ORAL PHYSIOLOGY- 2 MARCH

*Dr. Ashraf told us about the date of exams.

The topic in oral physiology today is ‘pulp and dental pain'. So far we covered the basic practicals of
teeth, so today we talked about dentin and pulp.

Q: why we don’t talk about pain on enamel? Anybody knows?

Y: there’s no nerve on enamel. That's why we don’t have enamel pain but we have dental pain or tooth
pain and we have pulp pain.

Dental pulp is a connective tissue but it varies for different patient...First of all, it contained within the
tooth and enclosed by dentine (speaks Arabic)

In case of inflammation, as we know, in general pathology, we know that with any inflammation we
should have swelling. So, swelling is one of the sign of inflammation. For example, if you have an
inflammation in your skin, this skin will swell. In fact, that’s why in dental pulp if we have swelling
inside the pulp, it will not actually swell, because it is surrounded by rigid walls. So what happens
instead of swelling, it will press on the nerves. That’s why dental pain is one of the strongest pain that
human encounter after delivery pain.

This is the first characteristic of dental pulp. It is pulpal .it is connective tissue surrounded by bone.
Number 2,it is continuous with periodontal ligament. (dr pointing the figure in slide) The tissue of the
pulp is continuous with the tissue of periodontal ligament and this is continuous to the apical
foramen. This apical foramen is very narrow,only allow for the passage of neurovascular bundle. The
pulp has small volume and the total volume in all pulp of teeth is 0.40 ml. this means that the pulp is
very small. It is very important to know that the pulp is continuous with periodontal ligament, ya3ni
any problem that happens or takes place in pulp will spread to the periodontal ligament. For example,
pulpitis and it left untreated. So, it can move from pulp to the periodontal ligament,,and that’s why its
important. Any problem that takes place in that area can spread. Reversely, any problem that takes
place in periodontal ligament can sometimes spread to the pulp but it is uncommon.

Pulpodentine complex. Dental pulp contains the cells that form the dentine. That’s why they share
common characteristics.

Q: The function of pulp and dentine are interlinked. Why?

A: because they are very close to each other and close to the cells that form the dentine that exist in
the pulp.

Q: what is the function of the pulp?

A: they maintain dentinal health by supplying nutrients.

Now, dentin is hard tissue.in order for this hard tissue to have nutrients, it has to come from soft
tissue, from the pulp. But dentin actually is different from enamel, it has tubules but enamel is solid.

Provide a pathway for sensory impulses from dentin. Also sometimes, you can feel if we actually made
a cavity in your tooth. You will feel pain although we are not in the pulp because we have sensory
nerve that exists to the dentine that should pass through the pulp. hua 3ibarah 3n pathway the nerve
to the dentin.

Also initiate and govern repair of dentine in injury. When your dentine is injured, it can be repaired.

Q: What is the tissue that repair dentine?

A: dental pulp.

but if your enamel is lost or injured,it won’t be replaced.(dr explain in Arabic from 8.47- 9.13). so this is
how the tooth defend itself;by growing new layer of dentine inside.

Q:what is the part that build new dentine in response to it(tissue damage)?

A :pulpodentine complex.

For odontoblasts, odontoblasts are the cell that formed dentine. The layer of specialized cells
immediately adjacent to dentine and we have enamel,dentin and pulp (layer in teeth).we have a layer
of cells that we called odontoblastic layer (layer that form dentine). It’s have processes that penetrate
dentine for varying distances. Bima3na akhar,extension of these cells are called odontoblastic
processes. odontoblastic processes exist within the dentinal tubules.that’s why pulp and dentine are
very interlinked.

odontoblasts are cells that responsible for formation of dentine and also they are involved in sensory
perception of dentine (dr speaks Arabic from 10.55-11.05). they can act as receptors for impulses
from dentine. (dr said it is important to remember this point)

[slide 6]

The nerve that exist in pulp. we have sensory fibres. This

sensory fibers are Aδ and C fibers,the types of nerve
terminals near blood vessels. Near blood vessels in
dental pulp,we can see large fibers, medium and small
fibers. Large fibers contain small vesicles (this are for
neurotransmitter tob3an) they resemble cholinergic
endings. Medium fibers are numerous small dense cored
vesicles.they are found in pulp horns and pulp
chamber,and subfibres containing numerous large dense vesicles (purinergic or peptidergic endings) .
what I need u to know, we can have different type of nerve terminals, we can have large,medium and
small fibres. We need to know that for example medium fibres, they exist in pulp bone and pulp
chamber (in Arabic at 12.30-12.34)

For this slide,just know we have sensory fibers that are Aδ n C fibers,we have different terminal
nerves near blood vessels.

We have plexus of raschkow.this is subodontoblastic plexus. We have network of nerve caleed plexus
of raschkow.

(He skipped slide number 7,8, and 9 because the student were nice)
Function of Aδ fibres. First of all, Aδ fibres are myelinated.thats why they are responsible for the fast
conduction of impulses. Myelinated means they are ‘covered’ by myelin sheath,that’s why they are
responsible for the fast production/passage of impulses. The diameter is from 1 to 4 micrometer,
that’s why they are responsible for the rapid conduction of impulses in speed more than 2 metre per
second.

This actually mediate sharp, piercing pain sensations. Responsible for dentinal sensitivity and
respond to any stimuli causing fluid movement in dentinal tubules. (in Arabic from 14.44-15.14)
because of this fluid movement, if impulses generated,usually this will be conducted by Aδ fibers.
That’s why it is responsible for dentinal hypersensitivity and respond to any stimuli causing fluid
movement in dentinal tubules and when do we have fluid movements, there is impulses. For
example,if we have caries,or drilling, drying and application of osmotic solution,we feel pain a little
(15.36-15.53)

[slide 11]

Function of C fibres,these are unmyelinated,that’s why they are not responsible for the task
conduction of nerve and impulses. It slowly conducting less than 2 metre per second . They are
polymodal which is activated by more than one factor but it is usually activated by mechanical factor.
But it can activated thermal,mechanical and chemical stimuli. Example of chemical stimuli is the effect
of histamine and bradykinin. These are substances that are released in response to tissue injury.
Mediate dull,longer standing and less well-localized pain. ( speaks in Arabic)

[slide 12, 13, 14]

Neurotransmitters in dental pulp is by calcitonin gene-related peptide (CGRP), substance P and

neurokinin A. in addition to sensory fibre,we have autonomic-sympathetic and para sympathetic in
dental pulp. The majority of autonomic nervous system in the pulp is sympathetic and more than
autonomic is sympathetic,we don’t have much parasympathetic. Some of these are cholinergic.

Q:what are the neurotransmitters related to the sympathetic system?

A:the noradrenaline. Not acetyl choline.acetylcholine is associated with somatic nerve.

but here some of the neurotransmitters are acetylcholine , that’s why some of the nerves terminal are
cholinergic. You need to know that some of them are cholinergic. Removal of superior cervical
ganglion actually associate in some decrease in cholinesterase staining in the pulp. This ganglion-
superior cervical ganglion is responsible for ? of sympathetic supply of lipids and ? (he explained in
Arabic)

In mouse tob3n,don’t worry about this one. But in mouse,half of the sympathetic nerve exist in pulp
horn. One third in pulp chamber and the rest in root canal. this means this one are more associated
with the blood vessel.

Why should we have sympathetic in the vein and the pulp?why? because we have blood vessels. We
want to control amount of pressure inside the tooth(20.39). we want sympathetic system to control
the diameter of the small artery. So that’s why,they should have control pulp blood flow. Also pulp
blood flow is important in regulation of odontogenesis,,different structrures of teeth..(explained in
Arabic). its very important to have good amount on blood pressure to regulate the synthesis of enamel
and dentine.

Afferent transmission of impulses associated with pain sensation. ya3ni among the function is
responsible for afferent transmission of impulses that associated with pain sensation. Sometimes pain
signals can travel to sympathetic nerve sometimes. Evidences of function,anatomical,we found that
most of these sympathetic nerve are located near the blood vessels and near odontoblasts.this is
anatomical. And if we do sympathectomy ya3ni if we removed the sympathetic system in the mouth
for example,this will lead to vasodilatation and changed in dentine apposition. So that,sympathetic
system is very important to the pulp.

[slide 15]

Regarding the parasympathetic system, it is much less.. than sympathetic system. The majority are
cholinergic. Here ,some are cholinergic and here the majority of these are cholinergic and the section
of inferior and middle nerve*..supply nerve at lower speed.. abolishing of cholinesterase staining .. this
means,that the majority is cholinergic in parasympathetic system (keep explaining things in Arabic
and I just couldn’t hear and didn’t get the meaning.sorry. starting from * 22.33-23.38)

[slide 16]

Nociceptive response,substance P. Pulp reacts initially to stimulating dentine

• Electrically

• Mechanically

• Chemically

All these fibres can stimulate dentine . As a result,it counteracts with the stimulation. Basically this are
c fibers innervations. This is going to C fibers not Aδ fibers.

Retrograde impulse in C branches. Branches of the C fibres, we sometimes have retrograde the pulp
ya3ni pulp in opposite direction. This to the release of substance P at terminal.

Q:What is the function of substance P?

A: it is the vasodilatation,and this leads to tissue edema (fluids are outside of blood vessels) and this
also to release of histamine.

Q:what is the function of histamine?

A:it increase capillary permeability and fluid extravasation and this actually lead to inflammation to
dental pulp.

[slide 17]

Nociceptive response- bradykinin

Bradykinin is another material that is important in the reaction. This is responsible for noxious
stimulation of the pulp. When the bradykinin is formed,this accumulation(bradykinin) contribute to
vasodilation and may stimulate release of encephalins from pulp cells.

Q:What did encephalins made?

A:They are anti inflammatory . They inhibit in bradykinin release and this is negative feedback
mechanism.

[slide 18]

Nociceptive response,Ecosanoid group.Just know PG12 which is vasodilator.(don’t need to know the
whole slides)

(dr skipped slide 19,and 20.)

[slide 21]

What happens when we have injury to dentine? ya3ni for example, you are injured inside the
dentine,what happen to dentine?

nerve fibers and odontoblastic processes are pulled by hydronamic force.… (speaks
Arabic)..by hydrodynamic force,these are secreted from pulpal tissue.tob3n damaging nerve
fibres and ..of odontoblasts..pain in dentine.this is one.tob3n when u have small injury,when
the odontoblasts layer bitkun…27.50..(Arabic again)------please fix it.we cannot figure
it out.
binnafsi tariqah,when the stimulus is very thick, it is actually very difficult for the pulp to build a new
dentine. This actually lead to killing the dental pulp and we called it pulp necrosis.

If happened injury in small damaged areas..(doctor said don’t worry about it )

What happens when we have small injury? (speaks Arabic again) 28.44-29.40

This is the pulpitis. Pulpitis is the inflammation of dental pulp. This time,inflammation occurs locally.
Sometimes,in small lesions,dentin bridge forms-inflammation resolves and pulp heal (reversible
pulpitis) (Arabic)

When more severe stimuli or in larger lesions, this will lead to irreversible pulpitis. Severe
inflammation and this inflammation are demarcated by fibrous tissue and lack of pain at a later stage
of pulpitis? (speaks Arabic ) T_T

this CGRP -mediated growth of nerve fibers outside necrosis area.

when the lesion extend to root apex,the periodontal ligament contribute ( I can’t hear,sorry)

[slide 26]

I will discuss three category of dentinal hypersensitivity in brief. The first theory of dentinal
hypersensitivities is odontoblastic processes as receptors.The odontoblastic process can transmit pain
or can detect pain itself, it act as nerve terminal ( in Arabic).This odontoblasts are neural crest in
origin.

Second one, nerve fibers extend through dentine ? most acceptable,fi 3ndi fluid inside dental..fluid
movement that stimulate things.

(I’m sorry .This one is really hard for me as there are words that I couldn’t hear and the doctor have
repeated and explained many things in Arabic and I can’t get the real meaning.)