PULP

by Jojo Quinitio, DDM

INTRODUCTION

the pulp is the soft connective tissue located in the central portion
of the tooth
the central part of the pulp is composed of large veins, arteries
and nerve trunks surrounded by fibroblasts and collagen fibers
embedded in an intercellular matrix

on the peripheral borders of the pulp can be found the

odontoblasts

the predominant cell type in the pulp is the fibroblast; the 2nd
most prevalent cell type is the odontoblast

intercellular matrix of pulp consists of glycoaminoglycans and

collagen fibers
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FUNCTIONS OF THE PULP

most important function of the pulp is to provide

vitality to the teeth with its cells, blood vessels and
nerves

however, the loss of the pulp (after a root canal

therapy) does not mean that the tooth will be lost; the
tooth can still function without the pulp
other functions of the pulp include:
1.

inductive early in the developmnet of the tooth, the

dental papilla interacts with surrounding tissues to
initiate tooth formation

2.

formative the odontoblasts on the outer layer of the

pulp forms the dentin

3.

protective /reparative the pulp protects against

injury such as caries, extreme heat or cold, pressure
by forming reparative dentin, sclerotic dentin

4.

nutritive carries oxygen and nutrition to the

developing and functioning tooth

5.

sensory rich innervation of the pulp alerts the

person when injury occurs on the tooth

ANATOMY OF THE PULP

The 2 forms of pulpal tissue are coronal and

radicular pulp
a.

Coronal pulp

occupies the crown of the tooth and follows the shape of

the outer surface of the crown
it has pulp horns which are protrusions of the pulp that
extend into the cusps of the teeth
the number of pulp horns depends on the number of
cusps
with age, the coronal pulp decreases in size due to
continued dentin formation
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b.

Radicular pulp

part of the pulp that

extends from the
cervical region to the
apex of the root
the radicular pulp of
the anterior teeth is
singular while the
posterior teeth have
multiple root pulps
it is tapered or conical
in shape
it also becomes smaller
with age because of
continued dentin
formation

APICAL FORAMEN AND ACCESSORY

CANALS

the apical foramen is the opening of the root pulp into the
periodontium

this opening varies from 0.3 0.6 mm

the apical foramen generally is located in the center of newly

formed root apex but moves away from the center with age

if several apical canals exist, the largest is the apical foramen

while the smaller lateral canals are called the accessory canals

accessory canals are located on the lateral sides of the apical

region of the root and may also be found on the bifurcation
area of multirooted teeth

blood vessels and nerves enter and exit the pulp through the
apical foramen

ZONES OF THE PULP

4 zones are seen when the pulp is observed

microscopically (from outer to inner)
a.
b.
c.
d.

Odontoblastic layer
Cell-free zone
Cell-rich zone
Pulpal core

Odontogenic zone

A.

Odontoblastic Layer
this layer consists of the cell bodies of odontoblasts whose
odontoblastic processes are located in the dentinal tubules
also found in this layer are the cell bodies of the afferent
axons from the dentinal tubules; these are located between
the cell bodies of the odontoblasts

B.

Cell-free Zone
also called zone of Weil
not really free of cells; it just appears free of cells at lower
microscopic power
in reality there are cells present but are fewer than in the
odontoblastic layer
this zone contains bundles of reticular fibers, numerous
capillaries and nerves

C.

Cell-rich zone
has an increased density of cells compared to the cell-free
zone but does not contain as many cells as the
odontoblastic layer
contains fibroblasts, undifferentiated mesenchymal cells,
lymphocytes, macrophages
this zone also has a more extensive vascular system than
the cell-free zone
below the cell-rich zone can be found the plexus of
Raschkow or parietal layer of nerves

D.

Pulpal core
innermost zone of the pulp
consists of many cells and extensive vascular supply
similar to the cell-rich zone

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CELLS IN THE PULP

the principal cells of the pulp are

a.
b.
c.
d.

odontoblasts
fibroblasts
undifferentiated ectomesenchymal cells
macrophages and other immunocompetent cells

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A.

Odontoblasts

the odontoblasts form a layer lining the periphery of the

pulp and
in the crown of the tooth, the odontoblasts often appear to
be arranged in a palisade pattern some 3 5 cells deep
the odontoblasts in the coronal pulp are larger than the
ones in the root area
in the pulp horns, the odontoblasts appear as tall, columnar
cells about 35 long; in the radicular pulp, they are
cuboidal and in the apical area of the root they are flat

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the morphology of the odontoblasts reflect their

functional activity:
1.

2.

3.

active (secretory) odontoblast appears elongated, has a

basal nucleus, much basophilic cytoplasm, organelles are
prominent such as numerous vesicles, endoplasmic
reticulum, well developed Golgi complex and numerous
mitochondria
resting (or aged) odontoblast appears small with little
cytoplasm and the nucleus is located at the apex of the cell;
decreased amounts of organelles because of decreased
functional activity
transitional stage appears narrower than the active
odontoblast; nucleus is displaced from the basal location;
exhibits condensed chromatin; amount of ER is reduced
and autophagic vacuoles are present

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B.

Fibroblasts

fibroblasts are the predominant cells in the pulp

they are most numerous in the coronal pulp where they
form the cell-rich zone
function of fibroblasts form and maintain the pulp matrix
which consists of collagen and ground substance
the fibroblasts of the pulp also has the ability to ingest and
degrade collagen
the appearance of the fibroblast reflects their functional
state:
1.
in young pulp fibroblasts produce collagen and ground
substance; they have a large nucleus that is centrally
located and have many processes and organelles
2.

in aged pulp fibroblasts appear smaller and shaped

like a spindle with few organelles

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C.

Undifferentiated ectomesenchymal cells

the undifferentiated mesenchymal cells reperesent the pool

from which the connective tissue cells of the pulp are derived
these undifferentiated cells can transform into new
odontoblasts or fibroblasts depending on the need of the tooth
found throughout the cell-rich zone and pulp core
they appear as large polyhedral cells with centrally located
nucleus; have abundant cytoplasm and cytoplasmic extensions
in older pulps, the number of undifferentiated mesenchymal
cells and other cells diminishes so that the regenerative ability
of the pulp are reduced

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D.

Inflammatory cells

macrophages are located throughout the pulp center

they are involved in eliminating dead cells which is
important in the turnover of cells in the pulp
in normal pulps, T lymphocytes are also found but B
lymphocytes are not common
some leukocytes (neutrophils and eosinophils) are also
present in blood vessels in the pulp; eosinophils are seen
only when there is an allergic reaction
plasma cells can also be seen in the pulp but only when
there is inflammation
antigen-presenting dendritic cells are found in and around
the odontoblast layer; their function is to capture and
present foreign antigen to the T cells
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PULP MATRIX AND GROUND SUBSTANCE

OF THE PULP

the pulp matrix consists of collagen fibers and ground

substance

collagen fibers in the pulp are mainly type 1 and 3

type 1 collagen are mainly produced by the

odontoblasts while type 3 collagen is produced by the
fibroblasts

the ground substance is composed mainly of

glycoaminoglycans, glycoproteins and water
function of ground substnace is to transport nutrients
from the blood vessels to the cells and remove
metabolites from the cells to the blood vessels

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INNERVATION OF THE PULP

nerves enter the pulp through the apical foramen and

also through the accessory foramen
these nerves divide into branches and in the cell-free
zone they contribute to an extensive plexus of nerves
called the plexus of Raschkow or parietal layer of
nerves
from this plexus the nerves pass into the odontogenic
zone and then terminate among the odontoblasts or
extend into the dentinal tubules
most nerves that enter the pulp are myelinated but as
they travel to the coronal portion, they lose their
myelin sheaths and so there are more unmyelinated
nerves in the coronal pulp

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the nerve bundles that enter the pulp consists of

1.
2.

sensory afferent nerves of the trigeminal nerve

sympathetic (motor) branches from the superior cervical
ganglion innervates the smooth muscle cells of the
arterioles and regulate the blood flow in the capillary
network of the pulp

the sensory nerves of the pulp can only percieve pain

(nociception) and interprets all stimuli (whether
heat, cold, pressure) only as pain

there are 2 types of nerves that mediate the sensation

of pain:
1.
2.

A-fibers myelinated nerves that conduct rapid and

sharp pain sensations
C-fibers unmyelinated nerves that are involved in dull
aching pain
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DENTIN SENSITIVITY

there 3 main theories proposed to explain the

sensitivity of dentin:
1.

Direct innervation theory the dentin contains

nerve endings that respond when it is stimulated

2.

Transduction theory states that the odontoblast

is the receptor and it conducts the pain to the nerve
endings in the dentinal tubules and peripheral pulp

3.

Hydrodynamic theory states that when dentin

is stimulated, dentinal fluid and the odontoblastic
process move inside the tubule and stimulates the
nerve endings in the pulp (most accepted theory)

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CHANGES IN THE PULP DUE TO AGING

AND ENVIRONMENTAL STIMULI

regressive changes in the pulp due to aging and

environmental stimuli include
1.

decreased volume of the pulp chamber and root canal due

to continued dentin deposition (secondary and tertiary
dentin)

2.

with age, there is a loss and degeneration of myelinated

and unmyelinated nerves in the pulp that causes
reduction in sensitivity in the tooth

3.

with age, there is decrease in number of cells and cellular

activity in the pulp

4.

with age, the pulp becomes more fibrotic; there is

increase in collagen fibers

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5.

formation of pulp stones or denticles

pulp stones or denticles are round to oval calcified

masses appearing in either the pulp chamber or root
canal
they usually appear in teeth that have suffered injury
but also in normal pulps
they are more common in persons more than 50 years of
age
possible causes of pulp stones:
a. degenerated cells which maybe surrounded by calcium salts
b. remnants of Hertwigs sheath may stimulate dentin
formation

they are classified according to their structure as true or

false pulp stones:
a. true denticles have dental tubules like dentin
b. false denticles have concentric layers of calcified tissue

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denticles may also be classified as free, attached or

embedded denticles:
1. free denticle appears free in the pulpal tissue
2. attached denticle the denticle is partly fused to the
dentinal wall
3. embedded denticle the denticle is entirely embedded
in the dentin

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6.

appearance of diffuse calcifications

appears as irregular calcified deposits along collagen

fiber bundles or blood vessels
this is considered as a pathologic condition and appears
more often in the root canal than in the coronal pulp

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