OHE M3 PULP •

PULPITIS • Inflammation of pulp Sharp pain, pulsating pain, dull pain

The only soft connective tissue of the tooth that occupies the center space of the tooth that contains nerves. Vessels and lymph • SENSORY o

PULP CAVITY • Wall is made up of dentin • Center space housing the pulpal tissue

A DENTAL FIBERS/MYELINATED FIBERS  Fast, sharp, severe

APICAL DELTA • Tributaries of vessels found at the apical portion of tooth o o

Associated with hypersensitivity C DENTAL FIBERS/UNMYELINATED FIBERS  Slow, dull, more diffuse

FURCATION CANAL • Accessory root canal found at the furcation area of the root

DENTAL MAP • • Connects the orifices Dark line on the floor of the pulp chamber that serves as guide to locate orifices

STRUCTURAL COMPONENTS OF PULP: 4 DISTINCT ZONES • ODONTOBLASTIC ZONE o Zone of the pulp tissue immediately after dentin Most peripheral For dentin formation Many complex junction occur between adjacent odontoblasts   Gap junctions Zonulae occludentes • Tight junctions

FUNCTION OF PULP TISSUE: • INDUCTIVE o Dental papilla initiates tooth formation from odontogenesis o o o

FORMATIVE o o o Primary function of pulp tissue Synthesize and secrete organic matrix Transport inorganic components to newly formed matrix Creates an environment that permits mineralization of matrix o

o

Zonulae adherentes • Demosomes

NUTRITIVE o o Contains a lot of blood vessels DENTINAL TUBULES  Hydration •

Junctions permit the free interchange of ions and small molecules

CELL – FREE ZONE

o
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Devoid of cells but in fibrous appearance PLEXUS OF RACKSHOW

DEFENSIVE o MORPHOLOGIC   Changes in the shape Formation of secondary and tertiary dentin

Network of myelinated nerve fibers in the parietal area beneath the zone of Weil

o

REMAK’S FIBERS

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INFLAMMATORY REACTION

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Plexuses of non-myelinated nerve fibers along the zone of Weil

o

SUBODOONTOBLASTIC PLEXUSES OF NERVES  Plexuses of non-myelinated nerve fibers along the zone of Weils and in between odontoblasts •

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o

Replace odontoblasts which produces ATUBULAR DENTIN Capable of maturing into macrophages or assuming the function of fibroblasts and odontoblasts

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For mobilization and replacement of odontoblasts

PERICYTES/ROUGET’S CELLS o Contractile cells capable of reducing the size of the vessel lumen

CELL – RICH ZONE o Numerous densely packed bipolar cells with spindle shaped nuclei Some are fibroblasts and others are unmyelinated mesenchymal cells Continuous with the central portion of the pulp in both the crown and the root

o

IMMUNOCOMPETENT CELLS OF THE PULP: • MACROPHAGES/HISTOCYTES o o o Near blood vessels but not attaching Eliminates dead cells Presence indicates the turnover in dental pulp Removes bacteria and interacts with other inflammatory cells Presents antigen to lymphocytes

o

PULP CORE/PULP PROPER

o

Characterized by the principal cells of the pulp, immunocompetent cells, major vessels & nerves of pulp

o PRINCIPAL CELLS OF THE PULP • ODONTOBLASTS o • Read odontoblastic zone •

o

DENDRITIC CELLS o o Peripherally located Capture and presents foreign antigen to Tcells Non-phagocytic and participates in pulpal immunosurveillance

FIBROBLASTS o o o Formative cells Most abundant cells Most common cell type of the pulp Numerous in the coronal potion of the pulp where they form the cell-rich zone o o Form and maintain the pulp matrix PULP MATRIX  Consists of collagen and ground substance •

o

LYMPHOCYTES o Monoclonal antibody labeling of normal dental pulp indicates there are various subgroups of T-lymphocytes associated with immune defense system B-lymphocytes are not usually found in normal dental pulp

o

o

o

Capable of ingesting and degrading collagen when appropriately stimulated

COLLAGEN FIBERS • Principally type I and III in an approximate ration of 55:45 TYPE Z or DENTIN COLLAGEN o • Exclusive product of ondontoblasts

UNDIFFERENTIATED MESENCHYMAL CELLS o o Reserve cells Found throughout the cell-rich zone and the pulp core Often related to blood vessels

o

Greatest concentration is generally seen in the most apical portion of the pulp

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VASCULAR SUPPLY OF PULP • SUPERIOR AND INFERIOR ALVEOLAR ARTERIES AND VEINS

CLINICAL IMPLICATIONS: • Pulp horns can present a potential problem in pulp exposure Accessory canals are important o Because they represent contact of the pulp with the periodontal tissues Inflammation of the pulp can spread to the periodontium and vice versa

• NERVE SUPPLY OF PULP • • RACKSHOW’S PLEXUS

o MAXILLARY & MANDIBULAR BRANCHES OF TRIGEMINAL NERVE (CN V) o SENSORY INNERVATION • •

Pulp horns recede with age Cementum becomes deposited around the apical canal causing cemental constrictions of apices o Thin walls of the veins are the first structures impinged Vascular congestion occurs leading to pulpal necrosis

SUPERIOR CERVICAL GANGLION o SYMPATHETIC INNERVATION

AGE CHANGES OF PULP: • PROGRESSIVE NARROWING OF PULP SPACE o Brought about by continued dentin deposition •

o

Cracked tooth from masticatory impact on the margin of the restoration

FORMATION OF PULP STONES OR DENTICLES o Round to oval calcified masses appearing on either the canal or coronal portions of the pulp organ Appear in teeth that have suffered injury as well as in otherwise normal appearing pulps Occur in unerupted as well as erupted teeth Noted in most pulps of permanent teeth, especially in individuals over 60 year of age

o

Salivary organisms can penetrate the crack, causing inflammation, pain and eventually pulpal pathosis

Presence of pulp stones is significant o Reduce the overall number of cells within the pulp Act as impediment to debridement and enlargement of the root canal system during endodontic treatment

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o o

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FIBROSIS OF THE PULP o Fibrous elements increase in amount but cellular elements decreases

Removal of pulp does not affect the tooth even after many years o Although the enamel of the tooth may become brittle, its function is not affected

ATROPHY OF THE PULP o Decrease in size of the pulp due to decrease in structure contents RETICULAR ATROPHY  Pulp may assume the appearance of a net o CLASSIFICATION OF PULP STONES/DENTICLES: • ACCORDING TO HISTOLOGIC STRUCTURE o TRUE DENTICLES  Have dentinal tubules like dentin

o

PARALYSIS OF FUNCTION o Due to chronic pathological processes like deep carious lesions, pulpal abcesses, chronic cellular infiltrations

FALSE DENTICLES   Concentric layers of calcified tissue In the center bay be a group of cells that appear necrotic

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Serve as the nidus of denticle formation

ACCORDING TO LOCATION IN RELATION TO DENTINAL WALL o FREE DENTICLE  Denticle completely surrounded by pulp tissue

o

ATTACHED DENTICLE (ADHERENT)  Denticle is partly fused to the dentinal wall

o

EMBEDDED DENTICLE (INTERSTITIAL)  Denticles completely surrounded by dentin

ACCORDING TO FORM o NODULAR  o Round in shape

AMORPHOUS  Indefinite or no determinate form

o

FIBRILLAR (DIFFUSE)  Elongated calcification following the course of blood vessels and nerves Appear more often in the root canal

-Rosette Go 020709 

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