National medical university of LVIV department of therapeutic dentistry



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Control questions to|by| practical lesson |fabric|

|fabric|

  1. Comment on the dentine and its chemical composition|storage|.

  2. What is|appear| the structure of a dentine?

  3. What forms the main substance of a dentine?

  4. What is a predentin|?

  5. What are the peculiarities of the external layers of the dentine (cloak dentine)|?

  6. What are the peculiarities of the parapulpal dentine?

  7. What are the differences between the cloak and parapulpal dentine?

  8. Give the definition to the term sclerotic| and interglobular| dentine?

  9. What is meant under the term „primary dentine”?

  10. What are the peculiarities of the secondary dentine?

  11. What are the peculiarities of the tertiary dentine?

  12. Give the definition to the term “denticles”, how are they classified depending on the localization?

  13. What are the so-called|so called| „dead tracks” in dentine?

  14. Comment on the cement, its chemical composition|storage|.

  15. What types of cements in human teeth do you know? Where are they located?

  16. What are the functions of a tooth cement?

  17. Give the definition to the term “hypercementosis”, and what causes this process?

  18. What are the fibres of Sharpee?



Situation tasks and test control
1. Organic component of a dentine is presented by:

A. Collagen type III

B. Collagen type I

C. Phosphoproteins

D. Chondroitinsulphate
2. Where are odontoblasts situated?

A. In a parapulpal dentine

B. In the peripheral layer of the pulp

C. In a cloak dentine

D. In predentin
3. Lines in a dentine which are|appear| caused by changes in the process of mineralization:

A. Lines of Gyuntera-Shreger

B. Lines of Rettsius

C. Lines of Owen

D. Lines of Ebner
4. What type of a dentine is|appear| the most mineralized |?

A. Peritubular dentine

B. Intertubular dentine

C. The dentine around sprouts of odontoblasts

D. Predentin
5. What are the low mineralized or non mineralized dentinal areas in the crown of the tooth?

A. Interglobular dentine

B. Secondary|secondary| dentine

C. Granular Toms layer

D. Sclerotic dentine
6. Name the dentine which appears in the period of dentinogenesis, before the teeth eruption|call|?

A. Sclerotic dentine

B. Secondary|secondary| regular dentine

C. Secondary|secondary| irregular dentine

D. Primary dentine
7. What is the proper term for a dentine which appears after the tooth eruption|call|, as a result to physiological stimuli?

A. Interglobular dentine

B. Primary dentine

C. Regular secondary dentine |secondary|

D. Tertiary dentine
8. What dentine appears in response to the influence of pathological processes in hard tissues of the tooth?

A. Predentin

B. Primary dentine

C. Secondary |secondary| irregular dentine

D. Secondary|secondary| regular dentine
9. What is the name for denticles located inside the pulp?

A. Interstitial

B. Free denticles

C. Close to the wall of a pulp chamber

D. Concrements
10. Explain the term „dead highways”.

A. An area in a dentine with the disintegration of odontoblasts|

B. An area in a dentine with the mineralization of odontoblasts C. Area of dentine with the absence of dentinal tubules|

D. An area of dentine where organic components prevail


11. What is the percentage of inorganic matter in a dentine?

A. 70-80%

B. 50-60%

C. 60-70%

D. 40-50%
12. What hard tissues of a tooth contain cellular elements?

A. The dentine

B. The enamel

C. The cement

D. The dentine and the cement
13. The predentin can be described as:|

A. External layer of a dentine which is adjacent to|by| the enamel

B. Highly mineralized dentine which forms the wall of a dentinal tubule|

C. External layer of the dentine which is adjacent to|by| the cement

D. Hypomineralized dentine, located near the pulp
14. The patient complains on the absence of the 21st tooth. It was revealed during the examination that the tooth is destroyed to the level of|by| a gingival edge|place|. What part of the tooth has been destroyed?

A. The root of the tooth

B. The head of the tooth

C. The crown of the tooth

D. The body of the tooth

E. The apex of the tooth



Reference literature


  1. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook for the students of dental faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.I.– Poltava: Divosvit, 2005.– 392 p.

  2. Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of dental faculties of higher medical educational establishments.– M.: Med. Inform. agency, 2006.– 840 p.

  3. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is for the students of dentistry faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.II.– Poltava: Divosvit, 2007.– 280 p.

  4. Preclinical course of therapeutic dentistry: course of lectures|fabric| /L.O. Tsvikh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.– 159 p.

  5. The methodological manual for|by| practical use of therapeutic dentistry /L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2003.– 98 p.

  6. Borysenko A.V. Dental caries|.– K.: Book plus, 2000.– 342 p.

  7. Dmitrieva AA. Therapeutic dentistry|.– M.: Medpress-inform, 2003.– 896 p.

  8. Pediatric dentistry (Editor prof|. L.O. Khomenko).– K.: Book plus, 1999.– 524 p.

  9. Tsarynskiy M.M. Therapeutic dentistry |.– Rostov.: Feniks, 2008.– 508 p.

  10. Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine, 2002.– 640 p.

  11. Preclinical course of therapeutic dentistry | /E.A. Skorikova, V.A. Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks, 2002.– 640 p.

Practical lesson|occupation| No 4
Theme: Structure of the pulp and the periodontal ligament. Age changes. The conception of the periodontium, its functions.

Short description of a theme
The pulp of the tooth  is a specialized connecting tissue which fills the crown and root parts of a tooth cavity. It consists of the basic substance, cells, fibers, vessels and nerves. 3 layers can be distinguished in the pulp: peripheral (odontoblastic), subodontoblastic (consists of two parts: Veyls layer and accumulated cells) and central layer. In the external layer of the pulp there are two or three lines of odontoblasts  cells providing trophicity of hard tissues of the tooth and formation of a dentine. Each of them has a long sprout which as a Toms fiber gets into the dentinal canal and pierces practically all layers of dentine.

There is a free of cells|mew| Veyls area|zone| under the layer of odontoblasts. It|her| consists mainly of intercellular substance in which|what| the reticular fibers and solitary fibroblasts are located|. The nervous subodontoblastic| plexus of Rashkov is also located in this layer.

An intermediate layer of the pulp contains|maintain| small low differentiated stellated cells which|what| can be transformed into odontoblasts|.

The central layer of the pulp is presented|represent| by the loose connective tissue, with fibroblasts, histiocytes,|what| lymphoid cells|mew|, reticular and thin argyrophilic fibers.

Functions of the pulp are: trophic, plastic, protective.

Age changes|changing| of the pulp are characterized by|character|: fibrosis|, sclerosis, atherosclerosis, calcification| and andd and others. The pulp chamber|cell| is reduced in volume (obliteration) due to the deposition of secondary|secondary| and tertiary dentine.



Periodontal ligament  is the connective tissue, located in a narrow space 0,2-0,25 mm between dental alveolus and the cement of a tooth root. It consists of fibers, cellular elements and basic matter.

Fibers are united in thick oblique bundles, which|what| are densely|tight| intertwined with a root cement in one side and bone tissue of alveolus in the other side.They have radial direction near the apex|top| of the root, horizontal direction near the neck of the tooth. Besides the collagen fibres there are also reticular|, elastic and oxytalan| fibres.

Among cellular elements there are:|: histiocytes|, macrophages|, basophils|mew|, a small amount of osteocytes,| cementocytes|, epithelial cells|mew|.

The basic material of the periodontium presented|represent| by high-molecular polysaccharides|, provides|secure| metabolic processes in the periodontal ligament |.

The main functions of the periodontium are|: retentional|, amortizable, trophic, plastic, sensory and protective.

Three periods of age changes can be distinguished in the periodontal ligament:

I period (under 20-24 years of age) is characterized by the development and formation of normal structure of the periodontal ligament;

II period (25-40 years of age) is characterized by the |describe| stability of the structure|building| of periodontal ligament tissues|;

III period (more than|more than| 40 years old) is characterized by the |describe| destructive changes|changing| of separate bundles of collagen| fibres, changes|changing| of tissues| properties|virtue|. The destruction of fibre structures is especially evident in the neck region of the periodontal ligament||.

The periodontium  is a complex of anatomical structures around the tooth (gums, the periodontal ligament, bone tissue of the alveolus and the cement of a tooth root), which have common innervation and blood supply, forming the unique unit.

Gums  a mucous membrane which covers the alveolar processes of the jaws and surround teeth in the neck region. Three anatomical parts of the gums are: interdental papillas, marginal part and alveolar part. Interdental papillas  are triangle areas of gums, which fill intervals between adjacent teeth. The marginal edge of gums is freely adjoining tooth surfaces and is separated with it by gingival furrow. Alveolar part of gums is closely connected with the periosteum of alveolar processes of the jaws.

Bone tissues of alveolus consists of the cells (osteoblasts, osteocytes, osteoclasts|) and intercellular substance (bone matrix|). Parts|portion| of the upper and lower|bottom| jaws where teeth are located are called|call| the alveolar processes. Walls of dental alveolus and supporting|underprop| alveolar bone with a compact and spongy substance are distinguished in the alveolar processes. The external and internal|inlying| surfaces of alveolar processes are covered by cortical layer which is made up from the compact substance of plate| bone. All of spaces|space| between the walls of a dental alveolus and cortical| plates of alveolar processes are filled by a spongy substance.



Control questions to|by| practical lesson

|occupation|

  1. Describe the structure|building| of the pulp chamber.

  2. What layers does the pulp consist of|from|?

  3. What cellular elements contain|maintain| the pulp and what is their role in the functioning of the pulp?

  4. How is innervation of the pulp provided|secure|?

  5. What nervous plexus does the pulp contain?

  6. How is blood supply| of the pulp carried out?

  7. Comment on the functions of the pulp.

  8. What age changes|changing| are typical|character| for the pulp?

  9. What are the main constituents of the periodontal ligament|?

  10. What functions does the periodontal ligament carry out|?

  11. How is blood supply| and innervation of the periodontal ligament provided?

  12. What cellular elements does the periodontal ligament contain, what is their role?

  13. What age changes|changing| take place in the periodontal ligament?

  14. What structures are called “ islets of Malyasse”?

  15. Give the definition to the term “the periodontium”.

  16. What are the functions of the periodontium|?

  17. Describe the histological structure|building| of the gums.

  18. What anatomical areas the gums consist of|from|?

  19. What is the composition of bone tissue of alveole?


Situation tasks and test control
1. What part|portion| of a dental germ forms the pulp?

A. Dental sack

B. Enamel organ

C. Dental papilla

D. The pulp of enamel organ
2. How many layers are there in the pulp of the tooth?

A. One


B. Two

C. Four


D. Three
3. What cells|mew| are under the peripheral layer of the pulp?

A. Pulpocytes (star-shaped cells)|shape|, preodontoblasts|

B. Histiocytes, odontoblasts|

C. Histiocytes

D. Odontoblasts
4. In what layer of the pulp the odontoblasts are situated|?

A. Central layer

B. Intermidium layer

C. Peripheral layer

D. In all of layers
5. What cells|mew| of the pulp ensure its plastic function?

A. Dendrite cells

B. Odontoblasts

C. Mast cells|mew|

D. Histiocytes |
6. What is the composition of fibred elements of the pulp?

A. Elastic and collagen|

B. Elastic and reticular|

C. Elastic, collagen| and reticular

D. Collagen, argyrophil| and reticular
7. What fibres are not present in the pulp?

A. Collagen

B. Elastic

C. argyrophil

D. Reticular

8. What is the amount|quantity| of nervous plexus in the pulp?

A. One


B. Two

C. Three


D. Plexus are absent
9. In what part|portion| of the pulp the nervous plexus of Rashkov is located?

A|but|. In a central layer

B. In a peripheral layer

C. In the area|zone| of Veyl

D. In the layer of cells accumulation|mew|
10. What type of vascularization is typical for the pulp?

A. The end type

B. Collateral type

C. Mixed type

D. The proper answer is absent|absent|
11. The histological structure|building| of periodontal ligament allows to classify it as the connective tissue. What type of connective tissue the periodontal ligament belongs to?

A. Dense coarse-fibered

B. Loose and organized

C. Loose and not organized

D. the periosteum of the alveolus
12. What is the thickness of the periodontal slit|standard|?

A|but|. 0,1-0,15 mm|

B. 0,2-0,25 mm |

C. 0,05-0,1 mm |

D. 0,35-0,40 mm |
13. What cellular elements of the periodontal ligament can be the source for the development of the| radicular cysts?

A. Fibroblasts

B. Cells of Malyasse

C. Plasmatic cells

D. Osteoblasts
14. What blood vessels do not participate in the blood supply of the periodontal tissues|?

A. A.|but| dentalis|

B. A.|but| interradicularis|

C. A.|but| interdentalis|

D. A.|but| lingualis|
15. The pulp and the periodontal ligament| are closely connected morphologically. A lot|many| of their functions are equal. What functions are typical for the periodontal ligament exclusively and not for the pulp?

A. Plastic

V. Trophic

C. Distribution|division| of the pressure

D. Protective

E. Sensory


16. What groups of fibres form the dental ligament|truss|?

A. Transseptal and oblique|braid|

V. Cemento-periostal and horizontal

C. Apical and interradicular

D. All mentioned before|enumerate|

17. What amount|quantity| of gingival liquid is produced within 24 hours?

A|but|. 0,05-0,1 mm |

B. 0,1-0,5 mm |

C. 0,5-2 mm |

D. 2-5 mm |
18. The epithelium of a gingival sulcus possesses the following peculiarities:

A. Is nonkeratinized

B. Lamina propria does not form papillae

C. It is thinner, than the epithelium of gums

D. All mentioned before|enumerate|
19. What is a normal depth of gingival sulcus|standard|?

A.|but| 0,1-0,5 mm|

B. 0,5-2 mm|

C. 2-3 mm|

D. 3-4 mm
20. What cells of the bone take part in its resorption?

A. Osteogenic cells

V. Osteoblasts

C. Osteocytes

D. Osteoclasts
21.What is the histological structure of the marginal gums ?

A. Squamous keratinized epithelium, submucosal| layer

B. Squamous non-keratinized epithelium, lamina propria, submucosal| layer is not clearly marked

C. Multi-layered squamous keratinized | epithelium, lamina propria

D. Multi-layered cylindrical epithelium, basal| membrane, submucosal| layer
22. The epithelium of a gingival sulcus is attached to|by|:

A. Tooth pelicle

B. Tooth cementum

C. Is not attached, but forms a dense|tight| superficial ring

D. The cuticles of the tooth enamel
23. During the period of a changed|changing| bite the marginal gums:

A. Are unchangeable|changing|

B. Are fully smoothed out

C. Have an expressed scalloped surface|

D. Are convex and oedematic
24. Taking into account that dentinogenesis| is|appear| the function of the pulp, name the lifetime when it takes place?

A. During embryonic development

B. During the first 6 months of life

C. Till the age of 7-14 years old

D. Till|by| the period of the physiological change|changing| of the bite

E. Throughout the whole life


25. The successful treatment of pulp inflammation|lighting| to great extend depends on the knowledge of its|her| anatomico-histological structures|building|. Several layers can be distinguished on the transversal cut of the pulp. Name the|indicate| layer, which is not typical|character| for the pulp of the tooth.

A. Endothelial

B. Peripheral

C. Subodontoblastic

D. Layer of star-shaped cells|mew|

E. Central layer



Reference literature


  1. Nikolyshyn a.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook for the students of dental faculties of higher medical educational establishments of IV level of accreditation in two volumes, T.I.– Poltava: Divosvit, 2005.– 392 p.

  2. Preclinical course of therapeutic dentistry: course of lectures|fabric| /L.O. Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.– 159 p.

  3. The methodological manual for|by| practical of therapeutic dentistry /L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2003.– 98 p.

  4. Dmitrieva AA. Therapeutic dentistry|.– M.: Medpress-inform, 2003.– 896 p.

  5. Pediatric dentistry (Editor prof|. L.O. Khomenko).– K.: Book plus, 1999.– 524 p.

  6. Tsarinskiy M.M. Therapeutic dentistry |.– Rostov.: Feniks, 2008.– 508 p.

  7. Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine, 2002.– 640 p.

  8. Preclinical course of therapeutic dentistry | /E.A. Skorikova, V.A. Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks, 2002.– 640 p.

Practical lesson|occupation| No 5
Theme: Saliva, mouth liquid: composition, properties, functions.

Short description of a theme
Saliva (saliva)  is a mixture of secretions of three conjugated large, and a great number of small salivary glands. The secretion from the excretory ducts of the salivary glands is mixed with the desquamative epithelial cells, food particles, salivary bodies, mucosa, gingival fluid as well as the microorganisms and their waste products. A biological liquid which is termed as a mouth liquid appears in the result.

1500-2000 ml| of saliva is produced daily in an adult organism. The rate of saliva secretion is variable and depends on:



  • age (after 55-60 salivation| is slown down);

  • nervous excitement;

  • food irritants;

  • the time of a day (during sleep the salivation| diminishes in 8-10 times).

The salivation rate influences on the susceptibility of teeth to dental caries.

Rekters, excretes, secretes and incretes appear in the result of processes of vital activities, metabolism and synthesis of secretory cells.

Rekters – inorganic matters (water, microelements, ions), which take part in the metabolism, but are resistant to chemical transformation|conversion| and remain just the same as they were while entering the cells.|mew|.

Ekskrets as waste products of disintegration (carbon dioxide, urinary and lactic acids), that as far as they accumulate in the body, they are gradually excreted from the cells.

Secrets are specific products composed of complexes of macromolecules| and synthesized in cells in the result of anabolic| processes.

Inkrets are substances of hormone-like| nature, together with the hormones of endocrine glands take part in the humoral regulation|adjustment| of activity of organs and systems. Salivary glands produce|produce| hormone-like| substances which|what| take part in the regulation of the|adjustment| phosphoric-calcium exchange of bones and teeth and the regeneration of the epithelium of mucous membrane of the oral cavity.

As to the percentage saliva consists of water 99-99,4% and of 0,6-1 % ( dissolved|opens| in it|her| organic and mineral substances). As for the inorganic components there are calcium salts, phosphates, potassium and sodium connections|compound|, chlorides, hydrocarbonates|, fluorines|, rodanides|, microelements present in saliva. Ionic activity of calcium and phosphorus in a mouth liquid serves as|appear| the index of solubility of hydroxy-| and fluorapatites|. Saliva in the physiological conditions (рН=6,8-7,0)| is supersaturated in relation to|concerning| hydroxy-| and fluorapatites and has| and remineralizing| features.

With the diminishing of рН| of mouth liquid the solubility of enamel prisms increases. The critical value|importance| of index of рН| is|folds| from 4,0 to 5,5.

The organic components of mouth liquid are partially synthesized by the salivary glands (glycoproteins|, amylase, mucin, Ig| A|but|), partially have a hematogenic| origin (amino acid, urea).

The enzymes of saliva are represented|represent| by five groups: carboanhydrazes|, esters, proteases|, enzymes of transfer and mixed group. There are over|more than| 60 enzymes in a mouth liquid. Amylase (partly hydrolyse| carbohydrates; phosphatase| (acid and alkaline) take part in to the phosphorus-calcium exchange, providing|secure| mineralization| of the enamel and dentine. Lizotsim has a bactericidal action|act|, takes part in the protective reactions of the organism and processes of regeneration of epithelium of mucous membrane of the oral cavity. Nukleases provide|secure| the antiviral defence|protection| of mucous membrane of the oral cavity.



Buffer capacity of the saliva  is the ability to neutralize the acids and alkalines by hydrocarbonate, phosphatic and albumen buffer systems. The buffer capacity of the saliva increases, if the diet contains proteins and vegetables, while the amount of carbohydrates in food is reduced. A high buffer capacity promotes resistance of teeth to dental caries.

The concentration of hydrogen ions (рН|) in a mouth liquid varies in different|diverse| people and in different|diverse| time of a day. The average index of рН| of mouth liquid fluctuates|sway| within the limits of 6,5-7,5.



Functions of the saliva:

1. digestive|grassy| ( consists of primary enzymatic processing of food and formation of food bolus before swallowing;

2. protective ( realized in various ways:


  • due to mucin| the mucous membrane of the oral cavity is covered with the thin layer of mucus which protects it|her| from drying up and influence of mechanical|mechanics| factors;

  • cleaning|clearing| the surface of teeth and mucous membrane of the oral cavity from microorganisms and their waste products and food debris|food|;

  • a bactericidal action|act| is carried out by enzymes (lyzocyme|, lactoferrin|, RNA-aza, DNAaza, leucines|);

3. the mineralizing| action|act| resists to demineralization| of the enamel and helps its mineralization;|;;;;

4. the anticarious action|act| is expressed in the mouth liquid, it dissolves and ensures excretion of the |deducesugars| of food products, neutralization of acids in dental plaque.


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