DENTAL PULP

Dr. Niveditha
Good Morning
 Introduc on
✦ ‘Pulp’ is derived from La n
which means animal or plant
ssues that are moist.
✦ Dental pulp can be de ned as a
richly vascularized &
innervated connec ve ssue
of mesodermal origin enclosed
by den n with communica ons
to the Periodontal ligament.
ti
ti
ti
ti
fi

ti
ti
ti
 General Features
✦ The pulp present in the crown
is called Coronal Pulp or Pulp
chamber.
✦ The pulp present in the root
is called Radicular Pulp or
Root Canal.

✦ The shape of the pulp

resembles the shape of the
tooth in which it is housed.
✦ The total volume of all the Gingiva

permanent pulp is 0.38 cc. And

the mean volume of a single
adult human pulp is 0.02 cc.
✦ Has the ability to form den n
throughout life.
ti

 Coronal Pulp
✦ It is the pulp occupying the pulp
chamber of the crown of the tooth.
✦ In young teeth it resembles the Pulp
Chamber
shape of the den n.
✦ It has six surfaces; Occlusal, Mesial,
Distal, Buccal, Lingual & Floor.
ti

 Midroot

Cervical
Mesiodistal Labiolingual
 ✦ Pulp horns are projec ons
of the Pulp chamber into
the Cusp.
✦ Pulp constricts at the Cervical
cervical region where it Constric on

con nues as the radicular

pulp.
ti
ti

ti
 Radicular Pulp
✦ The radicular or root pulp is that pulp
extending from the cervical region of the
crown to the root apex.
✦ Also referred to as pulp canals or root

Ro
canals of the tooth.

Cana

ot
Can
Root

al
✦ Shape of the radicular pulp is tubular.
✦ In the anterior teeth it is single and in
the posterior teeth it is mul ple.

ti

✦ They vary in size, shape &

number.
✦ The radicular por ons of the
pulp is con nuous with the
periapical ssues through apical
foramen.
✦ As age advances the width of the
radicular pulp is reduced, and so
is the apical foramen.

ti
ti
ti
 Apical Foramen
✦ Pulp cavity terminates at root
apex as small opening called
apical foramen.
✦ Radicular pulp is con nuous
with the periodontal ligament
through this foramen.

ti
 ✦ Diameter of apical foramen in
an adult Max.teeth - 0.4 mm
and in Mand.teeth - 0.3 mm. Young tooth

✦ Wide opening during

development of root.
✦ The loca on and shape of the
Old tooth
apical foramen may undergo
changes as a result of func onal
in uences on the teeth.
fl
ti

ti

 Apical Foramen
✦ A tooth may be pped from
horizontal pressure, or it may Apical
foramen
migrate mesially, causing the apex
to lt in the opposite direc on. Apex

Under these condi ons the ssues Original site of

entering the pulp through the apical foramen

apical foramen may exert pressure

Den n
on one wall, of the foramen, resorp on
causing resorp on. Cementum
apposi on
ti
ti
ti
ti
ti
ti
ti
ti
ti
✦ Some mes the apical opening is
found on the lateral side of the
apex.
✦ Some mes there are two or
more foramina separated by a
por on of den n and
cementum or by cementum
only.
ti

ti
ti
ti
 Accessory Canals
✦ Extends laterally from the
pulp into the periodontal
ligament.
✦ They are numerous in the
apical third of the root.
✦ May also be present at the
furca on area.
ti

✦ Formed due to premature loss of Hertwig’s epithelial root sheath or

when the developing root canal encounters a blood vessel.
✦ Clinically signi cant in spread of infec on, either from the pulp to the
Periodontal ligament or vice versa.

Pulp horns

Accessory
canals
fi
ti

Structural Features
of Pulp
 Cellular Extra cellular

Fibroblast/ Fibrocyte Fibres Ground substance Blood vessels

Odontoblast Collagen Glycosaminoglycans Lymph vessels
Undifferentiated Type l Chondroitin A Nerve endings
mesenchymal cells Type lll Chondroitin B
Defense cells Nerves
Chondroitin C
Neutrophil Proteoglycans
Basophil Syndecan
Eosinophil
Versican
Lymphocyte
Monocyte
Glycoproteins
Macrophage Laminin
Dendritic Cell Tenascin
Fibronectin
Pulpal stem cells Integrins

 Zones of Pulp
Dentinal tubules
✦ Odontoblas c zone
Odontoblastic zone
✦ Cell free zone
Nerve fibres
Cell free zone
✦ Cell rich zone

Cell rich zone

Fibroblasts
✦ Pulp Core Blood vessels

Pulp core
ti

OB Z

CF Z

CR Z
 Odontoblas c Zone
✦ Adjacent to the
preden n with the cell
bodies in the Pulp and

Predentin
cell processes in the
den nal tubules.

CRZ

CFZ

OZ
ti
ti
ti
 Cell Free Zone (Weil’s Zone)
✦ Found below Odontoblas c zone.
✦ 40 microns wide & rela vely free of cells.
✦ Is a space in which the Odontoblast may
move pulpward during tooth
development, & later to a limited extent
in func oning teeth.
✦ This zone is inconspicuous during early
stages of rapid den nogenesis since
odontoblast migra on would be greatest
at that me.
ti
ti
ti
ti

ti
ti

 Cell Rich Zone

Predentin

✦ Composed of broblasts and

undi eren ated mesenchymal cells. OBZ

✦ Is restricted to the coronal region, as it is

formed during the pre erup ve phase of CFZ
the tooth.
✦ During early den nogenesis there are CRZ

also many young collagen bres in this

zone.
ff
ti

fi
ti
fi
ti

 Pulp Core
✦ It is the central mass of
the pulp.
✦ Contains Intercellular
substance, Collagen
bres and Pulpal cells.
✦ Contains larger blood
vessels and nerves.
fi

 Odontoblasts Cell rich zone

High Cell density Central core
Fibroblasts
Undiff. Mesenchymal cells
Rich capillary plexus
Cell free zone
Extensive nerve plexus & capillary plexus

 Extra Cellular Matrix

✦ Connec ve Tissue bres
Collagen
Elas n
✦ Ground Substance
Proteoglycans
Glycosaminoglycans
ti

ti

fi

 Collagen Fibres
✦ Extra cellular structural protein, & is a
major cons tuent of connec ve
ssue.
✦ Collagen bres appear throughout the
pulp.
✦ Collagen bres in pulp exhibit typical
cross stria ons at 64nm.
✦ Collagen bres range in length from 10
to 100 nm or more.
ti

fi
fi
fi
ti
ti

ti
 ✦ Pulp collagen bres do not contribute to den n matrix
produc on.
✦ Collagen bres increases with age.
✦ In very young pulp ne bres ranging in diameter from 10 to
12 nm have been observed. These ne bres are called
brillin.
✦ A er root comple on the pulp matures & bundles of collagen
bres increase in number.
fi
fi
ft
ti

fi

fi
ti
fi
fi

fi
fi
ti
✦ Collagen bres may appear sca ered
throughout the Coronal or radicular
pulp, or they may appear in bundles.
✦ These are termed di use or bundle
collagen depending on their
appearance.
✦ Fiber bundles are most prevalent in
the root canals, especially near the
apical region.
fi

ff
tt

✦ The main type of collagen bre in the pulp is type 1.

✦ Type 3 collagen is also present.
✦ Type 4 is present along the blood vessel wall.
✦ Collagen turn over is maintained by broblasts.
✦ Collagen synthesis is accelerated during repara ve den n
forma on.
ti
fi

fi

ti

ti
 Ground Substance
✦ It is a structure less mass that makes up the bulk of the pulp.
✦ Dense & gel like in nature, varies in appearance from nely
granular to brillar, appears more dense in some areas.
✦ Consists of complexes of proteins, carbohydrates & water.
✦ It is composed of acid mucopolysaccharides & protein
polysaccharide compounds (glycosaminoglycans &
proteoglycans).
✦ Ageing pulp contains less of all these substances.
fi

fi

✦ Func ons;
Lends support to the cells of the pulp.
It servers as a means for transport of nutrients from the blood
vessels to the cells, as well as for transport of metabolites from
cells to blood vessels.
During den nogenesis, the ground substance show a nity for
collagen and in uence brinogenesis.
They have capacity to bind with calcium & help in mineraliza on.
ti
ti

fl

fi

ffi
ti
 Glycosaminoglycans
✦ Being hydrophilic, forms a gel and contributes to high ssue uid
pressure of the pulp.
✦ It is mainly comprised of chondroi n sulphate, dermatan sulphate
& hyaluronic acid.
✦ Hyaluronic acid - In addi on to mechanical func on it helps in cell
migra on.
✦ Syndecan - A important proteoglycan, acts as a adhesion molecule
between broblast, collagen & signaling molecules like broblast
growth factor.
ti
fi

ti
ti
ti
ti
fi
fl
 Ground Substance
✦ Tenascin & Fibronec n, which promote cell adhesion & cell
migra on.
✦ Laminin present in the basement membrane of blood vessels,
also coats the odontoblast cell membrane.
✦ Integrins, the glycoproteins interact to form cell surface
adhesion receptors.
ti

ti

 Fibronec n
✦ It is a high molecular weight glycoprotein.
✦ It plays a role in cell to cell & cell-matrix adhesion.
✦ Has a major e ect on the prolifera on, di eren a on &
organiza on of cells.
✦ Seen around the blood vessels.
✦ Fibronec n may be involved in cell migra on & anchorage in the
wound healing process of the connec ve ssue of pulp.
✦ It regulates the migra on and di eren a on of secondary
odontoblasts.
ti
ti
ti
ff

ti

ff
ti
ti
ti
ti
ti
ff

ti
ti
ti

 Cells of the Pulp

✦ Fibroblasts
✦ Odontoblasts
✦ Undi eren ated Mesenchymal cells
✦ Pulpal stem cells
✦ Defense ells
✦ Dendri c Cells
ff
ti
ti

 Fibroblast
✦ Most numerous cell type in the pulp.
✦ They func on in collagen bre
forma on.
✦ The broblasts are Stellate shaped
cells having extensive processes and
are joined by inter cellular junc ons to
the processes of other broblasts.
✦ Nuclei stains deeply with basic dyes,
and their cytoplasm is light stained.
fi
ti
ti

fi
fi
ti

✦ In young pulp the cells divide

and are ac ve in protein
synthesis.
✦ In older pulp they appear
rounded or spindle shaped with
short processes & exhibit fewer
intra cellular organelles. And
these are termed Fibrocytes.

ti
✦ Ultra structurally the cells
show abundant rough
endoplasmic re culum,
mitochondria & other cell
organelles. Which indicates
that the cells are ac ve in
pulpal collagen produc on.
ti
ti
ti
 Fibroblast
✦ The number of cells decreases with age.
✦ In embryonic & immature pulp the cellular elements
predominate.
✦ In mature pulp the brous components predominate.
✦ They also func on in degrada on of collagen bres.
✦ Fibroblasts have a dual func on with pathways for both synthesis
& degrada on.
ti

ti
fi
ti
ti

fi

 Odontoblast
✦ Second most predominant cell in the
pulp.
✦ Reside adjacent to the preden n with cell
bodies in the pulp & cell processes inside
the den nal tubule.
✦ Columnar in appearance with large oval
nuclei, which ll the basal part of the cell.
✦ Adjacent to the nucleus basally is rough
endoplasmic re culum & Golgi
apparatus.

ti
fi
ti

ti

✦ They are approximately 5 to 7 microns in

diameter & 25 to 40 microns in length.
✦ At the pulp-preden n junc on the cell
cytoplasm is devoid of organelles.
✦ Junc onal complexes are present where
the odontoblast cell body gives rise to the
process. Ac n laments are inserted into
this region.
ti
ti
fi
ti
ti

 ✦ Numerous junc ons such as gap junc on,

Desmosomes
ght junc on & desmosomes are found
between odontoblasts. Tight
junction

✦ Junc onal complexes indicate exchange of

Gap
ions & molecules. They promote cell to junction

cell adhesion & play a role in maintaining

polarity of odontoblasts.
Desmosomes - Mechanical Union.
✦ The clear terminal part of the cell body & Tight Junction - Forms
permeability barrier between pulp &
the adjacent inter cellular junc on is dentinal tubules.
termed as terminal bar apparatus. Gap junction - Communication
between odontoblasts.
ti
ti
ti
ti

ti
ti
✦ At this zone the cell constricts to a
diameter of 3 to 4 microns where the
cell process enters the den nal
tubule.
✦ The process of the cell contains no
endoplasmic re culum, but during
the ac ve den nogenesis it contains
occasional mitochondria & vesicles.
✦ The process contains abundance of
microtubular laments & coated
vesicles.
ti

fi
ti
ti
ti

 Shape of the odontoblasts also re ect the func onal ac vity of the
cell.
✦ Synthe c/Ac ve stage;
Tall columnar cells
Large basal nucleus with a basophilic cytoplasm.
Numerous rough endoplasmic re culum &
mitochondria.
Well developed golgi complex.
Abundant synthe c organelles.
Numerous secretory granules.
ti
ti

ti

ti
fl

ti
ti
✦ Transi onal/Intermediate stage;
Shows features of synthe c cells but
organelles are less in number & less
prominent.
Nucleus shows condensa on of chroma n
with organelles distributed around the
nucleus.
Decreased secretory granules.
Presence of autophagic vacuoles.
ti

ti
ti

ti
 ✦ Res ng/Aged odontoblast stage;
Stubby cells
Scanty cytoplasm
Dark close faced nucleus
Decreased organelles
Secretory granules are absent
ti

✦ The form & arrangement of the bodies of

odontoblasts are not uniform throughout the pulp.
✦ They are cynlindrical & longer in the crown.
✦ Cuboidal in the root.
✦ Spindle shaped or atened close to apex.
✦ But they are recognized by their processes
extending into den n.
✦ The pseudostra ed arrangement seen in the
coronal pulp is due to the crowding of the cells in
the region.
ti
fi
fl
ti

 Func ons of Odontoblasts

✦ Synthesis of organic matrix.
✦ Synthesis of non collagenous substances like sialoprotein,
phosphoryn, osteocalcin, osteonec n & osteopon n.
✦ Intracellular accumula on of calcium.
✦ Primary cilia in the odontoblasts play a role in response of
odontoblasts to external s muli.
ti
ti
ti

ti

ti

 Undi eren ated Mesenchymal Cells

✦ Are the primary cells in very young pulp.
✦ But very few are seen a er root comple on.
✦ Are to potent cell & when need arises they may become
odontoblasts, broblasts or macrophages.
✦ Distributed throughout the pulp, frequently around the peri
vascular area.
ti
ff
fi
ti
ft
ti

 Undi eren ated Mesenchymal Cells

✦ They are polyhedral shaped with peripheral processes &
large oval nuclei.
✦ Di cult to di eren ate from broblasts under light
microscope.
✦ In older pulp, their number and ability to di eren ate comes
down.
ffi
ff

ff
ti

ti
fi
ff
ti
 Undifferentiated
mesenchymal cells
 Defense Cells
✦ They play a major role in local in amma on & immunity.
✦ These cells migrate from the pulpal blood vessel.
✦ These cells are
Macrophages
Mast cells
Plasma cells
Lymphocytes
Neutrophils
Eosinophils, Basophils & Monocytes.

fl
ti

 His ocytes (Macrophages)

✦ In light microscope, the cells appear irregular in
shape with short blunt processes.
✦ Engulfment & diges on of foreign material.
✦ Cons tute 8-9% of total pulpal popula ons.
✦ The nucleus is small, more rounded & darker in
staining than broblast.
✦ Their presence is disclosed by intra vital dyes
such as trypan blue.
ti
ti
fi
ti

ti

✦ These cells are distributed around the

odontoblasts & small blood vessels &
capillaries.
✦ In case of in amma on, nuclei increase in
size & exhibit a prominent nucleolus.
✦ It exhibits granules & vacuoles in their
cytoplasm.
✦ Invagina ons of plasma membrane are noted
ultrastructurally with aggrega on of vesicles
or phagosomes.
ti

fl
ti
ti

 Mast Cells
✦ They have a round nucleus & their
cytoplasm contains many dark staining
granules.
✦ They are demonstrated by using
speci c stains as toluidine blue.
✦ They produce histamine & heparin.
✦ Occur in small groups in rela on to
blood vessels.
✦ Present only during pulpal
in amma on.
fl
fi

ti

ti

 Plasma Cells
✦ These cells are seen during
in amma on.
✦ The arrangement of chroma n gives the
nucleus a cart wheel appearance.
✦ The mature type exhibits a typical small
eccentric nucleus & more abundant
cytoplasm.
✦ The plasma cells are known to produce
an bodies.
fl
ti
ti

ti

 Lymphocytes
✦ Usually found extravascularly in the normal
pulp.
✦ During in amma on they increase in
number.
✦ Lymphocytes are present along the walls of
blood vessels.
✦ Usually they are not found in unin ammed
pulp.
✦ They phagocyte foreign material.

fl

ti
fl
 Eosinophils
✦ They are found in normal pulp and they increase during
in amma on.
fl
ti
 Dendri c Cells
✦ Seen in close contact with the
cell membranes of the
endothelial cell.
✦ These cells express macrophage
related an gens.
✦ These cells are similar to
Langerhans cell.
✦ They present the an gen to the
T cells.
ti
ti

ti
✦ In deciduous teeth they are seen in close
contact with odontoblasts & it’s processes.
✦ These cells increase in areas a ected by
caries, a ri on or restora ve procedures.
✦ These cells have a regulatory func on on
the odontoblast.
✦ These cells in the deciduous teeth are
increased in number during shedding.
tt
ti

ti
ff
ti

 Pulpal Stem Cells

✦ Are pluripotent cells, that have the capacity for angiogenic,
chondrogenic, osteogenic, adipogenic & neurogenic di eren a on.
✦ Pulpal stem cells of exfoliated deciduous teeth & perm. third molars
may serve as a suitable source.
✦ Stem cells are found in higher concentra on in coronal pulp than in
radicular pulp. Seen in close proximity to BV & nerves.
✦ Pulpal stem cells have the poten al for odontoblast di eren a on &
den n repair at sites of injury.
ti

ti
ti

ff
ff
ti
ti
ti
ti

Pulpal stem cells

 Blood Vessels
✦ The pulp organ is extensively vascular with vessels arising from
the external caro d, the superior or inferior alveolar arteries. It
drains by the same vein.
✦ The walls of the pulpal blood vessels become very thin as they
enter the pulp.
✦ The blood vessels gain entry into the pulp through the apical
foramen and at mes through accessory foramen.

ti
ti

 Blood Vessels
✦ Pulpal blood ow is more rapid than in most area of the body.
✦ Pulpal pressure is highest of body ssues.
✦ The ow of blood in
Arterioles - 0.3 to 1 mm/sec
Venules - 0.15 mm/sec
Capillaries - 0.08 mm/sec
fl
fl

ti

 Arteries
✦ The largest arteries in the human pulp
are 50 to 100 microns. These vessels
possess three layers;
Tunica in ma; The rst & the inner
most layer consists of squamous or
cuboidal endothelial cells surrounded
by a basal lamina.
Tunica In ma
Tunica Media
Tunica Adven a
ti
ti
ti
fi

 Tunica Media; The second layer is

5 microns thick & consists of 1 to
3 layers of smooth muscle cells,
with a basal lamina between
these muscle cells & in ma.
Occasionally endothelial cells are
in contact with the muscles cells.
This is termed a myoendothelial
junc on.
ti
ti
Tunica Adven a; The third &
the outer layer is made up of a
few collagen bres forming a
loose network around the larger
arteries. This layer becomes more
conspicuous with age.
fi
ti
ti
 Arterioles
✦ Diameter of 20 to 30 microns.
✦ Arterioles with diameters of 20 to 30 μm with one or
occasionally two layers of smooth muscle cells are common
throughout the coronal pulp.
✦ Tunica adven a blends with the bres of the surrounding
inter cellular ssue.
ti
ti
ti

fi
 Terminal Arterioles
✦ Diameter of 10 to 15 microns.
✦ Appear peripherally in the pulp.
✦ Endothelial cells contain numerous micropinocy c vesicles, that
func on in trans endothelial uid movement.
✦ A single layer of smooth muscle cells surround these small vessels.
✦ Occasionally a broblast or pericyte lies on the surface of these
vessels.
ti
fi
fl

ti

 Pericyte
✦ Capillary associated broblasts.
✦ Present par ally encircling the capillaries, they are capable of
reducing the size of the capillary lumen.
✦ They have contrac le proper es.
ti
ti
fi
ti

 Precapillaries
✦ Smaller diameter arterioles.
✦ Slightly larger than the terminal
capillaries.
✦ Exhibit a complete or incomplete
layer of muscle cells surrounding the
endothelial lining.
✦ Range in size from 8 to 12 microns.

 Veins & Venules

✦ Are larger than arteries.
✦ 100 to 150 microns in diameter.
✦ Walls appear less regular because
of bends & irregulari es along their
course.
✦ Microscopic appearance is similar
to that of arteries except that they
exhibit much thinner walls.
✦ Endothelial cells appear more
a ened.
fl
tt

ti

 ✦ Fewer intra cytoplasmic

laments appear in these cells
than in the arterioles.
✦ The tunica media consists of a
single layer or two of thin
smooth muscle cells that wrap
around the endothelial cells
and appear discon nuous or
absent in smaller venules.
fi
ti

 ✦ The basement membrane of these

vessels are thin and less dis nct than
those of arterioles.
✦ The adven a is lacking or appears as
broblasts and bres are con nuous with
the surrounding pulp ssue.
✦ Occasionally two venous-venous
anastomosis and arterioles-venous
anastamosis occur in the pulp.
fi
ti
ti
fi

ti
ti

ti
 Blood Capillaries
✦ Blood capillaries which appear as endothelium-lined tubes,
are 8 to 10 microns in diameter.
✦ The fenestrated capillaries are assumed to be involved in
rapid transport of metabolites den nal matrix forma on &
calci ca on.
✦ Both fenestrated & con nuous terminal capillaries are found
in the odontogenic region.
fi
ti

ti

ti
ti
✦ During ac ve odontogenesis
capillaries appear among the
odontoblasts adjacent to the
preden n.
✦ Later a er the teeth have reached
occlusion and den nogenesis slows
down, these vessels usually retreat
to a subodontoblas c posi on.
ft
ti
ti

ti
ti
ti
 Blood Supply of Teeth
External caro d artery

Maxillary artery

Mandibular ( rst) Pterygoid Pterygopala ne (third)

(second)

Inferior
alveolar branch Infraorbital Posterior superior
artery alveolar artery

Dental Mental Incisive Anterior superior

branches artery artery alveolar artery
Molars
Lower Lip Lower Incisors Molars
Premolars
& Chin incisors Canines
Canines Premolars
ti
fi
ti
 Lympha c Vessels
✦ Lymph capillaries are described as endothelium lined tubes that
join thin walled lymph vessels or veins in the central pulp.
✦ Lympha c capillaries have thin walls.
✦ More numerous in the central part of the pulp than in the
periphery.
✦ Di er from venules in that their walls and basement membrane
show discon nui es, with the absence of RBC’s but with the
presence of lymphocytes in the lumen.
ff
ti

ti
ti
ti

 Lympha c Vessels
✦ Lymph vessels draining the pulp
and periodontal ligament have a
common outlet.
✦ Anterior teeth drain to
submental lymph nodes and
posterior teeth to the
submandibular & deep cervical
lymph nodes.
ti

 Arterial Venous
system system

Collecting Lymphatic fluid

duct (thoracic ( moving through
duct) Heart vessels)

Lymph
node

Lymphatic
vessels Lymphatic
Lymphatic
vessels
vessels

Capillaries

Extra fluid draining from

cells & tissues)
 Nerves
✦ Has abundant nerve supply that follows the distribu on of the blood
vessels.
✦ Majority of the nerves are non myelinated. Many of these gain a
myelin sheath later in life.
✦ Non myelinated nerves are found in close associa on with the blood
vessels and many are sympathe c in nature. They func on in
vasoconstric on.
✦ The large myelinated bres mediate the sensa on of pain that may
be caused by external s muli.

ti

fi
ti

ti
ti
ti
ti
ti
 Plexus of Rashkow
✦ The thick nerve bundles enter through the
apical foramen and reach coronal pulp.
✦ These bres branch and radiate peripherally
to form the subodontoblas c nerve plexus of
Rashkow adjacent to cell rich zone.
✦ Also called as parietal layer of nerves these
develops gradually, becoming prominent
when root forma on is complete.
fi
ti
ti

 ✦ Only free nerve endings are in pulp; therefore only pain sensa on
is felt.
✦ Myelinated/fast conduc ng; ‘a’ delta bres mediate sharp pain.
✦ Non myelinated/slow conduc ng; ‘c’ bres mediate dull pain.
✦ Sympathe c bres end in in blood vessels to control blood ow.
✦ Sensory response in the pulp cannot di eren ate between heat,
touch, pressure, or chemicals. This is because the pulp organ lacks
those type of receptors that speci cally dis nguish these other
s muli.
ti

ti
fi
ti
ti
fi
fi
fi
ff
ti
ti
fl
ti

 Trigerminal Nerve

Ophthalmic nerve Maxillary nerve Mandibular nerve

Anterior superior Infraorbital Posterior superior Lingual Inferior alveolar

alveolar nerve nerve alveolar nerve nerve nerve

Middle superior
alveolar nerve
Tongue
Anastomoses Anastomoses
Inferior Incisor
with posterior & with posterior Mental
middle superior superior alveolar dental branches branches
dental nerve nerve branches

Maxillary Maxillary Maxillary Mandibular Mandibular Lower lip

molars & canines &
anteriors premolars molars & chin
premolars incisors
Dentin

Pulp
Func ons
1. Induc ve;
Dental papilla induced the enamel organ forma on and also
determines the morphology of the tooth.
2. Forma ve;
Pulp organ produces den n. Odontoblasts develop the organic
matrix and func on in it’s calci ca on.
ti
ti
ti

ti
ti
fi
ti

ti
3. Nutri ve;
The pulp nourishes the den n through the odontoblasts and their
processes and by means of the blood vascular system of the pulp.
4. Protec ve;
Any environmental irrita ng s muli such as heat, cold, pressure,
opera ve cu ng procedures, and chemical agents always elicit pain
as a response.
Sympathe c; The nerves also ini ate re exes that control circula on
in the pulp.
ti
ti
ti
ti
tti

ti
ti
ti
ti
fl
ti

 5. Repara ve;
Through the forma on of highly mineralized repara ve den n at the site
of injury to seal o the pulp from the source of irrita on. Also the pulp
may mineralize the a ected den nal tubules by forming sclero c den n.
6. Defensive;
Pulp in amma on represents other aspect of it’s response to irrita on. In
this condi on the defensive cells of the pulp will be increased and
ac vated to repair and heal the in ammed pulp and phagocytoses the
invading bacteria and their toxin.
ti
fl
ti
ti

ti
ff
ti
ff
ti
fl
ti
ti
ti
ti
ti
ti

 Di erences in Primary & Permanent Pulp Tissues

ff
 Primary Pulp
✦ The primary pulp func ons for a shorter period of me than do
the permanent pulps.
✦ The average length of me a primary pulp func ons in the oral
cavity is only about 8.3 years.
✦ This amount of me may be divided into three periods.
ti

ti
ti

ti
ti
 ✦ Pulp growth period; Is the me during which crown and roots are
developing. Tooth erup on to root comple on is about 1 year.
✦ Pulp matura on; The period of me a er the root is completed
un l root resorp on begins. 3 years 9 months.
✦ Pulp regression; The me from beginning root resorp on un l
the me of exfolia on. 3 years 6 months.
ti
ti
ti
ti
ti
ti
ti
ti
ti
ft
ti

ti
ti

✦ During crown forma on the pulps of primary and permanent teeth are
morphologically nearly iden cal.
✦ During this me the ssues are highly cellular, exhibi ng a high mito c
rates especially in the cervical region.
✦ Both the primary and permanent pulps are highly vascularized,
however the primary teeth never a ain the extent of neural
development that occurs in the permanent teeth. This is caused by the
loss of neural elements during the root resorp on.
✦ Greater the extent of root resorp on greater the degenera ve changes
seen in the primary pulps.
ti
ti
ti
ti

ti
tt

ti

ti
ti
ti
Permanent Pulp
The period of development for the pulps of the permanent teeth are
longer than the same process in the primary teeth.
✦ Crown comple on; During the me crown is comple ng forma on
and calci ca on is 5 years 5 months.
✦ Crown comple on to erup on; In both arches averages to 3 years 6
months.
✦ Erup on to root comple on; 3 years 11 months.
For both primary & permanent teeth the Maxillary arches require slightly
longer time to complete each process of development.
ti

fi
ti
ti
ti
ti
ti
ti

ti
ti
 Regressive Changes (Aging)
✦ The volume of the pulp chamber decreases with con nued
deposi on of secondary den ne.
✦ Cell changes
✦ Fibrosis
✦ Vascular changes
✦ Pulp stones
✦ Di use calci ca ons
ff
ti

fi

ti

ti

ti
 Age Changes in Pulp

The size of the pulp

The apical foramen
The cellular elements Decreased

The blood vessels & nerves

Vitality

✦ Cell changes; With age the pulp becomes less cellular. The
number of cells in the pulp decreases. The cells are characterized
by a decrease in size and number of cytoplasmic organelles.
✦ Fibrosis; Accumula ons of both di use brillar components as
well as bundles of collagen bres. The increase in the bres is
gradual and is generalized throughout the organ. The collagen
increase is noted in the walls of the blood vessel as well. The
increase in collagen bres may be more apparent than normal.
ti
fi
fi
ff
fi
fi

✦ Vascular changes;
Blood ow decreases with age. This is due to decrease in the number
of blood vessels and due to the form of atherosclero c plaques within
pulpal vessels.
The outer diameter of vessel walls becomes greater as collagen bres
increase in the blood vessel walls.
Also calci ca ons are found that surround the vessels. Calci ca on in
the walls of blood vessels is found most o en in the region near the
apical foramen.
fl
fi
ti

ft
ti
fi
ti
fi
 Pulp Stones (Den cles)
✦ Are nodular calici ed masses seen in both coronal pulp & radicular
pulp.
✦ They usually are asymptoma c unless they impinge on nerves or
blood vessels.
✦ They are seen in func onal as well as in embedded unerupted teeth.
✦ All den cles begin as small nodules but increase in size by
incremental growth on their surface.
✦ Commonly seen in coronal pulp.

ti

fi
ti
ti
ti

 According to their structure,

Pulp stones are classi ed as;
✦ True Pulp Stones
According to their rela onship with
✦ False Pulp Stones
den n, Pulp stones are classi ed as;
✦ Free Pulp Stones
✦ A ached Pulp Stones
✦ Embedded Pulp Stones
tt
ti

fi

ti

fi

 True Pulp Stones

✦ Are rare and smaller in size, found near
the apical foramen.
✦ They consist of irregular den n
containing traces of den nal tubules
and few odontoblasts.
✦ Remnants of the epithelial root sheath
invade the pulp ssues causing
undi eren ated mesenchymal cells of
the pulp to form this irregular type of
den n.
ti
ff
ti
ti

ti
ti
 False Pulp Stones
✦ They are concentric layers of calci ed
ssue without den nal tubules.
✦ They are evidence of dystrophic
calci ca ons of the pulp ssue.
✦ They are formed of degenerated
cells.
✦ Phleboliths or areas of hemorrhage
also act as a central nidus for
calci ca on.
ti
fi
fi

ti
ti
ti
ti

fi
 Pulp Stones (Den cles)
✦ Free den cles are en rely surrounded by pulp ssue.
✦ A ached den cles are partly fused with den n.
✦ Embedded den cles are en rely surrounded by den n.

All pulp stones are believed to be formed free in the pulp and later they
become a ached or embedded as den n forma on progresses.
tt
tt
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti

ti

 Embedded Pulp stones

(Entirely surrounded by
dentin)

Attached
Pulp stones Free Pulp stones
(Partly fused (Entirely surrounded by
with dentin) Pulp tissue)

 Di use Calci ca ons

✦ Irregular calci ca on deposits in the
pulp ssue following the course of
blood vessels or collagen bre
bundles.
✦ Usually found in the root canals and
less o en in the coronal area.
✦ Advancing age favours their
development.
ff
ti
ft

fi
fi
ti
ti
fi

 Development
✦ The tooth pulp is ini ally called the dental papilla. This ssue is
designated as ‘pulp’ only a er den n forms around it.
✦ Development of the dental pulp begins at about the 8th week of
embryonic life in the human.
✦ The young dental papilla is highly vascularized, and a well-organized
network of vessels appears by the me den n forma on begins.
✦ Capillaries crowd among the odontoblasts during this period of ac ve
den nogenesis.
ti
ti
ft

ti
ti
ti
ti

ti

ti
✦ The cells of the dental papilla appear as undi eren ated
mesenchymal cells. Gradually these cells di eren ate into stellate-
shaped broblasts.
✦ Nerve bers were rst seen in the dental follicle in the 11th week
of intrauterine life.
✦ In the 18th week the nerve bers were observed in the dental
papilla.
✦ At about 24th week the nerve bers reach the subodontoblas c
region.
fi
fi

fi

fi
fi
ff
ff
ti
ti
ti
 Clinical Considera ons
✦ Provides constant source to maintain the vitality of the tooth.
Every precau on should be taken to preserve the vitality of the
tooth.
✦ The preserva on of the healthy pulp during opera ng
procedures and successful management in cases of diseases are
two most important challenge to the clinicians.

ti
ti
ti
ti
Thank You