Prof. Dr.

Bilinç Bulucu/ Restorative Treatment Department

DENTAL PULP
The dental pulp is soft tissue of mesenchymal origin located in the center of the tooth.
It consists of specialized cells, odontoblasts arranged peripherally in direct contact
with dentin matrix. This close relationship between odontoblasts and dentin is known
as ‘ Pulp – Dentin complex’.
The pulp is connective tissue system composed of cells, ground substances, fibers,
interstitial fluid, odontoblasts, fibroblasts and other cellular components. Pulp is
actually a microcirculatory system consists of arterioles and venules as the largest
vascular component. Due to lack of true collateral circulation, pulp is dependent upon
few arterioles entering through the foramen. Due to presence of the specialized cells,
i.e. odontoblasts as well as other cells which can differentiate into hard tissue
secreting cells. The pulp retains its ability to form dentin throughout the life. This
enables the vital pulp to partially compensate for loss of enamel or dentin occurring
with age.

Connective tissue of
pulp
Histology of Dental Pulp
Basically the pulp is divided into the central and the peripheral region. The central
region of both coronal and radicular pulp contains nerves and blood vessels. The shape
of the pulp reflects the shape of the tooth in which it is located.

The peripheral region contains the following zones:

* Odontoblastic Layer:
Odontoblasts consist of cell bodies and their cytoplasmic processes. The odontoblastic
cell bodies form the odontoblastic zone whereas the odontoblastic processes are
located within predentin matrix. Capillaries, nerve fibersand dendritic cells may be
found around the odontoblastsin this zone.
* Cell Free Zone of Weil: Central to odontoblasts is subodontoblastic layer, termedas
cell free zone of Weil. It contains plexuses of capillariesand fibers ramification of
small nerve.
* Cell Rich Zone: This zone lies next to subodontoblastic layer. It contains fibroblasts,
undifferentiated cells which maintain number of odontoblasts by proliferation and
differentiation.
Contents of pulp:

 Cells
- Odontoblasts
- Fibroblasts
- Undifferentiated mesenchymal cells
- Defense cells ▪ Histiocytes and macrophages
▪ Polymorphonuclear leukocytes
▪ Lymphocytes
▪ Mast cells
▪ Eosınophils
 Matrix
- Collagen fibers: ▪Types I and II 2
- Ground Substance : ▪Glycosaminoglycans
▪Glycoproteins
▪ Water
- Blood Vessels:
- Lymphatics:
- Nerves:

Different zones of Dental pulp ( Dentin, Predentin, Odontoblasts, Zone of Wiel (cell
free zone), Cell rich zone, nerves,vessels....)
Structural or Cellular Elements
Odontoblasts:
• They are first type of cells encountered as pulp is approached from dentin.
• The number of odontoblasts range from 59,000 to 76,000/mm2 in coronal dentin with
lesser number in root dentin.
• In the crown of the fully developed tooth, the cell bodies of odontoblasts are
columnar and measure approximately 500 μm in height, whereas in the midportion of
the pulp, they are more cuboid and in apical part, more flattened.
• Ultrastructure of the odontoblast shows large nucleus which may contain up to 4
nucleoli. Nucleus is situated at basal end. Golgi bodies is located centrally.
Mitochondria, rough endoplasmic reticulum (RER), ribosome are also distributed
throughout the cell body.

Odontoblast cell

• Odontoblasts synthesize mainly type I collagen, proteoglycans.They also secrete

sialoproteins, alkaline phosphatase, phosphophoryn (phosphoprotein involved in
extracellular mineralizations).
• Irritated odontoblast secretes collagen, amorphous material and large crystals into
tubule lumen which result in dentin permeability to irritating substance.
• Odontoblasts are the closest cell of the pulp to the external environment and the
first injured cell with environmental irritants. They do not show mitosis.

Fibroblasts:
• The cells found in greatest numbers in the pulp are fibroblasts.
• These are particularly numerous in the coronal portion of the pulp, where they form
the cell-rich zone.
• These are spindle shaped cells which secrete extracellular components like collagen
and ground substance.
• The health status of fibroblasts shows the age, vitality and strength of the pulp to
withstand irritant effects.

Histology of pulp showing fibroblasts

• They also eliminate excess collagen by action of lysosomalenzymes.

Undifferentiated Mesenchymal Cells:

Undifferentiated mesenchymal cells are descendants of undifferentiated cells of
dental papilla which can dedifferentiateand then redifferentiate into many cells types. 4

They are located adjacent to the vessel. Transforms to other cells of the connective
tissue and participate in regeneration events when needed.

Defence Cells:
• Histiocytes and macrophages: They originate fromundifferentiated mesenchymal
cells or monocytes.They appear as large oval or spindle shaped cells whichare involved
in the elimination of dead cells, debris,bacteria and foreign bodies, etc.
• Polymorphonuclear leukocytes: Most common formof leukocyte is neutrophil, though
it is not presentin healthy pulp. They are major cell type in microabscesses formation
and are effective at destroying andphagocytising bacteria and dead cells.

• Lymphocytes: In normal pulps, mainly T-lymphocytesare found. They are associated

with injury and resultant immune response.

• Mast cells: They have a round nucleus and their cytoplasm contains many dark
staining granules. They are demonstrated by using spesific stains as toluidine blue.
On stimulation, degranulation of mast cells release histamine (They produce histamin &
heparin) which causes vasodilatation,increased vessel permeability and thus allowing
fluids and leukocytes to escape. Produce only during pulpal inflammation.

• Eosınophils: They are found in normal pulp and they increase during inflammation.

Cells taking part in defense of pulp

Extracellular Components
The extracellular components include fibers and the ground substance of pulp:
Fibers: The fibers are principally type I and type III collagen. Collagen is synthesized
and secreted by odontoblasts and fibroblasts.
Ground Substance; It is a structureless mass with gel like consistency forming bulk of
pulp.
Components of ground substance are:
• Glycosaminoglycans
• Glycoproteins
• Water.
Functions of ground substance:
• Forms the bulk of the pulp.
• Supports the cells.
• Acts as medium for transport of nutrients from the vasculature to the cells and of
metabolites from the cells to the vasculature.

- Blood Vessels: ▪Arterioles, venules, capilleries. An anastomosis adjusts the blood

entering the pulp according to the need between the pulp artery and the veins exiting
the pulp. Vessels: Pulp artery enters the pulp through the apical hole. They form a
capillary network near odontoblasts.

- Lymphatics: ▪ Draining to submandibular,submental and deep cervical nodes

- Nerves: ▪Subodontoblastic plexus of Rashkow sensory afferent from Vth nerve and
superior cervical ganglion. There are 2 type of nerve;
i- Myelin nerve: Sensory nerves. They loose their myelins near Odontoblast layer and
form plexus (Raschkow plexus)
ii-Myelin-free nerve: They are found alone, sometimes in groups. They play a role in
contraction and dilatation of vessels.

Anatomy of Dental Pulp

Pulp lies in the center of tooth and shapes itself to miniature form of tooth. This
space is called pulp cavity which is divided into pulp chamber and root canal.
 Pulp cavity
Pulp Chamber
It reflects the external form of enamel at the time of eruption,but anatomy is less
sharply defined. The roof of pulp chamber consists of dentin covering the pulp
chamber occlusally.
Root Canal
It is that portion of pulp preparation which extends from canal orifice to the apical
foramen. The shape of root canal varies with size, shape, number of the roots in
different teeth.
The apical foramen is an aperture at or near the apex of a root through which nerves
and blood vessels of the pulp enter or leave the pulp cavity.
Functions of Pulp 7
The pulp lives for dentin and the dentin lives by the grace of the pulp.
Basic function of pulp:
1- Formation of dentin
2- Nutrition of dentin
3- Innervation of tooth
4- Defense of tooth.

1- Formation of Dentin:
The formative function is the production of primary and secondary dentin by the
odontoblasts. It is primary function of pulp both in sequence and importance.
Odontoblasts are differentiated from the Dental papilla adjacent to the basement
membrane of enamel organ which later deposits dentin. Pulp primarily helps in:
• Synthesis and secretion of organic matrix
• Initial transport of inorganic components to newly formed matrix
• Creates an environment favorable for matrix mineralization.
2- Nutrition of Dentin:
The nutritive function supplies nutriments and moisture to the dentin through the
blood vascular supply to the odontoblasts and their processes. Nutrients exchange
across capillaries into the pulp interstitialfluid, which in turn travels into the dentin
through the network of tubules created by the odontoblasts to contain their
processes.

3- Innervation of Tooth:
The sensory function provides sensory nerve fibers within the pulp to mediate the
sensation of pain. Dentin receptors are unique because various stimuli elicit only pain as
a response. The pulp usually does not differentiate between heat, touch, pressure, or
chemicals. Motor fibers initiate reflexes in the muscles of the blood vessel walls for
the control of circulation in the pulp.Through the nervous system, pulp transmits
sensations mediated through enamel or dentin to the higher nerve centers. Pulp
transmits pain, also senses temperature and touch.

4- Defense of Tooth:
The defensive function of the pulp is related primarily to its response to irritation by
8
mechanical, thermal, chemical, or bacterial stimuli. Such irritants can cause the
degeneration and death of the affected odontoblastic processes and corresponding
odontoblasts and the formation of replacement odontoblasts (from undifferentiated
pulpal mesenchymal cells) that lay down irregular or reparative dentin. The deposition
of reparative dentin acts as a protective barrier against caries and various other
irritating factors. In cases of severe irritation, the pulp responds by an inflammatory
reaction similar to that for any other soft tissue injury. The inflammation may become
irreversible, however, and can result in the death of the pulp because the confined,
rigid structure of the dentin limits the inflammatory response and the ability of the
pulp to recover. Odontoblasts form dentin in response to injury particularly when
original dentin thickness has been compromised as in caries, attrition, trauma or
restorative procedure.
Age Changes in Pulp
Pulp like other connective tissues, undergoes changes with time. Pulp can show changes
in appearance (morphogenic) and in function (physiologic).
Morphologic Changes
• Continued deposition of intratubular dentin-reduction in tubule diameter
• Reduction in pulp volume due to increase in secondary dentin deposition
• Presence of dystrophic calcification and pulp stones
• Decrease in sensitivity
• Reduction in number of blood vessels.
Physiologic Changes
• Decrease in dentin permeability provides protected environment for pulp-reduced
effect of irritants
• Possibility of reduced ability of pulp to react to irritants and repair itself.
Importance of Pulp in Dentistry:
Knowledge of the contour and size of the pulp cavity is essential during tooth
preparation. In general, the pulp cavity is a miniature contour of the external surface
of the tooth. Size varies among the various teeth in the same mouth and among
individuals. With advancing age, the pulp cavity usually decreases in size. Radiographs
are an invaluable aid in determining the size of the pulp cavity and any existing
pathologic condition. A primary objective during operative procedures must be
preservation of the health of the pulp.

Pulpal changes and treatment needs due to the effect of caries spread.
References:
nd
1- Textbook of Operative Dentistry, 2 Edition, Nisha Garg, Amit Garg

2- Sturdevant’s Art and Science of Operative Dentistry. Reberson TM., Heymann HO., Swift EJ. Fifth Edition.
10