Cov hniav yog ib feem ntawm lub cev, uas pab zom zaub mov kom saturate nws nrog lub zog tsim nyog. Ib qho ntawm lawv cov qauv yog cov pulp. Nws cov yam ntxwv, kev ua haujlwm, lub ntsiab lus thiab cov qauv tau piav qhia hauv qab no.
Definition
Pulp yog cov ntaub so ntswg txuas nrog lub hauv paus thiab xoob. Nws tshwm sim los ntawm kev kho hniav papilla tsim los ntawm ectomesenchyme. Xws li cov ntaub so ntswg nyob rau hauv cov kab noj hniav ntawm cov hniav thiab tag nrho rov qab nws cov contours sab nraud. Lub koov ntawm lub coronal kab noj hniav, nyob ntawm seb lub hnub nyoog ntawm tus neeg mob, tuaj yeem nyob ntawm ntau theem sib txawv ntawm lub caj dab ntawm tus hniav.
Lub pulp muaj cov hlab ntsha xaus, cov qauv fibrous thiab cov hlab ntsha. Lwm feature ntawm cov qauv ntawm lub pulp yog hais tias nws muaj intercellular tshuaj. Lawv tsuas yog sau cov hauv paus kwj dej thiab coronal qhov chaw. Hauv thaj chaw ntawm cov hniav, qhov twg cov tubercles ntawm cov yas tshwm rau ntawm qhov chaw, "horns" ntawm lub pulp yog nyob. Nyob rau hauv ib tug ntau-rooted hniav, txoj kab nruab nrab ntawm xws aav yog kom meej meej pom, tab sis nyob rau hauv ib tug-rooted hniav nws yog smoother.
Functions
Cov qauv ntawm cov tawv nqaij yog qhov nyuaj, vim nws ua haujlwm ntau yam.
1. Yas - odontoblasts koom nrog hauv kev ua haujlwm, lawv yog lub luag haujlwm rau kev tsim cov pulp txheej thiab koom nrog kev tsim cov dentin. Nws ua rau kev txiav txim siab los tham txog qhov tseem ceeb ntawm cov dentin, txawm tias ua ntej teething, thiab tom qab ntawd tus thib ob yog yug los, uas histologically muaj qhov zoo sib xws nrog thawj. Raws li cov khoom no tshwm sim, qhov txo qis hauv cov kab noj hniav ntawm cov hniav tuaj yeem pom.
2. Vim yog cov qauv ntawm cov ntaub so ntswg, kev tiv thaiv kev ua haujlwm yog ua, uas microphages raug tsim uas koom nrog:
- ua kom lub cev tiv thaiv kab mob;
- tshem tawm cov cell tuag;
- tsim cov lymphocytes thiab lawv ntau yam;
- tshwm sim ntawm fibroblasts lub luag haujlwm rau kev tsim khoom thiab kev saib xyuas ntawm qhov xav tau ntawm cov khoom muaj txiaj ntsig zoo ntawm cov tshuaj intercellular, vim qhov no, cov txheej txheem metabolic tshwm sim;
- txhim kho ntawm tertiary dentin, uas kuj ua haujlwm tiv thaiv.
3. Trophic - nws yog nqa tawm ua tsaug rau lub vascular system tsim tau zoo, uas muaj qee qhov tshwj xeeb:
- hauv cov tawv nqaij, tag nrho cov txheej txheem tshwm sim ntawm qhov nrawm dua piv rau lwm cov ntaub so ntswg;
- cov hlab ntsha nyias nyias tau pom;
- nyob rau hauv cov qauv ntawm cov tawv nqaij ntawm cov hniav muaj xws li ib tug feature uas lub siab muaj ntau dua nyob rau hauv lwm yam kabmob;
- nyob rau hauv nruab nrab txheej muaj ib tug loj tus naj npawb ntawm capillaries uas tau sai activated thaum lub sij hawm o;
- vim muaj qhov tshwm sim ntawm anastomosis, muaj qhov ua tau ncaj qha shunting ntawm cov ntshav ntws.
4. Sensory - lub xub ntiag ntawm qhov nokev ua haujlwm yog tus cwj pwm los ntawm kev ua haujlwm ntawm ntau cov paj hlwb uas nyob hauv cov kab noj hniav vim yog cov apical foramen uas twb muaj lawm thiab cov ntaub so ntswg zoo li tus kiv cua sib txawv hauv cov kev taw qhia peripheral hauv thaj tsam ntawm cov yas.
Anatomical structure
Yog peb xav txog cov qauv ntawm cov hniav los ntawm sab ntawm lub cev, ces cov ntaub so ntswg muab faib ua ob thaj chaw.
- Crown pulp yog cov nqaij friable zoo koom nrog hauv dentogenesis. Txhua txheej uas ua rau cov tawv nqaij yog permeated nrog ntau cov hlab ntsha hlwb thiab cov hlab ntsha.
- Lub hauv paus pulp yog denser, vim nws tsis muaj xws li cov cellular ntau, tab sis muaj collagen fibers.
Vim yog cov qauv ntawm cov yas thiab cov hauv paus hniav, tsim cov hniav muaj zog txaus. Cov ntaub so ntswg tawv khaws cov pulp, uas nyob rau hauv lem yog lub luag hauj lwm rau tsim ntawm dentin.
Los ntawm cov apical foramen, cov kwj dej txuas nrog cov ntaub so ntswg, yog li pab cov as-ham thiab cov zaub mov kom ntws mus rau cov hniav.
Lub cev ntawm cov hniav pem hauv ntej yog smoothly redirected ntawm lub crown mus rau hauv paus. Cov kab hniav ntawm cov molars muaj ntau qhov sib txawv.
Histological qauv ntawm lub pulp
- Collagen thiab elastin fibers muab lub cev nrog hyaluronic acid, txo cov kab mob thiab co toxins.
- Fibroplasts, lymphocytes thiab leukocytes pab txhawb lub neej ntawm epithelium thiab tsim kev sib txuas ntawm lawv.
- Stellate hlwb thiab ib qho blasts yog lub luag haujlwm raupulp regeneration.
- Capillaries thiab hlab ntsha muab cov ntshav rau cov nqaij mos uas tsim nyog rau cov nqaij mos noj.
- Ib lub network loj ntawm cov hlab ntsha xaus ua rau muaj kev tsim ntawm Rozhkov's plexuses thiab yog lub luag haujlwm rau qhov mob thaum raug stimuli. Lub innervation ntawm cov ntaub so ntswg tshwm sim vim muaj cov hlab ntsha trigeminal.
Pulp composition
74% ntawm cov ntaub yog dej, thiab cov seem yog inorganic thiab organic txheej. Cov hlwb muaj cov kua qaub, cov protein sib txuas, ntau yam enzymes thiab qabzib, uas pab lub epithelium kom nquag siv thiab ua cov pa oxygen.
Vessels
- Arterioles thiab cov hlab ntsha - lawv raug xa rov qab los ntawm lub apical ib feem ntawm lub pulp mus rau coronal, qhov chaw uas lawv ceg mus rau hauv ib tug loj tus naj npawb ntawm capillaries. Lawv nyob ze nrog odontoblasts, yog li muab lawv nrog cov as-ham xav tau.
- Yog tias peb xav txog cov qauv ntawm cov tawv nqaij, ces kuj muaj cov hlab ntsha - vim lawv muaj, lub cev cov khoom pov tseg raug tso tawm.
- Lymphatic hlab ntsha - tsim cov hnab dig muag ze ntawm odontoblasts uas cov metabolism tshwm sim.
- Apical foramen - ua tiav nws tsis tuaj yeem hu ua ib feem ntawm cov hlab ntsha ntawm cov hlab ntsha, tab sis nws yog los ntawm nws qhov nkag thiab tawm ntawm cov hlab ntsha lymphatic, cov hlab ntsha thiab cov hlab ntsha los ntawm cov ntaub so ntswg tsim.
Nerves
Cov qauv ntawm cov tawv nqaij yog xws li cov hlab ntsha hauv cov hniav hla dhau ntawm lub apical foramen nrog rau cov hlab ntsha. Lawv raug xa mus rau qhov chaw coronal thiab tsim lub network loj. Nyob zeodontoblast qab haus huv tsim lub thiaj li hu ua Rozhkov plexus, los ntawm qhov uas lawv redirected tsis muaj ib tug myelin sheath, uas ua rau nws muaj peev xwm mus innervate odontoblasts. Ua ke nrog cov txheej txheem peripheral, cov hlab ntsha nkag mus rau hauv cov hlab hniav, dentin thiab predentin.
Pulp ntawm cov hniav ib ntus
- Qhov sib txawv ntawm cov qauv ntawm cov tawv nqaij ntawm cov yas thiab cov hauv paus hniav yog qhia me ntsis.
- Feem ntau, cov ntaub so ntswg sib txuas yog xoob thiab ntau dua hydrophilic nrog txo cov ntsiab lus fiber ntau thiab ntau cov xov tooj ntawm tes.
- Tus naj npawb tseem ceeb tshaj plaws ntawm cov hlab ntsha thiab cov hlab ntsha yog pom hauv cov menyuam yaus hnub nyoog 2-3.5 xyoo. Cov qauv ntawm cov pulp hauv cov menyuam yaus hnub nyoog 4-6 xyoo hloov pauv loj heev. Tus naj npawb ntawm qhov sib piv ntawm collagen thiab precollagen substrate nce hauv kev pom zoo ntawm yav dhau los, nrog rau qhov no, qhov nce hauv amorphous intercellular tshuaj yog tsim.
- Zoo meej txhais cov pob neurovascular.
- Lub pulp ntawm cov hniav ib ntus yog nruj nreem txuas rau lub sij hawm los ntawm lub qhov ntawm cov hauv paus hniav.
- Cov qauv ntawm cov tawv nqaij ntawm cov hniav ib ntus yog cov paj hlwb raug coj mus rau thaj tsam ntawm odontoblasts, qhov twg cov hlab ntsha xaus.
- Thaum cov tawv nqaij loj tuaj, cov ntaub so ntswg loj hlob zuj zus, thiab thaum lub sij hawm ntawm resorption ntawm cov hniav ib ntus, nws degenerates ua ntej, yog li ntawd, thaum cov hauv paus hniav resorbed, qhov rhiab heev txo qis.
- Thaum cov hniav ib ntus tau resorbed, lawv cov pulps ua qhov chaw rau kev tsim cov clasts - cov hlwb loj heev, uas, tig mus, zoo liosteoclasts. Tom qab ntawd, dentin thiab predentin yog resorbed, pib ntawm lub hauv paus.
- Cov kab noj hniav tsis tseem ceeb tshwm sim nyob rau hauv cov txheej txheem ntu - vacuoles, lawv muaj homogeneous loj.
Hloov nrog hnub nyoog
Vim qhov tsim tas li ntawm physiological Secondary dentin, qhov no nws thiaj li ua rau txo qis hauv cov hauv paus kwj dej thiab cov pulp chamber. Cov yam ntxwv tseem ceeb ntawm cov qauv ntawm cov tawv nqaij ntawm cov hniav mus tas li yog cov txheej txheem hauv qab no:
- Thinned odontoblast txheej lossis nws tsis ua tiav. Kuj tseem muaj cov ntaub so ntswg fibrosis nrog txo cov cellular cov ntsiab lus.
- Muaj kev hloov pauv atherosclerotic hauv cov hlab ntsha ntawm cov tawv nqaij. Muaj calcification ntawm capillaries thiab paj hlwb xaus.
- Pulp cov ntaub so ntswg ua ntau mineralized nrog lub hnub nyoog, feem ntau manifesting li diffuse calcification.
- Tus neeg mob laus dua, cov ntaub so ntswg ntau zuj zus. Tag nrho cov no tau lees tias cov neeg nyob rau hauv pawg no tsis yog ib qho kev pom zoo heev thaum siv kev pabcuam ncaj qha lossis tseem ceeb heev.
mob khaub thuas
Cov qauv ntawm cov ntaub so ntswg yog tias thaum cov kab mob pathogenic nkag mus rau hauv cov enamel, lawv pib cuam tshuam rau cov hniav, txav mus rau cov ntaub so ntswg. Thaum cov txheej txheem ntawm kev puas tsuaj mus txog rau cov hlab ntsha, ib tug pathogenic o yog tsim - pulpitis. Cov kab mob no tshwm sim hauv 20 ntawm 100% ntawm cov neeg mob uas xav tau kev kho mob rau qhov mob hnyav.
Qhov laj thawj tseem ceeb ntawm pathology yog qhov sib kis ntawm tus kabmob. Txawm li cas los xij, kev puas tsuaj rau cov enamel, nrog rau kev kho hniav tsis zoo, tuaj yeem dhau los ua lub zog rau pulpitis.
Yog tias peb tham txog cov cim tshwj xeeb tshaj plaws ntawm pulpitis, ces nws yog thawj zaug uas yuav tsum nco ntsoov txiav thiab mob hnyav, feem ntau paroxysmal. Raws li lub sijhawm dhau mus, cov ntu yuav txo qis, thiab tsis ntev qhov mob yuav dhau mus. Nyob rau hauv txhua txoj hauj lwm, txawm tias pw tsaug zog, tsis muaj qhov so ntawm qhov tsis xis nyob, uas tuaj yeem ua rau lub sijhawm, feem ntau thaum hmo ntuj, tiv thaiv tus neeg mob kom tsaug zog.
Thaum lub sijhawm kuaj mob, hmoov tsis zoo, nrog kev pabcuam X-ray nws tsis tuaj yeem kuaj pom tus kabmob. Yog li ntawd, txoj hauv kev tseem ceeb ntawm kev paub txog tus kab mob yog kev kuaj xyuas niaj hnub ua los ntawm tus kws tshaj lij. Pulpitis kuj muaj qee yam cim qhia los ntawm tus kws kho mob tuaj yeem kuaj pom qhov mob. Piv txwv li, thaum tom ntawm cov hniav, tsis muaj qhov tshwm sim, tab sis qhov txias ua rau muaj kev ntxhov siab ntau dua thiab tsis tuaj yeem tiv taus.
Kev kho tsuas yog tshem tawm cov tawv nqaij. Nws tau ua tsuas yog nyob rau hauv cov tshuaj loog tag nrho, feem ntau hauv ob peb kauj ruam. Nyob rau hauv thawj theem, ib tug tshuaj yog muab tso rau hauv cov hniav uas yuav pab kom rov qab tau cov ntaub so ntswg, nrog rau cov tshuaj loog. Nyob rau theem thib ob, cov hniav kab noj hniav raug ntxuav kom huv si thiab tom qab ntawd kaw. Tag nrho cov dej num saum toj no yog ua tau zoo tshaj plaws raws sij hawm, vim qhov mob uas nrog rau qhov mob no tsuas yog mob tsis taus.
Kev tsis haum xeeb ntawm daim tawv nqaij
Tag nrho cov kab mob pulpitis feem ntau tshwm sim hauv daim ntawv mob. Ib chav kawm ntev kuj tseem pom, tab sis nws cov cim qhia tsis tau hais tawm raws li qhov tshwm sim ntawm qhov mob hnyav, thiab feem ntau tshwm sim los ntawm kev xaav ntawm cov teebmeem thermal - cov zaub mov kub thiab txias. Feem ntau nws ua tsis taus pa. Nyob rau hauv cov ntaub ntawv ntawm exacerbation, paroxysmal mob tshwm sim. Yeej, pulpitis muab faib ua:
- gangrenous - muaj lub siab nyob rau hauv cov hniav thaum sib cuag nrog cov khoom noj kub, thaum cov hniav qhib, koj tuaj yeem soj ntsuam cov paug ntawm cov teeb meem grey nrog cov ntxhiab tsw;
- proliferative - mob tshwm sim thaum lub sijhawm sib cuag nrog cov zaub mov, uas pib nkag mus rau hauv qhov qhib kab noj hniav ntawm cov hniav, tag nrho cov no tuaj yeem ua rau pulpal los ntshav;
- fibrous - mob yog tshwm sim los ntawm kev siv tshuab, thermal thiab tshuaj stimuli.
Txhua cov txheej txheem ua rau lub cev, nyob ntawm cov qauv ntawm cov ntaub so ntswg, yog tus cwj pwm los ntawm kev tawm tsam sai uas tshwm sim los ntawm:
- ntse txav;
- kev vibrations;
- nce of the elevator.
