PULP

BY : SNEHA SEMWAL
 CONTENT

• Introduction
• Morphological characteristics of
pulp
• Zones of pulp
• Structure of pulp
• Functions of pulp
• Age changes
• Clinical considerations
 INTRODUCTION

• Pulp is an ectomesenchymal connective tissue that

supports the dentin.
• It occupies the pulp cavity in the central part of the
teeth. Because it is the central or innermost tissue
of the tooth, it is sometimes called endodontium.
• It is surrounded by dentin on all sides except at the
apical foramen and accessory pulp canal openings,
where it is in communication with periodontal soft
tissue.
 DEVELOPMENT
• The pulp derived from ectomesenchymal cells of dental papilla.
During dentinogenesis, when the dentin forms around the dental
papilla, the innermost tissue is considered pulp .

• During bell stage of tooth development, highly cellular dental

papilla becomes well organized and well vascularized. Under the
organizing influence of inner enamel epithelium the peripheral
cells surrounding the dental papilla differentiate into odontoblasts
which forms dentin.

• Once dentin formation starts, the dental papilla is designated as

dental pulp organ. As the dentin formation proceeds the dental
papilla becomes enclosed in the central space within the tooth and
remain as pulp tissue. The pulp is considered as mature dental
papilla and the term pulp is used after dentin forms around it.
 Morphological Characterstics Of Pulp

• PULP is a soft connective tissue which

occupies center cavity .
• The portion of the tooth that houses the pulp
is divided into pulp chamber and root canal.
• The pulp chamber is the area located in the
crown of the tooth and the root canal is seen
in the root portion of each tooth.
 Coronal Pulp

• Coronal pulp is located centrally in the crown of

the teeth. In young teeth, the shape of the pulp
chamber resembles outer surface of dentin.
• The coronal pulp has pulp horns (cornua), which
are protrusions that extend into the cusps of the
tooth.
• The coronal pulp has six surfaces, namely the
occlusal, mesial, distal, buccal, lingual and the
floor.
 Radicular Pulp
• Radicular pulp (Fig. 6.1) extends from the cervical
region of crown to theroot apex. Depending on the
tooth, they vary in size, shape and number.
• It may be seen as a single extension of the coronal
pulp in case of anterior tooth which single root and
as multiple extensions in case of multi-rooted teeth.
• The radicular pulp is initially tubular in shape, which
later becomes narrower as it goes to apical region.
The radicular pulp is continuous with periapical
tissues through apical foramen.
 Apical Foramen
• Apical foramen is the opening seen at the root
apex, through which the radicular pulp
communicates with the peri-radicular area.
• It is through this opening, that the blood vessels
and nerves enter the tooth. The apical foramen is
wide in young tooth and becomes narrower with
age.
• Occasionally the opening is found on lateral side of
the root apex. Sometimes there may be two or
more foramen, separated by dentin and cementum
or cementum only.
 Accessory Canals or Lateral Canals
• Accessory canals or lateral canals are extra canals that are
present in the root dentin. They are more numerous in the
apical third of the root.
• They are formed as a result of premature loss of root sheath or
when a developing root encounters blood vessel and the
developing tooth root winds around the blood vessel, which
later forms the extra canal.
• Accessory canals may be seen in furcation area due to lack of
complete fusion of tongue like extensions of epithelial
diaphragm that helps in division of roots.
• They result in communications between the radicular pulp and
periodontal tissue which can lead to pulpoperiodontal lesions
and failure of conventional root canal treatment (RCT).
 HISTOLOGICAL STRUCTURE OF DENTAL
PULP

The structure of pulp can be studied by

microscopic examination of decalcified
sections of tooth. Histologically four
distinct zones can be distinguished which
include odontoblastic zone, cell free zone,
cell rich zone and pulp core.
 Odontoblastic Zone

• It is found at periphery of the pulp and consists of

the cell bodies of odontoblasts which lie in a
continuous row near the dentinal end of the pulp.
• Many nerve fibers enter this zone and terminate
between the odontoblasts. The odontoblastic layer
and the subodontoblastic nerve network combine
to form a sensory complex (peripheral sensory
unit) that completely envelop or encapsulate the
central pulp core.
Histology
of pulp
 Cell Free Zone

• Beneath the odontoblastic zone layer of approximately 40

microns width is seen which is devoid of cells. This layer is
called zone of Weil or subodontoblastic layer. It is more
prominent in the coronal pulp.

• The cell free zone diminishes in size or temporarily

disappears when the dentin formation occurs at a rapid rate.

• This zone contains network of nerve fibers that have lost

their myelin sheath and are known as subodontoblastic
plexus or plexus of Rashkow . These terminal, naked, free
fibers are dendrites of sensory nerves and are specific
 Cell Rich Zone
• Cell rich zone is situated just below the cell free
zone. It is a narrow zone with increased density of
cells and rich capillary network.
• Although the cell rich zone is present both in
coronal and radicular pulp, it is more prominent in
coronal pulp. It consists of fibroblasts,
undifferentiated mesenchymal cells, macrophages,
immunocompetent cells and young collagen fibers.
• It serves as a reservoir for replacing the destroyed
odontoblasts
4. Pulp Core or Pulp Proper
• The connective tissue located in the center of the
coronal and radicular pulp is referred to as pulp
core. It is a core of loose connective tissue with
abundant cellular elements which also contains the
larger nerves and bloodvessels that branch out
towards the peripheral pulp area.
• In young pulp, the core contains more cells while in
older pulp, it contains more of fibrous components
 STRUCTURAL COMPONENTS OF DENTAL
PULP

Cells in the dental pulp include

• Odontoblasts
• Fibroblasts
• Undifferentiated mesenchymal cells
• Immunocompetent cells

Extracellular components
• Fibers: Collagen
• Intercellular ground substance

Connective tissue structures

• Blood vessels
• Lymphatic channels
 CELL IN PULP
Odontoblasts
• Odontoblasts are dentin forming cells which are of
ectomesenchymal origin and are the most distinctive and
the second most prominent cells in the pulp.
• Odontoblasts have a cell body residing in pulp and
cytoplasmic process extending to the dentinal tubules.
• The synthetic odontoblasts can be distinguished under
light microscope and appears elongated and having a
basal nucleus with a basophilic cytoplasm.
• The intermediate odontoblasts show all features of
synthetic cells, but the organellae are less in number and
less prominent.
• The resting odontoblasts are stubby cells and can be
appreciated under light microscope.
 Fibroblasts
• Fibroblasts are the most numerous cell types in
the pulp, especially abundant in the coronal
pulp.
• The shape of fibroblasts vary from fusiform with
long slender protoplasmic processes to stellate
(star shaped) with shorter numerous branches.
• The fibroblasts are numerous in young teeth
and decreases with age. They help in synthesis,
maintenance and degradation of pulp matrix.
 Undifferentiated Mesenchymal Cells

• Represent the pool of reserve cells from which

connective tissue cells of pulp are derived.
• They are found along the pulp vessels in the cell rich
zone and are scattered throughout the central pulp.
• They appear larger than fibroblasts and are polyhedral
in shape with peripheral processes and a large oval
nucleus.
• They are totipotent cells and can give rise to
odontoblasts, fibroblasts, etc.
• They are more in young pulp and decreases with age,
which reduces the regenerative potential of the pulp.
 Immunocompetent Cells
• The immune-competent cells are predominated by
macrophages, dendritic cells and lymphocytes.
• Apart from these, mast cells, plasma cells,
neutrophils, lymphocytes, monocytes, etc. are also
seen.
• Macrophages are distributed in the central part of
pulp.
• Dendritic cells are antigen expressing or antigen
presenting cells and are found in and around the
odontoblast layer with dendritic processes extending
between the odontoblasts.
• Lymphocytes and Eosinophills are found
 EXTRACELLULAR COMPONENTS
• Fibers
Fibers present in the pulp are predominantly collagen type I
and III in the ratio of 55:45. The collagen fibers are distributed
throughout the pulp and a delicate network.

• Ground Substance
The ground substance is particularly abundant in young pulp and
is composed of acid mucopolysaccharides and protein
polysaccharide complex (glycosaminoglycans and proteoglycans).
Ground substance provides a medium for distribution of cells and
extracellular fibers and gives support to cells of the pulp.
 CONNECTIVE TISSUE STRUCTURES
• Blood Vessels

The pulp organ is well vascularized and is supplied by

superior and inferior alveolar arteries. The blood vessels
enter and exit the dental pulp through apical and
accessory foramina. The arterioles entering the apical
foramen follow a straight course up to the coronal pulp.
In the coronal pulp the vessels undergo extensive
branching and some travel to the periphery of the pulp
to form a subodontoblastic capillary network.
• Lymphatic Channels

 The lymph vessels that drain the pulp are thin

walled having an irregular lumen composed of
endothelial cells surrounded by an incomplete
layer of smooth muscle cells.

 The anterior teeth drains into the submental

lymph nodes and the posterior teeth drains
into the submandibular and the deep cervical
lymph nodes.
• Nerves
 Nerve supply to pulp is abundant. Nerve bundles enter
pulp through apical foramen. Pulp receives sensory
supply from trigeminal nerve and superior cervical
ganglion.
 The nerves in the pulp are non-myelinated—A δ and A
β fibers which transmits sharp pain or nonmyelinated
or “c” fibers which transmits dull pain.
 In the coronal pulp they undergo extensive branching
and advance towards the cell rich zone, again branch
and form a network of nerves in the cell free zone
below the odontoblastic zone. This network of nerves
are known as plexus of Raschkow.
 FUNCTIONS OF DENTAL PULP

Nutritive
The blood vascular system of dental pulp
nourishes and maintains the vitality of
dentin by providing oxygen and nutrients
to the odontoblasts and their processes, as
well as providing a continuing source of
dentinal fluid.
 Sensory

The pulp has both myelinated and non-

myelinated nerve fibers. Sensory nerve fibers
present in the pulp respond to stimuli such as
changes in temperature, pressure, vibration
and chemical agents that affect the dentin and
pulp.
 Inductive

The dental papilla, the primordium of dental

pulp performs an important function in
determining the crown pattern and
differentiation of ameloblasts through its
inductive influence.
 Formative

• The pulp performs the formative function

because of the presence of odontoblasts
which are the formative cells of dentin.
• These cells are involved in the support,
maintenance and continued formation of
dentin.
 Defensive and Protective

• The pulp responds to irritation and protects itself and

the vitality of the tooth by producing reparative
dentin or inducing dentinal sclerosis which can block
the dentinal tubules and prevent the irritating
stimulus reaching the pulp.
• Pulp being a highly vascularized connective tissue
may initiate an inflammatory reaction in response to
an irritating stimulus. Various immune cells such as
macrophages, lymphocytes, plasma cells,
neutrophils, etc. are involved which aid in the
AGE OR REGRESSIVE CHANGES IN PULP

Size
With age there is progressive
reduction in pulp size due to
continuous secondary dentin
deposition. As a result the pulp horns
become less prominent or even
obliterated.
 Cellular and Fibrous Components

• In aging pulp the fibrous component becomes more

prominent. The number of collagen fibers increases with
age and in older pulp the fibrils aggregate into fibers of a
great dimension.
• They may be more diffuse and randomly arranged in
coronal pulp but are in bundled form in radicular pulp. In
older teeth, more fibrous appearance of the pulp may be
apparent, possibly due to reduction in size of pulp reducing
the space available for their
distribution.
• The number of cells in the pulp including fibroblasts and
odontoblasts decreases with age. The cells also show a
decrease in the amount of cytoplasm and cytoplasmic
 Changes in Blood Supply and Innervations

• Loss and degeneration of myelinated and

unmyelinated axons occur which can be correlated
with an age related reduction in sensitivity. As this
progresses, the number of nerves gets greatly
diminished.

• There is a decrease in the blood supply as the

apical foramen is almost obliterated by secondary
dentin and cementum which initiates most of the
other changes in the pulp.
 Reduction in Sensitivity and Healing Potential

• As age advances the sensitivity and healing or

reparative capacity of pulp decreases. Decreased
sensitivity can be directly related to nerve
degeneration.

• Overall reduction in vascular supply and cellular

component could be responsible for decreased
reparative capacity of pulp.
 Pulpal Calcifications
• Calcification may occur in pulp tissue as a result of
aging or external stimuli.
• These may be nodular, calcified masses referred to
as pulp stones or diffuse calcifications.
• Pulp stones or denticles are nodular calcified
masses present in coronal or radicular pulp. They
are seen in functional as well as embedded or
unerupted teeth.
• Incidence increases with age: 66% between the age
group of 10–30 years, 80% between 30 and 50 years
and 90% above 50 years
Pulp stones
Pulp stones are classified based on its relation to
adjacent dentin into three groups :
 Free pulp stones
 Attached pulp stones
 Embedded pulp stones

Depending on structure pulp stones can be

grouped into :
 True denticles
 False denticles
• Free pulp stones : are those calcified structures
lying free in the pulp without being attached to the
dentin.
• Attached pulp stones : Those which are attached to
the dentin.
• Embedded pulp stones : When pulp stone is
completely surrounded by dentin it is called
embedded pulp stone. They are believed to be
formed as free pulp stones which later becomes
attached or embedded due to progressive dentin
formation.
Pathogenesis of pulp calcifications

Types of pulp calcifications

 True denticles :

 True denticles are localized masses of calcified tissue having tubular

structure containing odontoblast processes and thereby resembling
dentin and hence called as true denticles.
 They are very small and are seen only rarely. The true denticles
are thought to be formed due to entrapped remnants of root sheath
in pulp. These cells may induce the differentiation of odontoblasts
which form calcified structures; resembling dentin.

False denticles :

 False denticles are localized masses of calcified tissue having a

laminated structure made of concentric layers of calcium deposited
around a central nidus, which could be dead cells. They do not have
a tubular structure or structural resemblance to dentin. They are
larger than the true denticles and may fill the entire pulp chamber.
 DIFFUSE CALCIFICATION

• Diffuse calcification is composed of small calcified particles

with a few larger masses. The calcified structures are
arranged as linear strands parallel to the long axis of pulp.
They are found to be closely associated with blood vessels
with an orientation parallel to the vessels and nerves. It is
usually seen only in radicular pulp.

• Clinical Significance :
Affected tooth is vital, and usually symptomatic but
sometimes manifest mild neurologic pain. Pulpal calcifications
may cause difficulty in extripating the pulp during RCT.
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