New Dental Pulp

DENTAL PULP
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CONTENTS
 INTRODUCTION
 EMBROLOGY
 ANATOMY
 STRUCTURAL ORGANISATION OF PULP
 CELLS OF PULP
 EXTRA CELLULAR MATRIX
 CIRCULATION OF PULP
 METABOLISM OF PULP
 INNERVATION OF PULP
 FUNCTIONS OF PULP
 PULP OF DECIDUOUS TOOTH
 PULP CALCIFICATION
 AGE CHANGES
 CLINICAL SIGNIFICANCE
 CONCUSION
INTROUDCTION
• The Pulp is a soft mesenchymal connective
tissue that occupies pulp cavity in the
central part of the teeth.
• It is a special organ because of the unique
environment
DEVELOPMENT
• During the 8th week of IUL, there is condensation
of the mesenchmye under the enamel organ-
Dental papilla.
• The enamel organ enlarge and enclose the dental
papilla in their central portion.
• Dental papilla controls the morphology & type of
tooth to be formed.
• Dental papilla shows :
extensive proliferation of cells
High vascularity
• Following the differentiation of the IEE into
ameloblasts, odontoblast differentiate from
the peripheral cells of dental papilla
• Well organized capillaries are found at

beginning of dentinogenesis
• Capillaries crowd around the odontoblast
during active dentinogenesis
• Rim of the enamel organ (IEE & OEE) is
the cervical loop.
• Root formation is carried out by the
proliferation of cells at the cervical loop.
Dental Papilla
Dental papilla capped by the

enamel organ
GENERAL FEATURES
• Total of 52 pulp organs 32 in the permanent
and 20 in the primary teeth.
• Total pulp volume in permanent teeth is
0.38cc with mean being 0.02CC
• Each of these organs has a shape that
conforms to that of the respective tooth.
• Has ability to form dentin throughout life
The pulp cavity is divided into
1. Coronal pulp
2. Radicular pulp
CORONAL PULP
• It is the pulp occupying the pulp chamber of the
crown of the tooth
• In young teeth it resembles the shape of the outer
dentin
• It has six surfaces : occlusal, mesial, distal, buccal,
lingual and floor.
• Pulp horns are projections into the cusp
• This pulp constricts at the cervical region where it
continues as the radicular pulp
RADICULAR PULP
• It is the pulp occupying the pulp canals of the root
of the tooth
• In the anterior tooth it is single and in the posterior
teeth it is multiple
• The radicular portions of the pulp is continuous
with the periapical tissues through apical foramen
• As age advances the width of the radicular pulp is
reduced, and so is the apical foramen.
APICAL FORAMEN
1. Pulp cavity terminates at root apex as small
opening called apical foramen
2. Radicular pulp continuous with connective
tissue of the periodontium through this
foramen.
3. Diameter in an adult- maxillary teeth-0.4mm
mandibular teeth-0.3mm
4. Wide open during development of root
APICAL FORAMEN
5. Undergoes changes
I. Tooth may tipped from horizontal
pressure cause apex to tilt in opposite
direction, exert pressure on one wall of the
foramen causing resorption
6. Same time cementum laid down on
opposite side resulting relocation of the
original foramen
7. Sometimes apical opening is found on the
lateral side of the apex
8. There may be 2-3 foramina split by
cementum or dentin- APICAL DELTA
Apical Foramen
Neurovascular
bundle entering
pulp through the
foramen
ACCESSORY CANAL
• Leading laterally from the radicular pulp into the
periodontal tissue.
• Present in the apical third of the root sheath cells
• Formed due to premature loss of HERS or when
developing root encounters a blood vessel.
• Overall occurrence is 33%
• May also be present at the furcation region
Accessory Canals
Structural Organization of pulp
HISTOLOGICAL ZONES OF
PULP
ODONTOBLAST LAYER
CELL-POOR ZONE
CELL-RICH ZONE
PULP PROPER
THE ODONTOBLASTIC ZONE
A layer of odontoblasts are found
along the pulp periphery.
They are dentin forming cells.
 CELL FREE ZONE
• It is also called weil’s zone
• 40 microns wide &relatively free of cells
• Traversed by
• blood vessels
• unmyelinated nerves
• cytoplasmic process of fibroblasts
• This zone is found below the odontoblastic zone
• Represents the space into which odontoblasts
move during tooth development.
CELL RICH ZONE
Present in subodontoblastic layer
Contains more proportions of fibroblast and
undifferentiated mesenchymol cells.
Also contains macrophages, dendritic cells and
lymophocytes.
Zone formed due to migration of cells from pulp
proper
Mitosis seen when dead odontoblasts are replaced
Also contain young collagen fibres during early
dentiogenis.
PULP CORE
It is central region of the pulp

Contains major blood vessels and nerve of
the pulp
Pulpal cells and fibroblasts are also seen
CELLS OF PULP
 ODONTOBLASTS
 FIBROBLASTS
 UNDIFFERENTIATED CELLS
 DEFENSE CELLS
ODONTOBLASTS
A Peripheral area of the pulp where the
odontoblasts reside is termed odontogenic
zone.
Arranged in Palisading pattern cells one tall
columnar forming a layer of 3 to 5 cells in
depth.
Shape may vary cornal pulp- columnar
midportion - cuboidal
Apical region - Flattened
These cells have large process extending
into dentin
The no of odontoblasts corresponds to the
number of dentinal tubules
Average no of odontoblasts estimated to
45,000 per Sq.mm of odontogenic zone.
Odontoblasts in the crown are larger than in
the root.
Shape of the odontoblasts also reflect the
functional activity of the cell.
During active phase, cells show increase in
endoplasmic reticulum golgi appartus and
secretory vesicles.
Resting (or) Non active phase cells are
flattened little cytoplasm condensed
chromatin and decrease no of ER
JUNCTIONAL COMPLEX
Numerous junctions such as gap junctions
tight junction and desmosomes are found
between odontoblasts.
Indicating exchange of ions and small
molecules.
They promote cell to cell adhension and
play a role in maintaining polarity of
odontoblasts
JUNCTIONAL COMPLEXES
ODONTOGENIC PROCESS
 Odontoblasts give off a single process that
extends into dentin and housed within
dentinal tubules
These process devoid of major organelles
They contain abundance of microtubular
filaments and coated vesicles
Mainly composed of protein-tubulin, act in
and vimentin
FUNCTIONS OF ODONTOBLASTS
Synthesis of organic matrix

Synthesis of non collagenous substances
like sialoprotein, phosphophoryn,
osteocalcin, ostenoectin & osteopontin
Intracellular accumulation of calcium
Degradation of organic matrix
FIBROBALSTS
Cells that occur in greatest number in the
pulp
Function is to form, maintain the matrix
that consists of collages, fiber and ground
substance throughout the pulp
The fibroblasts are stellate shaped cells
having extensive process.
Fibroblast
H&Estain
Immunohistochemical
method
Young teeth - Fibroblasts have abudant
cytoplasm having numerous
cell organcells.
Older pulp - Fibroblasts appear spindle
shaped posses short
processes having few
cytoplasmic organelles
such cells are called
fibrocytes
Dual function :
a) It has capability of ingesting and
degrading the organic matrix.
b) Pathway of both synthesis and
degreadation in the same cell.
UNDIFFERENTIATED MESENCHYME
These mesenchymal cells are distributed through
out the pulp, frequently around the perivascular
area - believed to be toti potent cell
They are Polyhedral shaped with peripheral
processes and large oval nuclei
Difficult to differentiate from fibroblast under
light microscopy
Under adequate stimilus they may differentiate
into odontoblast or fibroblast or macrophages.
In older pulp,their number and ability to
differentiate comes down
IMMUNOCOMPETENT CELLS
They play a major role local inflammation and
immunity.
They are recruited from blood stream and remain
as transient inhabitants in pulp
These cells are
1. Macrophages
2. Mast cells
3. Plasma cells
4. Lympocytes,Neutrophils,Eosinophils
basophils and manocytes.
MACROPHAGES IN PULP
Described as histiocytes (or) as resting wandering
cells
Located close to blood vessel
Have several phenotypes
Macrophages are phagocytes,function of which
are engulfment and digestion of foreign material
During inflammation they appear in large no to aid
in defense the organism
In all they constitute 8-9% of the pulpal cell
population
Macrophages
Dark staining nucleus with cytoplasmic

granules
PLASMA CELLS
• Plasma cells are seen during inflammation
of the pulp
• The plasma cells function in the production
of antibodies.
• Plasma cells may be present in coronal pulp
• They have small nuclei with radiating
chromatin that appears like a cast wheel.
Plasma Cell
Peripheral arrangement of chromatin in

nucleus
MAST CELLS
Occur in small groups in relation to blood

vessels
Present only during pulpal inflammation
Have round nucleus and contain many dark
staining granules in the cytoplasm.
Their number increase during inflammation.
LYMPHOCYTES,EOSINOPHILS
AND LEUCOCYTES
Usually found extravascularly in the normal pulp
During inflammation they increase in number.
Lymphocyte present along the walls of blood
vessels
Involved in initial immunodefense
Usually they are not found in uninflamed pulp
Eosinophils are present in some allergic
types of inflammation
In pulp.they are found in an inflammatory
exudate.
LYMPHOCYTES IN PULP
Leucocytes are not found normally in the
connective tissue
They are transported to such sites in
response to injury and then present directly
in the involved tissue as well as in blood.
They phagocyte foreign material .
EXTRACELLULAR MATRIX
Connective tissue fibers
Collagen
Elastin
Fibronectin
Ground substance
Proteoglycans
Glycosaminoglycans
Basement membrane
FIBRES (COLLAGEN FIBRES)
Extra cellular structural protein,major constituent
of connective tissue
Collagen fibers appear throughout the pulp
young fine fibers ranging in diameter from 10-
12mm.
Pulp collagen fibers do not contribute to dentin
matrix production.
After root completion pulp matures and bundles of
collagen fibers increase in number
They scattered throughout the coronal or radicular
pulp,or they appear in bundles.These are termed
diffuse or bundle collagen
Most prevalent in root canals,especially near
apical region.
Collagen Fiber
Seen in relation with fibroblasts
Type I:
 Present as thick striated fibrils
Responsible for pulp architecture
Type III:
 Thinner fibrils,mainly distributed
in cell free and cell rich zones
 Contributes to the elasticity of pulp
Type IV:
Present along the basement membrane of
blood vessels
Type V and VI:
Seen to form dense meshwork of thin
microfibrils through out the stroma
• Collagen turnover is maintained by
fibroblasts
• During bacterial infection &
inflammation,collagenolytic activity is
accelerated following collagenase produced
by bacteria,PMN & fibroblats
• Collagen synthesis is accelerated during
reparative dentin formation
ELASTIC FIBER
• This has the ability to expand and contract
like a rubber band
• Elastic fibers are first formed in bundles of
thin micro filaments called Oxytalan fibers
• Elastin is then deposited in between oxytalan
fibers.
• Always associated with larger blood vessels
Elastic Fiber
Verhoeff's method stains the fibers black
FIBRONECTIN
It plays a role in cell-cell & cell-matrix
adhesion
Has a major effect on the proliferation,
differentiation & organization of cells.
Seen around the blood vessels
Also found in odontoblast layer with fibers
passing into predentin
Due to its close interaction with odontoblasts and
extracellular fibers,fibrinoectin helps to maintain
cell morphology and provide a tight seal at this
site.
Fibronectin may be involved in cell migration and
anchorage in the wound healing process of the
connective tissue of pulp.
It regulates the migration and differentiation of
secondary odontoblasts
Adherent property of fibronectin is due to cell
surface glycoprotein receptors called Integrins
GROUND SUBSTANCE
It is a structureless mass,makes up the bulk
of the pulp
Consists of complexes of
proteins,carbohydrate and water.
Broadly classified as
 Glycoaminoglycans
 Proteoglycans
GLYCOSAMINOGLYCANS
GAG found in pulp is mainly chondroitin
sulphate,dermatan sulphate & hyaluronic acid
Proteoglycans occupy larger area and they provide
protection against compression.
During dentinogenesis,the ground substance show
affinity for collagen and influence fibrinogenesis
They have capacity to bind with calcium and help in
mineralisation
BASEMENT MEMBRANE
It is a sheet like arrangement of extra
cellular protein matrix at the epithelial-
mesenchymal interface
Composed of 2 layers
 lamina densa-electron dense
 lamina lucida-electrolucent
Basement membrane is a product of
connective tissue and epithelium
It is composed of
 Collagen type IV
 Laminin-adhesive glycoprotein
 Fibronectin
 Heparin sulfate
Collagen IV provides binding sites for the
rest of basement membrane components
Laminin binds to both cells of connective
tissue and epithelium
In mature pulp,basement membrane forms
interface along endothelial cells & schwann
cells
FUNCTIONS
Act as sieve between epithelium and

connective tissue
Helps in organisation and differentiation by
enabling interactions between extra cellular
molecules and cell surface receptors
Eg: Odontoblasts during tooth
development
CIRCULATION OF THE PULP
 The pulp organ is extensively vascularized.

They are supplied by the superior and the
inferior alveolar arteries
The blood vessels gain entry into the pulp
through the apical foramen and at times
through accessory foramen.
The arterioles on entering the pulp show a
reduction in thickness of vessel wall musculature
and therefore luman size increases.
Pulpal blood flow is more rapid than in most area
of the body
So pulpal pressure is highest of body tissues
The flow of blood in asterioles - 0.3 to 1mm/sec
Venules – 0.15mm/sec
Capilaries – 0.08mm/sec
Organization of Pulp Vasculature
⃟Pulp is a micro circulatory system which
lacks true arteries and veins
⃟The largest vessels are arterioles & venules
which regulate the local interstitial
environment
⃟They enter the tooth through the apical
foramen
⃟Pulp tissue pressure is 14cm H20
Organization of pulp vasculature
H&E section showing the neurovascular bundle
 ARTERIOLES:
Arterioles
(50µ diameter)
Terminal arterioles
Precapillaries
Metarterioles
Capillaries (8µ)
The branching point of terminal arterioles is
characterized by smooth muscle clumps that
act as sphincters which are under the local
cellular & neuronal control
Thus pulpal inflammation elicits a localised
circulatory response restricted to the area of
inflammation
Arteriolar pressure – 43mm Hg.
PULP VASCULATURE
Apical third Middle third

Microcirculatory System
Arterioles & venules
 CAPILLARIES
• Function as exchange vessels regulating the
transport of diffusion of substances between
blood and local interstitial tissue elements
• They consists of single layer of endothelium
surrounded by basement membrance
• Capillary pressure –35 mmHg
• Capillary wall is 0.5µ thick & acts as
semipermeable membrane
Based on the property of semi permeability
capillaries may be grouped as
Class I : Fenestrated capillaries
Class II: Continuous capillaries
(non fenestrated)
Class III : Discontinuous capillaries
Class IV : Tight junction capillaries
Class I & II are present in the dental pulp
Capillary network is organized in 3 layers
1. Terminal capillary network located in the
“odontoblastic layer”
2. “Capillary network” present adjacent to
the odontoblastic layer & consists of pre
capillary & post capillary vessels
3. Venular network of vessels
During aging & decreased metabolism
these layers appear as single layer
SEM shows extensive arborization of capillaries from
the metarterioles
VENULES
Collecting venules receive pulpal blood
flow from the capillaries & transfer it to the
venules
Arterio-venous anastomosis permits direct
shunting from arterioles to venules
Venular pressure –19mm Hg
LYMPHATICS
Lymphatic vessels are formed from fine
meshwork of small, thin walled lymph capillaries
Lymph capillaries coalesce to form larger
lymphatic vessels with valves
They start as blind openings near Weil’s zone &
odontoblastic layer
The larger lymphatic vessels run along the blood
vessels & nerves
Multiple collecting lymph vessels exit
though the apical foramen & drain lymph
from pulp into the periodontium
Role in pulp:
They remove high molecular
solutes from the interstital fluids thus
maintain interstitial COP
They transport lymph to the
regional lymph node before it enters into
the blood vessels. This provides an
immuno surveillance function.
METABOLSIM
• Metabolism has been studied by measuring
the rate of O2 consumption & production of
Coz lactic acid by pulp tissue
• Radiospriometry is also used to evaluate the
metabolism. Pulp tissue is placed in 14C
labeled substractures, such as succinate &
rate of apperance of CO2 is measured.
• During dentinogenesis, rate of O2
consumption is high than after crown
completion.
• Greatest metabolic activity is seen in the
odontoblast layer.
• Reduced pH of pulp causes decreases in O2
consumption as in pulp abscess.
• In addition to the glycolytic pathway, the
pulp has the ability to produce energy
through Pentose shunt pathway, suggesting
that the pulp can function under varying
degrees of ischemia
• Several dental materials have shown to
inhibit O2 consumption Eg. ZOE , Ca(OH)2
& silver amalgam
• Pulpal irritation causes increases in
cycloxygenase products, which is inhibited
by ZOE
• As cellular composition reduces, the rate of
oxygen consumption decreases.
INNERVATION
Principles role is to help in conscious
recognition of irritants to the pulp, which
gives the opportunity to have the problem
corrected before irreversible effects can
occur
Nerve fibers, mylinated & unmyelinated,
enter the tooth through the apical foramen
INNERVATION
Dental pulp contains sensory and motor

fibers to fulfill the vasomotor and defense
function
Sensory afferent fibers are branches of
maxillary & mandibular division of
trigeminal nerve.
After entering the foramen, they arborize.
Larger fibers are present in the central zone.
They divide as they proceed peripherally
and coronally.
Subjacent to the cell rich zone, the nerves
branch extensively forming a parietal layer
of nerves-NERVE PLEXUS OF
RASHKOW. This layer contains both A
and C fibers.
Types of nerve fibers
Above the cell free zone, myelinated fibers
begin to lose their myelin sheath.
In the cell free zone, they form a rich
network responsible for pain
In the cell free zone, they form a rich
network responsbile for pain.
Many of these fibers pass between the
odontoblastic zone.
Nerve endings may also enter the dentinal
tubules
incidence - 10-20% in cusp tips
1% at the level of CEJ
Motor nerves are supplied by the
sympathetic division of autonomic nervous
system.
• They wrap around the arteries and terminate
in the tunica media.
• They control the diameter of the vascular
lumen & therefore blood flow & volume &
ultimately the intrapulpal pressure.
Table 3.2 Classification and function of fibers in peripheral nerves
Diameter Conduction velocity Function
(µm) (speed of impulse,
Fiber m/sec)
A-alpha (α) 6-20 15-80 (myelinated) Afferent fibers for touch, pressure
A-beta(β ) 5-12 30-70 proprioception, vibration
(mechanorecptors)
A-gamma(µ)
A-delta (δ) 1-5 2-30 (myelinated) Afferent fibers for pain and temperature
B 1-3 3-15 (myelinated) Visceral afferent fibers preganglionic
visceral efferent fibres
C 04-1.0 0.4-2(unmyelinated) Afferent fibers for pain and tempature;
post ganglionic visceral efferent fibers
Neuropeptides in Pulp
Neuropeptides are proteins that have been
associated with central & peripheral
nervous system
Following are the neuropeptides
demonstrated in pulp :
Originate from trigeminal ganglion (C fibres)
Substance P
CGRP
Neurokinin A
FUNCTIONS OF DENTAL PULP
– INDUCTIVE
– FORMATIVE
– NUTRITIVE
– PROTECTIVE
– DEFENSE
INDUCTIVE
It induces oral epithelial differentiation
into dental lamina and enamel organ
It also induces the enamel organ to
differentiate into a particular type of tooth
morphology
FORMATIVE
The cells of Pulp induces dentin formation
This involves formation of primary and
secondary dentin.
The primary dentin is tubular and regularly
arranged.Formed before root closure
Secondary dentin contain fewer tubules and
is formed after root closure.
NUTRITIVE
• Dental pulp maintains the vitality of dentin
by providing O2 and nutrients to the
odontoblasts
• Also provides continuing source of dentinal
fluid
• Nutrition made possible by rich peripheral
capillary network.
PROTECTIVE
Pulp helps in recognition of stimuli like
heat,cold,pressure,chemicals by way of
sensory nerve fibres.
Vasomotor innervation controls the
muscular wall of blood vessels.This regulates
the blood volume and rate of blood flow and
hence the intrapulpal pressure.
DEFENSIVE (OR) REPARATIVE
 Pulp as remarkable reparative abilities
It responds to irritation by producing
reparative dentin and mineralizing and
affected dentinal tubules.
Mild to moderate irritation results in
continued peritubular dentin formation,
sclerosis and intratubular calcifiction-
(Tublar sclerosis)
Stimuli like operative procedures abrasion,
caries can result in rapid dentin formation
(Tertiary dentin)
Inflamed pulp due to bacterial infection the
cells in pulp aid in the process of repair
(macrophages, lymphocycts, neutrophils,
monocytes, plasma , mast cells)
PULP OF DECIDUOUS TEETH
• Overall dimensions smaller
• Pulp chambers larger
• Roots are long and slender and root canals
narrower and follow a tortuous course
• Pulp horns at a higher level, especially mesial
horns of primary molars
• Resorption starts soon after root completion
• Root resorption and dentin deposition changes
size shape and number of root canals.
PRIMARY PULP ORGAN
• Primary pulp functions for a mean of 8.3 years.
This time can be divided into three periods
Pulp organ growth
Time of crown and root development
Pulp maturation (3 years, 9 months)
Time after root completion to beginning
of root resorption
Pulp regression (3 Years , 6 months)
Beginning of root resorption to exfoliatin
REGRESSIVE CHANGES (AGING)
Cell Changes
 Appearance of fewer cells in aging pulp
 Cells are characterized by a decrease in size
and no of cytoplasmic organelles
 Active pulpal fibrocyte (or) fibroblast has
abundant rough-surfaced endoplasmic
reticulum notable golgi complex, numerous
mitochondria
 Fibroblast exhibit less perinuclear
cytoplasm, long thin cytoplasmic processes.
 Intra cellular organelles are reduced in no
and size
FIBROSIS
Diffuse fibrillar components
 Accumulation of both
Bundles of collagen fibres
 Fiber bundles may appear arranged longitudinally
in the radicular pulp and more diffuse in coronal
pup
 Collagen accumulation also occurs in some older
pulps
 Increase in fibers in the pulp organ is gradual and
generalized
 External trauma such as dental caries (or)
deep restorations cause a localized fibrosis
(or) scarring effect
 Increase in collages fibers decrease in the

size of the pulp
 Vascular changes occur in aging pulp
Pulp Fibrosis
 Atherosclerotic plaques may appear in
pulpal vessels.
 Calcifications are found that surround
vessels.
 Calcification is found most often in the
region near the apical foramen.
Pulp Stones(denticles)
 Appearing in either or both coronal and root
portions of the pulp organ
 Develop in teeth that appear to be normal in
other respects.
 Asymptomatic unless they impinge on
nerves (or)blood vessels
 Seen in functional as well as embedded
unerupted teeth.
Classification
1. True denticles
2. False denticles
3. Diffuse calcifications
True denticles
True denticles are similar in structure to dentin
They have dental tubules and contain processes
of the odontoblasts
Usually located close to the apical foramen
Development of true denticles is caused by the
inclusion of remnants of the epithelial root
sheath with in the pulp
Epithelial remnants induce the cells of pulp to
differentiate into odentoblasts then form the
dentin mass.
True Denticle
• H&E section of
true denticle
• Higher
magnification
False denticles
 They do not exhibit dentinal tubules

 They appear as concentric layers of calcified
tissue
 Some cases these calcification sites appear within
a bundle of collagen fibers.
 Some cases they appear in pulp free of collagen
accumulations
 Some cases arises around vessels
 Center of these concentric layers of calcified
tissues there may be remnants of necrotic and
calcified cells
 Calcification of thrombi in blood vessels called
phleholiths, may also serve as nidi for false
denticles
 An denticles begin as small nodules but increase
in size by incremental growth
 Classified as free, attached (or) embedded
depending on their relation to the dentin
a) Free denticle – entirely surrounded by
pulp tissue
b) Attached denticle – Partly fused with the
dentin
c) Embedded denticles – Entirely surrounded by
dentin
Incidence as well as the size of pulp stones
increase with age.
False Denticle
False calcification seen along the walls of the blood

vessel
Diffuse Calcifications
 Appear as irregular calcific deposits in the pulp
tissue, following collagenous fiber bundles, blood
vessels,
 Sometimes they develop into larger mass, persist
as calcified spicules
 These calcifications are usually found in the root
canal and less often in coronal area
 These calcification surrounds blood vessels
 These calcifications may be classified as
dystrophic calcification
Diffuse calcification
Diffuse calcification of the pulp, seen along with

pulp fibrosis
Dystrophic Mineralization
Ground substance alterations in the dental
pulps occurs on aging, such charges may
contribute to cellular degeneration and
increase dystrophic mineralization.
Circulatory disturbances may be the
initiating factor
Mineralizations also seen in the myelin
sheaths of nerves.
Their beginnings are also found in the
vessel walls as in arteriosclerosis.
Older, fibrotic pulp attract mineral salts
more readily.
A mineralized pulp when extirpated, feels
wooden hard.
Dystropic mineralization due to caries
and periodontal disease
DM also increase as result of disease
processes such as caries and periodontal
diseases
Teeth whose pulps one chronically
inflammed contain DM in regions of
previous liquefaction necrosis.
Alkaline phosphate in odontoblasts may
function as a calcium pyso phosphatus,
there by stimulating ca2 uptuke in pulps.
Teeth with periodontal disease, DM
increase in both cornonal and radicular
pulp.
AGE CHANGES
• Formation of secondary dentin through out
life, reduces the size of the pulp chamber
and root canals
• Decrease in cellularity
• Odontoblast decrease in size & number, &
may disappear in certain areas. Especially
on pulpal floor over bifurcation & trifurca
• Increase in number & thickness in collagen
fibers particularly radicular pulp
• Reduction in the nerve fibers & blood
vessels
• Increase resistance of pulp against action of
enzymes
• In dentin,
Increase in peritulular dentin
Dentinal sclerosis, reduces permeability
Increase in dead tracts
Factors infulencing Tertiary
Dentinogenesis
Reactionary Dentinogenesis:
• Shallow cavity- RDT > 0.5mmRD
• Deep cavity - RDT 0.25mm - RD
• Very deep cavity- RDT 0.008 –0.25mm RD
Reparative Dentinogenesis:
• Pulp exposure – RDT< 0.008mm- Reparative dentin
formation.
Tertiary Dentinogenesis
CLINICAL CONSIDERATIONS
1. Anatomic considerations
2. Factors to be considered during
endodontic treatment.
3. Effect of Operative Procedures
4. Effect of dental materials on pulp
5. Effects subsequent to restoration
ANATOMIC
CONSIDERATIONS
Pulp Chamber withwww.rxdentistry.blogspot.com

stone Cervical horns
OPERATIVE PROCEDURES
Anatomic considerations
2) Shape of the pulp chamber and its
extensions into the cusps pulpal horns is
important.
3) Wide pulp chamber into tooth of young
person will make a deep cavity
preparation hazardous
3) The pulpal horns project high into the
cusps exposure of pulp can occur
4) If opening a pulp chamber for treatment its

size and variation in shape must be taken
into consideration
FACTORS TO BE CONSIDERED DURING
ENTODONTIC TREATMENT
5) Age advance , the pulp chamber becomes
smaller difficult to locate the root canals.
6) Shape of the apical foramen and its
location may play an important part in
treatment of root canals.
7) Accessory canals, and multiple canals are
rarely seen in roentgenograms.
FACTORS TO BE CONSIDERED
DURING OPERATIVE PROCEDURES
8) The pulp is highly responsive to stimuli,

even slight stimulus cause inflammatory
cell infiltration.
9) Dehydration causes pulpal damage
operative procedures producing this
condition should be avoided.
 Filling material contain harm ful chemicals
Silicate cement - acid
Composites - monomer
 Vital pulp is essential to good dentition.
Now vital tooth becomes brittle and is
subject to fracture.
EFFECT OF DENTAL MATERIALS ON
PULP
GIC – Well tolerated by pulp
Calcium hydroxide – includes dentin bridge
formation.
Zine oxide – eugenol- has an anti-bacterial effect.
Formocresol – Cause chronic inflammation of the
pulp.
Dentin bonding agent – can irritate the pulp
causing inflammation
DETECTION OF PULP VITALITY
Electric pulp testing

More accurate than some of the tests used
to detamine pulp vitality
Heat testing
Thermal testing
Cold
Anesthetic testing
Anesthetic testing
Test cavity
This test performed when other methods of
diagnosis have failed
The test cavity is made drilling through
enamel – dentin junction of an
unanaesthetized tooth
 Pulse oximeter
Based on evaluating oxygen saturation
of the tissue.
CONCUSION
• THE PRESEVATION OF A HEALTHY
PULP DURING OPERATIVE
PROCEDURES AND SUCCESSFUL
MANAGEMENT IN CASES OF
DISEASES ARE TWO OF MOST
IMPORTANT CHALLENGE TO THE
CLINICAL DENTIST.
REFERENCES
 DENTAL PULP; Seltzer & bender;
 ORAL HISTOLOGY AND EMBROLOGY; Orban
 ORAL HISTOLOGY; Tencate
 PATHWAYS OF THE PULP; Cohen
 ENDODONTIC PRACTICE; Grossman
 ENDODONTICS;Ingle
 ENDODONTIC PRACTICE;Weine

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DENTAL PULP

• Well organized capillaries are found at

Dental papilla capped by the

They are dentin forming cells.

It is central region of the pulp

Synthesis of organic matrix

Dark staining nucleus with cytoplasmic

Peripheral arrangement of chromatin in

Occur in small groups in relation to blood

Seen in relation with fibroblasts

Verhoeff's method stains the fibers black

Act as sieve between epithelium and

 The pulp organ is extensively vascularized.

H&E section showing the neurovascular bundle

Apical third Middle third

Arterioles & venules

Dental pulp contains sensory and motor

 Increase in collages fibers decrease in the

 Vascular changes occur in aging pulp

 They do not exhibit dentinal tubules

False calcification seen along the walls of the blood

Diffuse calcification of the pulp, seen along with

Pulp Chamber withwww.rxdentistry.blogspot.com

4) If opening a pulp chamber for treatment its

8) The pulp is highly responsive to stimuli,

Electric pulp testing

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