The dental pulp is that loose

delicate connective tissue

occupying the cavity lying
in the center of dentin.

Morpholog
Morpholog
y
y

*The coronal pulp: it is present

in the pulp chamber.
*The radicular pulp: it is that
part of the pulp extending
from the cervical region of the
crown to the root apex.

Accessory canals:
They are commonly seen to
extend from radicular pulp
laterally through the root
dentin to the periodontal
ligament.
They are numerous in the
apical third of the root.

Accessory
canals

Mechanism
Mechanism of
of formation
formation
accessory
accessory canals
canals
1- it occurs in areas, where the developing
root encounters a large blood vessel,
where dentin will be formed around it.
2- Early degeneration of the epithelial root
sheath of Hertwig before the differentiation
of the odontoblasts.
3-Lack of complete union of the epithelial
diaphragm at the floor of the pulp chamber.

*Apical foramen: The pulp organs are

continuous with the periapical tissue through
the apical foramen.

The average size of the apical foramen:

maxillary teeth : 0.4 mm
mandibular teeth : 0.3mm

Pulp Exposure

Infected
pulp

Abces
s

Dental
Dental pain
pain (acute
(acute

pulpitis)
pulpitis)
Dental pain occurs in 12% of
population.
The origin of the
dental pain is difficult
to localize.
(referred pain)

Dental pain is the most unkilling acute

pain

Loss of the pulp

results in loss of the
pulp functions, but
the tooth is still
functioning

Histological structure of
the pulp
The dental pulp is formed of specialized
loose connective tissue:
cells

fiber
s

intercellular
substances

blood vessels and

nerves

Zones of the
pulp
peripheral zone
(odontogenic zone).

Dentin

Central
zone (pulp
core).

Odontogenic zone:
a- odontoblasts:
Location: Adjacent to the predentin
with the cell bodies in the pulp and
cell processes in the dentinal tubules.

Denti
n

B- Cell free zone (the zone of Weil):

*It is present beneath the odontoblastic

layer.
*It is suggested to be the area of
mobilization and replacement of
odontoblasts.
C- cell rich zone:
It is present beneath
the cell free zone.
It is composed of
fibroblasts and
undifferentiated
mesenchymal cells.

odontogeni
c
zone

Cell free zone &

cell rich zone
might be
artifacts.

Cells of the pulp

1- Progenitor cells:
Undifferentiated mesenchymal
cells.

2- Synthetic cells (formative

cells):
Odontoblasts and fibroblasts.

3- Defensive cells:
Macrophages, lymphocytes,
eosinophils, mast cells and plasma
cells.

1- Progenitor cells:
(UMC):
They are smaller than
fibroblasts but have a similar
appearance.
They are usually found along
the walls of blood vessels.
These cells have the
potentiality of forming other
types of formative or
defensive cells.

2-Formative cells:

A- Odontoblasts

Length: 25-40u
Diameter: 5-7u

In the early stages of development

odontoblasts consist of a single
layer of columnar cells .
In the later stages of development,
the odontoblasts appeared
pyriform where the broadest part of
the cell contains the nucleus

Odontoblasts are
longer in the crown

cuboidal rootwise,

apex

flat at the root

The cell membranes of adjacent odontoblasts

exhibit junctional complexes.
The clear terminal part of the cell body and
the adjacent intercellular junction is known
as terminal bars.
Gap
junction
desmosom
e

BBFibroblasts
Fibroblasts
*These are the most numerous
type of pulp cells.

numerous

*They are spindle in shape.

*They have elongated processes
which are link up with those of
other pulpal fibroblasts (stellate
appearance).
*The nucleus stains deep
with basic dye and the
cytoplasm is highly stained
and homogenous.

These cells have a double function: formation

and degradation of fibers and ground
substances.
mitochondr

In young pulp, they are :

*Large cells .
*With large multiple
processes *Centrally
located oval nucleus,
*Numerous mitochondria,
*Well developed Golgi
bodies
*Well developed RER

protein
secreting

ia

Fibroblast

In periods of less activity and aging

they appear smaller and round or spindleshaped with few organelles, they are
termed fibrocytes.
fibrocyte

fibroblas
t

Infected pulp

L
L

3- Defensive cells:
A- Histiocyte
(macrophage):

They appear irregular in shape with

short blunt processes.

The nucleus is small, more rounded &

darker in staining than fibroblast.

They are distributed around the

odontoblasts and small blood
vessels and capillaries.

In case of inflammation:
*Nuclei increase in size and
exhibit a prominent nucleolus.
*It exhibits granules and
vacuoles in their cytoplasm.
Ultastructurally,
invaginations of plasma
membrane with aggregation
of vesicles or phagosomes .

*Macrophages are
involved in the
elimination of dead
cells.
*Macrophages remove
bacteria and interact
with other inflammatory
cells to protect the pulp
during inflammation.

Phagocytosi
s

Hydrolyti
c
enzymes

B- Plasma cells:
These cells are seen during
inflammation.
The nucleus of this cell is small
and appears eccentric in the
cytoplasm.
The arrangement of chromatin
in the nucleus gives the cell a
cart wheel appearance,
The plasma cells are known to
produce antibodies.

C- Lymphocytes
They are found in normal
pulp and they increase
during inflammation.

D-Eosinophils
They are found in
normal pulp and they
increase during
inflammation.

E- Mast cells:
*They have a round nucleus and their
cytoplasm contains many granules.
*They are demonstrated by using
specific stains as toluidine blue.

*They produce histamine& heparin.

The ground substances of the

pulp:
*The ground substances consists of acid
mucopolysaccharides and neutral
glycoprotein.

*These substances are the environment that

promotes life of the cells.
*Glycoseaminoglycans are bulky molecules
and hydrophilic, they form gels that fill most
of the extracellular space, They contribute to
the high tissue fluid pressure of the pulp.

Blood vessels
*The pulp is highly vascularized. It is
supplied by the inferior and
superior alveolar arteries.
*As the vessels enter the tooth, their
walls become considerably thinner
than those surrounding the tooth.
D

*Along their course they give

numerous branches in the radicular
pulp that pass peripherally to form
a plexus in the odontogenic region.

The rate of blood flow in the pulp of the tooth is

four time the rate of blood flow in resting
muscle.

Laser Doppler
Flowmetry
It measures the rate of
pulpal blood flow

The capillaries adjacent to the odontoblasts

are fenestrated. Such capillaries are
found in areas of rapid exchange.

Assessment
Assessment of
of pulp
pulp
vitality
vitality

Current pulp tests assess the function of

nerves in the pulp, by the application of
electric current or a rapid change in
temperature.
Recently, blood flow rate in the pulp is
used to measure the degree of the pulp
vitality.

Nerves
Nerves of
of the
the
pulp
pulp

The pulp has an abundant nerve

supply which follows the
distribution of the blood vessels.
Two types of nerve fibers are
present:
*Sympathetic in nature.
They control the contraction of the
smooth muscles of the blood
vessels.
*Sensory nerves.

Both contain myelinated and

unmyelinated axons.

*As the mylelinated nerves run coronally, they

give off side branches and lose their myelin
coat. They form then sub-odontoblastic plexus
of nerves known as plexus of Rashkow. Few
axons extend in-between the odontoblasts to
give the nerve endings.
*More nerve endings are found in the pulp horns
than in other peripheral areas of the coronal or
radicular pulp.

Sensory response in the pulp cannot

differentiate between heat, touch,
pressure or chemicals. This is because
the pulp organs lack those types of
receptors.
Heat,
Touch,
Pressure,
Chemicals

Pai
n

Functions
Functions of
of the
the pulp
pulp
1- Inductive:
Dental papilla induces the enamel
organ formation and also determines
the morphology of the tooth.

2- Formative :
Pulp organ produces dentin. Odontoblasts
develop the organic matrix and function
in its calcification.

3- Nutritive :
The pulp nourishes the dentin.
Nutrition is mediated through the
odontoblasts and their processes.
Denti
n

4- Protective:
The sensory nerves in the tooth respond
with pain to all stimuli, Pain sensation is a
useful alarm system of the pulp.

5- Defensive or reparative:
The pulp responds to irritation by producing
reparative dentin and mineralizing any
affected dentinal tubules.
These reparative reactions are an attempt to
wall off the pulp from the source of irritation.
The presence of macrophages, lymphocytes
and leucocytes aid in the process of repair of
the pulp.

Age
Age changes
changes in
in the
the
pulp
pulp
The size of the pulp
The apical foramen
The cellular elements
The bl. vessels & n.
Vitality

decrease
d

Reticular atrophy: The total affect is the

production of a lessened vitality of the pulp
tissue and a lessened response to
stimulation.

Pulp clacification
localized
(pulp stones )

True denticle

diffuse

False denticle

True denticles
True denticles are rare &
small in size&
found near the apical
foramen.

They consist of irregular dentin

containing traces of dentinal
tubules and few odontoblasts.
Remnants of the epithelial root
sheath invade the pulp tissues
causing UMC of the pulp to
form this irregular type of
dentin.

odontobla
st

dentin
al
tubules

False denticles
*They are evidence of dystrophic
calcification of the pulp tissue .
*They contain no dentinal tubules and
can exist in any area of the pulp.
*They are formed of degenerated cells
or areas of hemorrhage which act as
a central nidus for calcification.
*Overdoses of vit. D, may favor the
formation of numerous denticles.

*Pulp stones are classified

according to their location into:
free, attached and embedded.
*They continue to increase in
size and in certain cases they
fill up the pulp chamber
completely.
*If pulp stones come close
enough to a nerve bundle pain
may be elicited.
*The close proximity of pulp
stones to blood vessels may
cause atrophy of it.

attached

free

Diffuse pulp calcification

*Commonly occurs on top of
hyaline degeneration in the
root canal and not common in
the pulp chamber.
*They are irregular calcific
deposition in the pulp tissue
following the course of blood
vessels or collagenous bundle.
*Advancing age favors their
development.