Clinical Struggle

Role of neutrophils in inflammation

Attach to plaque matrix

Secrete antibacterial enzymes

Kill bacteria

Dissolve plaque matrix

Demarcation between enamel prisms is?

Rod sheath

An imbalance between types of organism present in a persons natural microflora

dysbiosis

Hypermineralised dentine layer within each tubule

Intratubular dentine

3 reasons for ultrasonic water irrigation

Fluid lava he

Cools instrument

Washes away toxins

False pockets

Gingival margin being coronal and above level of CEJ

Dosage of fluoride for mixed dentition

Up to 0.4ml

Pulp test - hot

Heated gutta percha points

What happens when pressure in the pulp get's higher than the incoming pressure of capillary blood from the circulation?

Pulp will necrose

Fibres that are randomly arranged throughout the PDL supporting the blood vessels and nerves

interstitial

What does Hertwig's epithelial root sheath initiate? And how?

Formation of dentine within the root by differentiation of odontoblasts from the dental papilla

Sort linear defects found at the DEJ formed by entrapment of odontoblast process between ameloblasts during amelogenesis

Enamel spindles

Arise from changes in prism orientation

Reflect the alternating direction taken by groups of enamel rods as they move away from DEJ during formation

Enamel hunter Schreger bands

Purpose of keratinised epithelium

Allows to withstand friction from mastication

Occurring in or representing two distinct forms

dimorphic

3 anatomical risk factors of periodontitis

Malpositioned teeth

Furcations

Root grooves

How often should adults have bite wings

6-24 months

What 2 pathological events are involved in the early stage of a periodontal lesion? What host cells mediates this?

Increased infiltrate

Loss of gingival collagen

T-lymphocytes and macrophages

Dentine near the ADJ is

Narrower

Less numerous

Incremental growth lines that appear on the enamel surface as a series of grooves. They may disappear as the enamel wears over a period of time.

Perikymata

This theory states that different types of stimuli act on exposed dentine, causing increased fluid flow through dentinal tubules. In response to this movement, mechanoreceptors on the pill nerves trigger the acute, temporary pin of dentine hypersensitivity

Hydrodynamic theory of pain

Cementum composition

65,23,12

Swirling effect produced within confined space of a pocket leads to disruption of subgingival plaque biofilm

acoustic microstreaming

Inflammation - fluid response

Increased crevicular fluid flow

Gingival erythema

Oedema and swelling of the gingiva

Investigation for caries

Visuotactile

Radiographs

Pulp vitality

Percussion

Odontoblast process

1. Secrete collagen and other EC matrix proteins and minerals

2. Migrate from ADJ to pulp becoming crowded together and trailing odontoblast processes

What does Chlorahexidine do?

Prevents sugar transport

Prevents adhesion

Inhibits proteases

What 2 pathological events are involved in the established stage of a periodontal lesion? What host cell mediates this?

Chronic inflammatory cell infiltrate replaces gingival CT

Pocket starts to form

Plasma cells

What 2 pathological events are involved in the initial stage of a periodontal lesion? What host cells mediates this?

Vasodilation

Increased crevices fluid

Neutrophils

Fibres of the periodontal ligament (2)

Interstitial

Principal

What does Tome's process do?

Releases vesicles of amelogenin

Transports ions into matrix

Releases enzymes to digest organic matrix

Last and first enamel are said to be

Non-prismatic

Cause of suppuration in periodontitis (3 steps)

1. JE elongates + separates from root surface at coronal end

2. Plaque bacteria release chemotactic substances that increase flow of neutrophils into gingival sulcus

3. Neutrophils react with bacteria + produce suppuration

3 principle cariogenic bacteria in human dental plaque

Streptococci

Lactobacilli

Actinomyces

Incremental lines in dentine of the tooth that reflect variations in mineralisation during dentine formation; the distance between the lines correspond to the daily rate of dentine formation

Dentine imbricarion lines of von ebner

Fibres within the PDL that are dense and arranged in bundles running from cementum to bone i.e. holding the tooth in the socket

principal

Odontoblasts produce dentine in response to damage

Tertiary dentine

6 categories of SCD

Medical complexity

Elderly

Learning disability

Mental disability

Physical disability

Dental anxiety

Histamines role in host response

vasodilation and increased vascular permeability

4 types of gingival fibres

Circular fibres

Dentogingival fibres

Alveolar crest fibres

Transseptal fibres

Non-modifiable risk factors for periodontitis

Socioeconomic status

Genetics

Age

Darker lines in the striae of Retzius result from what?

Systemic disturbances in the human body e.g a fever

Type of linear hypomineralised enamel defect

enamel lamellae

Incremental growth lines seen in enamel and are results of enamels development. When viewed microscopically in cross section, they appear as concentric rings

Striae of Retzius

4 structures of the periodontium

Gingiva

Periodontal ligament

Alveolar bone

Cementum

Enamel composition

96,4

Mild alveolar bone loss (%)

<15%

Severe caries

Inner 50% dentine

What are prostaglandins produced from and what do they cause?

Produced from arachidonic acid in cell membranes of inflammatory cells.

They cause capillary dilation.

Odontoblast dies, new generation of odontoblast like cells form from progenitor cells to produce tertiary dentine

reparative

What 3 pathological events are involved in the advanced stage of a periodontal lesion? What host cell mediated this?

JE migrates apically

PDL fibres break down

Alveolar bone lost

Plasma cells

Pulp vitality test results

Discolouration

Breakdown of haemoglobin in pulp

Abscess

For cementogenesis to begin something must fragment.

Hertwig's epithelial root sheath

Thought to indicate the termination of striae of Retzius at the surface of enamel.

Perikymata

What are important molecular regulators in repair and reactions in Dentine pulp complex

transforming growth factor beta

Permeability of coronal dentine is _ than root dentine

higher

Dentine composition

70,20,10

6 criteria for BDA SDC Case Mix Model

Communication

Cooperation

Medical status

Oral risk

Access

Legal and ethical barriers

What is reduced periodontium

When interdental papilla is lost from gingival health

Exaggerated von Ebner lines

Contour lines of Owen