Dentin and Pulp Complex

DENTIN AND PULP
COMPLEX
1
FAQ’S
SHORT ESSAY
• Degenerative changes in dental pulp (RAJIV GANDHI UNIVERSITY)
• Internal morphology of deciduous teeth (RAJIV GANDHI UNIVERSITY)
• Innervations of primary teeth (MANIPAL UNIVERSITY)
• Dental pulp is a unique organ (MANIPAL UNIVERSITY)
LONG ESSAY
• Discuss the pathways of pulp in deciduous teeth and how it affects the endodontic
therapy in primary dentition (RAJIV GANDHI UNIVERSITY)
• How and why is the reaction of pulpal connective tissue to injury different from the
reaction of connective tissue elsewhere in the body? Discuss in detail the
pathophysiology of pulp (MANIPAL UNIVERSITY)
2
CONTENTS
DENTINE
• Introduction
• Development of dentine
• Morphology
• Physical properties
• Chemical properties
• Dentinal tubules
• Regional variations in dentine structure and composition
• Structural lines in dentine
• Innervation of dentine
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• Formation and repair of dentine
• Developmental disturbances of dentine
• Clinical considerations
PULP
• Introduction
• Development of pulp
• Anatomy of pulp
• Composition of pulp
• structural features
• Zones of pulp
• Functions of pulp
• Clinical considerations
4
• Dentine is the mineralised tissue that forms the
bulk of the tooth.
INTRODUCTION • It is a rigid but elastic tissue consisting of large
numbers of small, parallel tubules in a
mineralised collagen matrix
• Two major properties distinguish dentine from
enamel. Firstly, dentine is sensitive.
• Secondly, dentine is formed throughout life,
increasing in thickness at the expense of the
dental pulp
Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 5

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DENTIN PULP COMPLEX
• Developmentally, they both originate from the dental papilla
• Structurally, although the cell body of the odontoblast lies at the periphery of the dental
pulp, the odontoblast process continues along the dentinal tubule. Other structures
passing from the dental pulp into the dentinal tubule are nerve fibres and the dendritic
processes of antigen-presenting cells.
• Nutritionally, the tissue fluid that passes along the dentinal tubules is derived from the
vasculature of the dental pulp.
• Responsiveness of dentine to external stimuli resulting in the formation of tertiary
dentine is mediated by the recruitment of stem cells within the dental pulp.

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DEVELOPMENT OF DENTINE
• Dentinogenesis begins at the cusp tips after the odontoblasts have differentiated and begin
collagen production.
• In odontoblast differentiation, fibronectin, decorin, laminin, and chondroitin sulfate may be
involved.
• Recent studies showed that laminin α2, a subunit of laminin, is essential for odontoblastic
differentiation and to regulate the expression of dentin matrix proteins.
• Dentinogenesis factors like TGF, IGF, and BMP, which are present in the inner enamel
epithelium, are released and these are taken up by the preodontoblast.
• These factors help in the organization of odontoblast cytoskeleton assembly, which is
important for relocation of organelles that occurs prior to morphological changes.
GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

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As the odontoblasts differentiate, they change from an ovoid to a columnar shape,
and their nuclei become basally oriented at this early stage of development.
One or several processes arise from the apical end of the cell in contact with the basal
lamina. The length of the odontoblast then increases to approximately 40 µm,
although its width remains constant (7 µm).
Proline appears in the rough surface endoplasmic reticulum and Golgi apparatus.
The proline then migrates into the cell process in dense granules, and is emptied into
the extracellular collagenous matrix of the predentin

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• Factors controlling odontoblast secretion and mineralization are not known.
• One of the key proteins involved in mineralization and secreted by the odontoblast is the
DPP.
• It is highly anionic and binds to calcium, transports it to the mineralization front and
controls the growth of apatite crystals.
• Osteonectin secreted by the odontoblasts inhibits the growth of apatite crystals but
promotes its binding to collagen. Osteopontin, a phosphoprotein, also promotes
mineralization
• Gla protein (gamma carboxyglutamic acid)–containing protein and phospholipids act as
seeds or nucleators to attract and concentrate calcium.
• Chondroitin sulfate has opposite actions in mineralization. In predentin, they prevent the
transport of apatite crystals, but in mineralized dentin they get adsorbed into the collagen
and promote apatite binding to the collagen.

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• Matrix vesicles are involved in the mineralization of mantle dentin.
• It contains enzymes like alkaline phosphatase, which locally increases the concentration of
phosphates
• As the cell recedes, it leaves behind a single extension, and the several initial processes join
into one, which becomes enclosed in a tubule.
• As the matrix formation continues, the odontoblast process lengthens, as does the dentinal
tubule.
• Initially daily increments of approximately 4 µm of dentin are formed.
• This continues until the crown is formed and the teeth erupt and move into occlusion.
• After this time, dentin production slows to about 1 µm/day.
• After root development is complete, dentin formation may decrease further, although
reparative dentin may form at a rate of 4 µm/day

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• Dentinogenesis is a two-phase sequence in that collagen matrix is first formed and then
calcified.
• As each increment of predentin is formed along the pulp border, it remains a day before it is
calcified and the next increment of predentin forms .
• Korf ’s fibers have been described as the initial dentin deposition along the cusp tips.
• The radicular dentin formation compared to coronal dentin is slower and less mineralized
with collagen fibers laid down parallel to the cementodentinal junction.
• These collagen fibers unlike in coronal dentin are laid adjacent to the noncollagenous matrix
of Hertwig’s epithelial root sheath.

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MINERALIZATION
The earliest crystal deposition is in the form of very fine plates of hydroxyapatite
on the surfaces of the collagen fibrils and in the ground substance. Subsequently,
crystals are laid down within the fibrils themselves
The crystals associated with the collagen fibrils are arranged in an orderly fashion,
with their long axes paralleling the fibril long axes, and in rows conforming to the
64 nm (640 Å) striation pattern

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Within the globular islands of mineralization, crystal deposition appears to take place
radially from common centers, in a so-called spherulite form. These are seen as the
first sites of calcification of dentin
The general calcification process is gradual, but the peritubular region becomes
highly mineralized at a very early stage.

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• The ultimate crystal size remains very small, about 3 nm (30 Å) in thickness and 100 nm
(1000 Å) in length.
• The apatite crystals of dentin resemble those found in bone and cementum. They are 300
times smaller than those formed in enamel
• Calcospherite mineralization is seen occasionally along the pulp–predentin-forming front
• DSP present in mineralizing dentin affects the rate of mineral deposition while other
proteoglycans present more in the predentin, inhibit calcification to prevent premature
calcification of the predentin.
• Many genes are implicated in dentinogenesis, the newer ones being map1b for
odontoblast differentiation, and phex for dentin mineralization

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• Dentin is a porous biologic composite made up of
apatite crystal filler particles in a collagen matrix
MORPHOLOGY • Each dentinal tubule is an inverted cone with the
largest diameter at the pulp chamber or root canal
and the smallest diameter at the DEJ due to the
progressive formation of more peritubular dentin.
• Only 1% of the surface area of superficial dentin
near the DEJ contains tubules, whereas 22% of
deep dentin contains tubules.
• Hence, deep dentin is more permeable than
superficial dentin.
Seltzer And Bender’s Dental Pulp Second Edition Quintessence

Books Publications 15
PHYSICAL PROPERTIES
• Fresh dentine is pale yellow in colour and contributes to the appearance of the tooth
through the translucent enamel
• Dentine is harder than bone and cementum but softer than enamel. Dentine is much
more resistant to propagation of cracks than enamel (higher fracture toughness) because
of the intimate association of small apatite crystals with strong protein fibres.
• Its organic matrix and tubular architecture provide it with greater compressive, tensile
and flexural strength than enamel.

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• Dentine is permeable, the permeability depending on the size and patency of the
tubules, which will decline with age.
• Cracking occurs in dentine when it has been weakened by caries or cavity preparation
and can result in an unrestorable tooth. The development of cracks is more likely in older
teeth and in teeth in which the dentine has become dehydrated by root
• Stresses parallel to the direction of the dentinal tubules are more likely to result in
fracture than those at right angles to them. Some of the physical properties of dentine

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CHEMICAL PROPERTIES
• Dentine, like cementum and bone, is a composite material, consisting of apatite
crystals on an organic scaffold predominantly composed of collagen.
• The gross composition of dentine approximates
• 70% inorganic, 20% organic and 10% water by weight
• 50% inorganic, 30% organic and 20% water by volume.

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ORGANIC MATRIX
• The organic matrix consists of fibrils embedded in an amorphous ground substance. The fibrils are
collagen and comprise over 90% of the organic matrix.
• The principal collagen fibril is the ubiquitous type I collagen.
• Traces of type III and type V collagen, which are present in sizeable amounts in the pulp, have also
been detected.

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• Most of the collagen fibrils in dentine run parallel
to the pulpal surface
• In mineralised dentine the collagen fibrils are of
larger diameter (100 nm) and are more closely
packed than in predentine.
• Collagen fibrils in dentine are not assembled into
bundles as they are in many nonmineralised
connective tissues such as tendons or the
periodontal ligament

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NONCOLLAGENOUS PROTEINS
• Though comprising only a relatively small percentage of the organic matrix compared
with collagen (8%)
• Noncollagenous proteins of dentine have important, yet poorly understood biological
functions.
• They include dentine phosphoproteins, proteoglycans, gla-proteins, other acid proteins
and growth factors.
• Functions - some act as both inhibitors and promotors of mineralisation, depending on
concentration and posttranslational modification.
• Amino acids undergo changes with age, in which they convert from one racemic form
to another.

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DENTINE PHOSPHOPROTEIN
• These represent the main noncollagenous protein.
• There are several types, but the term dentine phosphoprotein (phosphophoryn or PP-
H) relates to the highly-phosphorylated protein species.
• Owing to its very high phosphate content it represents the most acidic protein known.
• The dentine sialophosphoprotein gene synthesises both dentine phosphoprotein and
dentine sialoprotein.

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• Dentine matrix protein 1 (DMP-1), present in dentine and bone, is thought to play a
pivotal role in mineralisation as it can initiate apatite nucleation.
• It has an Arg–Gly–Asp (RGD) cell attachment sequence and may act as a morphogen for
odontoblast differentiation and intertubular dentine formation for both primary and
tertiary dentine.
• It is present in only small amounts in predentine and intertubular dentine but is strongly
represented in peritubular dentine.
• As DMP-1 and dentine phosphophoryn are found at different sites they are likely to have
different actions during mineralisation

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PROTEOGLYCANS
• These also form a significant component of the noncollagenous proteins.
• In dentine they are represented by the smaller molecular weight types known as
biglycan and decorin.
• The glycosaminoglycans are primarily chondroitin-4-sulphate and chondroitin-6-
sulphate.
• Among the important functions of proteoglycans in general are their role in collagen
fibril assembly and their cell-mediated effects such as cell adhesion, migration,
proliferation and differentiation.
• They appear to bind calcium nonspecifically. They may be inhibitors of calcifications
that need to undergo some degree of degradation before mineralisation will occur.
Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth

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GLYCOPROTEINS/SIALOPROTEINS
• Dentine also contains other acidic proteins such as osteonectin, osteopontin and dentine
sialoprotein.
• Osteonectin, a protein containing high levels of glutamic and aspartic acid, is found in
dentine at levels of about 5% of total protein.
• Osteopontin, a phosphorylated glycoprotein, has been identified in predentine and
contains the receptor binding sequence RGD.
• The precise role of osteonectin and osteopontin in dentine (as in bone) is not known

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GAMMA-CARBOXYGLUTAMATE-CONTAINING PROTEINS
(GLA-PROTEINS)
• Little is known about the function of these small proteins
• Present in low amounts in dentine.
• They bind strongly, but reversibly, to hydroxyapatite crystallites and may play some role
in mineralisation.

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GROWTH FACTORS
• Growth factors include insulin growth factor (IGF)-II, bone morphogenetic protein (BMP)-
2 and transforming growth factor (tgf)-beta.
• As dentine does not turnover like bone, it is unlikely that these factors play an everyday
role in the tissue’s metabolism
• They could be released during the progress of dental caries and induce the production of
reactionary or reparative dentine.

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METALLOPROTEINASES
• The organic matrix of dentine contains small amounts of the enzymes collagenase
(MMP-1) and enamelysin (MMP-20).
• Trace amounts of tissue inhibitors of matrix metalloproteinaes (TIMPs) can also be
found

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SERUM-DERIVED PROTEIN
• Dentine matrix will also contain some serum-derived proteins, such as albumin.
• Several noncollagenous proteins have been grouped together as the SIBLING (small
integrin-binding ligand N-linked glycoproteins) family, including osteopontin, bone
sialoprotein, DMP-1, matrix extracellular phosphoglycoprotein and dentine
sialophosphoprotein.
• The group members contain a large fraction of aspartic and glutamic acids and numerous
serines that are 90% phosphorylated. They are therefore extremely acidic.

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LIPIDS
• These comprise about 2% of the organic content of dentine .
• They are in the form of phospholipids and cholesterol.
• Phospholipids have been detected in both predentine and mineralised dentine.
• They occupy the spaces between collagen fibrils along with the proteoglycans.
• In the predentine, they are most heavily concentrated near the mineralising front.
• In dentine, phospholipids are needlelike ‘crystal ghosts’ and may be involved in the
formation and growth of crystals.
• They seem to be absent from the centres of calcospherites but present in interglobular
dentine.

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• Dentine is permeated by the dentine tubules that
run from the pulpal surface to the enamel–dentine
and cementum–dentine junctions
DENTINE TUBULES • The dentine tubules follow a curved, sigmoid
course – the primary curvatures.
• The convexity of the primary curvatures nearest
the pulp chamber faces rootward.
• In the root and beneath the cusps, the primary
curvatures are less pronounced, the tubules
running a straighter course.
• The dentine between the tubules is termed
intertubular dentine

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• The tubules taper from approximately 2.5 µm in diameter at their pulpal ends to 1 µm or
less peripherally.
• During the formation of dentine tubules by the odontoblasts the cells migrate inwards and
occupy a smaller surface area. Hence, the tubules are more widely separated at their
peripheries.
• Approximately 22% of the cross-sectional area of the dentine near the pulp is composed
of tubules, while near the enamel–dentine junction the tubules comprise only about
2.5%.
• Estimates of the number of tubules vary somewhat between reports because of
differences in tooth age and type and the thickness of the dentine. A reasonable rounding
of the numbers suggests 20,000/mm2 in outer dentine, 50,000/mm2 in inner dentine and
40,000/mm2 in the middle

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• The tubules also show changes in direction of
much smaller (a few micrometers) amplitude.
These are known as the secondary curvatures
• In some regions the secondary curvatures may
coincide in adjacent tubules.
• At low magnification, this gives the appearance of
a line crossing the dentine, a contour line (of
Owen)
• These are not commonly seen in most of the
dentine, but one such line is usually evident at the
junction of primary and secondary dentine

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• The most profuse branching is in the periphery
near the enamel–dentine junction
• Many small side branches appear to end blindly
but some may unite with branches of other
tubules.
• In the root, the terminal part of the tubule
branches and the branches loop.
• This looping is thought by some to be responsible
for the appearance of the granular layer of Tomes

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PERITUBULAR DENTINE
• The walls of the dentinal tubules in recently
formed intertubular dentine at the pulp surface
are composed of mineralised type I collagen.
• With maturation, another type of dentine is
deposited on the walls of the dentinal tubule,
narrowing the lumen
• This type of dentine is known as peritubular
dentine (also known as intratubular dentine)

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• Peritubular dentine differs from intertubular dentine in lacking a collagenous fibrous
matrix.
• Its matrix is rich in glutamic acid and serine.
• It lacks dentine phosphophoryn but is rich in DMP-1.
• Peritubular dentine can be distinguished from intertubular dentine as a zone of increased
radiographic and electrondensity lining the internal surface of the dentinal tubule
• Peritubular dentine is about 5–12% more mineralised than intertubular dentine and has
a higher elastic modulus
• When dentine is routinely demineralised, the peritubular dentine will be lost as it lacks
the stabilising feature of collagen. The dimensions of the dentine tubules will thus be
increased to their initial dimensions

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• The dimensions of the dentine tubules will thus be increased to their initial dimensions
• Peritubular dentine is found in unerupted teeth.
• This, with its predominant distribution in apical dentine, indicates that it is an age change
rather than a response tissue
• In demineralised sections at the electron microscope level the matrix appears as an
amorphous material.
• The mineral component of peritubular dentine is mainly carbonated apatite but its
crystalline form is distinct from that of intertubular dentine.

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• Although the bulk of peritubular dentine is hypercalcified relative to the intertubular
dentine, hypocalcified areas bound its inner and outer surfaces.
• Peritubular dentine is formed at about the same time as (or soon after) intertubular
dentine.
• By the time primary dentine formation is complete, all peripheral tubules have a lining
of peritubular dentine that extends from the enamel–dentine junction to within 50–100
µm of the predentine.
• In outer dentine , peritubular dentine occupies two-thirds of the cross-sectional area of
the tissue; near to the predentine it occupies only approximately 3%
• Associated with physiological ageing, especially in root dentine, the dentinal tubules
become completely occluded by peritubular dentine formation.

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CONTENTS OF THE
DENTINAL
• The dentinal tubules contain the processes of the
TUBULES odontoblasts that are responsible for their
formation.
• In some parts of the tissue they also contain
afferent nerve terminals
• It is also possible that processes from antigen-
presenting cells in the peripheral pulp may extend
for a short distance into the tubules.
• It seems likely, however, that there is a
periodontoblastic space, and possibly a
postodontoblastic space, from which the process
has receded. These spaces are thought to be filled
with extracellular ‘dentinal’ fluid

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• If dentine is fractured, fluid exudes from the tubules and forms droplets on the surface of
the dentine.
• This suggests that there is a positive force, presumably pulpal tissue pressure, that is
exerted outwards (page 187). This could help limit the progress of chemicals or toxins on,
or in, dentine towards the dental pulp.
• The process of the odontoblast that extends into the dentine varies in structure at
different levels in the tissue, organelles being most numerous in the predentine
• Microtubules and intermediate filaments run longitudinally throughout the odontoblast
process.
• Mitochondria are sometimes present in the process in the predentine;
• Strands of rough endoplasmic reticulum are also occasionally seen.
• Vesicles of a variety of sizes are present, being denser near the cell membrane. Their
incidence declines in the more distal parts of the process.

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• In the predentine and very innermost mineralised circumpulpal dentine the
odontoblast process seems to occupy the full width of the dentinal tubule with no
discernible periodontoblast space
• Afferent nerve axons are also seen within the tubule and in close apposition to the
odontoblast process.
• The axons contain several mitochondria and an occasional vesicle.
• The microtubule and intermediate filament systems are characteristic of cell processes
and made up of proteins such asactin, tubulin and vimentin.
• The odontoblast process must occupy the entire dentinal tubule it forms in the early
stages of development when the dentine is thi

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• There are three hypotheses
• The process grows in length as dentine is
deposited and its peripheral termination remains
at the outer end of the tubule. This would result in
a metabolically unsupported cell process several
millimetres long, an arrangement unknown
elsewhere in the body
• The process reaches a predetermined length and
then moves pulpally as dentine is formed, leaving
behind an empty tubule in which peritubular
dentine forms.
• The peripheral end of the processes degrades
sequentially and its remains form part of the
matrix for the peritubular dentine.

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• Sensory terminals have been firmly identified within the dentinal tubule
• Nerve terminals are limited mainly to the dentine of the crown beneath the cusps,
where they may be found in over 40% of the tubules. In the cervical part of the crown,
nerves are found in 4–8% of tubules, while in the root dentine only 0.02–0.2%

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• The main body of dentin is composed of intertubular dentin.
• It is located between the dentinal tubules or, more specifically, between the zones of
peritubular dentin.
• Although it is highly mineralized, this matrix, like bone and cementum, is retained after
decalcification
• About one-half of its volume is organic matrix, specifically collagen fibers, which are
randomly oriented around the dentinal tubules

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• The fibrils range from 0.2 to 0.5 µm in diameter and exhibit cross-banding at 64 µm (640
Å) intervals, which is typical for collagen (Fig. 5.4A).
• Hydroxyapatite crystals, which average 0.1 µm in length, are formed along the fibers with
their long axes oriented parallel to the collagen fibers

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REGIONAL VARIATIONS IN DENTINE
STRUCTURE
• The properties and composition of mineralised dentine vary with distance from the
predentine to the enamel–dentine junction, allowing for the division of dentine into
different zones
• The mineral content of dentine decreases and the thickness of mineral crystals increases
towards DEJ
• Several different regions can be recognised in dentine
• The most peripheral region beneath the enamel and cementum has special
characteristics bestowed on it by being the earliest formed part of the tissue

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• Mantle dentine
• The outer layer of dentine in the crown differs from the bulk of the circumpulpal
dentine in four features:
• It is slightly (approx. 5%) less mineralised
• The collagen fibrils are largely oriented perpendicular to the enamel–dentine
junction.
• For this reason, it can be distinguished from the circumpulpal dentine beneath
using polarised light)
• The dentinal tubules branch profusely in this region)
• It undergoes mineralisation in the presence of matrix vesicles

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• Interglobular dentine
• Much of the mineral in dentine is deposited as globules or calcospherites
• These, in most areas, fuse to form a uniformly calcified tissue. However, in some areas,
usually beneath the mantle layer in the crown and beneath the granular layer in the root,
the fusion may be incomplete.
• When ground sections are viewed in transmitted light, internal reflection of the light makes
the uncalcified, interglobular areas appear Dentinal tubules pass without deviation through
interglobular areas)
• As interglobular areas remain uncalcified, peritubular dentine is also absent from the
tubules as they pass through interglobular dentine

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• Granular layer
• In ground sections the periphery of the dentine in the root is marked by the presence of
a dark granular zone, the granular layer
• Various explanations for this appearance have been suggested.
• The most currently accepted is that the dentinal tubules in this area branch more
profusely and loop back on themselves, creating air spaces in ground sections that result
in internal reflection of transmitted light.

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• Hyaline layer
• Outside the granular layer is a clear hyaline layer usually included as a component of the
dentine but whose origin is obscure.
• This narrow band (up to 20 µm wide) appears to be nontubular and relatively structureless
• The hyaline layer may serve to bond cementum to dentine and may be of considerable
clinical significance when considering periodontal regeneration.

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• Circumpulpal dentine
• The basic structure of dentine as described throughout this chapter is that of
circumpulpal dentine.
• It forms the bulk of the dentine and is uniform in structure except at its edges where,
peripherally, interglobular dentine marks incomplete initial mineralisation and, centrally,
the mineralising front represents ongoing mineralisation.
• In older teeth its tubular pattern is modified on the pulpal surface due to the age-related
deposition of secondary dentine.

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Dentine at root apex
• Due to its importance in the root canal, researchers have investigated the nature of the
dentine in this region compared with that more cervically.
• At the root apex, accessory root canals are common.
• Apical dentine often deviates from the long access of the tooth.
• There may be localised areas of dentine resorption and repair.
• The dentinal tubules themselves may show irregularities in direction and density.

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• Predentine
• In demineralised sections stained with haematoxylin and eosin, the innermost layer of
dentine, the predentine, has a distinct pale-staining appearance
• The width of the predentine can vary from 10 µm to 40 µm, depending on the rate at
which dentine is being deposited: it is, for example, thicker in young teeth.

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• Tomes granular layer
• Structure seen only in radicular dentine adjacent to CEJ
• Appears as dark granular structure gradually increasing in thickness from CEJ to apex

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STRUCTURAL LINES IN DENTINE
• A variety of lines approximately perpendicular to the dentinal tubules can be seen.
• There are two related groups of lines:
• Those originating from curvatures in the dentinal tubules
• Those arising from the incremental deposition of dentine and its subsequent
mineralisation

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Lines associated with the primary curvatures of the dentinal tubules
• In some longitudinal sections the peaks of the sigmoid primary curvatures coincide to
form broad bands in the dentine.
• These lines are known as Schreger lines

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• Lines associated with the secondary curvatures of the dentinal tubules
• When the secondary curvatures coincide they also give rise to an optical effect, resulting in
the appearance of lines, the contour lines of Owen
• They are unusual in primary dentine but are sometimes seen. An exaggerated line is found at
the border of primary and secondary dentine and between dentine formed before and that
formed after birth.
• This latter neonatal line may include compositional variations in the matrix and
mineralisation.

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• Incremental lines associated with matrix deposition and
mineralisation
• Dentine has regular, incremental, short-period and long-period markings.
• These fine lines are sometimes referred to as von Ebner’s lines.
• In cuspal dentine, where deposition is most rapid, the amount of dentine formed each
day and the distance between adjacent dark bands is approximately 4 µm

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• In the root peripherally near the granular layer where the dentine has a calcospheritic
pattern, the distance between lines is nearer 2 µm
• In demineralised sections the values are smaller
• The coarser, long-period lines (Andresen lines) are approximately 16–20 µm apart.
• Between each long-period line there are 6 to 10 pairs of short-period lines
• As with enamel, an exaggerated line, the neonatal line (Fig. 9.48), can be seen in teeth
mineralising at birth

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INNERVATION OF DENTINE
• Intratubular nerves
• Nerve fibers were shown to accompany 30%–70% of the odontoblastic process and these
are referred to as intratubular nerves.
• Dentinal tubules contain numerous nerve endings in the predentin and inner dentin no
farther than 100–150 µm from the pulp.
• Most of these small vesiculated endings are located in tubules in the coronal zone,
specifically in the pulp horns.
• The nerves and their terminals are found in close association with the odontoblast process
within the tubule.

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• There may be single terminals or several dilated and constricted portions
• The nerve endings are packed with small vesicles
• Synapse-like relation between the process and nerve fibers were demonstrated.
• It is believed that most of these are terminal processes of the myelinated nerve fibers of
the dental pulp.

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• Theories of pain transmission through dentin
• There are three basic theories of pain conduction through dentin.
• The first is that of direct neural stimulation, by which the nerves in the dentin get
stimulated.
• The nerves in the dentinal tubules are not commonly seen and even if they are present,
they do not extend beyond the inner dentin. Topical application of local anesthetics does
not abolish sensitivity. Hence this theory is not accepted.
• The second and most popular theory is the fluid or hydrodynamic theory. Various stimuli
such as heat, cold, air blast desiccation, or mechanical or osmotic pressure affect fluid
movement in the dentinal tubules.

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• This fluid movement, either inward (due to cold stimuli) or outward (due to drying of
exposed dentinal surface), stimulates the pain mechanism in the tubules by mechanical
disturbance of the nerves closely associated with the odontoblast and its process.
• The third theory is the transduction theory, which presumes that the odontoblast
process is the primary structure excited by the stimulus and that the impulse is
transmitted to the nerve endings in the inner dentin

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FORMATION AND REPAIR OF DENTINE
• Primary Dentinogenesis
• Dentin which is formed before root completion is known as primary dentin
• Mantle dentin is the name of the first-formed dentin in the crown underlying the
dentinoenamel junction.
• Compared to circumpulpal dentin, mantle dentin is less mineralized
• Mantle dentin undergoes globular mineralization whereas the circumpulpal dentin
mineralizes either by globular or linear pattern.

ition Elseiver
Secondary dentine
• Secondary dentin is a narrow band of dentin bordering the pulp and representing that
dentin formed after root completion.
• secondary dentin is formed more slowly than primary dentin and that it looks similar to
primary dentin but contains fewer tubules.
• Secondary dentin is not formed uniformly and appears in greater amounts on the roof and
floor of the coronal pulp chamber, where it protects the pulp from exposure in older teeth.
• Due to the regular arrangement of dentinal tubules, it is known as regular secondary dentin

ition Elseiver
• Tertiary dentine
• Tertiary dentin is reparative, response, or reactive dentin. This is localized formation of
dentin on the pulp–dentin border,

ition Elseiver
• Reactionary dentinogenesis
• Reactionary dentin is, by definition, secreted by surviving primary odontoblasts .
• Tertiary dentin matrices have been suggested as characteristic of this response

• Reparative dentinogenesis
• May be a sequel to reactionary dentinogenesis
• The reparative response of tertiary dentinogenesis will always take place at sites of
pulpal exposure because of the loss of odontoblasts and the need for dentin bridge
formation.
• Reparative dentinogenesis involves a much more complex sequence of biologic events
than reactionary dentinogenesis
• Progenitor cells from the pulp must be recruited and induced to differentiate into
odontoblast-like cells before their secretion may be upregulated to form the reparative
dentin matrix

• Sclerotic dentine
• In addition to infilling with peritubular dentine as a physiological response to ageing
dentinal tubules commonly fill in as a response to an external stimulus
• This type of dentine is termed sclerotic dentine and, like translucent dentine, will present
as areas that lack structure and appear transparent
• Sclerotic dentine, unlike
• Normal dentine, exhibits almost no yielding before failure

ition Elseiver
Dead tracts
• If the primary odontoblasts are killed by an external stimulus, or retract before peritubular
dentine occludes the tubules, empty tubules will be left.
• They may be sealed at their pulpal end by tertiary dentine.
• When ground sections are prepared and mounted, the mounting medium will not enter
these sealed-off tubules and they will remain air-filled. Under the microscope, transmitted
light will be totally internally reflected and these tubules will appear dark
• This appearance, which is due partly to the pulpal response and partly to the preparatory
procedure, has been termed a ‘dead tract’

ition Elseiver
DEVELOPMENTAL DISTURBANCES OF DENTINE
• DENTINOGENESIS IMPERFECTA
• Dentinogenesis imperfecta is an autosomal dominant condition affecting both deciduous
and permanent teeth.
• Affected teeth are gray to yellowish-brown and have broad crowns with constriction of the
cervical area resulting in a ‘tulip’ shapes.
• Enamel is easily broken leading to exposure of dentin that undergoes accelerated attrition.
• The gene maps to chromosome number 4. It encodes a protein called dentin
sialophosphoprotein (DSPP)
Shafers Book Of Oral Pathology 8th Edition

73
• Dentinogenesis imperfecta I: dentino genesis imperfecta without osteogenesis
imperfecta
• Dentinogenesis imperfecta II: brandywine type dentinogenesis
• Treatment of patients with dentinogenesis imperfecta is directed primarily towards
preventing the loss of enamel and subsequent loss of dentin through attrition.
• Cast metal crowns on the posterior teeth and jacket crowns on the anterior teeth have
been used

74
• Dentin dysplasia (rootless teeth)
• Dentin dysplasia is a rare disturbance of dentin formation characterized by normal enamel
but atypical dentin formation
• These conditions be referred to as radicular dentin dysplasia (type I) and coronal dentin
dysplasia (type II) .
• Etiology – hereditary

75
• Type I (radicular). Both dentitions are affected
• Occasionally there may be a slight amber translucency
• Extreme mobility and are commonly exfoliated prematurely
• Type II the pulp chambers of the deciduous teeth become obliterated
• The permanent teeth; however, exhibit an abnormally large pulp chamber in the coronal
portion of the tooth, often described as ‘thistle-tube’
• Treatment – no treatment and its prognosis depends on the occurance of periapical
lesions
76
CLINICAL CONSIDERATIONS
• Permeability of dentine
• This depends on several factors:
• that the dentine surface is exposed by caries, attrition, abrasion or trauma
• That the tubules are patent.
• Tubules may be occluded physiologically by peritubular (intratubular) dentine or by
exogenous material precipitated in them peripherally. They may also be sealed off from
the pulp by tertiary dentine
• That the outward movement of interstitial ‘dentinal’ fluid does not wash them out of the
tubule
• The most significant materials to travel down the tubules are the bacteria of dental caries
and, more importantly, the toxins they produce.

ition Elseiver
• Response to external stimuli
• The response to outside stimuli comes from the dental pulp but is manifest in the
structure of the dentine it produces.
• The deposition of tertiary dentine provides a barrier to the progress of caries and toxins.
• The presence of secondary dentine and its continuing deposition throughout life, although
not a response to external stimuli, contributes to the barrier function of the dentine .

ition Elseiver
• Cavity preparation
• Any drilling through dentine will potentially open a pathway towards the pulp.
• The greater the distance between the floor of the cavity and the surface of the pulp, the less the
dental pulp will be affected.
• The term ‘remaining dental thickness’ refers to the amount of dentine separating the floor of the
dental cavity from the periphery of the dental pulp. A residual dentine thickness of about 0.5 mm
is thought to be a reasonable estimate to ensure the dental pulp is unlikely to be compromised.
• When the remaining dental thickness is less than 0.5 mm care must be taken in treating any
residual dental caries

ition Elseiver
• Adhesion of dental materials to dentine
• When cavity preparation is done smear layer forms on the surface consisting of dentin
embodied in bacteria from caries being removed
• Removing the smear layer is therefore a pre requisite

ition Elseiver
• Hypersensitivity
• Hypersensitivity is defined as a short, sharp pain arising from exposed dentine in response
to a stimulus such as thermal, tactile, osmotic and chemical, that cannot be ascribed to
any other form of dental defect or pathology, such as dental caries or lateral pulp canals.
• Eliminating or reducing the sensitivity of exposed dentine requires the patent tubules to
become infilled and occluded with calcium phosphate material.

ition Elseiver
• Dentine resorption
• In the case of internal resorption, the pulp contains at the pulp–dentine surface
multinucleated cells known as odontoclasts that are responsible for resorbing the
dentine
• External resorption of the dentine begins on the external surface of the root and
penetrates through the cementum into dentine.
• It does not normally penetrate the pulp and, radiologically, is difficult to distinguish from
internal resorption. However, a thin shell of dentine may be visible on a radiograph and
the area of resorption is not continuous with the pulp

ition Elseiver
PULP

ition Elseiver
INTRODUCTION
• The dental pulp is the tissue derived from the dental papilla and responsible for the
formation of dentine.
• It is contained within the pulp chamber and root canals of the tooth
• At the apical constriction of the root canal it becomes continuous with the periodontal
ligament

ition Elseiver
Development
• The tooth pulp is initially called the dental papilla. This tissue is designated as “pulp” only
after dentin forms around it.
• In the earliest stages of tooth development, it is the area of the proliferating future papilla
that causes the oral epithelium to invaginate and form the enamel organs.
• The enamel organs then enlarge to enclose the dental papillae in their central portions
• At the location of the future incisor, the development of the dental pulp begins at about
the 8th week of embryonic life in the human. Soon thereafter the more posterior tooth
organs begin differentiating.

Elseiver 85
• The young dental papilla is highly vascularized, and a well-organized network of vessels
appears by the time dentin formation begins
• Capillaries crowd among the odontoblasts during this period of active dentinogenesis. The
cells of the dental papilla appear as undifferentiated mesenchymal cells.
• Gradually these cells differentiate into stellate-shaped fibroblasts. After the inner and
enamel organ cells differentiate into ameloblasts, the odontoblasts then differentiate from
the peripheral cells of the dental papilla and dentin production begins.
• As this occurs, the tissue is no longer called dental papilla but is now designated the pulp
organ

Elseiver 86
• Nerve fibers were first seen in the dental follicle in the 11th week of intrauterine life. In
the 18th week, the nerve fibers were observed in the dental papilla.
• Few large myelinated nerves are found in the pulp until the dentin of the crown is well
advanced
• At that time nerves reach the odontogenic zone in the pulp horns
• sympathetic nerves, however, follow the blood vessels into the dental papilla as the pulp
begins to organize.
• During development, dental pulp cells produce nerve growth factor and semaphorin 7A as
well as brain-derived and glial cell line–derived neurotrophic factor, all of which help to
innervate the pulp.
• Growth factors like neurotrophin and neurturin were shown not be involved in this
process.

Elseiver 87
ANATOMY OF PULP
• GENERAL FEATURES
• The dental pulp occupies the center of each tooth and consists of soft connective tissue.
• The pulp is housed in the pulp chamber of the crown and in the root canal of the root.
• The shape of the pulp therefore resembles the shape of the tooth in which it is housed.
• The total volume of all the permanent teeth pulp is 0.38 cm3 , and the mean volume of a
single adult human pulp is 0.02 cm3 .

ition Elseiver
• CORONAL PULP
• The coronal pulp in young individuals resembles the shape of the outer surface of the
crown dentin.
• It has pulp horns, which are protrusions that extend into the cusps of each crown.
• The number of these horns thus depends on the cuspal number.
• The cervical region of the pulp organs constricts as does the contour of the crown, and at
this zone the coronal pulp joins the radicular pulp.
• Because of continuous deposition of dentin, the pulp becomes smaller with age. This is
not uniform through the coronal pulp but progresses faster on the floor than on the roof
or side walls.

ition Elseiver
RADICULAR PULP
• The radicular or root pulp is that pulp extending
from the cervical region of the crown to the root
apex.
• In the anterior teeth, the radicular pulps are single
and in posterior ones multiple.
• The radicular portions of the pulp are continuous
with the periapical connective tissues through the
apical foramen or foramina.
• During root formation, the apical root end is a
wide opening limited by an epithelial diaphragm
• As growth proceeds, more dentin is formed, so
that when the root of the tooth has matured, the
radicular pulp is narrower.
• The apical pulp canal becomes smaller also
because of apical cementum deposition
Elseiver 90
APICAL FORAMEN
• The average size of the apical foramen of the
maxillary teeth in the adult is 0.4 mm.
• In the mandibular teeth, it is slightly smaller, being
0.3 mm in diameter.
• The location and shape of the apical foramen may
undergo changes as a result of functional
influences on the teeth.
• Sometimes the apical opening is found on the
lateral side of the apex
• Frequently, there are two or more foramina
separated by a portion of dentin and cementum or
by cementum only.

Elseiver 91
• Accessory canals leading from the radicular pulp
laterally through the root dentin to the periodontal
tissue may be seen anywhere along the root but are
most numerous in the apical third of the root
ACC • They are clinically significant in spread of infection,
either from the pulp to the periodontal ligament or
vice versa.
• It is likely that they occur in areas where there is
premature loss of root sheath cells because these
cells induce the formation of the odontoblasts
which form the dentin.
• Accessory canals may also occur where the
developing root encounters a blood vessel. If the
vessel is located in the area where the dentin is
forming, the hard tissue may develop around it,
making a lateral canal from the radicular pulp

Elseiver 92
COMPOSITION
• The dental pulp is a loose connective tissue and made up of a combination of cells
embedded in an extracellular matrix of fibres in a semifluid gel.
• It contains 75% water and 25% organic material by weight.
• The extracellular matrix is made up of a versatile group of polysaccharides and proteins
secreted by the cells of the tissue and assembled into a complex framework closely
associated with the cells.
• The matrix plays a very active role in controlling the activity of the cells within it. It affects
their development, migration, division, shape and function.
• Collagen is the predominant extracellular matrix component, comprising 25–32% of the
dry weight.

ition Elseiver
STRUCTURAL FEATURES

ition Elseiver
FIBRES
• The principal fibrous component of the dental
pulp is a combination of collagen types I (60%)
and III (40%) present as fibrils 50 nm in diameter
grouped into fibres thinly and irregularly
scattered throughout the tissue.
• The arrangement becomes more organised in
the periphery, with the fibres aligned parallel to
the forming predentine surface.
• Type III collagen has a similar 67 nm banding
pattern to type I but differs from it by having
only α1 chains rather than α1 and α2.

ition Elseiver
• Noncollagenous beaded microfibrils 10–14 nm in diameter are also present.
• These are formed from fibrillin, a large glycoprotein which, in other tissues, is
associated with elastic fibres. There has been no convincing demonstration of elastic
fibres in the pulp
• collagen forms 3–5% of the wet weight of the pulp,
• Small amounts of type V and type VI collagen are also present as a meshwork of fine
microfibrils.
• Type IV is nonfibrous and present in the basement membrane of blood vessels.
• Fibronectin is a glycoprotein found in several forms, one of which is fibrous and is
distributed throughout the pulp

ition Elseiver
NONFIBROUS MATRIX
• The macromolecules that make up the bulk of the nonfibrous component of the
extracellular matrix are proteoglycans, glycoproteins and unbound glycosaminoglycans.

ition Elseiver
GLYCOSAMINOGLYCANS
• Glycosaminoglycans (GAGs) are unbranched polysaccharide chains composed of
repeating disaccharide units.
• There are four GAGs; chondroitin sulphate, dermatan sulphate, heparan sulphate and
hyaluronic acid.
• These are bulky hydrophilic molecules that swell when hydrated and form gels that fill
most of the extracellular space.

ition Elseiver
• They readily allow the movement of water and
ions and probably act as a reservoir for holding
growth factors and other bioactive molecules.
• Hyaluronic acid is the only GAG found unbound to
protein in any quantity
• In mature pulp 60% of the GAG content is
hyaluronic acid, 20% dermatan sulphate, 12%
chondroitin sulphate and the remainder heparin
sulphate. In the developing pulp chondroitin
sulphate is the major GAG, with hyaluronic acid
only a minor component

ition Elseiver
PROTEOGLYCANS

ition Elseiver
GLYCOPROTEIN
• Collagen is a glycoprotein (saccharides attached to

a protein core).
• Two other glycoproteins, fibronectin and tenascin
have been described in the pulp and are at their
highest concentration near the odontoblast layer.

ition Elseiver
• Four groups of cell adhesion molecules are
generally recognised: the immunoglobulin
superfamily, the selectins, the cadherins and the
integrins
• They are responsible (along with structurally
specialised cell junctions) for cell to cell adhesion.
The selectins have a very special role in guiding the
diapedesis of leukocytes during inflammation.
• The large family of integrins anchor cells to the
matrix
• The basement membrane of the epithelial cells in
the pulp, the Schwann cells and the endothelial
cells, consist of a meshwork created from collagen
type IV in which many adhesion and bioactive
molecules are embedded.

ition Elseiver
BLOOD VESSELS
OF THE DENTAL • Arterioles and venules enter the dental pulp via
PULP the apical foramina and lateral canals as
components of neurovascular bundles.
• The largest of the arterioles are approximately
150 µm in diameter. They run longitudinally
through the root canals
• Within the root canals, they send off side
branches to the periphery.
• The vessels divide and narrow to some degree in
the root canal but branch profusely once they are
within the coronal pulp

ition Elseiver
• These capillaries are 6–8 µm in diameter.
• Capillaries are present both within and
below the odontoblast layer and between
the odontoblasts and the predentine.

ition Elseiver
• Numerous arteriovenous and venous–venous
anastomoses are found between peripheral
pulpal vessels, presumably to allow rapid
changes in blood perfusion.
• It is difficult to differentiate lymphatic vessels
in the dental pulp

ition Elseiver
• In the healthy pulp, blood flow is under nervous control.
• The smooth muscle of the arterioles (present in the central radicular pulp) is
innervated by terminals of sympathetic nerves, which maintain a vasoconstrictor tone
as they do in most other sites.
• The neurotransmitters are noradrenaline (norepinephrine) and neuropeptide Y. There
is little evidence for parasympathetic innervation of the pulp.
• Vasoconstrictor tone probably accounts for most of the vascular control

ition Elseiver
• The most prominent neuropeptides in these nerves are calcitonin-gene-related peptide
(CGRP) and substance P , both of which induce vasodilatation and increased capillary
permeability.
• Pulpal blood flow has been estimated to be 20–60 mL/min per 100 g of tissue. The pulp
has a high, pulsatile interstitial tissue fluid pressure.
• This pressure would allow dentinal fluid to move outwards whenever the dentinal
tubules were patent peripherally. It may also slow the inward movement of toxins during
the progression of dental caries

ition Elseiver
NERVES OF THE DENTAL PULP
• The dental pulp is heavily innervated.
• The nerve bundles run centrally in the pulp of the root in close association with the blood
vessels.
• A few fibres leave the central bundles in the root and travel to the periphery. Most
continue to the coronal pulp where they spread apart and branch profusely
• Most of the branches end in the odontoblastic or subodontoblastic regions in the crown

ition Elseiver
• In the crown, there is a pronounced plexus of nerves beneath the odontoblasts, known as
the plexus of Raschkow.
• This plexus is not evident until after the tooth has erupted
• Branches from the plexus pass into the odontoblast layer and form the marginal plexus
between the odontoblast layer and the predentine; others continue into the dentine to
accompany odontoblast processes in the dentinal tubules.
• This subodontoblastic plexus may be one of the sites of sensory activation in the pulp
• Many of the axons are devoid of a Schwann cell covering, either completely or partially,
rendering them susceptible to changes in the extracellular environment
• The axons branch profusely, providing a broad surface area for activation. Within the
Schwann cell, there are often many axons in a single pocket and the spread of signals from
axon to axon is possible

ition Elseiver
• Afferent nociceptors
• The myelinated nerves in the dental pulp are trigeminal afferents.
• They are all thought to be nociceptive and carry sensations of sharp pain centrally.
• The larger diameter Aβ afferents in some regions carry other nonnoxious sensations
• There are considered to be three major classes of nociceptors
• Thermal nociceptors, which are activated by extreme temperatures >45°C or <5°C, are
innervated by small myelinated Aδ fibres that conduct impulses at about 5–30 m s
• Mechanical nociceptors are activated by intense pressure applied to the tissues in which
they lie and are also innervated by small myelinated Aδ fibres.
• Polymodal nociceptors are activated by high intensity mechanical, chemical or thermal
(both hot and cold) stimuli and are innervated by either Aδ fibres or unmyelinated C fibres
with conduction velocities of less than 0.5–2 m s

ition Elseiver
• Autonomic fibres
• Some of the C fibres are sympathetic efferents and supply arteriolar smooth muscle.
• As there are only a few arterioles within the dental pulp, sympathetic fibres are scarce
• They seem to mediate their vasoconstrictive effect by the release of noradrenaline
(norepinephrine) and neuropeptide Y.

ition Elseiver
• Nerve endings
• Autonomic nerves end on the smooth muscle of the arterioles and special neuromuscular
junctions are present.
• Some of the afferent fibres (probably a proportion of the Aδ fibres) enter the tubules
largely in the coronal dentine and predentine.
• Others may end at the pulp–predentine junction in what is sometimes known as the
marginal plexus
• Both of these groups would be in an ideal position to detect stimuli applied to the outside
of the dentine

ition Elseiver
• Many axons end in close proximity to odontoblasts.
• The nerves in the dentinal tubules, at the pulp–predentine border and among the
odontoblast cell body, have all lost their ensheathing Schwann cells and their axolemmas
are exposed directly to the extracellular environment
• CGRP is a potent vasodilator and quite possibly the principal agent controlling blood flow
locally in the periphery of the dental pulp.
• CGRP is synthesised in the cell bodies of the nerves in the trigeminal ganglion and
moved peripherally by axonal transport

ition Elseiver
• Lymph vessels
• Lymph capillaries are described as endothelium-lined tubes that join thin-walled lymph
venules or veins in the central pulp. The lymphatic capillaries have thin walls.
• Cellular projections arise from the endothelial cells. The cells contain multivesicular
structures, Weibel– Palade bodies, and paracrystalline inclusions.
• The lymphatic vessels were more numerous in the central part of the pulp than in the
peripheral areas.
• The larger vessels have an irregular-shaped lumen composed of endothelial cells
surrounded by an incomplete layer of pericytes or smooth muscle cells or both.

Elseiver 114
• The lymph vessels differ from venules in that their walls and basement membrane show
discontinuities, with the absence of RBCs but with the presence of lymphocytes in the
lumen.
• In inflamed pulps, due to increased interstitial fluid pressure, gap junction develops
between the endothelial cells of the dilated lymph capillaries.
• Lymph vessels draining the pulp and periodontal ligament have a common outlet.
• Those draining the anterior teeth pass to the submental lymph nodes; those of the
posterior teeth pass to the submandibular and deep cervical lymph nodes.

Elseiver 115
• Intercellular substance
• The intercellular substance is dense and gel like in nature, varies in appearance from finely
granular to fibrillar, and appears more dense in some areas, with clear spaces left between
various aggregates.
• It is composed of both acid mucopolysaccharides and protein
• Polysaccharide compounds (glycosaminoglycans and proteoglycans). During early
development, the presence of chondroitin A, chondroitin B, and hyaluronic acid has been
demonstrated in abundance
• Glycoproteins are also present in the ground substance. The aging pulp contains less of all
of these substances.

Elseiver 116
• The ground substance lends support to the cells of the pulp while it also serves 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.
• Glycosaminoglycans being hydrophilic, forms a gel and contributes to high tissue fluid
pressure of the pulp
• Hyaluronan, in addition to mechanical function helps in cell migration.
• Versican forms the bulk of the proteoglycans.

Elseiver 117
CELLS OF PULP
• Fibroblasts
• Fibroblasts are the most numerous cell type in the pulp.
• As their name implies, they function in collagen fiber formation throughout the pulp
during the life of the tooth
• They have the typical stellate shape and extensive processes that contact and are joined by
intercellular junctionsIn the embryonic and immature pulp, the cellular elements
predominate, while in the mature pulp, the fibrous components predominate.

ition Elseiver
• Undifferentiated mesenchymal cells
• They appear larger than fibroblasts and are polyhedral in shape with peripheral processes
and large oval staining nuclei.
• They are found along pulp vessels, in the cell-rich zone and scattered throughout the
central pulp.
• Viewed from the side, they appear spindle shaped.
• They are believed to be a totipotent cell and when need arises they may become
odontoblasts, fibroblasts, or macrophages.
• They decrease in number in old age

Elseiver 119
• Odontoblasts
• Odontoblasts, the second most prominent cell in the pulp
• They have a constant location adjacent to the predentin, in what is termed the
“odontogenic zone of the pulp”
• The cell bodies of the odontoblasts are columnar in appearance with large oval nuclei
• Immediately adjacent to the nucleus basally is rough-surfaced endoplasmic reticulum
• Between odontoblasts gap, tight and desmosomal junctions exist

Elseiver 120
• Defense cells
• In addition to fibroblasts, odontoblasts, and the cells that are a part of the neural and
vascular systems of the pulp, there are cells important to the defense of the pulp.
• These are histiocytes or macrophages, dendritic cells, mast cells, and plasma cells.
• Dendritic cells were found in close relation to and in contact with the cell membranes of
the endothelial cell. These cells express macrophage-related antigens (CD14 and CD68)
• Both lymphocytes and eosinophils are found extravascularly in the normal pulp

Elseiver 121
ROLE OF DENTAL PULP
• Once differentiated from the dental papilla the dental pulp is a single industry organ
dedicated to the production of dentine
• A young tooth with a large vital pulp is more elastic than a tooth in which most of the pulp
has been replaced with secondary dentine or

ition Elseiver
Zones of Pulp

ition Elseiver
• Inductive The primary role of the pulp anlage is to interact with the oral epithelial cells,
which leads to differentiation of the dental lamina and enamel organ formation. The pulp
anlage also interacts with the developing enamel organ as it determines a particular type
of tooth.
• Formative The pulp organ cells produce the dentin that surrounds and protects the pulp.
The pulpal odontoblasts develop the organic matrix and function in its calcification.
Through the development of the odontoblast processes, dentin is formed along the tubule
wall as well as at the pulp–predentin front.
• Nutritive The pulp nourishes the dentin through the odontoblasts and their processes and
by means of the blood vascular system of the pulp.

ition Elseiver
• Protective The sensory nerves in the tooth respond with pain to all stimuli such as heat,
cold, pressure, operative cutting procedures, and chemical agents. The nerves also
initiate reflexes that control circulation in the pulp. This sympathetic function is a reflex,
providing stimulation to visceral motor fibers terminating on the muscles of the blood
vessels.
• Defensive or reparative The pulp is an organ with remarkable reparative abilities. It
responds to irritation, whether mechanical, thermal, chemical, or bacterial, by producing
reparative dentin

ition Elseiver
AGE-RELATED CHANGES IN THE
DENTAL PULP
• The dental pulp gets smaller with age because secondary dentine depositionPulp stones
may resemble dentine in being, at least partially
• The incidence of pulpal calcifications increases with age

ition Elseiver
CLINICAL CONSIDERATIONS
• Pulpal responses to disease

• When dental caries begins, the pulp responds at a very early stage.
• Pain from the dental pulp is difficult to localise and is commonly referred to other sites,
either teeth or elsewhere

ition Elseiver
• Lateral root canals
• Gingival recession may expose the opening of a lateral root canal, especially in the
furcation area of cheek teeth, causing pain and the possible spread of infection into the
pulp
• Infection associated with periodontal disease may also affect the pulp and vice versa

ition Elseiver
• Regeneration following dental pulp exposures
• Some materials, such as calcium hydroxide, seem to facilitate dentine bridge formation
• If the exposed pulp is infected or contaminated, the likelihood of successful bridge
formation is much reduced

ition Elseiver
REFERENCES
• GS KUMAR Orbans Oral Histology And Embryology 12th Edition Elseiver
• Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Edition Elseiver
• Seltzer And Bender’s Dental Pulp Second Edition Quintessence Books Publications
• Shafers Book Of Oral Pathology 8th Edition
130

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Dentin and Pulp Complex

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DENTIN AND PULP

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 5

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 6

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 8

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

Seltzer And Bender’s Dental Pulp Second Edition Quintessence

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 16

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 17

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 18

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 38

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 39

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 41

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 42

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 45

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 46

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 47

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 54

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 57

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 58

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 59

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Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 61

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

GS KUMAR Orbans Oral Histology And Embryology 12 th Edition

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 66

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 67

Bkb Berkovitz Oral Anatomy ,Histology And Embryology Fifth Ed 68

Seltzer And Bender’s Dental Pulp Second Edition Quintessence