PULP *ODONTOBLASTS

-outermost region/layer of the pulp

-responsible for the secretion of dentin and the
DENTAL PULP
formation of dentinal tubules
-an unmineralized oral tissue composed of:
-incapable of cell division
a. soft connective tissue
-the formation of new dentin after destruction
b. vascular
c. lymphatic; and of odontoblasts depends on the differentiation of new
odontoblasts from multipotential cells
d. nervous elements
(undifferentiated mesenchymal cells)
- has a soft, gelatinous consistency
- by either weight or volume, the majority of pulp (75- C. other cell types:
80%) is water and the rest are organic materials a. MACROPHAGES
- has presence of pulp stones b. LYMPHOCYTES
- -no inorganic component c. PLASMA CELLS
- has 32 pulp organs in adult dentition d. EOSINOPHILS
- pulp cavities of molar teeth are four times
larger than those of incisors o FIBROUS MATRIX
- extends down through the root of the tooth as A. Type I collagen fibers - produced by the
the root canal which opens into the odontoblasts as dentin
periodontium via the APICAL FORAMEN B. Type II collagen fibers -produced by the pulp
fibroblasts
o APICAL FORAMEN *Older pulp- has more collagen
-form of communication between the pulp and *Type I and II, are present in an unbundled and
surrounding tissue randomly dispersed fashion, higher in density around
-Clinical Significance: clinically important in the blood vessels and nerves.
spread of inflammation from the pulp out into
the surrounding periodontium. o GROUND SUBSTANCE- the environment that
surrounds both cells and fibers of the pulp
o PULP and DENTIN - rich in: proteoglycans, glycoproteins and large
-closely related amounts of water.
-products of the neural crest-derived
connective tissue that formed the DENTAL ARCHITECTURE OF PULP
PAPILLA -has 4 zones or regions
(A) dentin-forming
HISTOLOGY OF DENTAL PULP odontoblasts
Dental Pulp
-a loose connective tissue (B) reticular (Korff's)
-appearance similar to mucoid connective tissue fibers
-contains:
(C) capillaries
o CELLS
- function: for the maintenance and defense of (D) nerves
the tissue
(E) Fibroblasts
A. FIBROBLASTS
B. UNDIFFERENTIATED MESENCHYMAL CELLS (F) new dentin
(PERIVASCULAR CELLS)
- facilitates the recruitment of newly (G) Subodontoblastic
differentiating cells to replace others when plexus (of Raschkow;
they are lost - specifically odontoblasts. parietal layer)
1. ODONTOGENIC ZONE
- can be found in the peripheral aspect of
dental pulp
- differentiates into a layer of dentin-forming
odontoblasts
2. CELL-FREE ZONE (OF WEIL)
-subjacent to the odontoblast layer
-contains numerous bundles of RETICULAR (KORFF'S)
FIBERS
-Numerous capillaries and nerves are also found in this
zone.
3. CELL-RICH ZONE
-containing numerous fibroblasts
*FIBROBLASTS
- the predominant cell type of pulp
-have the ability to degrade and form collagen
*PERIVASCULAR CELLS (UNDIFFERENTIATED
MESENCHYMAL CELLS)
-can give rise to odontoblasts, fibroblasts or
macrophages
4. DEEP PULP CAVITY
- medial to the cell-rich zone
-contains subodontoblastic plexus (of Raschkow;
parietal layer) of nerves
VASCULAR SUPPLY
-dental pulp has the extensive vascular pattern
-primary function : support and maintenance of
the peripheral odontoblast layer
-walls of pulpal vessels are very thin as the pulp is
protected by a hard unyielding sheath of dentin.
-One or more small arterioles enter the pulp via the
apical foramen and ascend through the radicular pulp
of the root canal
-Once they reach the pulp chamber in the crown they
branch out peripherally to form a DENSE CAPILLARY
NETWORK immediately under - and sometimes
extending up into - the odontoblast layer.
-CAPILLARIES has numerous pores, reflecting the
metabolic activity of the odontoblast layer.
-Small venules drain the capillary bed and eventually
leave as veins via the apical foramen
-blow flow is more rapid and blood pressure is quite
high
-Arteriovenous anastomoses of arteriolar size are
frequent in the pulp.
LYMPHATIC VESSELS
- found it very difficult to establish the presence of
lymphatics in the pulp
-most believed that there was no lymphatic drainage of
the teeth
- Tissue fluid was speculated to have drained
back into the capillary or postcapillary sites of the
blood vascular system
-in recent studies, they have demonstrated the
presence of thin-walled, irregularly shaped lymphatic
vessels
-larger than capillaries and have an incomplete basal
lamina
FUNCTION: facilitates the resorption of tissue fluid
and large macromolecules of the pulp matrix
*The formation of cementum is continuous to the root
up to the apical foramen that leads to the blocking of
the foramen.
*The walls of pulpal veins are first affected by the
cemental constriction where vascular congestion may
occur that can lead to necrosis of the pulp.
INNERVATION OF THE PULP
In molars: several large nerves enter the apical
foramen
In premolars and anterior teeth: single nerve enter
in each tooth
A young premolar may have as many as 700
myelinated and 2,000 unmyelinated axons entering
the apex.
These nerves have two primary modalities:
1. AUTONOMIC NERVE FIBERS
-only sympathetic autonomics fibers are found in
the pulp.
- extend from the neurons whose cell bodies are
found in the superior cervical ganglion at the
base of the skull.
-they are unmyelinated fibers and travel with the
blood vessels.
 -innervate the smooth muscle cells of the
arterioles
-function in regulation of blood flow in the
capillary network.
2. AFFERENT (SENSORY) FIBERS
-arise from the V2 and V3 of the CNV (Trigeminal).
- predominantly myelinated fibers and may
terminate in the central pulp.
- some will send out small individual fibers that form
the subodontoblastic plexus (of Raschkow) just
under the odontoblast layer. From the plexus the
fibers extend in an unmyelinated form toward the
odontoblasts where they then loose their Schwann
cell sheath.
-fibers terminate as "free nerve endings" near the
odontoblasts, extend up between them or may
even extend further up for short distances into the
dentinal tubule.
-they function in transmitting pain stimuli from
heat, cold or pressure.
*Subodontoblastic plexus
-located in the roof and lateral walls of the
coronal pulp. It is less developed in the root canals.
Few nerve endings are found among the
odontoblasts of the root.
illustrates the free nerve endings (F) arising
from the subodontoblastic plexus (E) and
passing up between odontoblasts (A) to enter
the dentinal tubule where they terminate (G) on
the odontoblast process (D). B = predentin, C =
dentin
TYPES OF PULP
1. Coronal pulp (A)
-occupies the crown of the tooth
-has six surfaces; occlusal, mesial, distal,
buccal, lingual and the floor.
- At the cervix of the tooth the coronal pulp
joins the radicular pulp
2. Pulp horns (B)
-are protrusions of the pulp
-extend up into the cusps of the tooth
*With age, pulp horns diminish and the coronal pulp
decreases in volume due to continued (secondary)
dentin formation - often the result of continued
masticatory trauma.
3. Radicular pulp (C)
-extends from the cervix down to the apex of the
tooth.
-Molars and premolars exhibit multiple radicular pulps
-this pulp is tapered and conical
-In a fashion similar to coronal pulp, it also decreases in
volume with age due to continued dentinogenesis
-Pulp passing through the apical
foramen may be reduced by continued cementum
formation.
AGE-RELATED AND PATHOLOGIC
CHANGES IN THE PULP
-specific changes occur in dental pulp with age
-Cell death results in a decreased number of cells
-The surviving fibroblasts respond by producing more
fibrous matrix (increased type I over type II collagen)
but less ground substance that contains less water.
So with age the pulp becomes:
a) less cellular
b) more fibrous
c) overall reduction in volume due to the continued
deposition of secondary/reactive dentin
*Aging decreases the ability of dental pulp to respond
to injury and repair itself.
*The fact that the pulp is surrounded by mineralized
dentin makes relatively minor pathologic events like
inflammation, that cause swelling elsewhere, lead to a
compression of the pulp leading to intense pain. This
generally results in the death of the pulp.
illustrates the normal appearance of
the pulp cavity (P) at a young
stage.
illustrates some attrition of the pulp
as the result of normal aging as well
as trauma from wearing of the
enamel at the cusp (A).
Note the pulp horn (B) is not as well
defined due to responsive ingrowth
of secondary dentin below the worn
cusp. Cementum has begun to
thicken on the root (C).
shows the changes in pulp cavity
size by middle age. The pulp horn
continues to be reduced in
response to increased wearing of
the overlying enamel. An overall
reduction in pulp cavity dimensions
through the continued deposition
of normal secondary dentin has
occurred. Histology of the pulp
reveals a decreased cellularity
coupled with increased fibrosis.
Cementum (C) deposition
continues and the apical foramen
subsequently has undergone a
reduction in
diameter (D).
illustrative of the pulp cavity in old age.
Continued wearing of the enamel on
the cusp has resulted in the formation
of dead tracts of dentin (E). It has also
stimulated the formation of reactive
secondary dentin (F) that has
obliterated the pulp horn and now
grows into the coronal pulp cavity. The pulp cavity,
coronal and radicular regions, has been markedly
reduced from that in the young stages. Cementum (C)
continues to be deposited and the apical foramen (D)
is now considerably narrower.
shows both types of stones: A and B
are false pulp stones, C is a
true pulp stone. A is an "attached"
stone (which may become embedded
as secondary dentin deposition
continues. B and C are "free" stones
found within the pulp cavity.
CALCIFIED BODIES IN THE PULP (PULP
STONES)
-Small calcified bodies are present in up to 50% of the
pulp of newly erupted teeth and in over 90%
of older teeth.
-these calcified bodies are generally found loose within
the pulp but may eventually grow large enough to
encroach on adjacent dentin and become attached.
-These bodies are classified by either their
development or histology.
1. DEVELOPMENT
Epithelio-Mesenchymal Interactions.
-Small groups of epithelial cells become isolated from
the epithelial root sheath during development and end
up in the dental papilla.
-they interact with mesenchymal cells resulting in their
differentiation into odontoblasts
-They form small dentinal structures within the pulp.
Calcific Degenerations.
-Spontaneous calcification of pulp components
(collagen fibers, ground substance, cell debris, etc.)
may expand or induce pulpal cells into osteoblasts.
-These cells then produce concentric layers of the dentin, caries, etc.. A direct response to cutting
calcifying matrix on the surface of the mass - but no procedures, caries, extreme pressure, etc.,
cells become entrapped. involves the formation of reactive (secondary) dentin
by the odontoblast layer of the pulp.
Diffuse Calcification.
-A variation of the calciific degeneration whereby
seriously degenerated pulp undergoes calcification in
a number of locations.
-These bodies resemble calcific degenerations except
for their smaller size and increased number.

2. HISTOLOGY
-Calcified bodies in the pulp may be composed of
dentin, irregularly calcified tissue, or both.

"True" Pulp Stone or Denticle

calcified body containing tubular dentin
-exhibit radiating striations reminiscent of dentinal
tubules.
-Usually formed by an epithelio- mesenchymal
interaction

"False" Pulp Stone or Denticle

-are irregularly calcified tissue and does not bear much
resemblance to any known tissue
-generally exhibit either a hyaline-like homogeneous
morphology or appear to be composed of concentric
lamellae

FUNCTIONS OF DENTAL PULP

-primary function: providing vitality to the tooth

-Loss of the pulp following a root canal does not mean
the tooth will be lost. The tooth then functions
without pain but, it has lost the protective mechanism
that pulp provides.

-Dental pulp also has several other functions:

INDUCTIVE: very early in development the future pulp
interacts with surrounding tissues and initiates tooth
formation.

FORMATIVE: the odontoblasts of the outer layer of the

pulp organ form the dentin that surrounds and
protects.

PROTECTIVE: pulp responds to stimuli like heat, cold,

pressure, operative cutting procedures of