APPLIED ORAL HISTOLOGY CASE STUDIES FROM 1/6/11

CASE ONE

Ivor Payne has come into the surgery with a toothache in his lower left quadrant. Clinically only a small break in the enamel through an occlusal pit of 36 can be detected. A bitewing radiograph of the area shows occlusal caries well established into dentine of the 36.


Discuss the histological properties of enamel and dentine that explain how the caries appears radiographically.

Why would the patient be experiencing pain from the tooth?

What mechanisms can the pulp initiate to protect itself from the bacterial invasion?

CASE TWO
You are seeing 8-year-old Hannah Fisher who requires a fissures sealant on the occlusal surfaces of her 46. As part of the procedure you apply 37% phosphoric acid etch to the areas to be sealed


Discuss the histological basis for the above procedure and how it contributes to clinical practice.


CASE THREE
Seven year old Becky is going to the movies with her 70 year old grandmother. As a treat Granny buys them both an ice cream. Becky bites into her treat with relish and winces with ‘pain’. Granny is surprised by this as she felt no sensitivity when she bit into her ice cream at the same time.

Explain why both these reactions could be considered ‘normal’.


CASE FOUR

You are treating a carious lower molar on a 10 year old patient. The cavity prep is quite deep and extends 3mms into the dentine. Explain the histological reasons why you should place a lining material before restoring the tooth.

CASE FIVE

You are doing your Masters in Oral Health after graduating dux of your year in the BOH. Your research is based around the structure of dentine and you are giving a tute to 1st year BOH students, using the above micrograph, to demonstrate and discuss the following components of the tissue:
· Peritubular dentine
· Intertubular dentine
· Odontoblastic processes
· Dentinal tubules.

Label all these features on the micrograph and discuss their structure and function.

CASE SIX

Sixty year old Charles Long visits you for a hygiene appointment. He describes himself as ‘long in the tooth’ in more ways than way. After you look in his mouth, you are inclined to agree!


Describe the histological implications of what has occurred here, and the oral health problems that Charles is at ‘high risk’ for.