GENERAL FEATURES

Every

person normally has a total of 52 pulp organs, 32 in the permanent & 20 in the primary teeth.

The

total volumes of all the permanent teeth pulp organs is 0.38 cc. The mean volume of a single adult human pulp is 0.02 cc.
Molar

pulps are 3 to 4 times larger than incisor pulps. Cuspid has the longest pulp. Mandibular central incisor has the smallest pulp.
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 The

average size of apical foramen of the maxillary teeth in the adult is 0.4 mm. the mandibular teeth it is slightly smaller, being smaller, being 0.3 mm in diameter.

In

ACCESSORY CANALS Found in apical third region & furcation region.

 The

average length of time a primary pulp functions in the oral cavity is only about 8.3 years. amount of time can be divided into three periods :Pulp organ growth Pulp maturation Pulp regression

This -

 Pulp

of the permanent teeth undergoes development for about 12 years, 4 months.

The

maxillary arches require slightly longer to complete each process of development than do the mandibular arches.

The pulp is circumscribed by the specialized odontogenic region composed of : The The The

odontoblasts (the dentin forming cells) cell-free zone (Weils zone), and

cell-rich zone

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 Are

the most numerous cell types in the pulp. Function in collagen fiber formation . Have the typical stellate shape & extensive processes that contact & are joined by intercellular junctions. Have abundant rough-surfaced endoplasmic reticulum, mitochondria & other cell organelles. Also have the capability of ingesting & degrading this same matrix.

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 In

the older pulp, they appear rounded or spindle shaped with short processes & exhibit fewer intracellular organelles. They are then termed fibrocytes.

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 They Only

are the primary cells in the very young pulp.

a few are seen in the pulps after root completion. larger than fibroblasts.

Appear

Are

polyhedral in shape with peripheral processes & large oval nuclei.

found along pulp vessels, in the cell-rich zone & scattered throughout the central pulp.
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Are

 Viewed

from the side, they appear spindle

shaped.
They

are believed to be a totipotent cell & when need arises they may become odontoblasts, fibroblasts, or macrophages.

Decrease

in number in old age.

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 The

second most prominent cell in the pulp.

Reside

adjacent to the predentin with cell bodies in the pulp & cell processes in the dentinal tubules. 5 to 7 um in diameter & 25 to 40 um in length.

About Cell

bodies are columnar in appearance with large oval nuclei, which fill the basal part of the cell.
plasma membranes of adjacent cells exhibit junctional complexes.
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The

 The

tight & intermediate junctional complexes are important for maintaining the integrity of the odontoblastic layer & preventing the ingress of foreign material, for example toxins & bacterial products, from the oral cavity.

The

tight junctions provide mechanical attachment between adjacent odontoblasts. Intermediate junctions have shown to extend around the perimeter of odontoblasts as narrow bands.
The

gap junctions are areas of reduced electrical resistance that also allow selective exchange of substances between odontoblasts.
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 Near

the pulpal-predentin junction the cell cytoplasm is devoid of organelles. process of the cell contains no endoplasmic reticulum, but during the early period of active dentinogenesis it does contain occasional mitochondria & vesicles. are columnar in the crown & cuboidal in the root.

The

They Close

to the apex of an adult tooth the odontoblasts are ovoid & spindle shaped, appearing more like osteoblasts.

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 These

are histiocytes, or macrophages, mast cells, and plasma cells.

addition, there eosinophils, basophils, monocytes. are neutrophils, lymphocytes, and

In

These

cells emigrate from the pulpal blood vessels & develop characteristics in response to inflammation.
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 Blood

vessels of both the pulp & periodontium arise from the inferior or superior alveolar artery. the vessels enter the tooth their walls become considerably thinner than those surrounding the tooth. pressure is among the highest of body tissues.

As

Pulpal The

flow of blood in arterioles is 0.3 to 1 mm/s, in venules 0.15 mm/s , & in capillaries 0.08 mm/s.
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 The

largest arteries in the human pulp are 50 to 100 um in diameter, thus equaling in size arterioles found in the most areas of the body. are capillary associated fibroblasts, have been suggested as progenitor cells for replacement of odontoblasts.

Pericytes

Veins

& venules measure 100 to 150 um in diameter.

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 Those

draining the anterior teeth pass to the submental lymph nodes;

Those

of the posterior teeth pass to submandibular and deep cervical lymph nodes.

the

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 The

sensory & postganglionic sympathetic nerves that innervate the dental pulp originate in the trigeminal & superior cervical ganglion & enter the teeth through the apical foramen. the neural receptor in the pulp, the central process of a trigeminal sensory neuron traverses the trigeminal ganglion located in the floor of the middle cranial fossa. central process then synapses on a second-order neuron located in the subnucleus caudalis of the brainstem trigeminal complex.
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From

The

 The

majority of second order neurons then decussate & ascend to synapse on neural cell bodies located on the ventro postero medial nucleus of the thalamus. third order neurons ascend to the area of the postcentral gyrus concerned with the orofacial region.

The

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 First

order neuron - detects a stimulus and transmits the signal to the spinal cord or brain stem. order neuron -continues to the thalamus at upper end of brainstem. order neuron -carries the signal to the cerebral cortex.

Second

Third

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 The

majority of the nerves that enter the pulp are non-myelinated. Many of these gain a myelin sheath later in life. Are sympathetic in nature. Function in vasoconstriction.
The

large myelinated fibers mediate the sensation of pain.

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 Rashkow.
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The

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Inductive - To induce oral epithelial differentiation into dental lamina & enamel organ formation. Formative - Produce the dentin that surrounds & protects the pulp. Nutritive - Nourishes the dentin through odontoblasts & by means of blood vascular system. Protective -Respond with pain to all stimuli. Defensive or reparative - Produce reparative dentin & mineralize any affected dental tubules.

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CELL CHANGES Cells decrease in number.

Decrease The

in size & number of cytoplasmic organelles.

fibroblasts in the aging pulp exhibit less perinuclear cytoplasm & possess long, thin cytoplasmic processes.

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 Increase

in fibers in the pulp organ is gradual. Any external trauma such as dental caries or deep restoration usually causes a localized fibrosis or scarring effect. Collagen increase is noted in the medial & adventitial layers of blood vessels as well. Decrease in the size of pulp. Plaques may appear in pulpal vessels. Calcifications in the walls of blood vessels is found most often in the region near the apical foramen.
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 Are

nodular, calcified masses appearing in either or both the coronal or root portions of the pulp organ. as true denticles, false denticles, & diffuse calcifications.

Classified

The

structure of true denticles is similar to dentin. Are rare & lie close to the apical foramen.
Development

of true denticle is caused by the inclusion of remnants of the epithelial root sheath within the pulp.
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 Do

not exhibit dentinal tubules. as concentric layers of calcified tissue.

Appear In

the center, there may be remnants of necrotic & calcified cells. of thrombi in blood vessels, called phleboliths, may also serve as nidi for false denticles.

Calcification

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Appear as irregular calcific deposits, usually following collagenous fiber bundles or blood vessels. Are usually found in the root canal & less often in the coronal area.

Also classified according to their location in relation to the surrounding dentinal wall; free, attached, & embedded denticles.
The incidence as well as size of pulp stones increase with age.
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 The

wide pulp chamber in the tooth of a young person will make a deep cavity preparation hazardous. opening a pulp chamber for treatment becomes necessary, its size and variation in shape must be taken into consideration. shape of the apical foramen and its location may play an important part in the treatment of root canals. lesion due to accessory canals.
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If

The

Pulpal-periodontal

When filling materials contain harmful chemicals (e.g. acid in silicate cements and monomer in composites), an appropriate cavity liner should be used prior to the insertion of restorations.
The vitality of the pulp depends on its blood supply. The instruments called vitalometers test the reaction of the pulp to electrical or thermal stimuli.

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