Dentin Pulp Complex

By Group 1
CONTENT
1. DENTIN
a. Composition of dentin
b. Types of dentin
c. Theories of hypersensitivity
2. PULP
a. Morphological zones of pulp
b. Cells of pulp
c. Blood supply
d. Lymphatics
e. Innervation
f. Functions
g. Ageing
h. Differences between primary & permanent pulp
DENTIN
Composition
Dentin is about 65% inorganic and 35% organic.

● Inorganic: hydroxyapatite crystal

● Organic: collagen, ground substance (mucopolysaccharides) and water
Development
● The formation of dentin is called dentinogenesis, which starts before
amelogenesis
● Dentin is formed by odontoblast cells
● Dentinogenesis takes place in two phases
1. formation of organic collagen matrix
2. deposition of hydroxyapetite crystals (mineralization)
● At the beginning of dentinogenesis the odontoblast elongate resulting in the
formation of Tomes fibres or odontoblastic processes.
● Odontoblasts then secrete matrix protein at the apical end of the cell and
along its process.
● The secreted matrix is collagenous and not mineralized hence it is called
predentin.
● As the matrix is being secreted the odontoblasts move towards the centre of
the future pulp.
● The matrix that forms around the elongated cell process eventually
mineralizes and the odontoblastic process will lie within a dentinal tubule.
● This begins in small spherical areas which become larger and fuse with one
another to form a mineralization front.
Histology
Dentinal Tubules
● run from pulpal surface to DEJ &
CEJ.
● indicates the course taken by the
odontoblasts during
dentinogenesis.
● follow an S- shaped path
● Straight tubules in root tip, incisal
edges and cusps
Peritubular dentin
● Forms the wall of dentinal tubules
● Highly mineralised
● Lost during decalcification
Intertubular dentin
● Located between the dentinal tubules
● the primary end product of the
odontoblasts.
● fibrils are arranged at roughly right
angles to the DT.
● Less mineralised than peritubular dentin
● Bulk of dentin
● Retained after decalcification
Interglobular dentin
● Areas of hypomineralized dentin
● seen in the circumpulpal dentin just
below the mantle dentin.
● The dentinal tubules pass
uninterruptedly, thus demonstrating a
defect of mineralization & not of
matrix formation.
Incremental Growth Lines (Von Ebner)
● appear as fine lines or striations in dentin
● Seen as alternating dark & light bands
● run at right angles to the dentinal tubules
● Reflect the daily rhythm of dentine
deposition as well as hesitation in the daily
formative process
Granular Layer of Tomes
● Seen in root dentin adjacent to
cementum
● when viewed under transmitted light
in ground sections a granular layer
can be seen.
● Caused by coalescing and looping of
the terminal portions of the dentinal
tubules
Types of Dentin
1. Primary
- Mantle
- Circumpulpal
1. Secondary
2. Tertiary
Primary dentin
● Formed before root completion
● Consists of mantle dentine and circumpulpal dentine

Mantle dentin
● First formed dentine in crown
● Underlying DEJ

Circumpulpal dentin
● forms the bulk of the tooth
● fibrils are much smaller in diameter & are more closely packed together
● Slightly more mineral content
Secondary dentin
● narrow band of dentin bordering the pulp
● forms after root formation is complete
● Contains fewer tubules than primary dentin
● formed more slowly than primary dentin
Tertiary dentin
● Reactive, reparative and irregular dentin.
● Produced in reaction to various stimuli.
● Quality and quantity depends on intensity and duration of stimulus.
● Tubules may or may not be present
Theories of dentin hypersensitivity
1. Direct innervation theory

Nerve fibres that are present within the dentinal tubules initiate impulses when
they are injured and this causes dentinal hypersensitivity.

Since histological examination shows the dentinal tubules does not contain any
nerve endings, this theory is not accepted.
2. Transduction theory

Membrane of the odontoblast process is excited by the stimulus and the impulse
is conducted to the nerve ending in the inner dentine ie. pre-dentine, odontoblast
zone and pulp.

Not popular theory since there is no neurotransmitter vesicles in the odontoblast

process to facilitate the synapse.
3. Hydrodynamic theory

Most popular theory

Rapid shifts of the fluids within the dentinal tubules, following stimulus application,
results in activation of sensory nerves in the inner dentin region of the tooth
PULP
-Soft connective tissue which supports
the dentin

-Exhibits four distinct zones on

histological examination: (1)
odontoblastic zone at the pulp periphery,
(2) cell free zone of Weil, (3) cell rich
zone, (4) the pulp core

-The principal cells of the pulp are the

odontoblasts, fibroblasts,
undifferentiated ectomesenchymal cells,
macrophages and other
immunocompetent cells

-The pulp has been shown to be a rich

source of multipotent stem cells
Cells of the pulp
1. Odontoblasts
● Second most prominent cell of the pulp
● Resides adjacent to predentin with their cell bodies in the pulp and cell
processes in the dentinal tubules
● Number of odontoblasts corresponds to the number of dentinal tubules
● Have a constant location adjacent to the predentin, termed the odontogenic
zone of the pulp
● Odontoblasts are end cells (having lost the capability to divide)
● Functions include: (1)formation of the physiological primary and secondary
dentin, (2)maintenance of dentin throughout the life of the tooth by synthesizing
reactionary dentin in response to pathological conditions (caries, attrition),
(3)sense bacterial invasion from caries and then initiate the pulp immune and
inflammatory response, (4)sense external stimuli and to mediate pain sensation
2. Fibroblasts
● Most numerous cell type in the
pulp
● Functions include: (1)Collagen
fiber formation throughout the
pulp, (2) ingest and digest pulpal
matrix, (3) plays an important
role in inflammation and healing
● In the older pulp, fibroblasts are
termed fibrocytes as they appear
rounded/spindle shaped, with
short processes and fewer
intracellular organelles
● In the embryonic and immature
pulp, cellular components
dominate while in the mature
pulp, the fibrous components
predominate.
3. Defense cells
Macrophages are located
throughout the pulp center. These
pulp macrophages are involved in
the elimination of dead cells.
Bone marrow-derived dendritic
cells, which are found in and
around the odontoblast layer acts
as antigen presenting cells, they
express macrophage related
antigens (CD14 and CD68).
Both lymphocytes and eosinophils
are found extravascularly in the
normal pulp, but during
inflammation they noticeably
increase in number. Most of the
lymphocytes present are T
lymphocytes.
The plasma cells are seen during
inflammation of the pulp and
functions in the production of
antibodies
4. Dental pulp stem cells

● These postnatal dental pulp stem cells have self-renewal capabilities

● Under the appropriate environmental conditions, these cells can differentiate
into odontoblasts, chondrocytes, adipocytes and neurons
● It has been shown these cells have the capacity to give rise to osteoblasts,
being a promising tool for bone regeneration
Matrix & ground substances

● Matrix consists of collagen fibres and ground substances

● Collagen fibres → Type I (main type) and type III.
● Ground substances → glycosaminoglycan (GAG), glycoprotein (in form of
fibronectin), water
Blood vessels
● Extensively vascularized
● Bv of pulp & periodontium arise from superior/inferior alveolar artery and drain
by same veins in maxilla and mandible
● Pulp communicates with periodontium apically and also laterally through the
accessory canals
○ Clinically significant because in either pathologic condition of pulp/periodontium, infection has
potential to spread through accessory and apical canals
● Pulpal blood flow is more rapid than most areas in body. Why??
○ Pulpal pressure is among the highest in the body tissues. Intrapulpal pressure is 18-40 mmHg
A is arteriole while B is venule.
How to differentiate these two?
By the thickness & contours of vascular
walls

C is nerve bundle, cut in cross-section

Lymph vessels
● Lymph vessels draining pulp and PDL have common outlet. For example,
anterior teeth → submental LN while posterior teeth → submandibular & deep
cervical LN
● More abundant in central part of pulp than in peripheral areas
● Lymphatic capillaries have thin endothelial walls
Innervation
● Nerves enter pulp through apical
foramen, along with blood vessels and
together from neurovascular bundle
● Once they reach coronal pulp, they act
beneath cell-rich zone, branch into
smaller bundles and ramify into plexus of
Raschkow
● It is in this plexus where A-fibres will
emerge from their myelin sheath, and
branch repeatedly to form
subodontoblastic plexus
A: Odontoblasts
● Finally, terminal axons exit from B: Cell-free zone of Weil
Schwann cells and pass between C: Plexus of Raschkow

odontoblasts as free nerve endings

TYPE OF NERVE FIBRES IN PULP
DIFFERENCES BETWEEN A-DELTA & C FIBRES
A-delta fibres C fibres

- Myelinated, larger diameter - Unmyelinated, smaller diameter

- Fast pain (5-35 m/sec)
- Associated with sharp, brief, pricking pain
- Well-localized
- Elicited by mechanical or thermal stimuli
- Slow pain (0.5-2.0 m/sec)
- Associated with dull, burning, aching,
prolonged pain
- More diffuse
- Elicited mainly by chemical stimuli OR
persisting mechanical/thermal stimuli

FACT: Regardless of type of stimuli (heat, touch, pressure, chemicals) which are afferent impulses
from pulp, pulp cannot differentiate between these stimuli. Why?
○ They lack receptors that can specifically distinguish these stimuli! So they will interpret this
as pain.
Functions
INDUCTIVE
FORMATIVE
- In early stage, interacts
- Pulpal odontoblasts develop
with oral epi cells, leads
matrix; pulp organ cells
to differentiation of DL &
produce dentin
enamel organ formation

NUTRITIVE
- Nourishes dentin via
blood supply

PROTECTIVE DEFENSIVE/REPARATIVE
- Via sensory nerves - By reproducing reparative
- Initiate reflexes that control dentin and mineralizing any
circulation in pulp infected dentinal tubules
Regressive Changes of the Pulp
● Cell changes

Appearance of fewer cells in the aging pulp, with cells

having a decrease in size and number of cytoplasmic
organelles.

● Fibrosis

Accumulations of both diffuse fibrillar components as

well as bundles of collagen fibers usually appear.

The increase in fibers in the pulp organ is gradual and

generalized throughout the organ. External trauma such
as caries or deep restorations results in localized fibrosis
or scarring effect.
 ● Vascular changes

In an aging pulp, atherosclerotic

plaques may appear in pulpal
vessels.

Outer diameter of the the vessel

walls becomes greater as collagen
fibers increase in the medial and
adventitial layers.

Calcifications in the walls of blood

vessels is often found in the region
near the apical foramen.
 ● Pulp stones (denticles)

Pulp stones are nodular, calcified masses appearing in either or both the coronal
and root portions of the pulp.

2 types: true or false denticles

Pulp stones may also be classified as free,
attached or embedded, depending on their
relation to the dentin of the tooth.
 PRIMARY PULP VS PERMANENT PULP
PRIMARY DIFFERENCES PERMANENT

- Larger 1. Pulp chamber - Smaller

- Hourglass appearance 2. Root canal - Well-defined
- Present, towards furcation 3. Accessory - Present towards apical
area canal portion
- Higher 4. Vascularity - Lesser degree
- More prominent & closer to 5. Pulp horn - Comparatively away
outer surfaces. Mesial pulp from outer surface
horn extends closer to
surface than distal pulp
horn
References
1. Ten Cate’s Oral Histology, 10th edition
2. Orban’s Oral Histology & Embryology, 13th edition