Chapter |5|

Dentin

CHAPTER CONTENTS Innervation of Dentin 104

Physical and Chemical Properties 93 Intratubular nerves 104
Structure 94 Theories of pain transmission through dentin 104
Dentinal tubules 94 Permeability of Dentin 106
Peritubular dentin 95 Age and Functional Changes 106
Intertubular dentin 96 Vitality of dentin 106
Predentin 96 Reparative dentin 107
Odontoblast process 97 Dead tracts 108
Primary Dentin 98 Sclerotic or transparent dentin 108
Secondary Dentin 100 Development 110
Tertiary Dentin 100 Dentinogenesis 110
Incremental Lines 100 Mineralization 112
Interglobular Dentin 101 Clinical Considerations 115
Granular Layer 103 Summary 117

The dentin provides the bulk and general form of the tooth and within tubules in dentin. Both are considered vital tissues
is characterized as a hard tissue with tubules throughout its because they contain living protoplasm.
thickness. Since it begins to form slightly before the enamel, it
determines the shape of the crown, including the cusps and
ridges, and the number and size of the roots. As a living tissue PHYSICAL AND CHEMICAL PROPERTIES
it contains within its tubules the processes of the specialized
cells, the odontoblasts. Although the cell bodies of the odonto- In the teeth of young individuals the dentin usually is light
blast are arranged along the pulpal surface of the dentin, the yellowish in color, becoming darker with age. Unlike enamel,
cells are morphologically cells of the dentin, because the odon- which is very hard and brittle, dentin is viscoelastic and subject
toblasts produce the dentin as well as the odontoblast processes to slight deformation. It is somewhat harder than bone but
casting within it. Physically and chemically the dentin closely considerably softer than enamel. Dentin hardness varies slightly
resembles bone. The main morphologic difference between between tooth types and between crown and root dentin.
bone and dentin is that some of the osteoblasts exist on the Dentin is somewhat harder in its central part than near the
surface of bone, and when one of these cells becomes enclosed pulp or on its periphery. The dentin of primary teeth is slightly
within its matrix, it is called an osteocyte. The odontoblasts’ less hard than that of permanent teeth. The lower content of
cell bodies remain external to dentin, but their processes exist mineral salts in dentin renders it more radiolucent than enamel.
94 Orban’s Oral Histology and Embryology

Dentin consists of 35% organic matter and water and 65% Dentinal tubules
inorganic material.
The course of the dentinal tubules follows a gentle curve in the
The organic substance consists of collagenous fibrils embed-
crown, less so in the root, where it resembles a gentle S (sigmoid
ded in the ground substance of mucopolysaccharides (proteogly-
course) in shape (Fig. 5.1). These curvatures are called primary
cans and glycosaminoglycans). Type I collagen is the principal
curvatures. Starting at right angles from the pulpal surface, the
type of collagen found in the dentin. The important constitu-
first convexity of this doubly curved course is directed toward the
ents of the ground substance are the proteoglycans-chondroitin
apex of the tooth. These tubules end perpendicular to the denti-
sulfates, decorin and biglycan; glycoproteins-dentin sialopro-
noenamel and dentinocementum junctions. Branches of the den-
tein (DSP), osteonectin, osteopontin; phosphoproteins-dentin
tinal tubules near the terminals are referred to as terminal branches.
phosphoprotein (DPP), gamma carboxyglutamate containing pro-
The terminal branching is more profuse in the root dentin than in
teins (Gla-proteins) and phospholipids. The protein of dentin
the coronal dentin. Near the root tip and along the incisal edges
matrix and bone are similar, but dentin sialoprotein and dentin
and cusps the tubules are almost straight. Over their entire
phosphoprotein are present only in dentin. In addition, the
lengths the tubules exhibit minute, relatively regular secondary
matrix contains growth factors like transforming growth factor
curvatures that are sinusoidal in shape. The tubules are longer
(TGF), fibroblast growth factor (FGF), insulin-like growth
than the dentin, and are thick because they curve through dentin.
factors (IGFs), bone morphogenic proteins (BMPs), epidermal
The dentin ranges in thickness from 3 to 10 mm or more. Dentin
growth factor (EGF), platelet derived growth factor (PDGF),
showed variation in thickness between the sexes, it was thicker
placenta growth factor (PLGF), vascular endothelial growth
in boys than girls of similar age group and this increased during
factor (VEGF), and angiogenic growth factor (AGF). The
puberty. Dentin thickness varied not only from tooth to tooth
matrix components have important roles to play in mineraliza-
but also in different surfaces of the same tooth. The buccal surfaces
tion of dentin.
showed maximum thickness, followed by lingual, and there was
The inorganic component has been shown by X-ray dif-
no difference in thickness between mesial and distal surfaces.
fraction to consist of hydroxyapatite, as in bone, cementum,
The ratio between the outer and inner surfaces of dentin is
and enamel. Each hydroxyapatite crystal is composed of
about 5:1. Accordingly, the tubules are farther apart in the
several thousand unit cells. The unit cells have a formula of
peripheral layers and are more closely packed near the pulp
3Ca3(PO4)2 • Ca(OH)2. The crystals are plate shaped and much
(Fig. 5.1). In addition, they are larger in diameter near the
smaller than the hydroxyapatite crystals in enamel. Dentin also
contains small amounts of phosphates, carbonates, and sulfates.
The crystals are poor in calcium but rich in carbon when Fig. 5.1
compared to enamel. Diagram illustrating the curvature, size, and distance between den-
Organic and inorganic substances can be separated by either tinal tubules in human outer (A), mid (B), and inner dentin (C). The
decalcification or incineration. In the process of decalcification the tubules are approximately 1 ␮m in diameter at the dentinoenamel
junction (DEJ), 1.5 to 2 ␮m midway through dentin, and 1.5 to 3 ␮m
organic constituents can be retained and maintain the shape of the
at the pulp. Bacterial penetration (D) follows line of least resistance
dentin. This is why decalcified teeth and bone can be sectioned to reach the pulp. Note that cut tubules in the floor and walls of a
and provide clear histologic visualization. The enamel, being cavity may be different; 1 mm2 of cavity exposes 30,000 tubules.
over 90% mineral in composition, is lost after decalcification.

STRUCTURE

The dentinal matrix of collagen fibers is arranged in a network.

As dentin calcifies, the hydroxyapatite crystals mask the indi-
vidual collagen fibers. Collagen fibers are only visible at the
electron microscopic level. B A
The bodies of the odontoblasts are arranged in a layer on the
pulpal surface of the dentin, and only their cytoplasmic pro-
cesses are included in the tubules in the mineralized matrix.
Each cell gives rise to one process, which traverses the preden-
tin and calcified dentin within one tubule and terminates in
a branching network at the junction with enamel or cemen-
tum. Tubules are found throughout normal dentin and are C D
therefore characteristic of it.
 Dentin 95

pulpal cavity (3 to 4 μm) and smaller at their outer ends extend through the dentinoenamel junction into the enamel
(1 μm). The ratio between the numbers of tubules per unit area for several millimeters. These are termed enamel spindles.
on the pulpal and outer surfaces of the dentin is about 4:1.
Near the pulpal surface of the dentin the number per square
Peritubular dentin
millimeter varies between 50,000 and 90,000. There are more
tubules per unit area in the crown than in the root. The den- The dentin that immediately surrounds the dentinal tubules is
tinal tubules have lateral branches throughout dentin, which are termed peritubular dentin. This dentin forms the walls of the tubules
termed canaliculi or microtubules. These canaliculi are 1 μm or in all but the dentin near the pulp. It is more highly mineralized
less in diameter and originate more or less at right angles to the (about 9%) than the dentin present between the tubules (the
main tubule every 1 to 2 μm along its length (Figs. 5.2A and intertubular dentin). Peritubular dentin differs from intertubular
B). Some of them enter adjacent or distant tubules while others dentin by its matrix composition. The crystal arrangement appears
end in the intertubular dentin. A few odontoblastic processes to be similar.

Fig. 5.2
(A) Secondary branching of human dentinal tubules in mid dentin. Note that branches join neighboring as well as distant tubules.
(B) Secondary branches of human dentinal tubules in outer dentin. Note relationships of these tubules to adjacent tubules and their
occasional anastomoses (Courtesy Dr Gerrit Bevelander, Houston).

Enamel

Enamel spindle Dentinoenamel

junction
Terminal branches
of dentinal tubules

Branching of
dentinal tubules

Branching of
dentinal tubules

B
96 Orban’s Oral Histology and Embryology

Fig. 5.3
Microscopic appearance of peritubular dentin. (A) Undermineralized ground section of soft X-ray showing increased mineral density in
peritubular zone (⫻1000). (B) Electron micrograph of demineralized section of dentin showing loss of mineral in peritubular zone.
Organic matrix in peritubular zone is sparse (approximately ⫻4000).

Peritubular Peritubular
dentin dentin
Odontoblastic Odontoblastic
process process

A B

It is twice as thick in outer dentin (approximately 0.75 μm) Between the odontoblastic process and the peritubular den-
than in inner dentin (0.4 μm). By its growth, it constricts the tin, a space known as periodontoblastic space is reported to be
dentinal tubules to a diameter of 1 μm near the dentinoenamel present. This space contains the dentinal fluid. The normal flow
junction. Studies with soft X-rays and with electron micros- of the fluid is outwards from the pulp. The dentinal fluid has
copy show the increased mineral density in the peritubular a higher K⫹ and a lower Na⫹ content. Dentin sensitivity is
dentin (Fig. 5.3). Since the deposition of the minerals occurs in explained on the basis of this fluid movement.
the inner wall of the tubule rather on the outer wall, the term
‘Intratubular dentin’ is considered to be more appropriate than Intertubular dentin
the term peritubular dentin.
A very delicate organic matrix has been demonstrated in this The main body of dentin is composed of intertubular dentin. It
dentin that along with the mineral is lost after decalcification is located between the dentinal tubules or, more specifically,
(Fig. 5.3B). After decalcification the odontoblast process appears between the zones of peritubular dentin. Although it is highly
to be surrounded by an empty space. In demineralized dentin mineralized, this matrix, like bone and cementum, is retained
visualized with a light microscope the tubule diameter will there- after decalcification, whereas peritubular dentin is not. About
fore appear similar in inner and outer dentin because of the loss one half of its volume is organic matrix, specifically collagen
of the peritubular dentin. This is important clinically, as etching fibers, which are randomly oriented around the dentinal tubules
of a cavity floor will open up the tubules. When peritubular (Figs. 5.4 and 5.5). The fibrils range from 0.5 to 0.2 ␮m in diam-
dentin is visualized ultrastructurally in a calcified section of eter and exhibit cross banding at 64 ␮m (640 Å) intervals, which
a tooth, the densely mineralized peritubular dentin appears struc- is typical for collagen (Fig. 5.5A). Hydroxyapatite crystals, which
turally different than the intertubular dentin. The collagen fibers average 0.1 ␮m in length, are formed along the fibers with their
in the tubule wall are masked in peripheral dentin (Fig. 5.4A). long axes oriented parallel to the collagen fibers.
A comparison of the tubule wall in inner and outer dentin is
shown in Figures 5.4 and 5.5. Several investigators believe the
Predentin
calcified tubule wall has an inner organic lining termed the
lamina limitans. This is described as a thin organic membrane, The predentin is located always adjacent to the pulp tissue and
high in glycosaminoglycan (GAG) and similar to the lining of is 2 to 6 ␮m wide, depending on the extent of activity of the
lacunae in cartilage and bone. Other investigators believe this odontoblast. It is not mineralized (Fig. 5.6).
lining in the tubules is absent or limited and that instead only The predentin appears to be pale staining than the mineral-
the plasma membrane of the odontoblast is present there. ized dentin owing to differences in composition of the matrix.
 Dentin 97

Fig. 5.4
(A) Cross-section of undecalcified peripheral human dentin, showing crisscross arrangement of collagen matrix fibers. Observe the
more densely calcified peritubular dentin. (B) Scanning electron microscope picture of pulpal surface of dentin illustrating random
arrangement of calcifying collagen fibers of matrix surrounding the dentinal tubules (⫻15,000) (Courtesy A Boyde, London).

A
B

Fig. 5.5
(A) Dentinal tubule representative of inner dentin near formative front as seen by scanning electron microscope. Collagen fibers are
evident, composing the walls of the dentinal tubules (⫻18,000). (B) Same dentinal tubule as in (A), further peripheral in calcified dentin
viewed by scanning electron microscope. Peritubular dentin masks collagen fibers in the tubule wall. Observe numerous side branches
(canaliculi) of dentinal tubule (⫻15,000) (From Boyde A: Beitr Electronmikroskop Direktabb Oberfl 1[S]:213, 1968).

Dentinal
tubules Intertubular
dentin

Intertubular
dentin Peritubular
dentin
Dentinal
tubules Dentinal
tubules

A B

As the collagen fibers undergo mineralization at the predentin- pulp at the pulp-predentin border and their processes extend
dentin junction, the predentin becomes dentin and a new layer into the dentinal tubules (Fig. 5.6). The processes are largest in
of predentin forms circumpulpally. diameter near the pulp (3 to 4 ␮m) and taper to approximately
1 ␮m further into the dentin. The odontoblast cell bodies are
approximately 7 ␮m in diameter and 40 ␮m in length. The
Odontoblast process
junctions between odontoblasts may be of gap junctions, tight
The odontoblast processes are the cytoplasmic extensions of the junctions, and desmosomal junctions. The life span of the odon-
odontoblasts. The odontoblast cells reside in the peripheral toblasts is equal to the age of the tooth as once differentiated,
98 Orban’s Oral Histology and Embryology

Fig. 5.6
Odontoblast processes (Tomes’ fibers) within dentinal tubules. They extend from the cell body below at the pulp-predentin junction into
the dentin above.

Calcified dentin

Uncalcified dentin
(predentin)
Odontoblastic
processes

Bodies of
odontoblasts
Nucleus of
odontoblasts

they cannot undergo further division. The odontoblastic pro- The odontoblast process is composed of microtubules of
cesses narrow to about half the size of the cell as they enter the 20 ␮m (200 to 250 Å) in diameter and small filaments 5 to
tubules (Fig. 5.6). There is disagreement among investigators 7.5 ␮m (50 to 75 Å) in diameter. The microtubules and inter-
even of now, whether the odontoblast processes extend through mediate filaments run longitudinally throughout the tubules.
the thickness of mature human dentin. Good evidence is shown Occasionally mitochondria, dense bodies resembling lyso-
by transmission electron microscopy that dentinal tubules 200 somes, microvesicles, and coated vesicles that may open to
to 300 ␮m from the pulp contain processes (Fig. 5.7A). Other the extracellular space are also seen (Fig. 5.7A). The odonto-
investigators, using scanning electron microscopy, have shown blast processes divide near the dentinoenamel junction and
what appear to be processes at the dentinoenamel junctions may indeed extend into enamel in the enamel spindles.
(Fig. 5.7B). Cryofractured human teeth revealed the odonto- Periodically along the course of the processes side branches
blast process to extend to the dentinoenamel junction (Fig. 5.8). (lateral branches) appear that extend laterally into adjacent
Recent studies with scanning electron microscope showed that tubules (Fig. 5.8).
odontoblastic process did not extend beyond the inner dentin.
The initial groups of investigators believe the findings in
Figures 5.7 and 5.8 represent the organic lining membrane of
the tubule (lamina limitans) and not the living process of the
PRIMARY DENTIN
odontoblast. Further investigations using immunofluorescent
Dentin which are formed before root completion are known as
techniques revealed tubulin (an intracellular protein of micro-
primary dentin. The primary dentin are of two types—mantle
tubules) throughout the thickness of dentin (Fig. 5.9A). It is
dentin and the circumpulpal dentin.
appropriate to consider that some odontoblast processes tra-
verse the thickness of dentin. In other areas a shortened process Mantle dentin is the name of the first-formed dentin in the
may be characteristic in tubules that are narrow or obliterated crown underlying the dentinoenamel junction. This zone
by mineral deposit. below the DE junction is soft and thus provides cushioning
 Dentin 99

Fig. 5.7
(A) Transmission electron micrograph of odontoblast processes in dentin tubules approximately 200 to 300 ␮m from the pulp. These
processes contain microfilaments, a few vesicles, and an occasional mitochondrion enclosed in the plasma membrane of the process
(x ⫽ artifact, ⫻ 6000). (B) Scanning electron micrograph of odontoblast process in dentinal tubules. Side branches of the process are
seen entering the peritubular dentin.

A B

Fig. 5.8
Low magnification scanning electron micrograph of the human odontoblast processes in intact crown dentin. The odontoblasts and
their processes are seen in the pulp predentin (left) extending through mid-dentin (center), and reaching the dentinoenamel junction
(right) (⫻ 1000) (Courtesy Dr Toshimoto Yamada).

10 µ
Near pulp Mid-dentin Dentinoenamel
junction
100 Orban’s Oral Histology and Embryology

Fig. 5.9
(A) Photomicrograph of immunofluorescence labeling of tubulin. This is a subunit protein of the microtubules present in the odonto-
blast process. P, pulp; PD, predentin; arrows, dentinoenamel junction (DEJ). (B) Scanning EM picture of odontoblast processes at DEJ
(arrowheads). One of the processes displays terminal branching near the DEJ (Courtesy Drs JE Aubin, AR Ten Cate, and S Pitaru, Medical
Research Council Group in Periodontal Physiology and Faculty of Dentistry).

PD

PD
P
A B

effect to the tooth. It is thus the outer or most peripheral part dentin contains fewer tubules than primary dentin. There is usu-
of the primary dentin and is about 20 μm thick. The fibrils ally a bend in the tubules where primary and secondary dentin
formed in this zone are perpendicular to the dentinoenamel interface (Fig. 5.10). Many believe that secondary dentin is
junction, and the organic matrix is composed of larger collagen formed more slowly than primary dentin and that it looks similar
fibrils than are present in the rest of the primary dentin (cir- to primary dentin but contains fewer tubules. Secondary dentin
cumpulpal dentin). The larger diameter collagen fibers (0.1– is not formed uniformly and appears in greater amounts on the
0.2 μm in diameter) are argyrophilic (silver stained) and are roof and floor of the coronal pulp chamber, where it protects the
known as von Korff’s fibers. They contain mainly type III col- pulp from exposure in older teeth. The secondary dentin formed
lagen. Compared to circumpulpal dentin, mantle dentin is less is not in response to any external stimuli and it appears very
mineralized. Mantle dentin also has fewer defects than circum- much like primary dentin. Due to the regular arrangement of
pulpal dentin. Unlike, rest of the dentin, matrix vesicles are dentinal tubules, it is known as regular secondary dentin.
involved in the mineralization of mantle dentin. Mantle dentin The apical dentin shows irregularity in the dentinal tubules
undergoes globular mineralization whereas the circumpulpal of both primary and secondary dentin.
dentin mineralizes either by globular or linear pattern. When
the rate of formation progresses slowly, the mineralization front
appears more uniform and the process is said to be linear. TERTIARY DENTIN
Circumpulpal dentin forms the remaining primary dentin or
Tertiary dentin is reparative, response, or reactive dentin. This
bulk of the tooth. The collagen fibrils in circumpulpal dentin are
is localized formation of dentin on the pulp-dentin border,
much smaller in diameter (0.05 ␮m) and are more closely packed
formed in reaction to trauma such as caries or restorative proce-
together compared to the mantle dentin. The circumpulpal den-
dures. This type of dentin is described in greater detail under
tin may contain slightly more mineral than mantle dentin.
reparative dentin.

SECONDARY DENTIN INCREMENTAL LINES

Secondary dentin is a narrow band of dentin bordering the pulp The incremental lines of von Ebner, appear as fine lines or stria-
and representing that dentin formed after root completion. This tions in dentin. They run at right angles to the dentinal tubules
 Dentin 101

Fig. 5.10
Dentinal tubules bend sharply as they pass from primary into secondary dentin. The dentinal tubules are somewhat irregular in second-
ary dentin. Pulpal surface on the right. Ground section human dentin (Courtesy Dr Gerrit Bevelander, Houston).

Demarcation
line

Secondary
dentin
Primary
dentin

and correspond to the incremental lines in enamel or bone (Fig. abrupt change in environment that occurs at birth. The dentin
5.11). These lines reflect the daily rhythmic, recurrent deposi- matrix formed prior to birth is usually of better quality than
tion of dentin matrix as well as a hesitation in the daily forma- that formed after birth, and the neonatal line may be a zone of
tive process. The distance between lines varies from 4 to 8 ␮m hypocalcification.
in the crown to much less in the root. The daily increment
decreases after a tooth reaches functional occlusion. The course
of the lines indicates the growth pattern of the dentin. Opinions
vary regarding the causes of the incremental lines. Some inves- INTERGLOBULAR DENTIN
tigators are of the opinion that the lines are 20 ␮ apart and they
represent a 5 day interval in dentin formation. 2 ␮m organic Sometimes mineralization of dentin begins in small globular
matrix of dentin is deposited in a 12-hour cycle, so the daily areas that fail to coalesce into a homogenous mass. This results
deposition is approximately 4 ␮m. Dentin is similarly mineral- in zones of hypomineralization between the globules. These
ized in a 12-hour cycle. zones are known as globular dentin or interglobular spaces. This
Occasionally some of the incremental lines are accentuated dentin forms in the crowns of teeth in the circumpulpal dentin
because of disturbances in the matrix and mineralization pro- just below the mantle dentin, and it follows the incremental
cess. Such lines are readily demonstrated in ground sections pattern (Fig. 5.14). The dentinal tubules pass uninterruptedly
and are known as contour lines of Owen, (Fig. 5.12). Analysis with through interglobular dentin, thus demonstrating defect of
soft X-ray has shown these lines to represent hypocalcified bands. mineralization and not of matrix formation (Fig. 5.15). In dry
Some investigators have shown that the contour lines of Owen ground sections some of the globular dentin may be lost, and
are due to the coincidence of secondary curvatures. a space results that appears black in transmitted light (Fig. 5.16).
In the deciduous teeth and in the first permanent molars, Recent studies reveal that interglobular dentin occurs most
where dentin is formed partly before and partly after birth, the frequently in the cervical and middle thirds followed by inter-
prenatal and postnatal dentin are separated by an accentuated cuspal and coronal third in the crown. In roots, the highest
contour line. This is termed the neonatal line and is seen in occurrence is seen in the cervical third followed by the middle
enamel as well as dentin (Fig. 5.13). This line reflects the third.
102 Orban’s Oral Histology and Embryology

Fig. 5.11
(A) Diagram of incremental appositional pattern in dentin in a human deciduous central incisor in a 5-month fetus. In the crown as much
as 8 ␮m/day was deposited and in the root 3 to 4 ␮m. (B) Incremental lines in dentin. Also known as imbrication lines or incremental
lines of von Ebner. Ground section human tooth (A from Schour I and Massler M: J Am Dent Assoc 23:1946, 1936).

5 m.i.u

8µ

6µ
5
µ
Neonatal
4µ

3 mo.
3.
5µ

3µ
6 mo.

6 mo.

B
 Dentin 103

Fig. 5.12
Accentuated incremental lines are termed contour lines (of Owen). Ground section human tooth.

Lines of
Owen

Lines of
Owen

Fig. 5.13
Postnatal formed dentin is separated from prenatal formed dentin by an accentuated incremental line termed the neonatal line (From
Schour I and Poncher HG: Am J Dis Child 54:757, 1937).

Prenatal dentin

Pulp
Neonatal line

Postnatal dentin

GRANULAR LAYER This zone increases slightly in amount from the cementoe-
namel junction to the root apex and is believed to be caused by
When dry ground sections of the root dentin are visualized in a coalescing and looping of the terminal portions of the den-
transmitted light, a zone adjacent to the cementum appears tinal tubules. Such a process is considered possible as a result of
granular (Fig. 5.14). This is known as (Tomes’) granular layer. the odontoblasts turning on themselves during early dentin
104 Orban’s Oral Histology and Embryology

Fig. 5.14
formation. These areas remain unmineralized, like interglobu-
lar dentin. The cause of development of this zone is probably
Granular layer (Tomes’) appears in root dentin a short distance similar to the branching and beveling of the tubules at the den-
from the cementoenamel junction. The spaces are air filled and
appear black in transmitted light in a ground section.
tinoenamel junction. Though Tomes’ granular layer and inter-
globular dentin have similarities in their formation, they differ
in their mineral content. Among the hypomineralized areas,
Enamel Tomes’ granular layer showed highest concentrations of calcium
and phosphorus, while interglobular dentin showed a higher
content of sulfur. Recent studies relate Tomes’ granular layer as
Dentin a special arrangement of collagen and noncollagenous matrix
proteins at the interface between dentin and cementum.
In any case the differentiating odontoblast initially inter-
Cementoenamel acts with ameloblasts or the root sheath cells through the basal
junction
Interglobular lamina. In the crown extensive branching of the odontoblast
dentin process occurs, and in the root there is branching and coalesc-
ing of adjacent processes.
Cementum

INNERVATION OF DENTIN
Tomes’
granular layer
Intratubular nerves
Interglobular Nerve fibers were shown to accompany 30 to 70% of the odon-
dentin toblastic process and these are referred to as intratubular nerves.
Dentinal tubules contain numerous nerve endings in the pre-
dentin and inner dentin no farther than 100 to 150 ␮m from
the pulp. Most of these small vesiculated endings are located in
tubules in the coronal zone, specifically in the pulp horns. The
Tomes’
nerves and their terminals are found in close association with
granular layer
the odontoblast process within the tubule. There may be single
terminals (Fig. 5.17) or several dilated and constricted portions
(Fig. 5.18). In either case, the nerve endings are packed with
small vesicles, either electron dense or lucent, which probably
depends on whether there has been discharge of their neu-
rotransmitter substance. In any case, they interdigitate with the
odontoblast process, indicating an intimate relationship to this
Fig. 5.15 cell. Synapse like relation between the process and nerve fibers
Globular dentin with interglobular spaces as seen in decalcified were demonstrated. It is believed that most of these are termi-
section of dentin. Dentin tubules pass uninterrupted through nal processes of the myelinated nerve fibers of the dental pulp.
uncalcified and hypocalcified areas. The primary afferent somatosensory nerves of the dentin
and pulp project to the descending trigeminal nuclear complex
(subnucleus caudalis).

Theories of pain transmission through dentin

There are three basic theories of pain conduction through den-
tin. 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 do 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,
 Dentin 105

Fig. 5.16
Globular dentin appears in the crown dentin a short distance from the dentinoenamel junction. Interglobular spaces are seen in a dry
ground section and appear as air-filled spaces that appear black in transmitted light (Courtesy Dr Gerrit Bevelander, Houston).

Dentinoenamel
junction Enamel

Mantle
dentin

Globular
dentin

Interglobular
spaces

Fig. 5.17
Nerve endings in dentinal tubules in region of predentin. The vesiculated endings are seen in adjacent tubules lying in contact with the
odontoblast processes.

Vesiculated nerve
endings in adjacent
tubules
106 Orban’s Oral Histology and Embryology

Fig. 5.18
On the left two nerve endings in a dentinal tubule along with an odontoblast process. On the right a nerve ending extends into the side
branch of a dentinal tubule in region of predentin (transmission electron micrograph).

Vesiculated
endings

Vesiculated nerve
ending in lateral branch

air blast desiccation, or mechanical or osmotic pressure affect hypermineralized. Dentin permeability depends upon the
fluid movement in the dentinal tubules. This fluid movement, patency of dentinal tubules. Therefore tubular occlusion, smear
either inward (due to cold stimuli) or outward (due to drying of layer formation and lack of tubular communication between
exposed dentinal surface), stimulates the pain mechanism in the primary and irregular secondary dentin will result in reduced
tubules by mechanical disturbance of the nerves closely associ- permeability. Reduction in dentin permeability would lessen
ated with the odontoblast and its process. Thus these endings the sensitivity of dentin.
may act as mechanoreceptors as they are affected by mechanical Dentin permeability increases rapidly as the pulp chamber
displacement of the tubular fluid. The third theory is the trans- is approached because the number and diameter of the tubules
duction theory, which presumes that the odontoblast process is the are more per unit area towards pulp than towards periphery.
primary structure excited by the stimulus and that the impulse is The outward flow of dentinal fluid and the odontoblasts act as
transmitted to the nerve endings in the inner dentin. This is not barriers for entry of bacteria or their toxins.
a popular theory since there are no neurotransmitter vesicles in
the odontoblast process to facilitate the synapse or synaptic spe-
cialization. However, odontoblasts, by modifying the local ionic AGE AND FUNCTIONAL CHANGES
environment, alter the threshold of intradentinal nerves. The
three theories are further explained in Figure 5.19. Vitality of dentin
Since the odontoblast and its process are an integral part of the
PERMEABILITY OF DENTIN dentin, there is no doubt that dentin is a vital tissue. Again, if
vitality is understood to be the capacity of the tissue to react to
Dentinal tubules becomes occluded by growth of peritubular physiologic and pathologic stimuli, dentin must be considered
dentin or by reprecipitation of minerals from demineralized a vital tissue. Dentin is laid down throughout life, although
areas of dental caries. Exposed dentinal surface becomes after the teeth have erupted and have been functioning for a
 Dentin 107

Fig. 5.19 Fig. 5.20

A diagram of the three main explanations of pain transmission Reparative dentin stimulated by penetration of caries into
through dentin. On the left is shown the transduction theory dentin. Dentinal tubules are irregular and less numerous than
in which the membrane of the odontoblast process conducts in regular dentin. Decalcified section.
an impulse to the nerve endings in the predentin, odonto-
blast zone, and pulp. In the center is the hydrodynamic theory. Dentin
Stimuli cause an inward or outward movement of fluid in the
tubule, which in turn produces movement of the odontoblast
and its process. This in turn stimulates the nerve endings. On
the right is the direct conduction theory in which stimuli directly
affect the nerve endings in the tubules.

Demarcation Reparative Pulp

line dentin

by the migration of undifferentiated cells arising in deeper

regions of the pulp to the dentin interface. It is believed that
the origin of the new odontoblast is from cells in the cell-rich
ct
re on zone or from undifferentiated perivascular cells deeper in the
Tran Di vati
sduc er pulp. The newly differentiated odontoblasts then begin deposi-
tion inn
tion of reparative dentin. This action to seal off the zone of injury
Hydrodynamic occurs as a healing process initiated by the pulp, resulting in
resolution of the inflammatory process and removal of dead
cells. The hard tissue thus formed is best termed reparative den-
short time, dentinogenesis slows, and further dentin formation tin although the terms tertiary dentin, response, or reactive den-
is at a much slower rate. This is the secondary dentin described tin are also used. Reparative dentin is characterized as having
earlier in this chapter. fewer and more twisted tubules than normal dentin (Fig. 5.20).
Pathologic effects of dental caries, abrasion, attrition, or the Dentin-forming cells are often included in the rapidly produced
cutting of dentin of operative procedures cause changes in dentin. intercellular substance, termed osteodentin, is seen, especially in
These are described as the development of dead tracts, sclerosis, response to rapidly progressing caries. In other instances a com-
and the addition of reparative dentin. The formation of repara- bination of osteodentin and tubular dentin are seen (Fig. 5.21)
tive dentin pulpally underlying an area of injured odontoblast It is due to the irregular nature of the dentinal tubules, these
processes can be explained on the basis of increased dentino- types of dentin are also referred to as irregular secondary dentin, in
genic activity of the odontoblasts. The mechanisms underlying order to differentiate from the regular secondary dentin formed
the series of events that occur in the development of reparative not as a result of any external stimuli. It is suggested that TGF-β
dentin, dead tracts, and sclerosis are not yet fully understood is involved in the production of tubular dentin, while BMP is
although the histology has been clearly described. involved in the production of osteodentin.
It is believed that bacteria, living or dead, or their toxic prod-
ucts, as well as chemical substances from restorative materials,
Reparative dentin
migrate down the tubules to the pulp and stimulate pulpal
If by extensive abrasion, erosion, caries, or operative procedures response, leading to reparative dentin formation. All of the events
the odontoblast processes are exposed or cut, the odontoblasts in this process are not yet known. In tertiary dentin formation,
die or survive, depending on the intensity of the injury. If they interglobular dentin, incremental lines with varying mineral con-
survive the dentin that is produced is known as reactionary or tent were seen suggesting that its formation is influenced by
regenerated dentin. Those odontoblasts that are killed are replaced biological rhythms. Ultrastructural studies showed that the
108 Orban’s Oral Histology and Embryology

Fig. 5.21
Diagrammatic illustration of normal (A) and other types of reparative dentin (B to E). Reparative dentin contains fewer than normal
tubules (B), or it includes cells within its matrix (C), shows irregularly arranged tubules (D), or is a combination of different types (E).

A Normal B Few tubules C Osteodentin D Irregular E Combination

dentinal tubules varied in size, shape, had irregular circumference and appear to a greater extent in older teeth. Dead tracts are
with projections of mineralized tissue into them and were tubules probably the initial step in the formation of sclerotic dentin.
with a high mineral content. Tertiary dentin differed from other
forms of dentin in that dentin phosphophoryn is not present.
Many similarities exist between development and repair,
Sclerotic or transparent dentin
including matrix-mediation of the cellular processes and the Stimuli may not only induce additional formation of reparative
apparent involvement of growth factors as signaling molecules dentin but also lead to protective changes in the existing dentin.
despite the absence of epithelium during repair. While some of In cases of caries, attrition, abrasion, erosion, or cavity preparation,
the molecular mediators appear to be common to these pro- sufficient stimuli are generated to cause collagen fibers and apatite
cesses, the close regulation that was seen in primary dentino- crystals to begin appearing in the dentinal tubules. This condition
genesis may be less ordered during tertiary dentin formation. is prevalent in older individuals. In such cases blocking of the
Several growth factors and extracellular matrix molecules tubules may be considered a defensive reaction of the dentin.
which are expressed during odontogenesis, are re-expressed Apatite crystals are initially only sporadic in a dentinal tubule but
under pathological conditions. Nestin and Notch protein which gradually the tubule becomes filled with a fine meshwork of crys-
are expressed in young odontoblasts and in subodontoblastic tals (Fig. 5.24). Gradually, the tubule lumen is obliterated with
layer during odontogenesis, are absent in adult tissue, but are mineral, which appears very much like the peritubular dentin
re-expressed during reparative dentin formation. (Fig. 5.25). The refractive indices of dentin in which the tubules
are occluded are equalized, and such areas become transparent.
Transparent or sclerotic dentin can be observed in the teeth of
Dead tracts
elderly people, especially in the roots (Fig. 5.26). Sclerotic den-
In dried ground sections of normal dentin the odontoblast pro- tin may also be found under slowly progressing caries (Fig.
cesses disintegrate, and the empty tubules are filled with air. 5.27). Sclerosis reduces the permeability of the dentin and may
They appear black in transmitted and white in reflected light help prolong pulp vitality. Mineral density is greater in this area of
(Fig. 5.22). Loss of odontoblast processes may also occur in dentin, as shown both by radiography and permeability studies.
teeth containing vital pulp as a result of caries, attrition, abra- The hardness of sclerotic dentin varied, those formed as a result
sion, cavity preparation, or erosion (Figs. 5.22 and 5.23). Their of aging were harder than those found below carious lesions.
degeneration is often observed in the area of narrow pulpal Though the sclerotic dentin was harder than normal dentin,
horns (Fig. 5.23) because of crowding of odontoblasts. Again, its elastic properties were not altered, but its fracture toughness
where reparative dentin seals dentinal tubules at their pulpal was reduced. The crystals present in the sclerotic dentin were
ends, dentinal tubules fill with fluid or gaseous substances. In smaller than those present in the normal dentin.
ground sections such groups of tubules may entrap air and It appears transparent or light in transmitted light and dark
appear black in transmitted and white in reflected light. Dentin in reflected light (Fig. 5.28).
areas characterized by degenerated odontoblast processes give The elastic modulus of intertubular, peritubular, transparent
rise to dead tracts. These areas demonstrate decreased sensitivity and healthy dentin did not differ appreciably.
 Dentin 109

Fig. 5.22
Dead tracts in vital tooth caused by attrition and exposure of dentin. (A) They appear black in transmitted light and (B) white in reflected
light. Reparative dentin underlies exposed dentinal tubules and, because of the absence of tubules, appears light in transmitted and
dark in reflected light. P, pulp (Courtesy Dr Gerrit Bevelander, Houston).

Dead
Dead tracts
tracts

Reparative
dentin Reparative
dentin

P
A B

Fig. 5.23
Dead tracts in dentin of vital human tooth caused by crowding and degeneration of odontoblasts in narrow pulpal horns and by exposure
of tubules to erosion.

Dead tract

Dead tract

Pulp horn
Pulp

Erosion

Reparative
dentin
110 Orban’s Oral Histology and Embryology

Fig. 5.24 Fig. 5.26

Scanning electron micrograph of partially sclerosed longitudi- Sclerotic dentin in apical area of root dentin from a section of
nal sectioned dentin tubules. Plate like crystals form a mesh- tooth. Absence of the tubules causes transparent appearance
work occluding tubule lumen (⫻9700) (From Lester KS and of the dentin (Courtesy Dr AEW Miles).
Boyde A: Virchows Arch [Zell-pathol] 344:196, 1968).

Tubule

DEVELOPMENT
Fig. 5.25
Scanning electron micrograph of fractured cross-section of Dentinogenesis
dentin located between attrited surface and the pulp. Various
degrees of closure of the tubule lumen are seen. Complete oblit- Dentinogenesis begins at the cusp tips after the odontoblasts have
eration (T) is seen as well as a minute lumen in other tubules. differentiated and begin collagen production. In odontoblast
(⫻5800) (From Brannstrom M: Dentin and pulp in restorative
differentiation, fibronectin, decorin, laminin and chondroitin sul-
dentistry, London, 1982, Wolfe Medical Publications Ltd).
fate 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 organi-
zation of odontoblast cytoskeleton assembly, which is important
for relocation of organelles that occurs prior to morphological
changes. 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 (Fig. 5.28). 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 ␮m, although its width remains
constant (7 ␮m). Proline appears in the rough surface endoplas-
mic 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.
 Dentin 111

Fig. 5.27
Sclerotic dentin under carious area viewed by, (A) transmitted light, (B) reflected light and, (C) radiograph (Grenz ray). Dentinal tubules
in dried ground section may be filled with air and appear black in transmitted light (A) and white in reflected light, (B). Sclerotic
dentin with mineral-filled tubules will appear transparent in transmitted light, dark in reflected light, and white in radiographs (Courtesy
Dr E Applebaum, New York).

Dentinal tubules
filled with air

Carious dentin

Transparent
dentin

Dentinal tubules
filled with air

Carious dentin

Transparent
dentin

Dentin

Carious dentin

Transparent
dentin

C
112 Orban’s Oral Histology and Embryology

Fig. 5.28
(A) Diagram of early dentinogenesis and amelogenesis. Lower right, on (B), is site of differentiation of odontoblasts and ameloblasts.
As the odontoblasts move away from the dentinoenamel junction, increments of dentin are formed.

Ameloblasts

Enamel rods
Dentin

Odontoblasts

Basal lamina

Factors controlling odontoblast secretion and mineralization slows to about 1 ␮m/day. After root development is complete,
are not known. One of the key proteins involved in mineralization dentin formation may decrease further, although reparative
and secreted by the odontoblast is the dentin phosphoprotein dentin may form at a rate of 4 ␮m/day for several months after
(DPP). It is highly anionic and binds to calcium, transports it to a tooth is restored. Dentinogenesis is a two-phase sequence in that
the mineralization front and controls the growth of apatite crys- collagen matrix is first formed and then calcified. As each incre-
tals. Osteonectin secreted by the odontoblasts inhibits the growth ment of predentin is formed along the pulp border, it remains a
of apatite crystals but promotes its binding to collagen. Osteopontin, day before it is calcified and the next increment of predentin
a phosphoprotein, also promotes mineralization. Gla protein forms (Fig. 5.29). Korff’s fibers have been described as the initial
(gamma carboxyglutamic acid) containing protein and phospho- dentin deposition along the cusp tips. Because of the argyrophilic
lipids act as seeds or nucleators to attract and concentrate calcium. reaction (stain black with silver) it was long believed that bundles
Chondroitin sulfate, has opposite actions in mineralization. In of collagen formed among the odontoblasts (Fig. 5.30). Recently,
predentin, they prevent the transport of apatite crystals, but in ultrastructural studies revealed that the staining is of the ground
mineralized dentin they get adsorbed into the collagen and pro- substance among the cells and not collagen. Consequently, all
mote apatite binding to the collagen. Odontoblast takes up the predentin is formed in the apical end of the cell and along the
calcium and maintains its concentration higher than in tissue fluid. forming tubule wall (Fig. 5.29). The finding of formation of
Matrix vesicles are involved in the mineralization of mantle collagen fibers in the immediate vicinity of the apical ends of the
dentin. The matrix vesicles, prior to its release by the odonto- cells is in agreement with the general concept of collagen synthe-
blast promotes the formation of apatite. It contains enzymes sis in connective tissue and bone. The odontoblasts secrete both
like alkaline phosphatase, which locally increases the concen- collagen and other components of the extracellular matrix.
tration of phosphates and these combine with calcium taken up The radicular dentin formation compared to coronal dentin,
from the tissue fluid to form apatite within it. is slower, less mineralized with collagen fibers laid down paral-
The role of effector nerves in dentin secretion is suggested lel to the cementodentinal junction. These collagen fibers
due to the presence of synapse proteins; synapsin and synapto- unlike in coronal dentin are laid adjacent to the non-collagenous
tagmin in the dentinal tubules. matrix of (Hertwig’s epithelial root sheath).
As the cell recedes it leaves behind a single extension, and
the several initial processes join into one, which becomes enclosed
Mineralization
in a tubule. As the matrix formation continues, the odonto-
blast process lengthens, as does the dentinal tubule. Initially The mineralization sequence in dentin appears to be as follows.
daily increments of approximately 4 ␮m of dentin are formed. The earliest crystal deposition is in the form of very fine plates of
This continues until the crown is formed and the teeth erupt hydroxyapatite on the surfaces of the collagen fibrils and in the
and move into occlusion. After this time dentin production ground substance (Fig. 5.29A). Subsequently, crystals are laid
 Dentin 113

Fig. 5.29
(A) First-formed dentin, showing cytoplasm of apical zone of ameloblast, above, and first-formed enamel matrix at the dentinoenamel
junction. Below the junction collagen fibers of dentin matrix are seen with calcification sites appearing near the first-formed enamel.
Predentin zone is seen below these sites with the odontoblast process extending from the odontoblasts at bottom of field. (B) Predentin
and dentin as visualized in a later developing tooth. Observe calcified (black) dentin above, predentin composed of collagen fibers
below, odontoblast processes, and the cell body (transmission electron micrographs).

Ameloblast

Forming
enamel matrix Mantle
dentin
First sites of
calcification
of dentin matrix

Odontoblast
process
Odontoblast
A

Dentin

Odontoblast
process

Predentin

down within the fibrils themselves. The crystals associated with cementum. They are 300 times smaller than those formed in
the collagen fibrils are arranged in an orderly fashion, with their enamel (Fig. 5.31). It is interesting that two cells so closely
long axes paralleling the fibril long axes, and in rows conforming allied at the dentinoenamel junction produce crystals of such a
to the 64 nm (640 Å) striation pattern. Within the globular size difference but at the same time produce chemically the
islands of mineralization, crystal deposition appears to take place same hydroxyapatite crystals. Calcospherite mineralization
radially from common centers, in a so-called spherulite form. These is seen occasionally along the pulp-predentin-forming front
are seen as the first sites of calcification of dentin (Fig. 5.29A). (Fig. 5.32). Dentin sialoprotein present in mineralizing dentin
The general calcification process is gradual, but the peritu- affects the rate of mineral deposition while other proteoglycans
bular region becomes highly mineralized at a very early stage. present more in the predentin, inhibit calcification to prevent
Although there is obviously some crystal growth as dentin premature calcification of the predentin.
matures, the ultimate crystal size remains very small, about Many genes are implicated in dentinogenesis, the newer
3 nm (30 Å) in thickness and 100 nm (1000 Å) in length. The ones being MAP1B for odontoblast differentiation, and PHEX
apatite crystals of dentin resemble those found in bone and for dentin mineralization.
114 Orban’s Oral Histology and Embryology

Fig. 5.30
Light micrograph of a silver-stained section of early forming dentin. The argyrophilic nature of the ground substances among the
odontoblasts appears like bundles of collagen fibers. Fig. 5.29B illustrates that the collagen formed by the odontoblast is apical to the
cell body in the area of the forming predentin.

Argyrophilic
staining
substance

Fig. 5.31
Dentinoenamel junction. Enamel is above and dentin below. Note dif-
ference in size and orientation between crystallites of enamel and
dentin. Whereas crystals of human enamel may be 90 nm (900 Å) Fig. 5.32
in width and 0.5 to 1 ␮m in length, those of dentin are only 3 nm Scanning electron micrograph of globular dentin (calcospherite
(30 Å) in width and 100 nm (1000 Å) in length. Crystals of dentin mineralization) formation at predentin-forming front. Later-
are similar in size to bone (Electron microphotograph; ⫻35,000). forming dentin may be linear, causing interglobular spaces
to appear among earlier-formed globular dentin. Treated with
ethylene diamine to remove organic material (Courtesy A Boyde,
London).

Enamel

Dentin
 Dentin 115

CLINICAL CONSIDERATIONS instruments cause dislodgement of the odontoblasts from the

periphery of the pulp and their “aspiration” within the den-
The cells of the exposed dentin should not be insulted by bacte- tinal tubule. This could be an important factor in survival of
rial toxins, strong drugs, undue operative trauma, unnecessary the pulp if the pulp is already inflamed. Repair requires the
thermal changes, or irritating restorative materials. One should mobilization of the macrophage system as healing takes place;
bear in mind that when 1 mm2 of dentin is exposed, about as this progresses there is the contribution of deeper pulpal
30,000 living cells are damaged. It is advisable to seal the exposed cells, through cytodifferentiation into odontoblasts, which will
dentin surface with a nonirritating, insulating substance. be active in formation of reparative dentin.
The rapid penetration and spread of caries in the dentin is The sensitivity of the dentin has been explained by the hydro-
the result of the tubule system in the dentin (Fig. 5.1). The dynamic theory, that alteration of the fluid and cellular contents
enamel may be undermined at the dentinoenamel junction, of the dentinal tubules causes stimulation of the nerve endings
even when caries in the enamel is confined to a small surface in contact with these cells (Fig. 5.19). Most pain inducing
area. This is due in part to the spaces created at the dentino- stimuli increase centrifugal fluid flow within the dentinal
enamel junction by enamel tufts, spindles, and open and tubules, giving rise to a pressure change throughout the entire
branched dentinal tubules. The dentinal tubules provide a pas- dentin. This in turn activates the Aσ intradentinal nerves at
sage for invading bacteria and their products through either the pulp–dentinal interface, or within the dentinal tubules
a thin or thick dentinal layer. thereby generating pain. Dentin sensitivity is seen more in
Electron micrographs of carious dentin show regions of patients with periodontal problems. The teeth most commonly
massive bacterial invasion of dentinal tubules (Fig. 5.33). The affected are maxillary premolars followed by the maxillary first
tubules are enlarged by the destructive action of the micro- molars with the incisors being the least sensitive teeth. This
organisms. Dentin sensitivity of pain, unfortunately, may not theory explains pain throughout dentin since fluid movement
be a symptom of caries until the pulp is infected and responds will occur at the dentinoenamel junction as well as near the
by the process of inflammation, leading to toothache. Thus pulp. Erosion of peritubular dentin and smear plug removal
patients are surprised at the extent of damage to their teeth accounts for dentin hypersensitivity caused by agents like
with little or no warning from pain. Undue trauma from opera- acidic soft drinks. Brushing after acidic drink consumption,
tive instruments also may damage the pulp. Air-driven cutting induces smear layer formation, thus reducing sensitivity.

Fig. 5.33
Electron micrograph of dentin underlying carious lesion. Coccoid bacteria are present in the tubules. The peritubular dentin has been
destroyed causing the enlargement of the tubules (⫻ 10,000).
116 Orban’s Oral Histology and Embryology

The basic principles of treatment of hypersensitivity are to layer has to be removed by etching and a rough porous surface
block the patent tubules or to modify or block pulpal nerve should be created for bonding agent to penetrate (Fig. 5.34).
response. The most inexpensive and first line of treatment is to Recent studies on tertiary dentin show that the patients
block the patent tubules with dentifrice containing potassium treated with transforming growth factor beta 1 (TGF-␤1) and
nitrate and/or stannous fluoride. Lasers have been used in the to a lesser extent with osteogenic protein-1 (OP-1) showed
treatment of hypersensitivity with varying success, ranging significantly greater tertiary dentin formation and intratubular
from 5.2 to 100%. mineralization, over an 8-week period when compared with
The permeability of radicular dentin near the pulp is only control group.
about 20% that of coronal dentin, and the permeability of Dentin formation, unlike bone, is not affected by vitamin D
outer radicular dentin is about 2% of coronal dentin. This sug- deficiency states. Fluoride incorporated during active dentino-
gests that the outer dentin of the root acts as a barrier to fluid genesis, as occurring in dental fluorosis, increases the hardness
movement across dentin in normal circumstances and recalls of dentin.
the correlation between root planing and hypersensitivity. A summary diagram illustrating the relationship of the
Smear layer consists of cut dentin surface along with the odontoblast and its process to the dentin matrix is shown in
embedded bacteria and the debris. Though the smear layer Figure 5.35.
occludes the tubules and reduces the permeability, it also prevents
the adhesion of restorative materials to dentin. Therefore this
Fig. 5.35
Diagram of the odontoblast and its process in the dental tubule.
Note the relationship of the process to the periodontoblastic
Fig. 5.34 space and the peritubular dentin.
Dentinal surface of prepared cavity with smear layer (S) covering
ends of tubules. Below surface are dentinal tubules (T) and in Dentinoenamel
one tubule a debris plug (P) (Courtesy of Dr Martin Brännström, junction
Karolinskã Institute, Stockholm).
Mantle dentin

Interglobular
dentin

Peritubular
dentin

Intertubular
dentin

Odontoblast
process

Periodontoblastic
space

Predentin

Nerve
Odontoblast
 Dentin 117

SUMMARY
Dentin forms bulk of the tooth tissues and occupies both the crown and the root. It is surrounded by the enamel in the crown and cementum in
the root. Physically and chemically it resembles bone. Dentin consists of 65% inorganic and 35% organic material. The organic substance con-
sists mainly of type I collagen fibers embedded in ground substance of mucopolysaccharides. The inorganic component consists of plate shaped
hydroxyapatite crystals.
Dentin is made up of dentinal tubules. The dentinal tubules contain the protoplasmic process of the odontoblasts called odontoblastic
process. The inner wall of the tubule is highly calcified and is termed as peritubular or intratubular dentin. Between the tubules is the intertu-
bular dentin and it is calcified to a lesser degree than peritubular dentin. Between the odontoblastic processes and the peritubular dentin is
the periodontoblastic space which contains the dentinal fluid. The tubules are broader at their point of origin, i.e., at their pulpal end (3–4 μm)
and become gradually narrower at their point of termination (1 μm), i.e., at dentinoenamel or cementoenamel junction. Also the tubules are
closer together at the pulpal end (50–90,000 tubules/mm2) and further apart at their terminal end. Therefore the number of tubules per unit
area is more at the pulpal end by 4 times than at their terminal end. Hence the intertubular dentin is well appreciated at the terminal end. The
tubules generally have a doubly convex course, the primary curvature (often called “S” shaped tubules), the first convexity of which is directed
towards apex. This is well appreciated in the middle portion of the tooth because the convexity lessens and the tubules gradually become
straighter near the incisal/cuspal regions and the apex. Apart from this primary curvature the tubules show smaller undulations called secondary
curvatures all along their course. Also, all along the course the tubules show lateral branches and terminal branches at their terminal end. The
odontoblastic process which contain microtubules, microfilaments, and mitochondria extends into these branches. Few of the odontoblastic
process cross the DEJ and they are known as enamel spindles.
The dentin which forms before root completion is called primary dentin. Primary dentin is of two types—the mantle dentin and the circum-
pulpal dentin. The mantle dentin found along the DEJ is about 20 μm thick and it contains larger-diameter argyrophilic (silver stained) collagen
fibers arranged perpendicularly to the DEJ. The circumpulpal dentin contains smaller-diameter closely packed collagen fibers. The dentin which
forms after root completion is called secondary dentin. This forms at a slower rate (1 μm/day) than primary dentin (4 μm/day) and regularly but
not uniformly—more formation is seen on the roof and floor of the pulp chamber. Hence this dentin is also known as regular secondary dentin.
If the dentin forms as a reaction to an irritant (trauma or dental caries) to protect the pulp, it is called reparative/reactive/tertiary/irregular dentin.
The tertiary dentin shows irregularity in the number, size, and arrangement of tubules—the irregularity increases with the rapidity of formation.
Whenever dentin forms, it forms in two phases—a distinct organic matrix known as predentin which calcifies subsequently but only after
another layer of predentin is laid down. Hence a layer of predentin always exist adjacent to the odontoblast. Many factors are involved in differ-
entiation of odontoblast, secretion of organic matrix, and in subsequent mineralization. Like other mineralized tissues dentin formation is not
a continuous process, the periods of rest are denoted by incremental lines—the incremental lines of Von Ebner which are 4–8 mm apart run at right
angles to the dentinal tubules. The accentuated incremental lines are known as contour lines of Owen, while those formed during the period of
birth are referred to as neonatal lines. The mineralization of dentin occurs in relation to collagen fibers as linear deposits (linear mineralization) or
by fusion of globules (globular mineralization). Incomplete fusion of globules leads to the formation of interglobular [Link] interglobular dentin
is found near DEJ, and are visible in ground sections as dark spaces under transmitted light. Similarly, the Tomes granular layer is visible near cemen-
todentinal junction as minute dark spaces and it is related to looping and coalescing of terminal portions of dentinal tubules in that region.
The nerves which enter dentin do not extend beyond the inner two thirds of dentin. The stimulation of dentin by any agent causes a pain
like sensation called hypersensitivity. The theories that explain sensitivity are based on the direct stimulation of the nerves (direct neural stimu-
lation theory) or due to inward or outward movement of dentinal fluid exciting the nerve endings (hydrodynamic theory) or due to stimulation
of odontoblastic process (transduction theory).
The age changes in dentin include the formation of sclerotic dentin and dead tracts. Hydroxyapatite crystals are laid down in the
intertubular dentin and within dentinal tubules to block the tubules against, the entry of bacteria, etc. The dentin then becomes transparent in
transmitted light hence often called transparent dentin. Permeability of dentin becomes reduced while hardness increases in these regions.
Breakage of apical thirds of roots during extraction of teeth of elderly is due to the brittle nature of sclerotic dentin. Dead tracts are
areas containing degenerated dentinal tubules which appear dark in transmitted light. These are often seen in attrited or abraded teeth or
below the carious lesions.

Review Questions
1. Describe the physical and chemical properties of dentin.
2. Describe the course, structure, and content of dentinal tubules.
3. Explain the terms mantle dentin, predentin, and circumpulpal dentin.
4. What are the lines seen in dentin? What is their significance?
5. What is Tomes’ granular layer?
6. Write about interglobular dentin.
7. When and why reparative dentin forms? How does it differ from normal dentin?
8. What are dead tracts?
9. What is transparent dentin? Why are they known as transparent dentin? What causes their formation?
10. What factors are involved in odontoblasts differentiation, secretion and mineralization of dentin?
11. Explain the theories of dentin sensitivity. What are the principles underlying their treatment?