Faculty of Dentistry

Oral Biology I
Pulp

It is a loose delicate connective tissue occupying the cavity lying in the

center of dentin.

Development

At first pulp is known as dental papilla but after the inner enamel
epithelium differentiate into ameloblasts, the odontoblasts then
differentiate from peripheral cells of dental papilla and dentin production
begins, as this occur the tissue is no longer called dental papilla but now
it is the pulp organ (after dentin formed around it).

Morphology

The dental pulp is divided into a coronal portion (pulp chamber) located
centrally in the teeth crowns and a radicular portion (root canal) located in
the root.

Function of the pulp

1. Inductive
Very early in development, the primitive pulp (dental papilla)
interacts with enamel organ and odontoblasts are developed.
2. Formative
§ The odontoblast cells produce dentin
§ The odontoblasts develop the organic matrix and
mineralization

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I

3. Nutritive
The blood vascular system of the pulp nourishes the dentin through
the odontoblastic processes.
4. Protective
§ The sensory nerves in the tooth respond with pain to all stimuli
such as heat, cold, pressure, chemical agents, and operative
cutting procedures.
§ Pain sensation is a useful alarm system of the pulp.
5. Defensive or reparative
• Pulp has remarkable reparative abilities as:
i. It responds to irritation whether mechanical,
thermal, chemical, bacterial by producing tertiary
and sclerotic dentin in attempts to seal off the pulp
from the source of irritation.
ii. Also the presence of macrophages, lymphocytes
and leucocytes aids in the process of repair of the
pulp.

Histology of the pulp

When the pulp examined histologically, 4 distinct zones are
distinguished:

1. The odontoblastic zone: it lines the outer pulpal wall. It consists of a

layer of the cell bodies of odontoblasts.
2. The cell free zone (zone of Weil); beneath the odontoblasts, which
is prominent in the coronal pulp. Some believe that it is area of

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
mobilization and replacement of odontoblasts, and this may explain
why this zone is not clear during active dentinogenesis.
3. The cell rich zone; located adjacent to cell free zone. It is composed
mainly of fibroblasts and undifferentiated mesenchymal cells. These
3 zones are termed together odontogenic zone.
4. The pulp core, which is characterized by the major vessels and
nerves of the pulp.

The pulp structure is composed of:

1. Cells.
2. Fibers and ground substance.
3. Blood vessels and nerves.

Cells
I. Synthetic cells
II. Defensive cells
III. Progenitor cells
I. Synthetic cells
A. Odontoblasts
Discussed before
B. Fibroblasts
• They are the most numerous cells seen forming a loose network
throughout the pulp.
• They exist in greater numbers in the cell rich zone.
• These cells have a dual function both synthesis and degradation
of collagen and ground substance in the same cell.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
II. Defensive cells
1. Histocyte (tissue macrophage cell)
• They are involved in elimination of dead cells, the presence of
which further indicates that turnover of dental pulp fibroblasts
occurs.
• They are located throughout the pulp core; they are usually
associated with small blood vessels and capillaries.
• In case of inflammation, it exhibits granules and vacuoles in
their cytoplasm, their nuclei increase in size with prominent
nucleolus.
2. Plasma cell
• They are seen during inflammation and their function is to
produce antibodies.
3. Mast cells
• Their number increase during inflammation and they produce
histamine & heparin.
4. Lymphocytes
• They are found extra-vascularly in normal pulp but during
inflammation they increase in number.
• In normal pulp T-lymphocytes are found but B-lymphocytes are
scarce.
5. Dendritic cells
• They are important components of normal pulp around the
odontoblasts and the central blood vessels.
• They act as antigen presenting cells and stimulate the division
and activity of native T-lymphocytes.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
III. Progenitor cells (UMC)
• They represent the pool from which the connective tissue cells of
the pulp are derived.
• They are the primary cells in the very young pulp, but few are seen
in pulp after root competition.
• Their number decreases in older pulp.
• They are found along pulp vessels in cell rich zone and pulp core.

Fibers and ground substance

A. Fibers
• The fibers of the pulp are of type I & III collagen.
• In young pulp, single fibrils of collagen are found scattered between
the pulp cells. And aggregated in bundles in older pulp.
• The greater concentration of collagen is at the apical part
J Clinical tips
F During root canal treatment, the nerve broach at the apical
region provides better opportunity to remove the pulp tissue
intact and make sure no pulp remanent exist
• No elastic fibers in the pulp except for those present in the walls of
large blood vessels

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
B. Ground substance:
• It is dense, gel like in nature and varies in appearance from finely
granular to fibrillar.
• It is composed principally of glycosaminoglycans, glycoproteins
and water.
• Function:
1. Support the cells of pulp
2. Maintain tissue integrity and physical properties
3. Act as medium for transport of nutrients and metabolites
4. Control cell migration

Blood vessels & nerves

I. Blood vessels
o It is supplied by inferior and superior alveolar arteries and drain by
the same veins in both mandibular and maxillary regions.
o Pulpal blood flow is more rapid than in most areas in the body this
may be attributed to the fact that the pulpal pressure is among the
highest of the body tissues.
o Arteries of pulp are branched into arteriole, small arteriole, terminal
arteriole, and capillaries.
II. Veins & venules
o They are larger than arteries and appear in the central region of
radicular pulp.
III. Lymph vessels
o Draining of anterior teeth pass to submental lymph nodes but those
of posterior teeth pass to submandibular & deep cervical lymph
nodes.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
IV. Nerves
• Pulp is richly innervated; nerves enter the pulp through apical
foramen along with afferent blood vessels and together form
neurovascular bundle.
• Two types of nerve fibers are present:
1. Non myelinated supply the large muscular blood
vessels in the central pulp to function in contraction or
dilatation of large blood vessels.
2. Myelinated sensory nerve
§ can’t differentiate between heat, touch, pressure,
or chemicals.
§ The pulp lacks those types of receptors and the
only identified sensation is the pain.
§ As the myelinated nerves give offside branches
that terminate in sub-odontoblastic plexus of
nerves known as plexus of Rashkow.
§ The plexus does not evident until the tooth has
erupted.
§ Most of the nerve bundles terminate in the sub
odontoblastic plexus as free nerve endings
especially in the pulp horns.
• A small numbers of nerve fibers lose their Schwann
cell coating, rendering them susceptible to changes
in the extracellular environment and pass between
the odontoblast cell bodies to enter the dentinal
tubules.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
Pain sensation
Ä Innervation of Dentin

§ Intra-tubular nerves
§ Nerves extends 100-150 µ in between the DTs to form
Raschkow’s plexus or Sub-odontoblastic plexus

§ Some nerve fibers lose their Schwann cell coating pass between
the odontoblasts cell bodies and enter the dentinal tubules.

§ Pain occurs because of exposed dentinal tubules in case of

enamel loss or gingival recession and root exposure
Ä Theories of pain sensation

I. Direct neural stimulation

1. Dentin contains nerve endings, which respond when
dentin is stimulated.
2. Arguments:
a. Nerve endings extends only 100-150 µ and
never reach near ADJ, which is the most
sensitive region.
b. The application of local anesthetic to the
surface of dentin doesn’t abolish the
sensitivity.
c. Newly erupted teeth are sensitive, although
plexus of Raschkow do not establish until a
tooth had erupted.
3. This theory was rejected

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 Faculty of Dentistry
Oral Biology I

II. Transduction stimulation

• Odontoblastic process conducts impulses to nerve

endings

• This theory is supported by the neural origin of

odontoblasts “neural crest cells”

• Arguments

o There are no neurotransmitter vesicles in

odontoblastic process

• This theory was rejected

III. Hydrodynamic theory

• It is the most popular one, which proposed that

various stimuli as heat, cold, air affect fluid
movement in DTs which stimulate nerve endings
in plexus of Rashcow.

• Supporting

o When the cavity is dried with air “cavity

desiccation” or cotton wool. A greater loss
of fluid is induced, leading to more
movements and more pain

o The increased sensitivity at ADJ due to

profuse branching of tubules in this region.

o This theory explains why local anesthetics,

applied to exposed dentin, fail to block
sensitivity.

• This is the most accepted theory

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
Age changes in pulp
1. Size
§ Pulp chamber and canal reduced in size dure to the
continuous formation of dentin
§ Apical foramen becomes narrowed with age and further
constricted by cementum deposition
2. Pulp cellular elements
§ Fewer undifferentiated cells are available for emergencies so
defensive& repair processes are slower in getting started.
§ Distribution of collagen fibrils changes leading to appearance
of fibrous bundles
3. Innervation
§ Loss & degeneration of myelinated &non myelinated axons
that is correlated with reduction in sensitivity.
4. Vascular changes
§ Decrease in blood vessels
§ Calcification in blood vessels wall found most often in the
region near the apical foramen or calcification surround the
vessels.
5. Reticular atrophy
§ Odontoblasts degenerate in some areas of the pulp, they may
have completely disappeared and vacuoles result this leads to
lesser vitality of pulp tissue and lesser response to stimulation.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
6. Pulp stones/ denticles/ calcification
A. They are discrete calcified masses appear in coronal or
radicular portion of pulp and they are asymptomatic until they
impinge on blood vessels or nerve.
B. It can be seen in functional & unerupted teeth.
C. They are classified according to their structure or according
to their location.
i. According to their structure
A. True denticle
• It consists of concentric layers of mineralized tissue.
• It contains traces of dentinal tubules and few
odontoblasts.
• It is small and rare to occur and commonly found near
the apex.
• Their development may be due to developmental
disturbance which occur during root formation causing
remnants of ERSH to invade pulp tissue leading to
differentiation of UDMCs of pulp to odontoblasts which
then form this irregular masses of dentin.
B. False denticle
• They have no cells associated but they are evidence of
dystrophic calcification.
• It is larger in size and found in pulp chamber.
• Dystrophic calcification generally originates in relation to
blood vessels or as diffuse mineral deposits along
collagen bundles.

Pulp Menatalla M. Elhindawy

 Faculty of Dentistry
Oral Biology I
• They formed of degenerated cells or areas of hemorrhage
which act as central nidus favoring deposition of
concentric layers in typical calco-spheric form, it continues
to increase in size till fill up the pulp chamber completely.
ii. According to their location
• That depend on their relation to the dentin of the tooth:
a) Free denticles: are surrounded by pulp tissue.
b) Attached denticles: are partly fused with dentin.
c) Embedded denticles: are surrounded by dentin.

7. Diffuse calcification
• They are irregular calcific deposits in pulp tissue. It is
commonly occurring on top of hyaline degeneration in the root
canal and not common in pulp chamber.
• They are amorphous and have no specific structure following
the course of blood vessels or collagenous bundle.
• It may be classified as dystrophic calcification.
• Overdoses of vitamin D may favor the formation of numerous
denticles.

Pulp Menatalla M. Elhindawy