Pulp

DEFINITION:
Dental Pulp can be defined as a richly
vascularized and innervated connective tissue
of mesodermal origin enclosed by Dentin with
communications established to the
Periodontal Ligament.
 GENERAL FEATURES:

Pulp present in the

crown: CORONAL PULP
 Pulp present in the
root: RADICULAR PULP
 The shape of the pulp
varies in different teeth
and resembles the outer
surface of the crown.
Total volume of all permanent teeth pulp:
0.38 cc
 Mean volume of a single adult human pulp
is: 0.02 cc
 Molar pulps are 3-4 times larger than
incisor pulps (Size of the pulp: posteriors >
anteriors
APICAL FORAMEN
Histology of pulp
CELLS OF THE PULP
FIBROBLASTS
Predominant cell of the pulp.
 The pulp organ is said to consist of
specialized connective tissue because it lacks
elastic fibers.
 Fibroblasts are the most numerous cell type
in the pulp.
 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 junctions to the
processes of other fibroblasts
  In the young pulp the
cells divide and are active
in protein synthesis, but in
the older pulp they appear
rounded or spindle shaped
with short processes and
exhibit fewer intracellular
organelles. They are then
termed fibrocytes
▪ Under the light microscope the fibroblast nuclei
stain deeply with basic dyes, and their cytoplasm is
lighter stained and appears homogeneous.
▪ Electron micrographs reveal abundant rough-
surfaced endoplasmic reticulum,mitochondria, and
other organelles in the fibroblast cytoplasm. This
indicates these cells are active in pulpal collagen
production.
The fibroblasts of the pulp, in addition to forming the
pulp matrix, also have the capability of ingesting and
degrading this same matrix. These cells thus have a
dual function with pathways for both synthesis and
degradation in the same cell
Fibroblasts play an important role in
inflammation and healing.
 Fibroblasts secrete angiogenic factors like
FGF-2 and VEGF, especially after injury,
which help in healing.
They also release inflammatory mediators
cytokines and growth factors
UNDIFFERENTIATED MESENCHYMAL
CELLS
Undifferentiated mesenchymal cells are the
primary cells in the very young pulp, but a
few are seen in the pulps after root
completion.
They appear larger than fibroblasts and are
polyhedral in shape with peripheral processes
and large oval staining nuclei.
The latter are distinctive because they lack a
ribosome-studded endoplasmic reticulum and
have mitochondria with readily discernible
cisternae.
 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
 ODONTOBLASTS
 Odontoblasts, the second most
prominent cell in the pulp,
reside adjacent to the
predentin with cell bodies in
the pulp and cell processes in
the dentinal tubules.
 The number of odontoblasts
corresponds to the number of
dentinal tubules.
 They are approximately 5 to 7
m in diameter and 25 to 40 m
in length. They have a constant
location adjacent to the
predentin, in what is termed
the “odontogenic zone of the
pulp
▪ Recently, primary cilia have been identified in
odontoblast. These cilia may play a role in response
of odontoblasts to external stimuli.
▪ The form and arrangement of the bodies of the
odontoblasts are not uniform throughout the pulp.
They are more cylindrical and longer (tall columnar)
in the crown and more cuboid in the middle of the
root
Odontoblasts are end cells. They have lost the ability to
divide. When they die they have to be replaced by cells,
which differentiate from the cell-rich zone. Odontoblast
and subodontoblastic cells have been shown to undergo
apoptotic cell death by apoptotic cell markers like bcl-2.
 Odontoblasts release inflammatory chemokine
interleukin-8 which is chemotactic for neutrophils
 Nitric oxide synthetase have been identified in
odontoblasts and endothelial cells of the pulp which are
important enzymes for vasodilatation and blood pressure
regulation.
This suggests that odontoblasts may help in controlling
blood flow and cell growth within the dental pulp.
DEFENSE CELLS
 GROUND SUBSTANCE
• Intercellular ground substance
– Glycosaminoglycans
– Hyaluronic acid
– Chondrotin Sulphate

• Functions
– Supports the cells of the pulp
– Medium for transportation of nutrients
Intercellular substance
Fibers
The main type of collagen fiber in the pulp is
type I.
 TYPE III is also present.
Bundles of these fibers appear throughout
the pulp
BLOOD VESSELS
 The pulp organ is extensively vascularized.
 It is known that the blood vessels of both
the pulp
and the periodontium arise from the inferior
or
superior alveolar artery and also drain by
the same veins in both the mandibular and
maxillary regions.
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
Characterized by absence of RBCs but with
the presence of lymphocytes
 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.
NERVES
The majority of the nerves that enter the pulp
through apical foramen are nonmyelinated.
The large myelinated fibers mediate the
sensation of pain that may be caused by
external stimuli
The peripheral axons form a network of
nerves located adjacent to the cell-rich zone.
This is termed the parietal layer of nerves,
also known as the plexus of Raschkow.
FUNCTIONS
1) 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.
4) Protective:
The tooth’s sensory nerves detect pain from
heat, cold, pressure, and chemicals. They also
help regulate blood flow in the pulp through
reflex actions.
Defensive or reparative:
The pulp repairs itself by forming dentin
when irritated. Mild injury leads to
reactionary dentin, while severe injury
causes reparative dentin formation.
Immune cells help in healing, but too much
pressure can damage the pulp.
REGRESSIVE CHANGES (Age changes in PULP

Fibrosis
Reduction in the size of pulp chamber
Decrease in the number of cells
Reduction in sensitivity
Pulp stones
 )

 CELL CHANGES
 A. In addition to the appearance of fewer cells in the aging pulp, the
 cells are characterized by a decrease in size and number of
 cytoplasmic organelles.

 B. The typical active pulpal fibrocyte or fibroblast has abundant

 rough-surfaced endoplasmic reticulum, notable Golgi complex,
 and numerous mitochondria with well developed cristae.
 Thefibroblasts in the aging pulp exhibit less perinuclear cytoplasm
 and possess long, thin cytoplasmic processes.
 The intracellular organelles are reduced in number and size; the
mitochondria and endoplasmic reticulum are good examples of this
 FIBROSIS
 A. In the aging pulp accumulations of both diffuse fibrillar
 components as well as bundles of collagen fibers usually appear.

 B. The increase in fibers in the pulp organ is gradual and is

 generalized throughout the organ. Any external trauma such as
 dental caries or deep restorations usually causes a localized
 fibrosis or scarring effect. Collagen increase is noted in the
 medial and adventitial layers of blood vessels as well.

 C. The increase in collagen fibers may be more apparent than

 actual, being attributable to the decrease in the size of the pulp,
 which makes the fibers present occupy less space, and hence
 they become more concentrated without increasing in total
 volume
 VASCULAR CHANGES
 A. Vascular changes occur in the aging pulp organ as they do in any
 organ.
 B. Atherosclerotic plaques may appear in pulpal vessels.
 In other cases the outer diameter of vessel walls becomes
 greater as collagen fibers increase in the medial and adventitial
 layers. Also calcifications are found that surround vessels.

 C. Calcification in the walls of blood vessels is found most often in

 the region near the apical foramen.

 D. The capillary endothelium shows changes due to age. The

 endothelium in the elderly shows numerous pinocytic vesicles,
microvesicles and microfilaments. In addition lipid like vacuoles, glycogen
granules and many Golgi complexes are present.
 E. Blood flow decreases with age
 PULP STONES
(DENTICLES)
 Pulp stones, or denticles, are
nodular, calcified masses
appearing in either or both
the coronal and root portions
of the pulp organ.

 They often develop in teeth

that appear to be quite normal
in other respects. They usually
ar asymptomatic unless they
impinge on nerves or blood
vessels. They have been seen
in functional as well as
embedded unerupted teeth.
Pulp stones are classified, according to their
structure as
 True denticles
 False denticles
Pulp stones may also be classified as free,
attached, or embedded, depending on their
relation to the dentin of the tooth.
 True denticles are similar in structure to dentin in that they
have dental tubules and contain the processes of the
odontoblasts that formed them and that exist on their surface.

 True denticles are comparatively rare and are usually located

 close to the apical foramen. A theory has been advanced that
the development of the true denticle is caused by the inclusion
of remnants of the epithelial root sheath within the pulp.

 These epithelial remnants induce the cells of the pulp to

differentiate into odontoblasts, which then form the dentin
masses called true pulp stones
False denticles do not exhibit dentinal tubules but
appear insteadas concentric layers of calcified tissue.
 In some cases these calcification sites appear within
a bundle of collagen fibers. Other times they appear in
a location in the pulpfree of collagen accumulations.

Some false pulp stones undoubtedly arise around

vessels. In the center of these concentric layers of
calcified tissue there may be remnants of necrotic and
calcified cells.


Calcification of thrombi in blood vessels,
called phleboliths, may also serve as nidi for
false [Link] denticles begin as small
nodules but increase in size by incremental
growth on their surface.
The surrounding pulp tissue may appear
quite normal. Pulp stones may eventually fill
substantial parts of the pulp chamber
 The free denticles are entirely surrounded by pulp tissue,
 Attached denticles are partly fused with the dentin, and


Embedded denticles are entirely surrounded by dentin .
 All pulp stones are believed to be formed free in the pulp and
later become attached or embedded as dentin formation
progresses.
 The incidence as well as the size of pulp stones increases with
age.

 According to one estimate, 66% of teeth in persons 10 to 30

years of age, 80% in those between 30 and 50 years, and 90% in
those over 50 years of age contain calcifications of some type.

 Astatistically significant relationship has been found between

patients with cardiovascular disease and presence of pulp
stones.
 DIFFUSE CALCIFICATIONS
 A. Diffuse calcifications appear as irregular calcific deposits in the pulp
tissue, usually following collagenous fiber bundles or blood
vessels .Sometimes they develop into larger masses but usually persist as
fine calcified spicules.

 B. The pulp organ may appear quite normal in its coronal portion
 without signs of inflammation or other pathologic changes but
 may exhibit these calcifications in the roots.

 C. Diffuse calcifications are usually found in the root canal and less
 often in the coronal area, whereas denticles are seen more
 frequently in the coronal pulp.

 D. Diffuse calcification surrounds blood [Link] calcifications

 may be classified as dystrophic calcification
UNIVERSITY QUSTIONS
1. Histology of pulp/zones
2. Describe function of pulp
3. Enumerate structure in the pulp and write
detail odontoblastic layer and its function
4. Pulp calcification/denticals
5. Age changes and clinical consideration