PULP

Contents:

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 1. Anatomy

2. Structural features

3. Cells

4. Fibres

5. Vascular supply

6. Nerve supply

ANATOMY

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General features:

The dental pulp occupies the center of each tooth and consists of

soft connective tissue. Every person normally has a total of 52 pulp organs,

32 in the permanent and 20 in the primary teeth. Each of these organs has a

shape that conforms to that of the respective tooth. They have a number of

morphologic characteristics that are similar. Each pulp organ resides in a

pulp chamber surrounded by dentin containing the peripheral extensions of

the cells that formed it. The total volumes of all the permanent teeth pulp

organs is 0.38cc, and the mean volume of a single adult human pulp is

0.02cc. molar pulps are three to four times larger than incisor pulps.

Coronal pulp:

Each pulp organ is composed of a coronal pulp located centrally in the

crowns of teeth and a root or radicular pulp. The coronal pulp in young

individuals resembles the shape of the outer surface of the crown dentin.

The coronal pulp has six surfaces; the Occlusal, the mesial, the distal, the

buccal, the lingual, and the floor. It has pulp horns, which are protrusions

that extend into the cusps of each tooth. The number of these horns thus

depends on the cuspal number. The cervical region of the pulp organs

constricts as does the contour of the crown, and at this zone the coronal

pulp joins the radicular pulp. Because of continuous deposition of dentin,

the pulp becomes smaller with age. This is not uniform through the coronal

pulp but progresses faster on the floor than on the roof of side walls.

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Radicular pulp:

The radicular pulp is that pulp extending from the cervical region of the

crown to the root apex. In the anterior teeth the radicular pulps are single

and in posterior ones multiple. They are not always straight and vary in

size, shape, and number. The radicular portions of the pulp organs are

continuous with the periapical connective tissues throught he apical

foramen or foramina. The dentinal walls taper, and the shape of the

radicular pulp is tubular. During root formation the apical end is a wide

opening limited to an epithelial diaphragm. As growth proceeds, more

dentin is formed, so that when the root of the tooth has matured the

radicular pulp is narrower. The apical pulp canal is made smaller also

because of apical cementum deposition.

STRUCTURAL FEATURES

The central region of both the coronal and the radicular pulp contains large

nerve trunks and blood vessels. Peripherally, the pulp is circumscribed by

the specialized odontogenic region composed of (1) the odontoblasts (the

dentin-forming cells, (2) the cell-free zone (Weil’s zone), and (3) the cell-

rich zone. The cell-free zone is a space in which the odontoblast may move

pulpward during tooth development and later to a limited extent in

functioning teeth. This may be why the zone is inconspicuous during early

stages of rapid dentinogenesis since odontoblast migration would be

greatest at that time. The cell-rich layer is composed principally of

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fibroblasts and undifferentiated mesenchymal cells. The latter are

distinctive because they lack a ribosome-studded endoplasmic reticulum

and have mitochondria with readily discernible cristernae. During early

dentinogenesis there are also many young collagen fibres in this zone.

Intercellular substance:

The intercellular substance is dense and gel like in nature, varies in

appearance from finely granular to fibrillar, and appears more dense in

some areas, with clear spaces left between various aggregates. It is

composed of both acid mucopolysaccharides and protein polysaccharide

compounds. During early development, the presence of chondroitin -A,

chondroitin B and hyaluronic acid has been demonstrated in abundance.

Glycoproteins are also present in the ground substance. The aging pulp

contains less of all of these substances. The ground substance leads support

to the cells of the pulp while it also serves as a means for transport of

nutrients from the blood vessels to the cells, as well as for transport of

metabolites from cells to blood vessels.

Fibroblasts. The pulp organ is said to consist of specialized connective

tissue because it lacks elastic fibers. Fibroblasts are the most it lacks elastic

fibers in the pulp. As their name implies, 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. Under the light

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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. There is

some difference in appearance of these cells depending on the age of the

pulp organ. 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 In the course of development the relative number of

cellular elements in the dental pulp decreases, whereas the fiber population

increases. In the embryonic and immature pulp the cellular elements

predominate, while in the mature pulp the fibrous components

predominate. 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.

Fibers. The collagen fibers in the pulp exhibit typical cross striations at

64nm (640A) and range in length from 100nm or more. Bundles of these

fibers, appear throughout the pulp. In very young pulp fine fibers ranging

in diameter from 10 to. 12 nm (100 to 120 A have been observed. Their

significance is unknown. Pulp collagen fibers do not contribute to dentin

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matrix production, which is the function of the odontoblast. After root

completion the pulp matures and bundles of collagen fibers increase in

number. They may appear scattered throughout the coronal or radicular

pulp, or they may appear in bundles. These are termed diffuse or bundle

Collagen depending on their appearance, and their presence may relate to

environmental trauma Fiber bundles are most prevalent in the root canals,

especially near the apical region.

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 in

shape with peripheral processes a large oval nuclei They are found along

pulp vessels, in the cell rich zone and scattered throughout the central pulp.

Viewed from the side, they appear spindle shape.

They are believed to be a totipotent cell and when need arises they

-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 sell bodies in the pulp and cell

processes in the dentinal tubule. They are approximately 0 to 0 µm in

diameter and 49 µm in length. They have a constant location adjacent to

the predentin.

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 The cell bodies of the odontoblasts are columnar in appearance with

large oval nuclei, which fill the basal part of the cell. Immediately adjacent

to the nucleus basally is rough surfaced endoplasmic reticulum and the

Golgi apparatus. The cells- in the odontoblastic row lie very close to each

other, and the plasma membranes of adjacent cells exhibit junctional

complexes. Further toward the apex of the cell appears an abundance of

rough-surfaced endoplasmic reticulum. Now the pulpal predentin junction

the cell cytoplasm is devoid of organelles. The clear- terminal part of the

cell body and the adjacent intercellular junction is described by some as the

terminal Lae-apparatus of the odontoblast. At this zone the cell constricts to

a diameter 8 to 4 µm where the cell process enters the predentinal tubule.

The process of the cell contains no endoplasmic reticulum, but during the

early period of active dentinogenesis- it does contain occasional

mitochondria and vesicles.

During the later stages of dentinogenesis these are less frequently seen.

There is also a striking difference in the cytoplasm of the young cell body,

active in dentinogenesis, and the older cell. During this early active phase

the Golgi apparatus is more prominent, the rough-surfaced endoplasmic

reticulum is more abundant, and numerous mitochondria appear throughout

the odontoblast. A great number of vesicles are seen along the periphery of

the process where there is evidence of protein synthesis along the tubule

wall. The cell actually increases in size as its process lengthens during

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dentin forma When the cell process becomes 2mm long, it is then many

times greater in volume than the cell body. 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. Close to the apex of an adult tooth the

odontoblasts are ovoid and spindle shaped, appearing more like osteoblasts

than odontoblasts, but they are recognized by their processes extending

into the dentin. In areas close to the apical foramen the dentin is irregular

in appearance.

Defense cells: In addition to fibroblasts, odontoblasts, and the cells that are

a part of the neural and vascular systems of the pulp, there are cells

important to the defense-of the pulp.

These are histiocytes macrophages, mast cells, and plasma cells. In

addition, there are the blood vascular elements such as the neutrophils

(PMNs), eosinophils, basophils, lymphocytes and monocytes These latter

cells emigrate from the vessels and develop characteristics in response to

inflammation.

The histiocyte or macrophage, is an irregularly shaped cell with short blunt

processes. In the light microscope the nucleus is somewhat smaller, more

rounded, and darker staining than that of fibroblasts, and it exhibits

granular cytoplasm. When the macrophages are inactive and not in the

process of ingesting foreign materials, one has difficulty distinguishing

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them from fibroblasts. In the case of a pulpal -inflammation these cells

exhibit, granules and vacules in their cytoplasm, and their nuclei increase

in size and exhibit a prominent nucleolus. These cells are usually

associated with small blood vessels and capillaries. Ultrastructurally the

macrophage exhibits a rounded outline with short, blunt processes.

Invaginations of the plasma membrane are noted, as are mitochondria,

rough-surfaced endoplasmic reticulum, free ribosomes, and also a

moderately dense nucleus. The distinguishing feature of- macro -is

aggregates of vesicles, or phagocytosis which contain phagocytosed dense

irregular bodies. Lymphocytes and eosinophils are found extravascularly in

the normal pulp, but during inflammation they increase noticeably in

number. Mast cells are also seen along vessels in 'the inflamed pulp. They

have a round nucleus and contain many dark-staining granules in the

cytoplasm and their number increases during inflammation.

The plasma cells are seen during inflammation of the pulp . With the

light microscope the plasma cell nucleus appears small and concentric in

the cytoplasm. The chromatin of the nucleus is adherent to the nuclear

membrane and gives the cell Cartwheel appliance The cytoplasm of this

cell is basophilic with a light-stained Golgi zone adjacent to the nucleus.

Under the electron microscope these cells have a densely packed, rough

surfaced endoplasmic reticulum. Both immature and mature cells may be

found. The mature type exhibits a typical small eccentric nucleus and more

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abundant cytoplasm. The plasma cells function in the production of

antibodies.

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 also drain the same veins in both the mandibular and

maxillary regions. The communication of the vessels of the pulp with the

periodontium, in addition to the apical connections, is further enhanced by

connections through the accessory canals These relationships are of

considerable clinical significance in the event of a potential pathologic

condition in either the periodontium or the pulp, because it has a potential

to spread through the accessory and apical canals. Although branches of the

alveolar arteries supply both the tooth and its supporting tissues, those

entering the pulp are different in structure from the branches to the

periodontium. As the vessels enter the tooth their walls become

considerably those surrounding the tooth.

Small arteries and arterioles enter the apical canal and pursue a

direct route to the coronal pulp. Along their course they give off numerous

branches in the radicular pulp that pass peripherally to form a plexus till

the odontogenic region. Pulpal blood flow is mew rapid than in most

areas of the body. This is perhaps attributable to the fact that the pulpal

pressure is among the highest of-body tissues. The flow of blood in

arterioles is 0.3 to1mm per second, in venules approximately and in

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capillaries about 0.08mm per second. The largest arteries in the human

pulp are 50 to 100 100µm in diameter, thus equaling in size arterioles

found in most areas of the body.

Terminal arterioles with diameters of A to 15µm appear peripherally in the

pulp. The endothelial cells of these vessels contain numerous

micropinocytotic vesicles, which function in transendothelial fluid

movement. A single layer of smooth muscle cells surrounds these small

vessels. Occasionally a fibroblast or pericyte lies on the surface of these

vessels. Pericytes are capillary associated fibroblasts, and their nuclei can

be distinguished as round or slightly oval bodies closely associated with

the outer surface of the terminal arterioles or precapillaries Some authors

call the smaller diameter arterioles precapillaries. They are slightly larger

than the terminal capillaries and exhibit a complete or incomplete single

layer of muscle cells surrounding the endothelial lining These range in size

from 4 to 12µm.

Veins and venules that are larger than the arteries also appear in the

central region of the root pulp. They measure 100 to 150µm to 160 µm in

diameter, and their walls appear less regular than those of the arteries

because of bends and irregularities along their course. The microscopic

appearance of the veins is similar to that of the arteries except that they

exhibit much thinner walls in relation to the size of the lumen. The

endothelial cells appear more flattened, and their cytoplasm does not

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project into the lumen. Fewer intracytoplasmic filaments appear in these

cells than in the arterioles. The tunica media consists of a single layer or

two of thin smooth muscle cells that wrap around the endothelial cells and

appear discontinuous or absent in the smaller venules. The basement

membranes of these vessels are thin and less distinct than those of

arterioles. The adventitia is lacking or appears as fibroblasts and fibers

continuous with the surrounding pulp tissue.

Occasionally two venous loops will be seen connected by an anastomosing

branch. Both venous anastomosis and arteriole venous anastomosis occur

in the pulp pulp The arteriole venous shunts may have an important role in

regulation of pulpal blood flow. Frequently arteriole or precapillary loops

with capillaries are found underlying the odontogenic zone in the coronal

pulp.

Blood capillaries, which appear as endothelium-lined tubes, are 8 to

10 Rm in diameter. The nuclei of these cells may be lobulated and have

cytoplasmic projections into the luminal surface. The terminal network of

capillaries in the coronal pulp appears nearly perpendicular to the main

trunks. The vascular network passes among the odontoblasts and underlies

them as well. A few peripheral capillaries found among the odontoblasts

have fenestrations in the endothelial cells. These pores are located in the

thin part of the capillary wall and are spanned only by the thin diaphragm

of contacting inner and outer plasma membranes of endothelial cells. These

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fenestrated capillaries are assumed to be involved in rapid transport of

metabolites at a time when the odontoblasts are active in the process of

dentinal matrix formation and its subsequent calcification. Both fenestrated

and continuous terminal capillaries are found in the odontogenic region.

During active dentinogenesis capillaries appear among the odontoblasts

adjacent to the predentin. Later, after the teeth have reached occlusion and

dentinogenesis slows down, these vessels usually retreat to a

subodontoblastic position.

Lymph vessels. The presence of lymph vessels in the dental pulp is

questioned by some and agreed upon by other investigators. Support for

this system stems from investigators who use injection of fine particulate

substances into the dentin or peripheral pulp-, which are subsequently

reported present in some of the thin-walled vessels that exit through the

apical foramen. Lymph capillaries. are described as endothelium lined

tubes that join thin-walled lymph venules or vein in the central pulp. The

larger vessels have an irregular-shaped lumen composed of endothelial

cells surrounded by an incomplete layer pericytes or smooth muscle cells

or both. They are further characterized by absence of red blood cells and

presence of lymphocytes. Absence of basal lamina adjacent to the

endothelium has also been reported. Lymph vessels draining the pulp and

periodontal ligament have a common outlet. Those draining the 'anterior

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teeth pass to the submental lymph nodes; those of the posterior teeth pass

to the submandibular and deep-cervical lymph nodes.

Nerves. The abundant nerve supply in the pulp follows the

distribution of the Mood vessels. The majority of the nerves that enter the

pulp are Many of these gain a myelin sheath later in life. The

nonmyelinated nerves are found in close association with the blood vessels

of the pulp and many are sympathetic in nature. They have terminals on the

muscle cells of the larger vessels and function in vasoconstriction. Thick

nerve bundles enter the apical foramen and proceed to the coronal area

where their fibers separate and radiate peripherally to the " odontogenic

zone. The number of fibers in these bundles varies greatly, from as few as

10 to more than 1200 The larger fibers range between 5 and 13 µm

although the majority are smaller than 4 µm 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).

Both myelinated axons, ranging from 2 to 5 µm in diameter, and minute

nonmyelinatcd fibers of approximately 200 to 1600 µm (2000 to 16,000 in

size make up this layer of nerves. The parietal layer develops gradually,

becoming prominent when root formation is complete.

Nerve endings. Nerve axons from the parietal zone pass through the cell-

rich and cellfree zones and either terminate among or pass between the

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odontoblasts to terminate adjacent to the odontoblast processes at the pulp-

predentin border or in the dentinal tubules . Nerve terminals consisting of

round or oval enlargements of the terminal filaments contain,

microvesicles, small, dark, granular bodies, and mitochondria. These

terminals are very close to the odontoblast plasma membrane, separated

only by a 20 µm (200 A) cleft. Many of these indent the odontoblast

surface and exhibit a special relationship to these cells. Most of the nerve

endings located among the odontoblasts are believed to be sensory

receptors. . Some sympathetic endings are found in this location as well.

Whether they have some function relative to the capillaries or the

odontoblast in dentinogenesis is not known. The nerve axons found among

the odontoblasts and in the cellfree and cell-rich zones are nonmyelinated

but are enclosed in a Schwann cell covering. 14 is presumed that these

fibers lost their myelin sheath as they passed peripherally from the parietal

zone. More nerve fibers and endings are found in the pulp horns than in

other peripheral areas of the coronal pulp.

It is a feature, unique to dentin receptors that environmental stimuli always

elicit pain as a response. Sensory response in the pulp cannot differentiate

between heat, touch, pressure, or chemicals. This is because the pulp

organs lack those types of receptors that specifically distinguish these other

stimuli.

FUNCTIONS

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Inductive. The first role of the pulp anlage is to induce oral-epithelial

differentiation into dental lamina and enamel organ formation. The pulp

anlage also induces the developing enamel organ to become 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 dentin through the odontoblasts and their

processes and by means of the Wood vascular system of the pulp.

Protective. The sensory nerves in the tooth respond with pain to all stimuli

such as heat, cold, pressure, operative cutting procedures, and chemical

agents. The nerves also initiate reflexes that control circulation pulp. This

sympathetic function is a reflex, providing stimulation to visceral motor

fibers terminating on the muscles of the blood vessels.

Defensive or reparative. The pulp is an organ with remarkable reparative

abilities. It responds to irritation, whether mechanical, thermal, chemical,

or bacterial, by producing reparative dentin and mineralizing any affected

dentinal tubules. Both the reparative dentin created in the pulp and the

calcification of the tubules (sclerosis) attempts to wall off the pulp from the

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source of irritation. Also, the pulp may become inflamed due to bacterial

infection or by cutting action and placement of an irritating restorative

material. The pulp cells, all of which aid in the process of repair of the

pulp.

References:
1. Essentials of Oral Histology : J.K. Avery.
2. Orban's Oral Histology : S.N. Bhaskar.
3. Introduction to Dental Anatomy : Scott & Symons.
4. Text Book of Histology : Ross & Reith.
5. Oral Structural Biology : H.E.Schroeder.
6. Glickmann's Clinical Periodontology : Carranza.

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