
especially in central pulp.
Gradual reduction of tubule diameter.
73. The continued deposition often leads to complete
closure of the tubule;
as can be seen readily in a ground section of
dentin, because the dentin becomes translucent
(or sclerotic).
Sclerotic dentin is found frequently near the root
apex in teeth from middle aged individuals.
74. Pulpitis
Acute or chronic.
Partial or total.
Open or closed.
Exudative or suppurative.
Reversible or irreversible.
75. Pulpitis is a dynamic process and presents a
continuous spectrum of changes reflecting
interplay between cause and host
defenses.
Poor correlation between microscopic
changes & clinical symptoms.
76. Pulpitis: Clinical Features
Presents as pain which patient may have difficulty
in localizing to a particular tooth.
Pain may radiate to adjacent jaw, face, ear, or neck.
May be continuous for several days or may occur
intermittently over a longer period.
Pulpitis is often described as acute or chronic
based on duration and severity of symptoms.
77. Acute pulpitis
Severe throbbing, lancinating pain on thermal
stimulation or lying down, keeps patient awake.
Generally lasts 10-15 minutes but may be more or
less continuous (reversible pulpitis).
With progression, may become spontaneous &
continuous (irreversible pulpitis).
78. Chronic pulpitis
Bouts of dull aching which can last for an hour or
more.
Pain on thermal stimulation or spontaneously.
79. Pulpitis may be asymptomatic.
Most important decision clinically is whether
pulpitis is reversible or irreversible.
Decision is made based on many factors
including:
1. Severity of symptoms.
2. Duration of symptoms.
3. Size of carious lesion.
4. Pulp tests.
5. Direct observation during operative procedure.
6. Age of patient.
82. Pulpitis starts before leading organisms in
carious dentin reach pulp.
Pulpitis is not usually seen histologically
until organisms are within 1 mm of the
pulp in permanent teeth, or 2 mm in
deciduous teeth.
83. Chemical and thermal injury
During restorative procedures: frictional heat,
irritant substances.
May respond by reactionary dentin formation.
84. Barotrauma (aerodontalgia)
Flying at high altitude in unpressurized aircraft,
or rapid decompression in divers.
Attributed to formation of nitrogen bubbles in
pulp tissue or vessels.
Thought not to be a direct cause, but rather an
exacerbating cause in presence of caries.
85. Pulpitis: Histopathology
Poor correlation between microscopic changes &
clinical symptoms.
Inflammatory process may be modified by
several factors:
Nature, severity and duration of insult.
Efficiency of host defenses.
Efficiency of pulpo-dentinal complex defenses.
Special anatomy of pulp: surrounded by hard
tissue and cannot tolerate edema.
85
86. Reactionary dentin may continue to form after
onset of pulpitis if odontoblasts and pulp have not
been irreversibly damaged, and may protect pulp.
Pulpitis caused by caries starts as a localized area,
but extends throughout pulp if caries is not
treated.
86
87. If inflammation is severe, local
microcirculation may be compromised,
leading to local necrosis and suppuration
of pulp (pulp abscess), or diffuse
suppuration and necrosis.
88. Pulpitis: Chronic Hyperplastic Pulpitis
(Pulp Polyp)
Open pulpitis or chronic hyperplastic pulpitis (pulp
polyp):
Large carious cavities.
Young molar teeth with wide apices and good
blood supply.
88
89. Usually devoid of sensation on gentle probing.
Polyp consists of chronically inflamed
hyperplastic granulation tissue protruding
from pulp cavity.
May become epithelialized by spontaneous
grafting of desquamated oral epithelial cells from
saliva.
90. Pulp Necrosis
May follow pulpitis or trauma to apical blood
vessels.
Coagulative necrosis after ischemia.
90
91. Liquefactive necrosis after pulpitis;
may become gangrenous with foul odor upon
infection by putrefactive bacteria from caries.
Pulp necrosis in sickling crisis of sickle cell
anemia.
93. Effects of cavity Preparation:
Frictional heat
Desiccation
Exposure of dentinal tubules
Direct damage to odontoblast processes
Chemical treatment to exposed dentinal surface
94. Cavity preparation: speed, heat, pressure &
coolant may all cause pulp irritation.
Aspiration or displacement of odontoblasts into
dentinal tubules, with reduction of numbers.
94
95. Factors associated with the restorative material & its placement
Material toxicity
Insertion pressure
Thermal effects
Induced stresses
96. Effects subsequent to restoration
Marginal leakage
Cuspal fracture
Effects of cavity preparation & restorative materials may
further complicate pulpitis caused by caries or other
causes.
Thickness & nature of remaining dentine may affect pulp
response to dental material.
98. Pulse Oximetry
Dental sensor (a modified finger probe) that can be
successfully applied and adapted to the tooth and well
suited to detect pulsatile absorbance.
The principle: relates the absorption of light, by a
solute to its concentration and optical properties at a
given light wavelength.
99. It also depends on the absorbance
characteristics of haemoglobin in the red
and infra-red range
In the red region, oxyhaemoglobin
absorbs less light than deoxyhaemoglobin
and vice versa in the infrared region.
100. Hence one wavelength was sensitive to
changes in oxygenation and the second was
insensitive to compensate for changes in
tissue thickness, haemoglobin content and
light intensity.
101. The system consists of a probe containing a diode that
emits light in two wavelengths:
I. Red light of approximately 660 nm
II. Infra-red light of approximately 850 nm
It is also useful in cases of impact injury where
the blood supply remains intact but the nerve
supply is damaged
102. Dual Wavelength Spectrophotometry
Dual wavelength spectrophotometry (DWLS) is a
method independent of a pulsatile circulation.
The presence of arterioles rather than arteries in the
pulp and its rigid encapsulation by surrouding dentine
and enamel make it difficult to detect a pulse in
the pulp space.
103. This method measures oxygenation changes in
the capillary bed rather than in the supply vessels
and hence does not depend on a pulsatile
blood flow.
A major advantage is that it uses visible light
that is filtered and guided to the tooth
by fibreoptics
The test is noninvasive and yields objective results.
104. Laser doppler flowmetry
Laser Doppler Flowmetry (LDF) is a noninvasive,
electro optical technique,
Which allows the semi-quantitative recording
of pulpal blood flow.
The Laser Doppler technique measures blood
flow in the very small blood vessels of the
microvasculature.
105. The technique depends on the Doppler principle;
whereby light from a laser diode incident on the
tissue is scattered by moving RBC's
and
As a consequence, the frequency broadened.
106. The primary issues in pulp-vitality testing as
follows:
A non-vital post-traumatized incisor has a better
long-term prognosis;
If root canal therapy is completed before the
necrotic pulp gets infected.
107. The best outcome for the post
traumatized immature incisor is for it;
To revascularize and,
Continue normal root development, including
increased root wall thickness.
Which is not possible to assess with conventional
electrical and thermal testing
108. Conclusion
Thus the Preservation of Healthy Pulp during
operative procedures and successful management
in cases of disease are two of the most important
challenges.
109. References:
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