Al-Kitab University – ‫جامعة الكتاب‬

College of Dentistry
Oral Histology – Group J

Dental Pulp
Prepared by: Vian Khalid Abdulkarim
Supervised by: Dr. Asmaa Siddeeq

2020-2021
6/28/2021

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Table of Contents

Introduction.................................................................................................................................................3
Types of Pulp...............................................................................................................................................4
Histology......................................................................................................................................................5
Pulp Innervation..........................................................................................................................................5
Pulp Nerves.................................................................................................................................................7
Functions of Dental Pulp.............................................................................................................................8
Conclusion...................................................................................................................................................9
References...................................................................................................................................................9

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Introduction

The dental pulp is enclosed in a rigid environment comprising three mineralized tissues: dentine,
enamel and cementum. This strong mechanical support protects the pulp from the microbialrich
oral environment. During the initial carious attack, the pulp turns out to be inflamed and
gradually, the evolution of the lesion leads to pulp necrosis and infection. Afterward, the
inflammation expands to the surrounding alveolar bone.[ CITATION Gol16 \l 1033 ] Three stages of
tooth formation are well identified in vivo 1) the crown should be completed, 2) root formation
and eruption were achieved, and 3) the whole length of the root was complete. Attempts were
carried out for culturing pulp cells, even a mixture of cells at immature and mature stages.
Cultured in vitro for 15 days, pulp cells became ALP-positive and produced a calcified matrix, as
judged from the von Kossa staining. However, the success for obtaining primary pulp cultures
displays significant variability. Unpredictability was found during the different evaluations
performed to establish cell lines. The proliferative activity was unrelated to donor age,
individuals and passage number [ CITATION Mou95 \l 1033 ]. Altogether, these studies highlight
the difficulties in establishing homogeneous and reliable cell lines from dental pulps.
Embryologically, the dental pulp derives from neural crest cells. Proliferation and condensation
of the cells lead to the formation of a dental papilla, from which the mature pulp is derived. The
peripheral odontoblasts and sub odontoblastic Hoehl’s cell layer are located in the lateral parts of
the pulp, with different origins and differentiation programs. In addition to pulp fibroblasts, the
dental pulp has high incidence on sensory nerves and on the capillary network.
Immunocompetent cells are also implicated in pulp defense. Inflammatory processes lead to pulp
wounding and degeneration. Regeneration of the pulp is mainly under the control of stem cells,
cells side population, and growth and transcription factors. Adult pulp cells are bound by
intercellular junctions, mostly desmosome-like and gap junctions. Tight junctions were not
identified. Intercellular junctions bind together pulp cells, which form a syncytium. This implies
that pulp cells are transported from the central part of the root to the crown, from the apical pulp
to the outer limits of the crown. Pulp cells are located just beneath the sub-odontoblastic, the so-
called Hoehl’s layer. Obviously, the pulp cells are not transported individually or separately

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toward the outer part of the pulp, despite the presence of processes acting independently. They
are sliding and/or transported altogether from the apical papilla to the coronal pulp.

Types of Pulp

The Pulp is a soft mesenchymal connective tissue that occupies pulp cavity in the central part of
the teeth. Every person normally has a total of 52 pulp organs, 32 in the permanent & 20 in the
primary teeth. Molar pulps are 3 to 4 times larger than incisor pulps. Cuspid has the longest pulp,
Mandibular central incisor has the smallest pulp. Pulp has a soft, gelatinous consistency,
indicates that the majority of pulp (75-80%) is water. Developmentally and functionally, pulp
and dentin are closely related. Both are products of the dental papilla.

1- Coronal pulp: occupies the crown of the tooth and has six surfaces; occlusal, mesial,
distal, buccal, lingual and the floor. Pulp horns are protrusions of the pulp that 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 2.
2- Radicular pulp: extends from the cervical region down to the apex of the tooth. Molars
and premolars exhibit multiple radicular pulps. This pulp is tapered, it also decreases in
volume with age due to continued dentin formation.

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Histology

Dental pulp is a loose connective tissue, so it contains the components common to all connective
tissues such as:

1- Cells: Which include fibroblasts and undifferentiated mesenchymal cells as well as other
cell types (macrophages, lymphocytes, etc.) required for the maintenance and defense of
the tissue. Also, odontoblasts comprise the outermost region of the pulp, immediately
adjacent to the dentin component of the tooth.
2- Fibrous matrix: Which contain type I and II collagen fibers. Type I collagen is produced
by the odontoblasts which present in the periphery of the pulp, while Type II collagen is
produced by the fibroblasts in the pulp.
3- Ground substance: is represent the environment that surrounds both cells and fibers of the
pulp and is rich in proteoglycans, glycoproteins and large amounts of water.

Pulp Innervation

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During initiation, nerves are seen below the primordium and its presumptive area. During the
bud formation, nerves are seen below the dental papilla. They form a plexus at early cap stage,
nerve emerging from the basal plexus. Later, innervation is seen around the follicle, and later
innervation of the papilla is seen inside the pulp papilla during tooth development. Penetration of
the human dental papilla occurs at the same time dentinogenesis starts. At later stages, pulp
contains substance P and somatostatins, which are neuropeptides associated with small diameter
nociceptive fibers. Monoamines, vaso-active intestinal peptide (VIP) have been located in
autonomic fibers in the dental pulp. Developmental studies of substance P-containing neurons
and cholinergic and mono-aminergic neurons correlate with stages of innervation of tooth
development [24]. The receptor tyrosine kinases ErbB3, ErbB4, and neuroregulin-1 mRNA are
expressed locally in a different way during tooth development. Antisera to S-100 protein,
neurofilament protein, neuronespecific enolase and protein gene product 9.5 are markers of pulp
innervation. PGP 9.5 is the most superior marker. Four members of the neurotrophin family have
been identified in mammals: nerve growth factor (NGF), brainderived neurotrophic factor
(BDNF), neurotrophin-3 (NT-3) and neurotrophin-4/5 (NT-4/5). Neuropeptides substance P
(SP), neurokinin A (NKA), calcitonin gene-related peptide (CGRP), neuropeptide Y (NPY) and
vasoactive intestinal polypeptide (VIP) have growth regulatory properties on pulpal cells in vitro.
Neuropeptides (CGRP and SP) may be involved in pulp development (proliferation) and in
wound healing after pulpal injury. Most nerve fibers in the dental pulp are unmyelinated. A-beta,
A-delta and C-fibers have been also identified as non-myelinated sympathetic fibers. Although
some larger fibers are present, myelinated fibers in the A-delta range are also recognized. Some
cellular substances are associated with nociceptive nerve cells, namely substance P (SP),
calcitonin gene related peptide (CGRP) and fluoride-resistant acid phosphatase (FRAP).
Carbonic anhydrase (CA), GM1 ganglioside (choleragenoid binding receptor), and RT 97, a
monoclonal antibody against neurofilament protein are expressed. Pain sensitivity to thermal
stimuli, thermal change, mechanical deformation or trauma induces pain. Careful regulation of
blood flow is of critical importance, and alterations are the first to occur with the onset of pulp
inflammation.[ CITATION Par04 \l 1033 ] The maxillary artery enters the tooth via arterioles
feeding. Pulp vessels are organized in a hierarchical system. Central arterioles form a capillary
network located at the periphery of the pulp and the blood drains into venules at the center of the
pulp.

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Perivascular sympathetic nerves liberate noradrenaline (adrenergic post-ganglionic fibers) and
possible neuropeptide Y causing a reduction of pulp blood flow (SP or CGRP). Sensory nerves
involved in pulp pain perception and transduction are branches of maxillary and mandibular
divisions of the trigeminal nerve. Small branches enter the apical foramina and progress
coronally and peripherally following the blood vessels and they branch extensively subjacent to
the cell-rich zone, forming the plexus of Raschkow. The plexus contains both large myelinated
A-δ and A-β fibers (2-5 μm in diameter) and the smaller C fibers (0.3 – 1.2 μm). Almost all the
A-δ fibers are located in the coronal portion of the pulp, with the greater density in the pulp horn.
1,25-dihydroxyvitamin D3 and TGF-β have examined the effects of 1,25-(OH)2 and TGF-β on
the synthesis of SPARC and ALP activity in human pulp fibroblasts. The interaction of TGF-β
and 1,25 (OH)2 D3 may influence the function and differentiation of dental pulp fibroblasts.

Pulp Nerves

Sensory Nerves
The sensory nerves, which are involved in pulp pain perception and transduction, are branches of
the maxillary and mandibular divisions of the trigeminal nerve. The small branches enter the
apical foramina and progress coronally and peripherally following the route of the blood vessels,
and they branch extensively subjacent to the cell-rich zone, forming the plexus of Raschkow.
The plexus contains both large myelinated A- and A- fibers (2–5µm in diameter) and the smaller
unmyelinated C fibers (0.3–1.2µm). At about the level of the cell-rich zone, myelinated fibers
lose their myelin sheath. In the cell-free zone, they form a rich network of free nerve fibers that
are specific receptors for pain. From there, the free nerve terminals may enter the odontoblastic
layer, and penetrate into the predentine zone or to the inner dentine next to the odontoblastic cell
process, but not every dentinal tubule will contain nerve endings. Myelinated nerves do not reach
their maximal development and penetration into the pulp until the tooth is fully formed, which
may explain why young teeth are less sensitive than adult teeth.

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The branching of nerve axons has been observed not only within the pulp but also occurs in the
periapical region where these axons may branch to supply the pulps of adjacent teeth just prior to
entering the pulp.85 It has been postulated that the A- and A- fibers produce the initial rapid
sharp pain in response to external stimuli without the presence of tissue injury because of their
peripheral location, low threshold of excitability and fast conduction. On the other hand, the
smaller C fibers cause a slow, dull and crawling pain related to pulp tissue damage and the
inflammatory process due to their much higher threshold of excitability and slow conduction.
Almost all of the A- fibers are located in the coronal portion of the pulp, with the greatest nerve
density in the pulp horns. In contrast, C- fibers are located in the pulp proper, extending most
likely into the cell-rich zone. Pulp usually responds to various stimuli as one sensation, i.e., pain.
However, the exact mechanism that transmits the stimuli through the dentine to initiate pain is
largely unknown. Several hypotheses about dental pain transmission have been proposed
including hydrodynamic mechanism, odontoblastic transduction and dentine innervation.

Sympathetic Nerves

A sympathetic adrenergic vascular control exists in the dental pulp. Mediators presently known
are noradrenaline and neuropeptide Y. The sympathetic nerve fibers originate from the cervical
sympathetic ganglion, and after joining the trigeminal nerve at its ganglion, most of them follow
the course of the sensory nerves to the teeth, or they possibly travel via the blood vessels.

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Sympathetic vasoconstriction is typically activated by stress stimuli and by painful stimuli
directed at almost any part of the body. Sympathetic vasoconstriction may modulate the
excitability of the sensory nerves. In the compromised pulp, sympathetic vasoconstriction is
attenuated. Local sensory vasodilation becomes predominant, which may contribute to further
progression of pulp inflammation.

Functions of Dental Pulp

The primary function of dental pulp is providing vitality to the tooth. 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: A direct response to cutting procedures, caries, extreme pressure, etc.,
involves the formation of reparative dentin by the odontoblast layer of the pulp.
Formation of sclerotic dentin, in the process of obliterating the dentinal tubules, is also
protective to the pulp, helping to maintain the vitality of the tooth.

Conclusion

The dental pulp is a unique tissue and its importance in the long-term prognosis of the tooth is
often ignored by clinicians. While pursuing technical excellence in endodontics, it is important
that clinicians also have an awareness and understanding of the physiological and pathological
features of the dental pulp as well as the biological consequences of treatment interventions.

The pulp cavity extends down through the root of the tooth as the root canal which opens into the
periodontium via the apical foramen. The blood vessels, nerves etc. of dental pulp enter and
leave the tooth through this foramen. This sets up a form of communication between the pulp

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and surrounding tissue - clinically important in the spread of inflammation from the pulp out into
the surrounding periodontium.

References

[1] Goldberg, M. (2016). Dental Pulp. Springer-Verlag Berlin An.

[2] Moule AJ, Li H, Bartold PM. Donor variability in the proliferation of human dental pulp
fibroblasts. Aust Dent J. 1995; 40: 110-114.

[3] Park SH, Hsiao GY, Huang GT. Role of substance P and calcitonin gene-related peptide in
the regulation of interleukin-8 and monocyte chemotactic protein-1 expression in human dental
pulp. Int Endo J. 2004; 37: 185-192.

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