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ORAL TISSUE AGING: processes WABeresford

Less stuff e.g. wear of enamel

More stuff e.g. fibrosis & fat tissue

Bad stuff e.g. collagen stiffer & less


digestible; DNA mutated

Misplaced e.g. gingival recession

Imbalance e.g. OSTEOCLASTS:osteoblasts

Compensation e.g. apical cementum

AGING ENAMEL

ATTRITION/ WEAR

MORE BRITTLE
reduced permeability
P
U More translucent = darker
L
P
More resistant to caries?
Changes in ion composition

1
AGING in DENTINE

CIRCUMPULPAL DENTINE - main


mass of dentine

{ SECONDARY DENTINE -
slow increment to pulpal surface
P
U
DEAD TRACT -
L
wide, empty dentinal tubules
P
REPARATIVE DENTINE -
response to caries/erosion

SCLEROTIC DENTINE -
tubules narow, then
become filled with mineral

AGING PULP

30 dentine PULP HORN


obliterated
deposition
makes CHAMBER
SMALLER
CELLS -
Odontoblasts
Fibroblasts
Denticles Macrophages
Mast cells
Diffuse Leukocytes
calcification ROOT CANAL
narrows
MATRIX Blood vessels
Collagen I fibers
Nerves
Collagen III fibers Lymphatics

2
AGING CEMENTUM

P
U
L
P
HYPERCEMENTOSIS -
excess deposition

CEMENTOCYTES CEMENTOCLASIA - eroded


cementum

Bone surface AGING PDL


Interstitial Area
more irregular

Bundles
less distinct

DENTINE

P
D PULP
L

BONE
PDL Width

3
AGING GINGIVA

TOOTH
Hyperkeratosis

DRY - Xerostomia -
“Dry mouth”

Epithelial
attachment INFLAMED
looser,
displaced

PERIODONTITIS

TOOTH EPITHELIAL ATTACHMENT-


unstable, loosens &
migrates down, & allows
bacteria into
CONNECTIVE TISSUE
GINGIVA resulting in chronic
Periodontal infection &
ligament inflammation &
systemic spread of
bacteria &
Alveolar bone
loss of teeth

4
EDENTULOUS MANDIBLE
illustrates dependence of bone on use

loss of teeth

causes loss of alveolar ridges Mx & Mb

& loss of facial height

BONE RESPONSE TO
TOOTH DISUSE Alveolar SPONGIOSA most
affected, with extensive
loss of trabeculae

However, mandibular
body is less affected
by aging osteoporosis
than spine & long
bones

5
RED MARGIN LIP
VERMILION BORDER

LABIAL MUCOSA
thick strat squam ep thins

HAIRY SKIN Fordyce’s spots - sebaceous


loses glands - more visible
elasticity
LABIALGLAND
mucous

MUSCLE

AGING TONGUE
Tongue papillae
smoother
Lingual gland

Sub-lingual blood
vessels engorge
- “Caviar tongue”

6
Mucosa CHEEK
loses elasticity

MUSCLE

BUCCAL MUCOSA
thick strat squam ep thins

BUCCAL GLAND
mucous

Fordyce’s spots - sebaceous


glands - more visible & #
SKIN

ADIPOSE TISSUE

CHEEK

MINOR SALIVARY GLANDS


MUSCLE

Smaller & fewer


Replaced by fibrous tissue
= STROMA:parenchyma
More lymphocytes present
Oncocytes develop

parenchyma = acini, tubules & ducts, i.e., epithelial components of gland

7
AGING PAROTID GLAND
INTER LOBULAR DUCT

SEROUS ACINi

FAT

INTRA LOBULAR
DUCT
less control of
secretion quality

INTERCALATED DUCT STROMA:parenchyma

ONCOCYTIC CONVERSION
As cuboidal epithelia and glands age, a few of
their epithelial cells lose most of their normal
organelles and fill up with mitochondria.
Mitochondria-rich cells are eosinophilic.

This event results in two classes of cell:


those that are functioning normally and need
many mitochondria - gastric parietal cells, renal
proximal-tubular cells, striated-duct cells, etc; &
non-functional mitochondria-stuffed cells in older
glands. These have acquired two names: the
usual - oncocyte, and, as an exception, the archaic
:

oxyphil cell in the parathyroids. & Hurthle cells


in thyroid

8
ORAL TISSUE AGING: Interactions with

Microbial flora & disease


Altered & aging immunity
Changes of diet & food preference
deficiencies, malabsorptions
Aging nervous & endocrine systems

Altered dentition & prostheses


Trauma & repair
Mutated & moved DNA - tumors
e.g., squamous carcinoma, adenocarcinoma, oncocytoma

Medicines & therapy

9
ALVEOLAR BONE: Roles
The bone holds the tooth firmly in position to
masticate and, for the lower jaw, transmits
the muscle-powered movements of the body
of the mandible. It also:
adapts the strength and orientation of
attachment to varying load
helps to move the teeth for better occlusion
supplies vessels for the PDL & cementum
houses & protects developing permanent
teeth while suppporting primary teeth
organizes successive eruptions of primary &
secondary teeth

TOOTH TISSUES: Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

DENTAL PAPILLA DENTINE


PULP

DENTAL SAC/FOLLICLE CEMENTUM

PDL
LAMINA DURA
ALVEOLAR BONE
SUPPORTING
BONE
Plate
Spongy bone

1
MANDIBULAR CENTRAL
Deciduous tooth INCISORS at 2 y

Gingiva
PDL
Permanent
tooth

ALVEOLAR BONE
in general

Cortical plate BODY of


dense bone MANDIBLE

ALVEOLAR BONE TERMS

ALVEOLAR BONE
specifically

SPONGIOSA
Alveolar crest

CORTICAL PLATE

ALVEOLAR BONE is
also termed Lamina dura
from its X-ray densit, or
cribriform bone from the
many holes for vessels
to reach the PDL

2
PDL Vessels DENTINE

PULP

Enter via cribriform


(sieve) walls of the
alveolus & at the
base

Lymphatic drainage

ALVEOLAR BONE TERMS

PDL
LAMINA DURA
ALVEOLAR BONE
SUPPORTING
BONE
Plate
Spongy bone

3
BONE MATRIX
Fine collagen fibrils - intrinsic
PDL fibers (extrinsic)
become imbedded in
Osteocyte newly formed bone

MATRIX
PROPORTIONS
collagen fibrils and
glycoproteins &
proteoglycans 35%
Imbedded PDL fibers - Organic
Sharpey’s fibers
mineral crystals 65%
Inorganic

LACUNA (hole) for OSTEOCYTE BODY


MATRIX

CANALICULUS Gap junction contact


(tiny channel) for with next osteocyte

OSTEOCYTE PROCESS

4
BONE DEVELOPMENT
BRAIN

MAXILLARY
BONE

TOOTH BUD
TONGUE
MANDIBULAR
BONE

DENTAL LAMINA from which DENTAL ORGANS (tooth germs) form

TOOTH

FACIAL REINFORCEMENT

SEPTAL CARTILAGE

NASAL CONCHAE

HARD PALATE
X X
Maxillary bone
X X

X TOOTH BUD
X TONGUE
X X

Mandibular bone
X Skeletal muscle starting

5
TOOTH PRIMORDIUM/GERM

DENTAL ORGAN DENTAL LAMINA

MESENCHYME

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

ALVEOLAR BONE

INTRAMEMBRANOUS OSTEOGENESIS

Condensations are
widely dispersed
and separated to
commit a territory
to becoming bone
Mesenchyme
Vessels present

Continued division
& recruitment to
osteoblast numbers

6
Mesenchyme INTRAMEMBRANOUS OSTEOGENESIS

LESS
ACTIVE
CELLS

OSTEOCLAST

TRABECULA

OSTEOID
ACTIVE OSTEOBLASTS

Mesenchyme later turns IM & EC OSTEOGENESIS


into marrow
Vessels : incorporated
from the start &
remodel with the bone

TRABECULAE
thicken by division &
recruitment of more
osteoblasts to
increase bone density

OSTEOCLASTS
active from the start to
remodel & reshape the
bone

7
Bone matrix = collagen fibrils + BONE CELLS
mineral crystals
Active Osteoblasts

Bone canal

vessels
Osteoclast
Periosteum
Resting cells

Osteocyte
Ca 2+

Osteon/Haversian system with DENSE BONE


concentric lamellar/layered bone REMODELING

Osteoblasts filling
in the tunnel

New bone -
start of new
osteon

Osteoclasts as a team eating out a resorption tunnel

8
DENSE BONE
Osteoblasts filling
in the tunnel New bone REMODELING*
REMODELING

Eaten-out hole is a
Howship’s lacuna
Sealing ring
of tight Osteoclast
attachment
to bone

Ruffled border agitating


released enzymes & acid
Osteoclasts as a team eating Un-mineralized OSTEOID between
out a resorption tunnel active osteoblasts & calcified bone

JAW & TOOTH DEVELOPMENT early arch


BONE starting DENTAL LAMINA
BUCCAL PLATE

BONE starting
LINGUAL PLATE

10 TOOTH GERM

20 Successional
WALLS OF BONY TOOTH GERM
TROUGH OF
DEVELOPING
MANDIBLE

SYMPHYSEAL
CARTILAGE

9
JAW & TOOTH DEVELOPMENT processes
DENTAL LAMINA will grow back to form
germs for 3 permanent molars (5th e m)

BONE

10 TOOTH GERM

20 Successional TOOTH GERM


on lingual side of 10
PLANTING POTATOES

Bone creates the


trench; tooth buds
are the spuds

JAW & TOOTH DEVELOPMENT processes


BONE starting DENTAL LAMINA will grow back to form
BUCCAL PLATE germs for 3 permanent molars (5th e m)
grows up more
than lingual BONE starting
LINGUAL PLATE

10 TOOTH GERM

20 Successional TOOTH GERM


Interradicular septum
on lingual side of 10
grows between roots
of multirooted teeth Bony wall grows around
& encloses 20 TOOTH
GERM in a crypt

Interdental septum SYMPHYSEAL CARTILAGE


grows across trough will be replaced by bone
to separate teeth

10
TOOTH & MANDIBLE DEVELOPMENT
Oral ectoderm
TONGUE
DENTAL SAC

10 TOOTH

ALVEOLAR
BONE

20 TOOTH GERM

MECKEL’S
ALVEOLAR CARTILAGE
NERVE

MANDIBLE DEVELOPMENT
DENTAL SAC contributes Remodeling will bring erupting
also to alveolar bone 1o tooth over developing 2o

Alveolar crest Bony plate grows up


grows up 10 TOOTH to enclose 2nd tooth
germ in a CRYPT

Bone added to
base of alveolus 20 TOOTH
for tooth eruption GERM

Bone grows over MECKEL’S


alveolar nerve & CARTILAGE
vessels regresses & not
used to form
Alveolus becomes
mandible
distinct from BODY

11
TOOTH & MANDIBLE DEVELOPMENT - Next

TONGUE
DENTAL SAC
Higher alveolar bone
- i.e. deeper socket 10 TOOTH

ALVEOLAR
BONE

20 TOOTH GERM

ALVEOLAR
NERVE
MECKEL’S
Denser alveolar bone & more CARTILAGE

body-alveolus distinction
Remodeling brings erupting 1o Meckel’s cartilage gone
tooth over developing 2o

BUNDLE BONE DENTINE

Imbedded ends of
PDL fibers create PULP
BUNDLE BONE

Imbedded PDL fibers


are Sharpey’s fibers

12
Tooth drifts mesially TOOTH MOVEMENT
by combined actions
of osteoclasts &
osteoblasts moving
bone, taking tooth
with it

Osteoblasts
laying down
bundle bone

Plus PDL
reorganization

Osteoclasts
resorbing bone

Occlusal wear FUNCTIONAL ERUPTION


& TOOTH MOVEMENT

Osteoclasts
resorbing bone

Osteoblasts
Bony laying down
interdental bundle bone
septum

PDL fibers
incorporated in bone
as Sharpey’s fibers
Cellular cementum added to apex
Compensates for occlusal wear? Basil

13
TOOTH MOVEMENTS Occurring in eruption & use

By root growth &


AXIAL - in long axis of the tooth
bone remodelling

DRIFTING e.g., mesially, laterally

TILTING By bone remodelling &


PDL reorganization
ROTATORY

Combinations of these four


movements frequently occur
Basil

TOOTH MOVEMENT 2
TILTING Tooth tilts by combined
actions of both osteoclasts
Earlier bone & osteoblasts on bone of
position each side of socket

Basil

14
TOOTH MOVEMENT

Tooth drifts mesially by


combined actions of
osteoclasts & osteoblasts
moving bone, taking tooth
with it

Earlier bone
position

Basil

10/Deciduous tooth Close to EXFOLIATION


of Deciduous/10 Tooth
Odontoclasts have
resorbed most of
deciduous root

Bone remodellling
has brought 20 tooth
under 10
20 tooth
Bone trabeculae
added by layers at
base of alveolus

20 tooth would be
LARGER than shown

15
STARTING EXFOLIATION of DECIDUOUS MOLAR I

ENAMEL

DENTINE

ALVEOLAR
PULP
BONE

PDL

Root resorption
by osteoclasts

Permanent Tooth under Inter-radicular septum of bone also


deciduous molar, & houses 2nd tooth germ & is its crypt
between its roots

EXFOLIATION of DECIDUOUS MOLAR III

ENAMEL

DENTINE

Bone remodelling also goes on, and the alveolus and


crypt are changing all the time - repeated all along the jaw

Erosion of bone and the deciduous root is not steady & continuous,
but may cease briefly, when some repair of eroded cementum &
dentine can occur (by cementum).

16
SPONGY BONE at more risk than dense bone

1 Struts are thin to


start with ~ weak

2 Much surface
area for attack by
osteoclasts

3 Gap in a strut/trabecula cut right through is


usually too wide to be bridged by any new bone

Loss of Periodontal reactions to disuse


alveolar bone Reduction in # &
size of principal
fibers
Mild bone Bundle
deposition definition
on wall DENTINE
lost
CEMENTUM
P thickens
D PULP
L
CEMENTUM
PDL
loses
narrower all
Sharpey’s
around
BONE fibers

17
BONE RESPONSE TO
TOOTH DISUSE

SPONGIOSA
most affected,
with extensive
loss of
trabeculae

ALVEOLAR BONE: Roles


The bone holds the tooth firmly in position to
masticate and, for the lower jaw, transmits
the muscle-powered movements of the body
of the mandible. It also:
adapts the strength and orientation of
attachment to varying load
helps to move the teeth for better occlusion
supplies vessels for the PDL & cementum
houses & protects developing permanent
teeth while suppporting primary teeth
organizes successive eruptions of primary &
secondary teeth

18
TOOTH TISSUES: CEMENTUM WABeresford

ENAMEL
GINGIVA
DENTINE

PULP
CEMENTUM

PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

TOOTH DESIGN: Spear me

Blade Shaft Grip

DENTINE CEMENTUM
ENAMEL

1
TOOTH DESIGN: Spear me

Refinements
Shaft is hollow for
ENAMEL PULP
DENTINE CEMENTUM

Hand represented by
PERIODONTAL LIGAMENT
& ALVEOLAR BONE

Closer to true proportions

CEMENTUM: Role

Cementum is the hard covering of the


root that can:
fuse to dentine, but
be alive and
grow outwards to trap the periodontal-
ligament fibers, and thus
attach the tooth to the alveolar bone.
It is itself a kind of bone, but is less
susceptible to erosion

2
Bone matrix = collagen fibrils + REMINDER -BONE CELLS
mineral crystals
Active Osteoblasts

Bone canal

vessels

Osteoclast
Periosteum
Resting cells

Osteocyte
Ca2+

CEMENTUM-BONE DIFFERENCES
Bone matrix = collagen fibrils +
mineral crystals
Active Osteoblasts
FORMING CELLS ARE
CEMENTOBLASTS Bone canal

IMBEDDED CELLS ARE


CEMENTOCYTES vessels

Osteoclast
Periosteum
ACELLULAR CEMENTUM Resting cells

EXISTS
Osteocyte
Ca2+
NO PERIOSTEUM

COLLAGEN FIBERS NO TRABECULAE


PERPENDICULAR TO NO MARROW
SURFACE NO VESSELS OR CANALS
WITHIN CEMENTUM
ALMOST NO REMODELING

3
BONE-CEMENTUM SIMILARITIES
Bone matrix = collagen fibrils +
mineral crystals
MATRIX MATERIALS
Bone canal
LACUNAE WITH
CANALICULI FOR CELLS &
CELL PROCESSES
vessels

SIMILAR APPEARANCE IN Periosteum


STAINED & GROUND
SECTIONS

APPOSITIONAL GROWTH
FROM SURFACE
EROSION BY
INCREMENTAL GROWTH OSTEOCLASTS
LINES IN MATRIX (cementoclasts)

ORIENTATION: Terms
CUSPAL/
Enamel
OCCLUSAL

CORONAL

P
U
L
CERVICAL { P
A
L
RADICULAR

APICAL Cementum

4
CEMENTUM: Position

ENAMEL

DENTINE

PULP
} CROWN

Cervix

CEMENTUM
} ROOT

Cementum is on the root, but can extend slightly


onto enamel. Cementum also can be exposed to
the oral cavity, if the gingiva recedes too far

CEMENTUM: types & width

The left of this Fig is


P misleading in
U suggesting that all
L cementum is
P cellular.
10 µm
thick
A
L } The cervical half is
thin and acellular -
no cementocytes
Cementum
700 µm APICAL
thick

5
INTER-RADICULAR CEMENTUM

Multi-rooted teeth usually


have particularly thick &
cellular cementum
between the roots in an
inter-radicular position

CEMENTUM: Boundaries

Cemento-enamel junction CEJ

Dentino-cemental junction DCJ

Ligamento-cemental junction

APICAL FORAMEN

6
CEMENTUM: CEJ VARIATIONS

E E E

D D D

CEMENTUM

OVERLAP C/E BUTT JOINT GAP


most frequent end-to-end dentine exposed

GROWTH OF CEMENTUM = PDL anchoring

E E E E

PDL
fibers
D D D D

Reactivated cementoblasts PDL fibers become


lay down cementoid Cementoid becomes imbedded in newly
another layer of cementum. formed cementum -
Cells make more cementoid Sharpey’s fibers

7
GROWTH OF CEMENTUM III

Further down the root


cementoblasts proliferated
so that one cell can
become imbedded as a
cementocyte, while
another remains on the
surface as a cementoblast
D D

Further down the root PDL fibers omitted.


cementoblasts proliferate

CEMENTUM MATRIX
Fine collagen fibrils - intrinsic
PDL fibers (extrinsic)
become imbedded in
newly formed cementum
-
MATRIX
PROPORTIONS
collagen fibrils and
glycoproteins &
proteoglycans 35%
Imbedded PDL fibers -
Sharpey’s fibers - not Organic
specific to cementum mineral crystals 65%
Inorganic

8
ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM

DENTINE

HERTWIG’S Root sheath


ROOT breaks up, allowing
sac mesenchymal
SHEATH cells to contact
root dentine

Epithelial diaphragm Odontoblast recruitment site

CEMENTOGENESIS START

DENTINE

Root sheath breaks up & lifts,


allowing sac mesenchymal cells
to contact root dentine

Dentine &/or Epithelial root


PULP sheath induces mesenchymal
cells to become cementoblasts

Odontoblast recruitment site by root sheath: pulp signaling

9
SEQUENCES

Directions of
cemental Dentine formed before
growth - cementum
outwards & & cervical before apical
apicalwards

Occlusal wear FUNCTIONAL ERUPTION


& TOOTH MOVEMENT

Osteoclasts
resorbing bone

Osteoblasts
Bony laying down
interdental bundle bone
septum

PDL fibers
incorporated in bone
as Sharpey’s fibers
Cellular cementum added to apex
Compensates for occlusal wear? Basil

10
CEMENTUM: Defects

CORONAL CEMENTUM
spurs, etc, on enamel

P
U
L
P
HYPERCEMENTOSIS -
excess deposition

CEMENTICLES
IN PDL CEMENTOCLASIA - eroded
cementum (occurs normally in
decidual-tooth shedding)

CEMENTUM: Repair

P
P
U U
L
L
P P After cementoclasia,
cementoblasts may fill
in the defect with new
cementum.
This cycle can be repeated,
and also occurs a little
during shedding & after
root fracture

11
EXFOLIATION of DECIDUOUS MOLAR III

ENAMEL

DENTINE

Erosion of bone and the deciduous root is not steady &


continuous, but may cease briefly, when some repair of
eroded cementum & dentine can occur (by cementum).

CEMENTICLES
Hard mineralized bodies found in
the periodontal ligament or
partially imbedded in cementum

P
U
L
P

12
WABeresford
DENTAL PAIN

Dental pain enters consciousness (HURTS) &


becomes a major aspect of dentistry

What is the innervation of the tooth & periodontium?

How are these nerve fibers and endings related


to dental pain?

How do the stimuli - heat, inflammatory


mediators, etc - activate the nerve fibers?

What are the central pathways, structures, &


interactions bringing pain to conciousness?

DENTAL SENSITIVITIES
SENSITIVE?
Enamel

Dentine

Pulp

Cementum

PDL

1
PULP INNERVATION Sub-odontoblastic plexus
in cell-poor zone of Weil

1
2 3

Nerves: sensory (V) to


Nerves:
autonomic 1 PULP
2 ODONTOBLASTS
3 DENTINAL TUBULES

Blood vessels

EXTENT of TOOTH INNERVATION

Sub-odontoblastic
plexus of Raschkow

Most fibers branch

Hundreds of nerve fibers per tooth

Fibers grow in during development & some “transfer” to


20 tooth, so 20s have more nerves fibers than 10s

2
FIBER CALIBER & MODALITY

80 % unmyelinated C fibers

δ fibers
10 % myelinated Aδ

< β fibers
1/2 % Aβ

No specialized receptors

NOCICEPTION - pain - sensory


Hundreds of nerve fibers modality for pulp & dentine
per tooth

FIBER FUNCTIONS

NOCICEPTION - pain - the sensory


modality for pulp & dentine

But what do these do?

< β fibers
1/2 % Aβ

Any trophic effects on


pulp from sensory fibers?

Autonomic roles

Hundreds of nerve fibers


per tooth

3
PNS: AUTONOMICS

Sympathetic fibers

V
Sup Cervical
Ganglion

Pulp vessel
Branch of external
Other targets?
carotid A

PNS:CNS Sensory relations

Superior alveolar nerves


Spinal nucleus of V

CNS

Inferior alveolar nerves


Trigeminal ganglion

Convergence from several teeth onto one CNS neuron

4
PAIN QUALITY

ACUTE, SHARP δ fibers


myelinated Aδ

DULL ACHE unmyelinated C fibers

POOR LOCALIZATION Convergence

Spinal nucleus of V
CNS

Inferior alveolar nerves


Trigeminal ganglion

PERIODONTAL LIGAMENT INNERVATION


Sup Cervical
Sympathetic Ganglion

Free ending V Ganglion CNS

Mesencephalic
“Ruffini” receptors nucleus of V
Mechanoreceptors for stretch

Modalities: PROPRIOCEPTION & pain

5
CNS: Dental pain pathways
SENSORY CORTEX
Parietal lobe

Thalamic VPM

Reticular formation
Periaqueductal
grey (PAG)

Spinal N V Mesencephalic N of V
Sensory V Nucleus CNS
Spinal V tract

TRIGEMINAL NERVE

CNS: Dental pain pathways


SENSORY CORTEX

Thalamic VPM

Reticular formation

Mesencephalic N
Spinal N V Periaqueductal grey
Sensory V Nucleus (PAG) can inhibit
Spinal V tract
ascending pain
signals by using
TRIGEMINAL NERVE endorphins, enkephalins

6
RETICULAR FORMATION: Roles

Reticular formation sends signals “everywhere”

Cortex - arousal

Hypothalamus -
autonomic responses
Limbic system -
emotions
Motor nuclei - reflexes

Sensory relays - Inhibition


of incoming & ascending
sensory signals

NERVE-FIBER:STIMULI RELATIONS I
Direct pulp
stimuli ODONTOBLASTS Worn dentine brings stimuli
nearer to pulp

Pulp
Heat
Cold
Enamel
Pressure
2 3
Chemicals?
Axons in tubules
Axons around
odondoblast bodies
Sub-odontoblastic plexus
ODONTOBLAST as
sensory transducer ?

7
NERVE-FIBER:STIMULI RELATIONS II
ODONTOBLASTS Worn dentine brings stimuli
nearer to pulp
Pulp
Heat
Cold
Enamel
Pressure
2 3
Chemicals
Axons in tubules
Axons around
odondoblast bodies

Pulp fibers sensitized by factors released


because of inflammation or previous activity

NERVE-FIBER:STIMULI RELATIONS III


ODONTOBLASTS
Dentine

Heat
Cold
Enamel
Pressure

Stimuli move fluid


Axons in tubules back & forth in the
Axons around tubule stimulating
odondoblast bodies tubule axons &/or
odontoblasts
HYDRODYNAMIC hypothesis of sensitivity

8
NERVE-FIBER:STIMULI RELATIONS IV
ODONTOBLASTS
Dentine

Heat
Cold
Enamel
Pressure

Stimuli move fluid


back & forth in the
Axons around tubule
odondoblast bodies

HYDRODYNAMIC hypothesis of sensitivity


with distortion of the odontoblast possibly causing it to release
ATP, and thus chemically exciting the axon - Alavi AM et al.
Immunohistochemical evidence for ATP receptors in human pulp. J Dent Res
2001;80:476-483

HYDRODYNAMIC hypothesis of sensitivity

Stimuli move fluid


back & forth in the
tubule
ODONTOBLAST as
sensory transducer ?

with distortion of the odontoblast possibly causing it to


release ATP, and thus chemically exciting the axon - Alavi
AM et al. Immunohistochemical evidence for ATP receptors in human
pulp. J Dent Res 2001;80:476-483

9
DENTAL PAIN: Unknowns

Stimulation mechanisms in pulp - normal & diseased

Reticular formation - what happens centrally

Patterns of firing - relation to perceptions

PAIN: Difficult to study


First Anatomy Journal about 1860; first Pain journal 1973
Animal cannot tell of pain; humans reluctant to let you
hurt them or do invasive investigations, e.g., nerve
recordings
Allowed to work on animals only if pain is prevented
or minimised
Many small nerve fibers used for other purposes,
e.g., autonomic

No specialized pain endings? Defining pain stimuli?

Complex chemistry with tissue injury

Poorly understood dynamic interactions between


CNS & PNS - Pain is in the mind & usually in the body
(CNS-PNS interactions: compare sexual arousal)

10
TOOTH TISSUES: DENTINE WABeresford

ENAMEL
GINGIVA
DENTINE

PULP
CEMENTUM

PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

TOOTH DESIGN: Spear me

Blade Shaft Grip

DENTINE CEMENTUM
ENAMEL

1
TOOTH DESIGN: Spear me
Blade Shaft Grip

DENTINE CEMENTUM
ENAMEL

Refinements Shaft is hollow for


ENAMEL PULP
DENTINE CEMENTUM

Hand represented by
PERIODONTAL LIGAMENT
& ALVEOLAR BONE

Closer to true proportions

DENTINE: Role

Dentine is the major tissue of the tooth,


acting as the living, hard, strong &
resilient core, to which specialized
tissues attach

2
DENTINE: Correlates

Dentine is the MATRIX of collagen fibrils and


major tissue of glycoproteins & proteoglycans -
the tooth, acting
as the living, STRENGTH & RESILIENCE
hard, strong &
resilient core, to mineral crystals - HARDNESS
which specialized
tissues attach

ODONTOBLASTS & their processes -


LIVING

DENTINE: Position

ENAMEL

DENTINE
} CROWN

Cervix

CEMENTUM
PULP } ROOT

CROWN/CORONAL ROOT/RADICULAR
versus
DENTINE DENTINE

3
DENTINE: Boundaries

Dentino-enamel junction DEJ

Pulp surface

Orally exposed - pathological

Dentino-cemental junction DCJ

APICAL FORAMEN

DENTINE: Composition

MATRIX of collagen fibrils, mineral


crystals, and glycoproteins & proteoglycans

Odontoblasts
in an epithelial- Penetrated by TUBULES containing long thin
like layer processes of cells - ODONTOBLASTS -
whose bodies lie outside and against the
pulpal surface of the dentine

4
DENTINE: Composition

MATRIX of collagen fibrils, mineral


MATRIX crystals, and glycoproteins & proteoglycans
PROPORTIONS
collagen fibrils and
glycoproteins &
proteoglycans 30%
Organic TUBULE

mineral crystals 70%


Inorganic

DENTINE: Composition II

MATRIX subdivided into

Peritubular dentine Neumann’s sheath

Inter-tubular dentine

TUBULES 1-3 µm wide

5
DENTINE: Reality

Matrix-tubule ratios vary


Tubules curve

Processes split

Processes extend
into enamel rare
“ENAMEL
SPINDLES”

DENTINE: Growth
Enamel PREDENTINE

DENTINE

Odontoblasts

Direction of growth -
pulpward from DEJ

Enamel is
Matrix color as seen with H&E: removed by the
dense collagen gives a red color, but decalcification
predentine is paler. Matrix fibrils are needed for wax
unseen. sections

6
TOOTH GERM: Odontoblast recruitment

outermost papilla
cells have become
Odontoblasts
DENTAL
Recruitment site
PAPILLA
becoming
pulp

Ingrowing pulp vessels

TOOTH GERM:
Dentinogenesis
Dentine is formed first as predentine -
organic phase precede mineralization

cusp Dentine
formed by
Odontoblasts
Recruitment site
for odontoblasts

DENTAL
PAPILLA
becoming
pulp Ingrowing pulp vessels

7
ORIENTATION: Terms
CUSPAL/
Enamel
OCCLUSAL

CORONAL

P
U
L
CERVICAL { P
A
L
RADICULAR

APICAL Cementum

SEQUENCES

Dentine first formed at CEJ

Pulpal-surface dentine is
formed last

Odontoblast
trajectories Coronal dentine formed
during growth before root dentine, AND
cuspal before cervical, &
cervical before apical

8
INCREMENTAL GROWTH

Dentine first formed at CEJ

Contour lines of Owen reflect


varying physiological
circumstances during growth
neonatal line is most prominent
Odontoblast
trajectories This view tries to show
during growth something of the appearance of
the ground section of tooth. To
see detail, the glare needs to be
taken out by closing the iris
diaphragm (the lever on the
condenser) as required

MATURE DENTINE: Varieties


MANTLE DENTINE just
below DEJ coarser fibrils

CIRCUMPULPAL DENTINE -
main mass of dentine
{

P
U TERTIARY DENTINE* - slow
L increment to pulpal surface
P
REPARATIVE DENTINE* -
response to caries/erosion

* * Response relies on the pulp and the


odontoblasts staying alive & active

9
REPARATIVE DENTINE 2

REPARATIVE DENTINE
in response to attrition/wear of
the cusp
P
U
L
P

MATURE DENTINE: Defects


CARIOUS DENTINE
wide bacteria filled tubules
INTERGLOBULAR AREAS
lack mineral
P
U DEAD TRACT -
L wide, empty dentinal tubules
P easily colonized by bacteria

TOMES’ GRANULAR LAYER


holes in root dentine near DCJ

SCLEROTIC DENTINE -
tubules filled with mineral

10
MATURE DENTINE: Usual Defects

INTERGLOBULAR AREAS
lack mineral
P
U
L ‘normal’ development
P

TOMES’ GRANULAR LAYER


holes in root dentine near DCJ

SCLEROTIC DENTINE -
tubules filled with mineral
‘normal’ aging

INTERGLOBULAR AREAS lack


mineral & appear as black bat’s
wings in the ground section. They
represent incomplete expansion of
the spherical (globular)
mineralising foci in the predentine

P
U
L
P

Interglobular areas are close to the CEJ,


but may be seen in radicular dentine

11
DENTINTICLES/ PULP STONES
Hard mineralized bodies found in
the pulp or the dentine

TWO TYPES:
P
U 1 TRUE - constructed of dentine
L by odontoblasts & showing
P dentinal tubules
2 FALSE - mineralized connective
tissue, etc, (not made of dentine)

Both may show layering/lamellar patterns from


incremental growth

DENTINTICLES/ PULP STONES:


further classification by place
Hard mineralized bodies found in the pulp or
the dentine

THREE SUBTYPES:

P 1 FREE - in the pulp


U 2 IMBEDDED - enclosed in the
L dentine as this has slowly grown
P inwards
3 ATTACHED - partly imbedded

12
TOOTH TISSUES: ENAMEL WABeresford

ENAMEL
GINGIVA
DENTINE

PULP
CEMENTUM

PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

TOOTH DESIGN: Spear me

Blade Shaft Grip

DENTINE CEMENTUM
ENAMEL

1
TOOTH DESIGN: Spear me

Refinements
Shaft is hollow for
ENAMEL PULP
DENTINE CEMENTUM

Hand represented by
PERIODONTAL LIGAMENT
& ALVEOLAR BONE

Closer to true proportions

ENAMEL: Role

Enamel is the dead, very hard,


but brittle cutting/grinding
oral covering of the tooth

2
ENAMEL: Position

ENAMEL

DENTINE
} CROWN

Cervix

CEMENTUM
PULP } ROOT

ENAMEL: Boundaries

Dentino-enamel junction DEJ

Orally exposed surface with acquired


PELLICLE

Cemento-enamel junction - CEJ

3
CEMENTUM: CEJ VARIATIONS

E E E

D D D

CEMENTUM

OVERLAP C/E BUTT JOINT GAP


most frequent end-to-end dentine exposed
60% 30% 10%

ORIENTATION: Terms
CUSPAL/
Enamel
OCCLUSAL

CORONAL

P
U
L
CERVICAL { P
A
L

APICAL

4
ENAMEL: Nature
Enamel is the dead, very hard, but brittle cutting/
grinding oral covering of the tooth
This degree of hardness can be achieved by the
dense packing of curved rods/prisms composed
almost entirely of densely arranged spikey mineral
crystals, with a keying together of the prisms
R
O
Mineral is hydroxyapatite, with
D
Ca2+, OH-, PO4--, etc, ions R
O
D
Cross-section of rods

Hardness from material & interlocking devices

ENAMEL

Last enamel is NON-PRISMATIC

Enamel is 96% large mineral


crystals arranged as long wavy
interlocked rods/ prisms
Demarcation between prisms
is called the ROD SHEATH -
more organic, slightly less
mineral
Enamel is:
PRISMS/ 96% mineral,
RODS 3% water,
1% organic material
DEJ First enamel is NON-PRISMATIC

5
SEQUENCES
Enamel first formed at DEJ

Enamel

Cusp enamel formed


Ameloblast
trajectory before cervical
during growth

One ameloblast
makes one prism/
rod

Enamel grows
outwards from
the DEJ

DEJ Story I

Starts as basal
lamina between
inner epithelial cells
& dental-papilla cells

Mesenchyme

6
DEJ Story II & III

Goes on to be a basal lamina


between inner epithelial cells
& dentine (third step)

Continues as basal lamina


between inner epithelial
cells & odontoblasts (2nd)

DEJ Story IV
cusp enamel
Dentine instructs inner epithelial formed by
cells to become ameloblasts - ameloblasts
through an intact, then through a
disintegrating basal lamina?

Ameloblasts lay down


enamel matrix on the
dentine to create the DEJ

7
DEJ Story V & VI

DEJ is actually a little irregular,


as a serrated or scalloped line
seen in ground sections

ENAMEL
SPINDLE

Odontoblast process stuck into


enamel matrix while it was soft,
thus crossing the DEJ

ENAMEL: Problems
R
Cross-section of rods O
D R
PROBLEMS:
O
the precise wear-resistant architecture needs D
a prior cell-oriented organic precursor
a maturation phase has to replace the
organic with inorganic mineral
the direction of growth outward from the DEJ
leaves the formative cells on the surface
where they cannot survive - no later repair
possible
deleterious agents can substitute for ions in
the crystal lattice, e.g., Pb, Sr90, Fl, &
tetracycline can bind to the mineral

8
ENAMEL FORMATION - AMELOGENESIS

Ameloblast

Tomes’ process
Organic first deposits,
COMPARTMENT FOR
SECRETORY RELEASE e.g., amelogenin, + 30%
mineral

ROD organic materials digested;


replaced by mineral to 96% -
maturation
DEJ DEJ

AMELOBLAST’S TOMES’ PROCESS

Ameloblast
Process defined by terminal
web of actin etc stretching
between junctional complexes
fastening ameloblasts together
COMPARTMENT FOR
SECRETORY RELEASE Tomes’ process
Releases vesicles of
amelogenin, etc

ROD transports ions into matrix

later releases enzymes to digest


organic matrix (replaced by
mineral to 96%- maturation)

9
AMELOBLAST’S VASCULAR RELATIONS

CAPILLARY
BASAL LAMINA

Ameloblast Outer dental epithelium


Stratum intermedium

Collapse of stellate
reticulum lets vessels
ROD approach closer to the
highly active ameloblasts

TOOTH GERM
Outer dental epithelium
collapsing down

Stellate reticulum DENTAL LAMINA


reducing over cusp upper degenerates
lower forms 2nd bud
Knot cells signal
to papilla outermost papilla
cells have become
Odontoblasts
DENTAL
Recruitment site
PAPILLA
becoming
pulp
Cervical loop
defines extent of
crown to crown
DENTAL SAC base; then it
quiescent starts the root
Ingrowing pulp vessels sheath

10
Dentine is formed first as predentine. TOOTH GERM:
It will signal to inner dental result & next steps
epithelial cells to become ameloblasts

Stellate reticulum
moving “apically”
cusp Dentine
formed by
Odontoblasts

TOOTH GERM: all crown-forming elements present

Ameloblasts Capillaries now close to


synthesizing ameloblasts
Stellate reticulum
cusp enamel
Dentine formed by
ameloblasts

Enamel is always
DENTAL SAC less extensive than
still quiescent dentine

11
CHANGES IN DENTAL/
Ameloblasts
ENAMEL ORGAN III will finish full
Second reduction in thickness of
enamel epithelium: cusp enamel
retired ameloblasts & & reduce in
compacted outer height
epithelium, stellate-
reticulum cells & Dentine widens
stratum intermedium DENTAL
Stellate reticulum PAPILLA
follows Cervical becomes pulp
process
loop down then proceeds
stops: Crown downs
defined
Odontoblast
recruitment
Cervical loop:
site

CROWN COMPLETED ENAMEL


REDUCED
CROWN
DENTAL
EPITHELIUM
DENTINE
Where Stellate
reticulum
stopped, the PULP
cervical loop
continued to
grow down, but
as
HERTWIG’S ROOT
ROOT SHEATH
& its

Epithelial diaphragm Odontoblast recruitment site

12
ROOT FORMATION: Coronal consequences
GINGIVAL
EPITHELIUM
Connective
REDUCED tissue broken
DENTAL down
EPITHELIUM will
fuse with gingiva

REDUCED
DENTAL
EPITHELIUM
protects As root
enamel lengthens
crown is
HERTWIG’S
pushed up -
ROOT
Pre-
SHEATH
grows to
EMERGENCE
lengthen root

TOOTH EMERGENCE
CUTICLE
GINGIVAL will wear away
EPITHELIUM
still fusing with

REDUCED DENTAL
EPITHELIUM

ENAMEL

13
ORGANIC ENAMEL SURFACE
CUTICLE
will wear away

PELLICLE of
glycoproteins etc is
acquired later from saliva

PLAQUE
the biofilm of many kinds
of bacteria then attaches
to the pellicle

INCREMENTAL GROWTH
Contour lines of Retzius
reflect varying physiological
circumstances during growth
neonatal line is most prominent

As ameloblasts make prisms, diurnal


fluctuations in their physiology
produce faint striations across the
rods

Unless erased by wear, perikymata


are a mild ripple effect seen on the
surface of enamel from the slightly
differing qualities of enamel
remember the flat-wet-sand, low-tide effect

14
ENAMEL IN HISTOLOGY

Being 96% mineral, enamel makes


teeth too hard to cut for imbedded
& stained sections

Demineralization with acid or a


chelator, for H&E sections destroys
mature enamel, creating a space

Ground sections, unstained, preserve


mature enamel, but may introduce cracks

Demineralization for H&E leaves


some of the immature enamel of
early formation, particularly in the
last-formed cervical region

AFTER DEMINERALIZATION
REDUCED
DENTAL
space where
EPITHELIUM
mature
ENAMEL has
been lost

immature
ENAMEL
matrix remains
DENTINE most recently
formed, hence
immature
PULP

15
FISSURE/PIT
ENAMEL: Special features

TUFT

GNARLED
ENAMEL

LAMELLA

SPINDLE

ENAMEL: Special features FISSURE/PIT


Ameloblasts
were cramped
while making
enamel

ENAMEL
SPINDLE
Odontoblast
process stuck into
enamel matrix
while it was soft

16
ENAMEL: Special features Mostly visual
TUFT effect from varied
rod directions

GNARLED
ENAMEL
Mostly
visual
effect
from
unusually
varied rod
directions
LAMELLA
Vertical cracks filled
Lamellae are seen in with mineralized
coronal cross-sections organic material

ENAMEL: minor defect

CORONAL CEMENTUM
spurs, etc, on enamel

P
U
L
P Reduced enamel epithelium
had gaps that allowed
mesenchymal cells in to
become cementoblasts

17
MATURE ENAMEL: Severe Defects

ATTRITION/ WEAR

CARIES/DECAY
P
U
L
P

Any loss is severe since there


are no ameloblasts to replace it

18
ROOT FORMATION & ERUPTION
WABeresford

PULP
CEMENTUM
DENTINE
PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

What has to be controlled

Number of roots
Shapes of root
Length of root
Four tissues in sequence
Pulp Dentine Cementum Ligament

Organize surroundings

Fasten tooth to surroundings

Times of eruption
& coordinated
Shedding of teeth
e.g., cementum with PDL
with bone
Successional teeth

1
TOOTH TISSUES: Cell Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL


Ameloblasts

DENTAL PAPILLA DENTINE


Odontoblasts
PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts

Crest

MECHANISMS OF ERUPTION
Construction & Reorganization of PDL

Formation of the root


Deposition of alveolar bone?

Remodelling of bone overall


FURTHER INFLUENCES from: tooth/teeth in occlusion; muscle actions

2
TOOTH GERM:
Outer dental epithelium
approaches inner
next steps
DENTAL LAMINA
Stellate reticulum upper part degenerates
reduces over cusp lower forms 2nd bud

Knot cells
signal to
Stratum intermedium
papilla

DENTAL PAPILLA
Inner & outer dental epithelia
join to form cervical loop DENTAL SAC/FOLLICLE

LATE CROWN FORMATION


cusp enamel
formed by
First reduction in ameloblasts
enamel epithelium:
active ameloblasts & Dentine
compacted outer
epithelium, stellate- DENTAL
reticulum cells & PAPILLA
stratum intermedium become pulp

remaining
Stellate reticulum

Cervical loop:
inner & outer
epithelium DENTAL SAC
still quiescent

3
END OF CROWN Ameloblasts
FORMATION will finish full
thickness of
cusp enamel
& reduce in
height

Dentine widens
DENTAL
Stellate reticulum PAPILLA
follows Cervical become pulp
process
loop down then proceeds
stops: Crown downs
defined
Odontoblast
recruitment
Cervical loop:
site

ROOT FORMATION ENAMEL


REDUCED
CROWN
DENTAL
EPITHELIUM
DENTINE
Where Stellate
reticulum
stopped, the PULP
cervical loop
continued to
grow down, but
as
HERTWIG’S ROOT
ROOT SHEATH
& its

Epithelial diaphragm Odontoblast recruitment site

4
FURTHER ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM

Root sheath
ENAMEL breaks up, allowing
sac mesenchymal
cells to contact
DENTINE
root dentine

PULP
Other sac
HERTWIG’S mesenchymal
ROOT cells construct
PDL & some
SHEATH
alveolar bone
grows to
lengthen root Fibroblasts
Epithelial diaphragm Odontoblast recruitment site

ROOT FORMATION: Multirooted


ROOT SHEATH & ITS
CROWN DIAPHRAGM widens
& constricts to create
ENAMEL
two diaphragms to
define two roots
DENTINE
Cross-sections

PULP

ROOT

Epithelial diaphragm ROOT SHEATH

5
ROOT FORMATION: Multirooted
Thus, one dental organ
CROWN can produce two or
three roots
ENAMEL
Similarly, one dental
organ can produce
DENTINE two or more cusps,
using multiple
enamel knots

PULP

ROOT

Epithelial diaphragm ROOT SHEATH

REITERATIVE SIGNALING V
REDUCED DENTAL
EPITHELIUM

ENAMEL

DENTINE

Root sheath breaks up & lifts,


allowing sac mesenchymal cells
to contact root dentine

Dentine &/or Epithelial root


PULP sheath induces mesenchymal
cells to become
cementoblasts
Odontoblast recruitment site by root sheath: pulp signaling

6
JAW & TOOTH DEVELOPMENT early arch
BONE starting
BUCCAL PLATE DENTAL LAMINA

BONE starting
LINGUAL PLATE

10 TOOTH GERM

20 Successional
WALLS OF BONY TOOTH GERM
TROUGH OF
DEVELOPING
MANDIBLE

SYMPHYSEAL
CARTILAGE

JAW & TOOTH DEVELOPMENT processes


BONE starting DENTAL LAMINA will grow back to form
BUCCAL PLATE germs for 3 permanent molars (5th e m)
grows up more
than lingual BONE starting
LINGUAL PLATE

10 TOOTH GERM

20 Successional TOOTH GERM


Interradicular septum
on lingual side of 10
grows between roots
of multirooted teeth Bony wall grows around
& encloses 20 TOOTH
GERM in a crypt

Interdental septum SYMPHYSEAL CARTILAGE


grows across trough will be replaced by bone
to separate teeth

7
TOOTH & MANDIBLE DEVELOPMENT
Oral ectoderm
TONGUE
DENTAL SAC

10 TOOTH

ALVEOLAR
BONE

20 TOOTH GERM

MECKEL’S
ALVEOLAR CARTILAGE
NERVE

MANDIBLE DEVELOPMENT
DENTAL SAC contributes Remodeling will bring erupting
also to alveolar bone 1o tooth over developing 2o

Alveolar crest Bony plate grows up


grows up 10 TOOTH to enclose 2nd tooth
germ in a CRYPT

Bone added to
base of alveolus 20 TOOTH
for tooth eruption GERM

Bone grows over MECKEL’S


alveolar nerve & CARTILAGE
vessels regresses & not
used to form
Alveolus becomes
mandible
distinct from BODY

8
TOOTH & MANDIBLE DEVELOPMENT - Next
Reduced enamel epithelium
fused with gingiva
TONGUE
DENTAL SAC
Higher alveolar bone
- i.e. deeper socket 10 TOOTH

ALVEOLAR
BONE
Longer root with
cementum forming 20 TOOTH GERM

More advanced 2nd tooth


ALVEOLAR
NERVE
MECKEL’S
Denser alveolar bone & more CARTILAGE

body-alveolus distinction
Remodeling brings erupting 1o Meckel’s cartilage gone
tooth over developing 2o

TOOTH EMERGENCE
CUTICLE
GINGIVAL will wear away
EPITHELIUM
still fusing with

REDUCED DENTAL
EPITHELIUM

ENAMEL

9
ORGANIC ENAMEL SURFACES
CUTICLE
will wear away
PELLICLE of
glycoproteins etc is
acquired later from saliva

PLAQUE
the biofilm of many kinds
of bacteria then attaches
to the pellicle, & later
mineralizes - tartar

LATE ERUPTING TOOTH


Epithelial diaphragm
ROOT SHEATH
GINGIVA
BONE CEMENTUM
PDL

DENTINE
ENAMEL
PULP

Rests of Mallassez
Cementum starting as remnants of Root sheath
sheath breaks down

10
LATE ERUPTING TOOTH
ENAMEL

DENTINE Rests of Mallassez


remnants of Root sheath

GINGIVA

CEMENTUM PULP
PDL
ROOT SHEATH

Epithelial diaphragm Cementum starting as


sheath breaks down

BONE

MANDIBULAR CENTRAL
Deciduous tooth INCISORS at 2 y

Gingiva
PDL
Permanent
tooth

ALVEOLAR BONE

Cortical plate BODY of


dense bone MANDIBLE

11
Go Gubba
Gubernacular cord of
fibrous tissue
Gubernacular cord
runs through a canal
left in the bony crypt,
where the dental
lamina extended
Permanent down to establish the
tooth germ for the 2nd
tooth

Deciduous tooth MANDIBULAR CENTRAL


Resorption of bone INCISORS at 2 y - Bone
& deciduous root
will start here

Permanent
tooth

Spongy/ cancellous bone

Cortical plate
dense bone

12
10/Deciduous tooth Close to EXFOLIATION
of Deciduous/10 Tooth
Odontoclasts have
resorbed most of
PDL attachment is
deciduous root
surprising persistent
Pulp is left
alive
Bone remodellling
has brought 20 tooth
under 10
20 tooth
Bone trabeculae
added by layers at
base of alveolus

20 tooth would be
LARGER than shown

LATE ERUPTING TOOTH: Origins


Epithelial diaphragm
ROOT SHEATH Dental organ
GINGIVA Oral Ectoderm
PDL CEMENTUM Dental sac

DENTINE
ENAMEL
PULP

BONE Rests of Mallassez


remnants of Root sheath

PDL Dental sac BONE Arch Mesenchyme & Dental sac

13
WHY STILL ERUPTING

APEX INCOMPLETE
BONE
PDL

DENTINE
ENAMEL
PULP

Cementum not to apex

Epithelial diaphragm present


Immature connective tissue Pulp chamber wide
(no apical taper)
& Bone forming in base of alveolus

STARTING EXFOLIATION of DECIDUOUS MOLAR I

ENAMEL

DENTINE

ALVEOLAR
PULP
BONE

PDL

Root resorption
by osteoclasts
Inter-radicular septum of bone also
Permanent Tooth under deciduous houses 2nd tooth germ & is its crypt
molar, & between its roots

14
EXFOLIATION of DECIDUOUS MOLAR II

Crypt bone
eroded here ENAMEL

DENTINE

ALVEOLAR
BONE

PDL

Resorbed dentine partly


Focal erosion along this line repaired by new cementum
leaves a ROOT FRAGMENT PDL is disrupted in regions of
which may be retained root resorption & repair

EXFOLIATION of DECIDUOUS MOLAR III

ENAMEL

DENTINE

Erosion of bone and the deciduous root is not steady &


continuous, but may cease briefly, when some repair of
eroded cementum & dentine can occur (by cementum).
Bone remodelling also goes on, and the alveolus and
crypt are changing all the time - repeated all along the jaw

15
Occlusal wear FUNCTIONAL ERUPTION
& TOOTH MOVEMENT

Osteoclasts
resorbing bone

Osteoblasts
Bony laying down
interdental bundle bone
septum

PDL fibers
incorporated in bone
as Sharpey’s fibers
Cellular cementum added to apex
Compensates for occlusal wear? Basil

Tooth drifts mesially TOOTH MOVEMENT


by combined actions
of osteoclasts &
osteoblasts moving
bone, taking tooth
with it

Osteoblasts
laying down
bundle bone

Osteoclasts
resorbing bone
Basil

16
TOOTH MOVEMENT

Tooth drifts mesially by


combined actions of
osteoclasts & osteoblasts
moving bone, taking tooth
with it

Earlier bone
position

Basil

TOOTH ERUPTION

Pre-oral phase Intra-oral phase

17
TOOTH ERUPTION

Once the teeth meet in


occlusion, their further
eruption separates the jaws

Once the teeth meet in


occlusion, they influence
each other mechanically

PERIODONTITIS

TOOTH EPITHELIAL ATTACHMENT-


unstable, loosens &
migrates down, & allows
bacteria into
CONNECTIVE TISSUE
GINGIVA resulting in chronic
Periodontal infection &
ligament inflammation &
systemic spread of
bacteria &
Alveolar bone
loss of teeth

18
PASSIVE ERUPTION
Gingival recession onto &
down the cementum with loss
of alveolar-crest bone

Raising the banana, then peeling the banana

Fate of exposed cementum &


dentinal consequences & reactions

P
U Cementum readily abraded &
L eaten by oral acids
P
DEAD TRACT in Dentine -
wide, empty dentinal tubules
easily colonized by bacteria

REPARATIVE DENTINE -
response to caries/erosion

19
TOOTH MOVEMENTS Occurring in eruption & use

By root growth &


AXIAL - in long axis of the tooth
bone remodelling

DRIFTING e.g., mesially, laterally

TILTING By bone remodelling &


PDL reorganization
ROTATORY

Combinations of these four


movements frequently occur
Basil

TOOTH MOVEMENT 2
TILTING Tooth tilts by combined
actions of both osteoclasts
Earlier bone & osteoblasts on bone of
position each side of socket

Basil

20
3rd MOLAR’S TILTING ERUPTION

2nd
2nd
3rd

3rd

TILTING mechanism may be useful, e.g., in bringing


upright the third molar that starts tilted

Failure can lead to an impacted molar still within the bone

YOUNG CHILD’S ERUPTION SEQUENCE


YEARS 0 1 2 3 4 5 6 7

KEY
Time of emergence

Crown forming Root forming

10 2nd Molar
Deciduous
20 Incisor Permanent

20 Cuspid

20 2nd PreMolar

21
YOUNG CHILD’S ERUPTION SEQUENCE
YEARS 0 1 2 3 4 5 6 7

10 Incisor

10 Cuspid

10 2nd Molar

20 Incisor

20 Cuspid

20 2nd PreMolar

5-yr CHILD’S DENTITION: 0ne arch

Oral
Pre-oral

5 deciduous teeth working, but 1o incisor root is being resorbed


7 successional/succedaneous teeth developing pre-orally

dental lamina for 3rd molar

22
5-yr CHILD’S DENTITION: 0ne arch

Oral
Pre-oral

These 12 “teeth” require a very coordinated remodelling of the


bone (& PDL) supporting & enclosing them

ERUPTION: Problems
Delayed eruption

Early eruption

Missing tooth

Impaction - failure to erupt e.g., from too little gap after


premature loss of deciduous tooth
Retained root fragment

Malocclusion
Infra-occlusion (not high enough)
Excessive drift
Tilting (can occur early from germ rotation)

23
GINGIVA: Roles WABeresford

Connect soft tissue to hard while it

Establishes a seal around the tooth

Fastens to the tooth along an extensive area


Provide sensation for control of biting & chewing

Control oral microbes

Protect the PDL & alveolar bone

Adapt to changing oral conditions & eruption

Attaches firmly to the bone supporting the tooth

Join with the adjacent aveolar mucosa

Free & attached gingiva

TOOTH
Gingival sulcus/ crevice

} FREE GINGIVA

Epithelial ATTACHED GINGIVA


attachment

1
Free & attached gingiva

TOOTH
Gingival sulcus/ crevice

} FREE GINGIVA

Epithelial
attachment
ATTACHED GINGIVA

Caution - In section, enamel dissolved out, just a space

Muco-gingival junction

TOOTH
Muco-gingival junction

FREE
GINGIVA
Periodontal
ligament
ATTACHED
GINGIVA

Crest of
Alveolar
bone
Alveolar mucosa
lies outside alveolar bone

2
GINGIVAL EPITHELIUM

Stratified squamous
para-keratinized
piled-up, tightly
attached, & internally
reinforced cells

very protective barrier,


needing glandular
lubrication

GINGIVAL EPITHELIUM: Cell types

Keratinocytes

Melanocyte

Langerhans APC cell

Merkel cell

Nerve cell (axon)

3
GINGIVAL EPITHELIUM: Cell types

dead

Keratinocytes Melanocyte to
make & transfer
alive pigment

Langerhans Merkel cell


APC cell sensory
immunity

Nerve cell represented


by its axon

GINGIVAL EPITHELIUM: Subtypes

TOOTH
Gingival sulcus/ crevice
GINGIVAL EPITHELIUM*
SULCULAR/CREVICULAR
EPITHELIUM
CUFF/ ATTACHMENT
EPITHELIUM

*Keratinization

4
EPITHELIAL ATTACHMENT
TOOTH

CUTICLE

BASAL LAMINA

JUNCTIONAL/ CUFF/
ATTACHMENT EPITHELIUM

GINGIVAL ELEMENTS - Dense connective tissue

TOOTH MATRIX -
Ground substance
Collagen I & III fibers
Elastic fibers

CELLS -
GINGIVA
Fibroblasts & Myofibroblasts
Macrophages
Mast cells
Leukocytes

Blood vessels
Nerves, receptors
Alveolar Lymphatics
bone

5
GINGIVAL ELEMENTS - Connective tissue cells

TOOTH Fibroblasts & Myofibroblasts


Macrophages
Mast cells
Leukocytes

Leukocytes, particularly PMNs &


GINGIVA lymphocytes, are very numerous
& infiltrate the epithelium

The gingiva is in a continuous


inflammatory state
Alveolar
bone

PERIODONTITIS

TOOTH EPITHELIAL ATTACHMENT-


unstable, loosens &
migrates down, & allows
bacteria into
CONNECTIVE TISSUE
GINGIVA resulting in
Periodontal chronic infection &
ligament inflammation &
systemic spread of
bacteria &
Alveolar bone
loss of teeth

6
GINGIVA ELEMENTS - The elastic question
MATRIX - Ground substance Collagen I & III fibers Elastic fibers

The Gingiva has the elasticity of bundled


collagen fibers in a water-containing matrix of
proteoglycans & glycoproteins. But it does
contain elastic fibers.

The complication is that elastic fibers comprise


microfibrils orienting the elastin, & these are separate
molecular species that have to assemble. The gingiva
does have the microfibrils arranged as OXYTALAN
fibers. Why? No-one knows.

The final complication is that there is an a fiber


intermediate between the elastic & oxytalan fibers - the
ELAUNIN fiber, also present in the gingiva. [Ignore.]

GINGIVAL COLLAGEN FIBER GROUPS

DENTO-GINGIVAL

ALVEOLO-GINGIVAL

CIRCULAR

DENTO-PERIOSTEAL In bucco-lingual plane

TRANS-SEPTAL Between adjacent teeth

7
GINGIVAL FIBER GROUPS
TOOTH

DENTO-GINGIVAL
GINGIVA

DENTO- CIRCULAR
PERIOSTEAL

ALVEOLO-
TRANS-SEPTAL in
GINGIVAL
medio-distal plane, Alveolar
not shown here bone Periosteum

TRANS-SEPTAL FIBER GROUP


TOOTH TOOTH

TRANS-SEPTAL GINGIVA
in medio-distal
plane

Alveolar
septum

8
GINGIVAL FIBER GROUPS
DENTO-GINGIVAL
TOOTH
ALVEOLO-GINGIVAL
CIRCULAR
DENTO-PERIOSTEAL
TRANS-SEPTAL

DENTO-GINGIVAL
GINGIVA

CIRCULAR

TRANS-SEPTAL
if in medio-distal ALVEOLO-
plane, not as GINGIVAL
Alveolar
shown here bone

9
PERIODONTAL LIGAMENT/ PDL
WABeresford

ENAMEL
GINGIVA
DENTINE

PULP
CEMENTUM

PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

TOOTH DESIGN: Spear me

Refinements Shaft is hollow for


ENAMEL PULP
DENTINE CEMENTUM

Hand represented by
PERIODONTAL LIGAMENT
& ALVEOLAR BONE

Closer to true proportions

1
PERIODONTAL LIGAMENT: Roles
The PDL is the means of attaching the tooth
to the muscle-driven bone for mastication.
As a labile connective tissue, it:
adapts the strength and orientation of
attachment to varying load
senses loads for proprioceptive feeback
controlling muscle actions
helps to move the teeth for better occlusion
supplies & nourishes cementum & alveolar
bone
defends against microbes
repairs damage to itself, while preventing
damage to cementum

CONNECTIVE TISSUE ROLES: PDL

Connect/Support
Transport/Nourish
Defend
EPITHELIUM
*
(Storage)
Control } Connective tissue

Repair VESSEL

*The tissues served are also bone & cementum

2
CONNECTIVE TISSUE - Mechanical functions

Supporting - ligament, cartilage, bone


Binding - ligament
Restraining - ligament
Directing - tendon
Separating - fascia
Padding - fat pad

Functions, including padding, all effected by PDL,


but adipose tissue is absent

DENSE REGULAR CONNECTIVE TISSUE: Tendon

Bundles of thick
{
collagen I fibers
{
Looser vascular CT
Elongated fibroblasts - tenocytes between the bundles -
endotendinuem

3
DENSE REGULAR CONNECTIVE TISSUE: PDL

Bundles of thick
{
collagen I fibers
{
PRINCIPAL FIBERS
Looser vascular CT
between the bundles
- interstitial areas
Elongated PDL fibroblasts

PDL Interstitial Areas DENTINE

PULP

Interstitial Areas
between

OBLIQUE & other


FIBER BUNDLES

4
PDL ELEMENTS - Dense & loose connective tissue
MATRIX -
Ground substance
Reticular fibers
Collagen I fibers

CELLS -
Fibroblasts & Myofibroblasts
Macrophages
Mast cells
Leukocytes
Cementoblasts
Osteoblasts & ‘clasts

Blood vessels
Nerves
Lymphatics

& Cementicles & Rests

PDL ELEMENTS - The elastic question


MATRIX - Ground substance Reticular fibers Collagen I fibers

The PDL, like tendon, has the elasticity of bundled


collagen fibers in a water-containing matrix of
proteoglycans & glycoproteins. But it does NOT
contain elastic fibers.

The complication is that elastic fibers comprise


microfibrils orienting the elastin, & these are separate
molecular species that have to assemble. The PDL
does have the microfibrils arranged as OXYTALAN
fibers. Why? No-one knows.

The final complication is that there is an a fiber


intermediate between the elastic & oxytalan fibers - the
ELAUNIN fiber, also absent from the PDL. Forget it.

5
LATE ERUPTING TOOTH
Epithelial diaphragm
ROOT SHEATH
GINGIVA
BONE CEMENTUM
PDL

DENTINE
ENAMEL
PULP

Rests of Mallassez
Cementum starting as remnants of Root sheath
sheath breaks down

PDL BOUNDARIES Mature


Epithelial diaphragm BONE
ROOT SHEATH CEMENTUM
GINGIVA GINGIVA
BONE
PDL PULP
DENTINE
ENAMEL
PULP

+ while developing
ROOT SHEATH
CEMENTUM
MESENCHYME

6
TOOTH TISSUES: Cell Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL


Ameloblasts

DENTAL PAPILLA DENTINE


Odontoblasts
PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts

Crest

TOOTH GERM: all crown-forming elements present

Ameloblasts Capillaries now close to


synthesizing ameloblasts
Stellate
reticulum cusp enamel
Dentine formed by
ameloblasts

DENTAL Cervical loop


PAPILLA moving apically
becoming
to define extent
pulp
of crown
DENTAL SAC
still quiescent
2nd

7
FURTHER ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM

Root sheath
ENAMEL breaks up, allowing
sac mesenchymal
cells to contact
DENTINE
root dentine

PULP Other sac


mesenchymal
HERTWIG’S cells construct
ROOT PDL & some
SHEATH alveolar bone
grows to
lengthen root Fibroblasts
Epithelial diaphragm Odontoblast recruitment site

GROWTH OF CEMENTUM = PDL anchoring

E E E E

PDL
fibers
D D D D

Reactivated cementoblasts PDL fibers become


lay down cementoid Cementoid becomes imbedded in newly
another layer of cementum. formed cementum -
Cells make more cementoid Sharpey’s fibers

8
CERVICAL REGION

TOOTH EPITHELIAL ATTACHMENT-

CONNECTIVE TISSUE
GINGIVA
Periodontal
ligament

Alveolar bone

PDL CERVICAL FIBER GROUPS


TOOTH

(GINGIVAL LIGAMENT)
GINGIVA

TRANS-SEPTAL
ALVEOLAR- if in medio-distal
CREST plane, not as
shown here
HORIZONTAL
Alveolar
bone
CEMENTUM

9
PDL TRANS-SEPTAL FIBER GROUP
TOOTH TOOTH

TRANS-SEPTAL GINGIVA
in medio-distal
plane

Alveolar
septum

PDL FIBER GROUPS II DENTINE

HORIZONTAL PULP

OBLIQUE
the major group

APICAL

10
III PDL INTER-RADICULAR GROUP

Inter-radicular

Inter-radicular
bony septum

FIBER GROUPS: A classification


INTERDENTAL
Trans-septal
ALVEOLO-DENTAL
Alveolar-crest

Horizontal

Oblique

Inter-radicular

Apical

GINGIVAL LIGAMENT

11
PDL: Force transduction

Pressure

Oblique fibers
turn pressure
on the tooth into
tension on the
bone

BUNDLE BONE DENTINE

Imbedded ends of
PDL fibers create PULP
BUNDLE BONE

Imbedded PDL fibers


are Sharpey’s fibers

12
PDL: Intermediate plexus Non-imbedded
ends of PDL fibers
meet & attach in
D INTERMEDIATE
E PULP PLEXUS
N

{
T
I
N
E
This arrangement
provides for greater
ease of remodelling &
readjustment of the
plexus for growth &
altered function. But
remodelling occurs
throughout the PDL

Tooth drifts mesially TOOTH MOVEMENT


by combined actions
of osteoclasts &
osteoblasts moving
bone, taking tooth
with it

Osteoblasts
laying down
bundle bone

Plus PDL
reorganization

Osteoclasts
resorbing bone

13
Wider on bone- PDL in Cross-section
Interstitial Area
depository side

Bundle

DENTINE
CEMENTUM
P
D PULP
L

BONE
Narrow on bone-
resorptive side

Loss of Periodontal reactions to disuse


alveolar bone Reduction in # &
size of principal
fibers
Mild bone Bundle
deposition definition
on wall DENTINE
lost
CEMENTUM
P thickens
D PULP
L
CEMENTUM
PDL
loses
narrower all
Sharpey’s
around
BONE fibers

14
PERIODONTAL LIGAMENT INNERVATION
Sup Cervical
Sympathetic Ganglion

Free ending V Ganglion CNS

Mesencephalic
“Ruffini” receptors nucleus of V
Mechanoreceptors for stretch

Modalities: PROPRIOCEPTION & pain

PDL Vessels DENTINE

PULP

Enter via cribriform


(sieve) walls of the
alveolus & at the
base

Lymphatic drainage

15
RESTS & CYSTS
ROOT SHEATH

Rests of Mallassez
BONE PDL remnants of Root sheath

DENTINE
ENAMEL
PULP

Any buried epithelial cells can proliferate &


start to secrete, forming a cyst., e.g., remnants
of dental lamina, thyroglossal duct, etc

CEMENTICLES
Hard mineralized bodies found
entirely in the periodontal ligament
or partially imbedded in cementum

P
U
L
P

16
TOOTH TISSUES: Pulp WABeresford

ENAMEL
GINGIVA
DENTINE

ALVEOLAR CEMENTUM
BONE
PERIODONTAL
PULP LIGAMENT/
PDL

DENTAL PULP: Functions

Service tissue keeping its Odontoblasts alive


for slow defensive responses in the dentine

Providing antimicrobial defense for the


dentine and itself

Providing sensory feedback from the dentine,


but for what purposes?

1
TOOTH TISSUES: Pulp & its roles WABeresford

ENAMEL
GINGIVA
DENTINE

ALVEOLAR BONE CEMENTUM

PERIODONTAL
PULP LIGAMENT/
PDL

Service tissue keeping its Odontoblasts alive for slow


defensive responses in the dentine
Providing antimicrobial defense for the dentine and itself
Providing sensory feedback from the dentine, but for
what purposes?

PULP CHAMBER

CORONAL PULP HORN

ACCESSORY
CANAL
ROOT CANAL

APICAL FORAMEN

2
PULP REGIONS

ODONTOBLAST
LAYER
Cell-poor
ZONE OF WEIL PULP PROPER/
- peripheral pulp PULP CORE

PULP ELEMENTS - Mucoid connective tissue

MATRIX -
Ground substance
Reticular fibers
Collagen I
fibers Elastic fibers
CELLS -
Odontoblasts
Fibroblasts
Macrophages
Mast cells
Leukocytes

Blood vessels
Nerves
Lymphatics

3
PULP INNERVATION Sub-odontoblastic plexus
in cell-poor zone of Weil

1
2 3

Nerves: sensory (V) to


Nerves:
autonomic 1 PULP
2 ODONTOBLASTS
3 DENTINAL TUBULES

Blood vessels

PULP ELEMENTS - Mucoid connective tissue


MATRIX - Ground
substance Reticular
fibers Collagen I fibers
Elastic fibers

CELLS -
Odontoblasts
Fibroblasts
Macrophages
Mast cells
Leukocytes

Blood vessels
Nerves
Lymphatics

& Denticles & Fibrosis with aging

4
DENTICLES/ PULP STONES
Hard mineralized bodies found in
the pulp or the dentine

TWO TYPES:
P
U 1 TRUE - constructed of dentine
L by ectopic odontoblasts & showing
P dentinal tubules
2 FALSE - mineralized connective
tissue, etc, (not made of dentine)

Both may show layering/lamellar patterns


from incremental growth

DENTICLES/ PULP STONES:


further classification by place
Hard mineralized bodies found in the pulp
or the dentine

THREE SUBTYPES:

P 1 FREE - in the pulp


U 2 IMBEDDED - enclosed in the
L dentine as this has slowly grown
P inwards
3 ATTACHED - partly imbedded

5
TOOTH GERM: Pulp development

DENTAL ORGAN DENTAL LAMINA

MESENCHYME

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

ALVEOLAR BONE

TOOTH TISSUES: Sources

ENAMEL
DENTAL ORGAN DENTAL LAMINA
DENTINE
MESENCHYME
PULP

CEMENTUM
DENTAL PAPILLA
PDL
DENTAL SAC/FOLLICLE

ALVEOLAR BONE
A BONE

6
TOOTH TISSUES: Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL


Ameloblasts

DENTAL PAPILLA DENTINE


Odontoblasts
mesenchyme PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts

Crest

TOOTH TISSUES: Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

DENTAL PAPILLA DENTINE


PULP

DENTAL SAC/FOLLICLE CEMENTUM

PDL
LAMINA DURA
ALVEOLAR BONE
SUPPORTING
BONE
Plate
Spongy bone

7
TOOTH GERM
Outer dental epithelium

DENTAL LAMINA
Stellate reticulum

Stratum intermedium

DENTAL SAC/FOLLICLE
Inner dental epithelium DENTAL PAPILLA

Vessels Nerves

FURTHER ROOT FORMATION

PULP
differentiates

HERTWIG’S
ROOT
SHEATH
grows to
lengthen root

Epithelial diaphragm Odontoblast recruitment site

8
EXTRACELLULAR MOLECULAR INTERACTIONS 1

Further assembly of the molecules to make larger &


eventually ‘visible’ structures, such as fibrils

Modification of the molecules, e.g., cross-linking, to make


them resistant to digestion

Deliberate breakdown of the molecules by the forming cells


for turnover and renewal, by proteases & other enzymes
Controlled breakdown, with more synthesis & assembly,
provides for remodeling & adaptation of ECM, e.g., to
heavier load in tendon or cartilage

Some of these enzymes, e.g. collagenase, include a zinc atom


& require Ca2+ to work - hence Matrix Metalloproteinases, e.g.
MMP-3

Some of these enzymes, e.g. collagenase, include a zinc


atom & require Ca2+ to work - hence Matrix
Metalloproteinases, e.g. MMP-3
The inhibitors of these enzymes go under the abbreviation
TIMPs - Tissue Inhibitors of MMPs; & are also made by
fibroblasts & other matrix-influencing cells

ECM MOLECULAR INTERACTIONS - Pathology 1

Unintended degradation by enzymes released from cells,


e.g., leukocytes, engaged in defensive reactions.
ECM is the battleground for defenses initially targeted at
microorganisms.
“--itises” occur throughout the body, & are real hazards to
comfort & life, e.g., endocarditis weakens & distorts heart
valves

9
ECM MOLECULAR INTERACTIONS - Pathology 2

Unwanted degradation by bystander inclusion in cytokine


signaling pathways of defensive cells
IL-1
Φ
MΦ Lymphocytes of inner joint synovium

IL-1
Joint cartilage cells also
Articular respond to the signal:
chondrocytes enzymes enzyme inhibitors
proteoglycans

= an inappropriate response causing cartilage matrix


destruction - ARTHRITIS

ECM MOLECULAR INTERACTIONS - Pathology 2

Unwanted degradation by bystander inclusion in cytokine


signaling pathways of defensive cells
IL-1
Φ
MΦ Lymphocytes of inner joint synovium

IL-1
Joint cartilage cells also
Articular respond to the signal:
chondrocytes enzymes enzyme inhibitors
proteoglycans

= an inappropriate response causing cartilage matrix


destruction - ARTHRITIS

10
ECM MOLECULAR INTERACTIONS - Pathology 3
Unwanted degradation by:
microbes trying to colonize, e.g., using bacterial hyaluronidase
to liquify ground substance
metastasizing cancer cells breaking through basal laminae
& connective tissues

Unwanted synthesis - the formation of excess collagen,


clogging organs with delicate blood-cell relations.
Cytokines released by activated macrophages trigger
synthesis in fibroblasts, causing cirrhosis in the liver and
fibrosis in kidney, lung, marrow, etc

Bad assembly - genetically defective fibrillin makes an


inadequate scaffold for elastin deposition weak aorta,
slack connective tissues, etc, of Marfan’s syndrome

11
ORAL STRUCTURES Sagittal view

HARD PALATE SOFT PALATE


TOOTH
LIP

TONGUE
LIP

SALIVARY GLANDS

+ CHEEK ALVEOLAR BONE WABeresford

ORAL STRUCTURES
LIP & CHEEK

TONGUE SOFT PALATE


TOOTH
MANDIBLE & MAXILLA Alveolar bone

HARD PALATE

SALIVARY GLANDS - major & minor

ORAL LINING - oral mucosa of stratified


squamous epithelium + lamina propria

1
SALIVARY GLANDS - major & minor
Parotid
serous
Sub-mandibular
mixed - SERO-mucous
Sub-lingual
mixed - MUCO-serous
MINOR
Labial mucous

Buccal mucous

Lingual serous, mucous & mixed

Palatal mucous

SEROUS ALVEOLUS
MUCOUS TUBULE

BL

MYOEPITHELIAL CELL

MUCOUS TUBULE

with

SEROUS DEMI-LUNE

2
SALIVA - Functions
Epithelial
PROTECTION lubrication
Anti-microbial materials
For tooth: Rinsing Buffering
Mineralization Pellicle coat

Food approval: taste, texture


ALIMENTARY
Mastication
Digestion

Swallowing

OTHER Vocalization
Excretion ?
Spit as a tool

SALIVA - Functions
Epithelial
PROTECTION lubrication
Anti-microbial materials
For tooth: Rinsing Buffering
Mineralization Pellicle coat

ALIMENTARY Food approval: taste, texture


Mastication
MATERIALS
Digestion
Water
Swallowing Mucins (glycoproteins)
OTHER Vocalization Antibodies IgAs
Lysozyme Defensins
Excretion ?
Ions - buffering
Spit as a tool Ions - tooth mineral
Amylase
Iodine

3
SALIVA - Functions & means
Epithelial lubrication Water Mucins
Anti-microbial materials Antibodies IgAs Lysozyme Defensins
For tooth: Rinsing Buffering Mineralization
Pellicle coat Water) Ions - buffering Ions - tooth mineral
Food approval: taste, texture Touch & taste receptors & nerves
Mastication Water Mucins
Digestion Amylase
Swallowing
Water Mucins Mucous glands concentrated
Vocalization at back of mouth

Excretion ? Iodine
Spit as a tool Water
Cleaning
Showing disapproval

PANCREATIC DUCTS: model for salivary


Duodenal Exocrine acini
papilla
}

Principal duct
Lobule
Interlobular duct
Intralobular ducts
Salivary gland is more compact,
Intercalated ducts
has denser CT, & no islets

4
SALIVARY DUCTS

Principal duct

Interlobular duct

Intralobular duct

Intercalated duct

SALIVARY DUCTS: Epithelia Accompanied by CT

Be prepared for pseudo-strat & mixed types


Principal duct
Stratified cuboidal /columnar

Interlobular duct
Simple cuboidal/columnar
Accompanied by CT

Intralobular duct
Simple cuboidal

Intercalated duct
Low cuboidal/squamous

5
SALIVARY DUCTS: Synonyms
Classifications by site versus function

Principal duct
Wharton’s, Stensen’s, etc

Interlobular duct
Excretory (drain-pipe)

Intralobular duct
Secretory/Striated (from basal Eosinophilic
mitochondria and membrane
infoldings for ion transport)
Intercalated duct
Intercalated (in between)

PAROTID GLAND
INTER LOBULAR DUCT

SEROUS ACINi

INTRA LOBULAR
DUCT

INTERCALATED DUCT

6
SUBMANDIBULAR GLAND
INTER LOBULAR DUCT
A FEW MIXED
MUCOUS
TUBULES

SEROUS
demilune

SEROUS ACINi

INTRA LOBULAR
DUCT

SUBLINGUAL GLAND
INTER LOBULAR DUCT
MIXED
MUCOUS
TUBULES

SEROUS
demilune

PURE
MUCOUS
TUBULE
INTRA LOBULAR DUCT
(few & not striated)

7
DUCT SYSTEM complex tributaries
The scheme does not do
Principal duct
justice to the length and
branching of a duct sytem for a
Interlobular large compound gland. Think
ducts streams entering Decker’s creek all the
way to the mouth of the Mississippi.

So one term, e.g,


Intralobular ducts intralobular duct, covers
a variety of widths and
even epithelial types,
and there will be
Intercalated ducts transitional forms, and
strange section cuts.

SALIVARY GLANDS - major & minor

MINOR
Labial mucous

Buccal mucous

Lingual serous, mucous & mixed

Palatal mucous

8
TONGUE
Tongue papillae

Lingual gland
Connective
tissue Muscular core

Blood vessels

Duct
Nerve
Sub-lingual gland

TONGUE - dorsum

TONSILS

CIRCUMVALLATE
PAPILLA
Trench

FUNGIFORM PAPILLA

FILIFORM PAPILLAE

Taste bud

9
TONSILS TONGUE - dorsum
Weber’s posterior mucous
glands to flush out tonsils

CIRCUMVALLATE PAPILLA

von Ebner’s
serous glands
for taste
FUNGIFORM PAPILLA
Neither associated
with glands
FILIFORM PAPILLAE

Blandin/Nuhn’s
mixed anterior
lingual glands

RED MARGIN LIP


VERMILION BORDER

LABIAL MUCOSA
thick strat squam ep

LABIALGLAND
HAIRY SKIN mucous

RED MARGIN
keratin thins away
MUSCLE no follicles or glands

10
CHEEK

MUSCLE

BUCCAL MUCOSA
thick strat squam ep

BUCCAL GLAND
mucous

NO RED MARGIN
HAIRY SKIN
ADIPOSE TISSUE

HARD PALATE: Cross-section


PALATE BONE

RAPHE
ADIPOSE CT - anterior
MUCOUS GLANDS -
posterior

11
GUT MOTOR INNERVATION
with H & E staining, the only neural elements seen are the neuron
bodies & characteristic nuclei. The plexuses of fibers are unseen.

Meissner’s submucosal plexus Rare neuron bodies of


plexus

submucosa

muscle Clumped
neurons of A’s
plexus

Unmyelinated autonomic nerve


Auerbach’s myenteric plexus
neurons are multipolar, with dendrites!

SALIVARY GLAND INNERVATION


with H & E staining, the only neural elements seen are the few neuron
bodies & characteristic nuclei. The plexuses of fibers to acinar cells,
myoepithelial cells, ducts, & vessels are unseen.
Sympathetic post-gangionic fibers

Parasympathetic post-
gangionic fibers

Clumped neurons
of minor ganglia

Unmyelinated autonomic nerve

Parasympathetic neurons are multipolar, with dendrites!

12
TEMPOROMANDIBULAR JOINT/ TMJ
One jaw has two TMJs *
C *
Each joint is between the C
condyle of the mandible and
the temporal bone of the skull
The joint is a freely moveable
synovial joint with a cavity
There are actually two cavities because
of an intervening cushioning disc
There are other differences from the
typical synovial joint
WABeresford

PARTS OF THE MANDIBLE


CONDYLE
CORONOID PROCESS

ALVEOLAR RIDGE
CONDYLAR RAMUS TEETH
PROCESS

BODY

ANGLE MENTAL SYMPHYSIS

1
RELATED SKULL FEATURES
EXT AUD MEATUS FOSSA
ARTICULAR
TUBERCLE

ZYGOMA
in outline

Lateral pterygoid
plate (deep)

STYLOID PROCESS

Why so much ramus & coronoid process?

CORONOID PROCESS

RAMUS

BODY

“ATTACHMENT SURFACE FOR


MASTICATORY MUSCLES”
These muscles enclose, define & stabilize the TMJ:
And capsules & ligaments play a role

2
FIBROUS ATTACHMENTS TO SKULL
Joint capsule Lateral ligament

Sphenomandibular
ligament inserts on
medial side (lingula)

Stylomandibular
ligament

DISLOCATION beyond art. tubercle

These attachments
allow an anterior
dislocation of the
mandible, taking the
condyle in front of
the tubercle

3
DISLOCATION beyond art. tubercle
Anterior dislocation of
the mandible: condyle in
front of the tubercle

RESET: Pressure
down on the molars,
while pushing back
the mandible &
tipping it past the
tubercles

TMJ ARTICULAR
upper synovial cavity TUBERCLE/
GLENOID FOSSA PROTUBERANCE
/ EMINENCE
ARTICULAR DISC

CONDYLE

MUSCLE
lower synovial cavity

4
TMJ DISC
ELASTIC FIBERS Posterior band/ enlargement

Thin intermediate
region avascular
Anterior band

DENSE IRREGULAR FIBROUS


CONNECTIVE TISSUE tending
to chondrify with age

TMJ DISC’s Roles


A DENSE IRREGULAR FIBROUS CONNECTIVE
TISSUE does not sound exciting. However the
disc’s shape, consistency, & materials allow it to:

Distribute & thereby reduce loads over the hard


condylar & tubercular surfaces as the condyle
slides forward & back

Provide weeping lubrication to the surfaces

Compensate for the incongruence of the two


hard surfaces and the lack of hyaline cartilage

5
DISC: Attachments & Pulls

ARTICULAR
ELASTIC FIBERS

RETRODISCAL
REGION

DISCO-MANDIBULAR
LIGAMENTS to condyle
condyle moves - disc moves?

LTRL PTERYGOID MUSCLE

DISC ANTERIOR DISLOCATION

Attachment failure
Wrong muscle pull
Lubricant loss & condyle
‘catching’

Disc dislocation/
displacement

6
EASY SLIDING

BOUNDARY
FIRM ELASTIC SUBSTRATE
LUBRICANT

FLUID FILM

FIRM ELASTIC SUBSTRATE

EASY SLIDING: Synovial Joint


Attached, polar
PHOSPHOLIPID molecules
DISC

Articular layer

WATER +
HYALURONAN
+ PROTEINS

7
EASY SLIDING: Synovial Joint
Attached, polar
PHOSPHOLIPID molecules
DISC
Hydrophilic side
attaches to cartilage

Bond to
Articular layer
Hydrophobic side
lowers surface
WATER + energy for NON-
HYALURONAN STICK surface
+ PROTEINS

JOINT COMPONENTS
SYNOVIUM

Joint cartilage JOINT CAPSULE


absorbs and
spreads load

Spongy bone LIGAMENT


with struts/
trabeculae
Periosteum
Fibrous
Osteoblastic

8
JOINT CAPSULE & SYNOVIUM
SYNOVIUM JOINT CAPSULE
JOINT SPACE

Synovium lines
the joint capsule,
but it itself has a
lining or surface

Beware: “Synovial lining” thus can refer to the


layer of cells lining the synovium, (OR to the
whole synovium as a lining for the capsule)

SYNOVIUM: Layers

SUB-INTIMA
INTIMA

INTIMA - epithelial-like
layer of attached CT cells
SUB-INTIMA - layer of
loose irregular CT

no basal lamina

9
SYNOVIUM: Cell types

FIBROBLAST

MACROPHAGE

MAST CELL

LYMPHOCYTE

DENDRITIC CELL
antigen-presenting cell

‘FIBROBLAST’ &
SYNOVIOCYTES
‘MACROPHAGE’

SYNOVIUM: Variation in sub-intima

SUB-INTIMA - core of
projections - synovial villi

SUB-INTIMA - substitutions of
denser fibrous CT or adipose
tissue for the loose irregular

10
SYNOVIOCYTE ROLES
SYNOVIAL FLUID
‘FIBROBLAST’
synthesizes hyaluronan
& glycoproteins

‘MACROPHAGE’
phagocytoses debris
in the joint space

SUB-INTIMA for inflammatory defensive


responses

ECM MOLECULAR INTERACTIONS - Pathology 2

Unwanted degradation by bystander inclusion in


cytokine signaling pathways of defensive cells
IL-1
Φ
MΦ Lymphocytes of inner joint
synovium

IL-1
Joint cartilage cells also
Articular respond to the signal:
chondrocytes enzymes enzyme inhibitors
proteoglycans

= an inappropriate response causing cartilage


matrix destruction - ARTHRITIS

11
MUSCLE ATTACHMENTS I

TEMPORALIS M
Lateral pterygoid
plate (deep)
lat
LATERAL & MEDIAL
PTERYGOID Ms

med

MYLOHYHOID M

MUSCLE ATTACHMENTS II

MASSETER M
ELEVATION

12
MUSCLE & JOINT ACTIONS
LATERAL

PROTRUSION
RETRACTION
ELEVATION
DEPRESSION

TMJ ACTIONS
hinge & slide

MUSCLE & JOINT ACTIONS


LATERAL

PROTRUSION
RETRACTION OPEN

CLOSE DEPRESSION
ELEVATION

TMJ ACTIONS
hinge & slide

13
MUSCLE ACTIONS I
RETRACTION
TEMPORALIS M
ELEVATION

lat PTERYGOID Ms PROTRUSION


LATERAL +DEPRESSION
& MEDIAL +ELEVATION
med

MYLOHYHOID M
tenses floor of mouth only

MUSCLE ACTIONS II

MASSETER M

ELEVATION
major biter

14
TMJ RECEPTORS: Proprioceptive
1 MUSCLE SPINDLE Nuclear-bag

encapsulated

2 MUSCLE SPINDLE Nuclear-chain

Ruffini
5 corpuscle
3 Golgi tendon organ 4 encapsulated
Pacinian
corpuscle
6 Free endings
encapsulated
encapsulated

All these receptors, innervated by mandibular


branches of Trigeminal nerve V will be in the
muscles and connective tissues serving the TMJ
1 MUSCLE SPINDLE Nuclear-bag

encapsulated

2 MUSCLE SPINDLE Nuclear-chain

Ruffini
5
4 corpuscle
3 Golgi tendon organ Pacinian encapsulated

corpuscle
6 Free endings
encapsulated
encapsulated

Mandibular muscles also heed sensations from the periodontium

15
TMJ ARTICULAR
upper synovial cavity TUBERCLE/
GLENOID FOSSA PROTUBERANCE
/ EMINENCE
ARTICULAR DISC

CONDYLE

MUSCLE
lower synovial cavity

MANDIBULAR CONDYLE

Condylar cartilage
(not all cartilage)

Spongy bone

16
MATURE CONDYLAR LAYERS

ARTICULAR
} (FIBROUS)
I
PROLIFERATIVE II
} FIBROCARTILAGE III

} CALCIFICATION IV
} OSSIFICATION

new bone on calcified


SUBCHONDRAL cartilage
BONE TRABECULAE

TUBERCLE COVERING

}} Dense BONE

OSSIFICATION
CALCIFICATION
IV

}FIBROCARTILAGE III
}PROLIFERATIVE II
} ARTICULAR I
(FIBROUS)

17
LINING OF FOSSA

} Dense BONE
PROLIFERATIVE
} ARTICULAR
(FIBROUS)

MATURE CONDYLAR LAYERS

ARTICULAR
} (FIBROUS)
I
PROLIFERATIVE II
} FIBROCARTILAGE III

} CALCIFICATION IV
} OSSIFICATION

new bone on calcified


SUBCHONDRAL cartilage
BONE TRABECULAE

18
YOUNG CONDYLAR LAYERS

} ARTICULAR I
} PROLIFERATIVE II

}} HYALINE CARTILAGE

HYPERTROPHY
III
IV

} CALCIFICATION V
} OSSIFICATION
VI
Chondrocytes not in columns
new bone on calcified cartilage
for endochondral ossification
Hyaline cartilage later will turn into fibrocartilage

THE BONE-JOINT STORY: background to TMJ

What follows in the next few slides is


the general story, from which the TMJ
has made subtle departures

19
STRUCTURES OF A WORKING JOINT
Articular cartilage absorbs & spreads the load

Marrow Joint space with


synovium
Bone

Joint capsule
Ligament
Periosteum
Tendon Nerve Muscle dense irregular

HARD/IMPOSSIBLE TO MOVE & ENJOY LIFE WHEN

Joints get inflamed Cartilage wears out Bones break


Bones grow out of shape Muscles weak or painful
Brain, cord or nerves injured (paralysis)

Articular cartilage absorbs & spreads the load

Marrow Joint space with


synovium
Bone

Joint capsule
Ligament
Periosteum
Tendon Nerve Muscle dense irregular

20
BONE COMPONENTS
Joint capsule
EPIPHYSIS

SHAFT

Fibrous
Periosteum
Osteoblastic

vessels
marrow
Joint cartilage
absorbs and
spreads load Spongy bone with
struts/ trabeculae Dense bone
Inner surfaces of both types lined by ENDOSTEUM of
resting cells, active osteoblasts, & osteoclasts

Bone matrix = collagen fibrils + BONE CELLS


mineral crystals
Active Osteoblasts

Bone canal

vessels

Osteoclast
Periosteum
Resting cells

Osteocyte
Ca2+

21
DENSE BONE
Osteon/Haversian system with
concentric lamellar/layered bone REMODELING

Osteoblasts filling in
the tunnel

New bone - start


of new osteon

Osteoclasts as a team eating out a resorption tunnel

SKELETAL DEVELOPMENT

Skeletal piece of Grows by internal expansion


hyaline cartilage and from the surface

Cell
enlargement/hypertrophy
Matrix calcification
Calcified cartilage can be
resorbed like bone, and selective erosion into
be attached to bone mineralized cartilage

22
EARLY ENDOCHONDRAL OSSIFICATION

perichondrium

periosteum
} EPIPHYSIS

Bony collar
provides support
as mineralized
cartilage is eaten
away
} DIAPHYSIS/SHAFT

primary ossification
front

EARLY ENDOCHONDRAL OSSIFICATION: Cell activities

Expansive/interstitial
growth by cartilage Hypertrophy of chondrocytes
cell division and precedes calcification
matrix synthesis

Chondroclasts & other cells


eating into calcified cartilage
Bony collar
Bone laid down as a seam
Marrow on remnants of calcified
cartilage by
osteoblasts
primary ossification front

23
MIDDLE ENDOCHONDRAL OSSIFICATION

}
Secondary ossification
centers start by repeating EPIPHYSIS
the processes of the 1o
center

} SHAFT

primary ossification
front
Bone would be larger than
in the previous view

ZONES/LAYERS OF THE GROWTH PLATE

}RESTING

Expansion
} PROLIFERATION

} HYPERYTROPHY

} CALCIFICATION

Matching erosion

Osteoclasts stop the


} OSSIFICATION

trabeculae from forever new bone on


extending calcified cartilage

24
TOOTH & RELATED TISSUES: Developmental goal
WABeresford

ENAMEL
GINGIVA
DENTINE

PULP
CEMENTUM

PERIODONTAL
ALVEOLAR BONE LIGAMENT/ PDL

What has to be controlled


Whether teeth are to form (turtles & birds have beaks)
Number of teeth
Position of teeth
Shapes of teeth
Crown formed before root
Four tooth tissues in sequence
Organize surroundings
Fasten tooth to surroundings
Times of eruption
Shedding of teeth
Successional teeth
Protect enamel

1
MECHANISMS OF DEVELOPMENT 10
Ectodermal laminae can be used:

At discrete points only, for making dental organs of


tooth germs. The remainder of the lamina then breaks
up and disappears, but a few ectodermal cells may
remain as epithelial rests or pearls
LAMINA

DENTAL ORGAN

DENTAL LAMINA
Dental lamina
Mesenchyme the line of thickened ectoderm

Oral ectoderm

2
TOOTH DEVELOPMENT
BRAIN

TOOTH BUD
TONGUE

DENTAL LAMINA from which DENTAL ORGANS (tooth germs) form

TOOTH

FIRST DENTAL ARCHES FROM BELOW


UPPER LIP
TECTAL RIDGE (future Gum)
Left Maxillary arch - starts
as a dental lamina in oral
ectoderm overlying tectal-
ridge mesenchyme

LATERAL PALATINE SHELF

3
DENTAL LAMINA
Dental lamina line of
Mesenchyme thickened ectoderm

Oral ectoderm

MECHANISMS OF DEVELOPMENT 10
Ectodermal laminae can be used:

At discrete points only, for making dental organs of


tooth germs. The remainder of the lamina then breaks
up and disappears, but a few ectodermal cells may
remain as epithelial rests or pearls
REST
LAMINA

DENTAL ORGAN

4
DENTAL LAMINA: Two meanings
LAMINA
Dental lamina first refers to the
LAMINA thickening in the ectoderm along the
tectal ridge. From this a secondary
dental lamina grows down into the
mesenchyme. At intervals along this
deep lamina, dental organs (tooth
buds) form.

As the dental organs are established,


the original surface lamina reverts to
oral lining ectoderm (differentiating into
gingival epithelium) & the secondary
lamina starts to disintegrate, leaving
the first dental organ & a successional
lamina for the second tooth bud

DENTAL LAMINA
Dental lamina
Mesenchyme first sense - the line of
thickened ectoderm

Dental lamina second sense -


the individual downgrowths from
the ectoderm

Oral ectoderm

Next step - formation of a


BUD from the dental lamina

5
DENTAL LAMINA

Mesenchyme Oral ectoderm

Dental lamina line of


thickened ectoderm
What is to be controlled:
Whether teeth are to form Lamina - yes
Line of teeth Line of lamina in arch

Position of teeth Siting of tooth buds

Number of teeth # of dental organs


Successors of teeth to be shed
Successional laminae & buds

TOOTH PRIMORDIUM/GERM

DENTAL ORGAN DENTAL LAMINA

MESENCHYME

DENTAL PAPILLA

DENTAL SAC/FOLLICLE

ALVEOLAR BONE

6
TOOTH TISSUES: Sources

ENAMEL
DENTAL ORGAN DENTAL LAMINA
DENTINE
MESENCHYME
PULP

CEMENTUM
DENTAL PAPILLA
PDL
DENTAL SAC/FOLLICLE

ALVEOLAR BONE
A BONE

TOOTH TISSUES: Cell Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL


Ameloblasts

DENTAL PAPILLA DENTINE


Odontoblasts
PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts

Crest

7
TOOTH TISSUES: Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

DENTAL PAPILLA DENTINE


PULP

DENTAL SAC/FOLLICLE CEMENTUM

PDL
LAMINA DURA
ALVEOLAR BONE
SUPPORTING
BONE
Plate
Spongy bone

TOOTH GERM
Outer dental epithelium
DENTAL LAMINA
Stellate reticulum

Stratum intermedium

DENTAL PAPILLA
Inner dental epithelium
DENTAL SAC/FOLLICLE

8
TOOTH GERM:
context Dental lamina

Oral ectoderm

Vestibular lamina

Mesenchyme

Oral ectoderm
Dental
Vestibular lamina lamina
will grow down and
split on the tooth’s
labial/buccal side
creating alveolar &
labial/buccal
mucosae

9
DENTAL LAMINA
Dental lamina
Mesenchyme first sense - the line of
thickened ectoderm

Dental lamina second


sense - the individual
downgrowths from the
ectoderm
Oral
ectoderm

Next step - formation of a


BUD from the dental lamina

DENTAL LAMINA: Bud stage


Formation of a BUD from
the dental lamina

Odontogenic mesenchyme

Next step - formation of a


CAP from the bud

10
DENTAL ORGAN: Cap,
Outer dental epithelium becoming Bell stage
Enamel knot DENTAL LAMINA

Stellate reticulum

Stratum intermedium

Basal lamina

Inner dental epithelium


Cap determines: position,
type, & size of tooth

TOOTH GERM:
Outer dental epithelium
approaches inner
next steps
DENTAL LAMINA
Stellate reticulum upper part degenerates
reduces over cusp lower forms 2nd bud

Knot cells
signal to
Stratum intermedium
papilla

DENTAL PAPILLA
Inner & outer dental epithelia
join to form cervical loop DENTAL SAC/FOLLICLE

11
TOOTH GERM:
Outer dental epithelium
collapsing down
result & next steps
Stellate reticulum DENTAL LAMINA
reducing over cusp upper degenerates
lower forms 2nd bud
Knot cells
signal to outermost papilla
papilla cells have become
Odontoblasts
DENTAL
Recruitment
PAPILLA
site
becoming
pulp
Cervical loop
defines extent of
crown to crown
DENTAL SAC base; then it
quiescent starts the root
Ingrowing pulp vessels sheath

Dentine is formed first as predentine. TOOTH GERM:


It will signal to inner dental result & next steps
epithelial cells to become ameloblasts
DENTAL LAMINA
Inner dental upper degenerates
epithelium
Stellate reticulum lower forms 2nd bud
moving “apically”
cusp Dentine
formed by
Odontoblasts
DENTAL Recruitment site
PAPILLA
becoming
pulp
Cervical loop
moving apically
to define extent
of crown
DENTAL SAC
Ingrowing pulp vessels
still quiescent

12
TOOTH GERM: all crown-forming elements present

Ameloblasts Capillaries now close to


synthesizing ameloblasts
Stellate
reticulum cusp enamel
Dentine formed by
ameloblasts

DENTAL Cervical loop


PAPILLA moving apically
becoming
to define extent
pulp
of crown
DENTAL SAC
still quiescent
2nd

ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM

ENAMEL
CROWN
DENTINE

PULP

HERTWIG’S Root sheath


ROOT breaks up, allowing
sac mesenchymal
SHEATH cells to contact
root dentine

Epithelial diaphragm Odontoblast recruitment site

13
FURTHER ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM will
fuse with gingiva
Root sheath
ENAMEL breaks up, allowing
matures sac mesenchymal
cells to contact
DENTINE
root dentine
deepens
PULP
differentiates Other sac
HERTWIG’S mesenchymal
ROOT cells construct
PDL & some
SHEATH
alveolar bone
grows to
lengthen root Fibroblasts
Epithelial diaphragm Odontoblast recruitment site

TWO STORIES: crown & root

Crown details
continue

Root details in
Eruption.ppt

14
CHANGES IN DENTAL/ENAMEL ORGAN I
Ameloblasts Capillaries

Stellate
reticulum Starting at the
cusp the dental
organ reduces to
two layers: active
ameloblasts & a
narrow layer of
compacted outer
epithelium,
stellate-reticulum
cells & stratum
intermedium
Stratum intermedium
Cervical loop moving apically to
define extent of crown & pinches in

CHANGES IN DENTAL/
cusp enamel
ENAMEL ORGAN II formed by
First reduction in ameloblasts
enamel epithelium:
active ameloblasts & Dentine
compacted outer
epithelium, stellate- PULP
reticulum cells & from Dental
stratum intermedium Papilla
remaining
Stellate reticulum DENTAL
PAPILLA
still becoming
Cervical loop: pulp &
odontoblasts
inner & outer
epithelium DENTAL SAC
still quiescent

15
CHANGES IN DENTAL/
Ameloblasts
ENAMEL ORGAN III will finish full
Second reduction in thickness of
enamel epithelium: cusp enamel
retired ameloblasts & & reduce in
compacted outer height
epithelium, stellate-
reticulum cells & Dentine widens
stratum intermedium DENTAL
Stellate reticulum PAPILLA
follows Cervical becomes pulp
process
loop down then proceeds
stops: Crown downs
defined
Odontoblast
recruitment
Cervical loop:
site

ROOT FORMATION ENAMEL


REDUCED
CROWN
DENTAL
EPITHELIUM
DENTINE
Where Stellate
reticulum
stopped, the PULP
cervical loop
continued to
grow down, but
as
HERTWIG’S ROOT
ROOT SHEATH
& its

Epithelial diaphragm Odontoblast recruitment site

16
ROOT FORMATION: Coronal consequences
GINGIVAL
EPITHELIUM
Connective
REDUCED tissue broken
DENTAL down
EPITHELIUM will
fuse with gingiva

REDUCED
DENTAL
EPITHELIUM
protects As root
enamel lengthens
crown is
HERTWIG’S
pushed up -
ROOT
Pre-
SHEATH
grows to
EMERGENCE
lengthen root

FURTHER CORONAL EVENTS


GINGIVAL
EPITHELIUM
fusing with
REDUCED DENTAL
EPITHELIUM
still protecting
enamel

ENAMEL

Root
lengthening
not shown

17
TOOTH EMERGENCE
CUTICLE
GINGIVAL will wear away
EPITHELIUM
still fusing with

REDUCED DENTAL
EPITHELIUM

ENAMEL

EVENTS WHERE EPITHELIA MEET?


CUTICLE
GINGIVAL will wear away
EPITHELIUM
still fusing with

Which reduced-
REDUCED DENTAL epithelial cells
EPITHELIUM cells join the
gingiva, which
contribute to the
cuticle, & which
die, is unclear;
along with the
mechanisms
determining fate

18
ORGANIC ENAMEL SURFACE
CUTICLE
will wear away

PELLICLE
of glycoproteins etc
is acquired later
from oral sources

DENTAL LAMINA
Dental lamina
Mesenchyme first sense - the line of
thickened ectoderm

Dental lamina second sense


- the individual downgrowths
from the ectoderm

Oral
ectoderm

Next step - formation of a


BUD from the dental lamina

19
DENTAL LAMINA: Bud stage
Formation of a BUD from
the dental lamina

Odontogenic mesenchyme

Next step - formation of a


CAP from the bud

REPEATED BACK-&-FORTH SIGNALING I


Oral ectoderm to mesenchyme

Dental lamina

Odontogenic
mesenchyme

Early signaling center

SIGNALS: FGFs,
BMPs, Wnt, etc

Condensed dental mesenchyme

20
REITERATIVE SIGNALING II

Enamel knot
Inner enamel
epithelium

Knot cells signal to epithelial


cells to proliferate, extending
inner epithelium, & creating Bell-
shaped dental/enamel organ

REITERATIVE SIGNALING III

Knot cells signal


to papilla

outermost papilla cells become

Odontoblasts

21
REITERATIVE SIGNALING IV

outermost papilla cells have


become Odontoblasts

Odontoblasts make dentine, which


signals inner epithelial cells to
beome ameloblasts

REITERATIVE SIGNALING V
REDUCED DENTAL EPITHELIUM

ENAMEL

DENTINE

Root sheath breaks up & lifts,


allowing sac mesenchymal cells
to contact root dentine

Dentine &/or Epithelial root


PULP sheath induces mesenchymal
cells to become cementoblasts

Odontoblast recruitment site by root sheath: pulp signaling

22
What has to be controlled:structures & mechanisms
W hether teeth are to form (turtles & birds have beaks) Dental lamina
Number of teeth # of buds
Position of teeth siting of buds
Shape(s) of teeth shape of dental organ
Crown formed before root start with cusp tissues
root sheath for root control
Four tooth tissues in sequence mesenchyme for three,
ectoderm for one tissue
Organize surroundings alveolar bony trough &
dental sac mesenchyme
Fasten tooth to surroundings dental sac mesenchyme

Times of eruption ? & sequence of formation


Shedding of teeth Use bone remodeling cells on root
Successional teeth Successional lamina & bud

To be controlled:structures & mechanisms


W hether teeth are to form (turtles & birds beaks) Dental lamina
Number of teeth # of buds
Position of teeth siting of buds
Shape(s) of teeth shape of dental organ
start with cusp tissues
Crown formed before root
root sheath for root control
4 tooth tissues in sequence mesenchyme for three,
ectoderm for one tissue
Organize surroundings alveolar bony trough &
dental sac mesenchyme
Fasten tooth to surroundings dental sac mesenchyme
Times of eruption ? & sequence of formation
Shedding of teeth Use bone remodeling cells on root
Successional teeth Successional lamina & bud
Protect enamel Reduced enamel epithelium

23