551 201 Oral Anatomy and Physiology I

Anatomy and Physiology of Dental Pulp

Department of Oral Biology Faculty of Dentistry Khon Kaen University

jarin@kku.ac.th

Jarin Paphangkorakit

References: Nanci A. Dentin-Pulp Complex. In: Ten Cate's Oral Histology: Development, Structure, and Function. St. Louis: Mosby, 2003. Garant PR. Oral Cells and Tissues. Chicago:Quintessence, 2003.

Objectives
1. 2. 3. 4. 5. 6. 7. Hydrodynamic of dentine sensitivity exposed dentine

Functions of dental pulp

Formation of dentine (dentinogenesis) Sensation (pain only?) First line of defense to injuries and infection of dentine
Tertiary dentine Immuno-competent Clearance of toxic substances

Components of dental pulp

Cells + (extracellular) Matrix Fiber
Structural
Collagen Elastin

Ground substance
GAG
HS DS

Adhesive
Fibronectin Laminin

Proteoglycan
Decorin Versican

CS

Components of dental pulp

CELLS (odontoblast, fibroblast, undifferentiated cell, macrophage, dendritic cell) FIBERS AND GLYCOPROTEIN (collagen type I, III, no elastic fiber, fibronectin) GROUND SUBSTANCES (glycosaminoglycans, chondroitin sulfate proteoglycan) BLOOD VESSELS, NERVES, LYMPH VESSELS

Functions of pulpal extracellular matrix

Maintain tissues physical properties and integrity

Control of growth and development and repairs

Control of cell migration

Control of diffusion of macromolecules

Collagen in dental pulp

Concentration varies from species to species, 32% in human pulp. Higher content in the middle and apical pulp. Total collagen decreases with age. Interestingly high level of collagen type III. (43%) : vascular content, tissue extensibility (cf. Elastin) Absence of elastin (except in b.v.).

Adhesive glycoproteins in dental pulp

Fibronectin found in predentine NOT mature dentine. Fibronectin present in pulp and dental papilla. Fibroblasts synthesize pulpal fibronectin. Fibronectin is expressed during reparative dentinogenesis.
Immunoreactive fibronectin molecules detected along the border of predentine and between odontoblast (Yoshiba et al., 1994)

Glycosaminoglycans in dental pulp

Chondroitin sulfate, dermatan sulfate, hyaluronic acid present Amount of uronic acid decreases with age

Total GAG decreases with reduced dentinogenic activity

Decorin may involve in mineral nucleation at the mineralization front

Organization of cells in the pulp

nerve terminals

tight junction

Pulp vasculature

Pulp tissue is highly vascularized.

40-50 ml/min/100g

(Kim, 1985)

(20 mm Hg)

Hydrostatic pressure in dental pulp

(5.5-10.3 mm Hg*)

(35 mm Hg)

(43 mm Hg)

Dental pulp interstitial fluid (ISF) and exchange of substances between plasma and ISF. (* values from Tonder and Kvinnsland, 1983; Ciucchi et al., 1995)

Intradentinal nerves are mostly found in pulpal horns.

Approx. 1800 non myelinated + 400 myelinated

Types and properties of pulpal sensory nerve fibers

A-beta fibers

C fibers

Conduction velocity 30-70 m/s Very low threshold, non-noxious sensation 50% of myelinated fibers in pulp Functions not fully known

A-delta fibers

Conduction velocity 0-2 m/s Higher threshold Involved in slow, dull pain Stimulated by direct pulp damage Sensitive to anesthetics Dull pain

Conduction velocity 2-30 m/s Lower threshold Involved in fast, sharp pain Stimulated by hydrodynamic stimuli Sensitive to ischemia Sharp pain

Non-myelinated sympathetic fibers

Conduction velocity 0-2 m/s Post-ganglionic fibers of superior cervical ganglion Vasoconstriction

Possible mechanisms of dentine sensitivity

Hydrodynamic mechanism (Gysi, 1900; Brannstrom, 1963)

Pulpal axonal reflex due to dentine stimulation

Increased tubular fluid flow STIMULATION

Dentine
Increased A-V shunt blood flow Outward dentinal fluid flow and aspiration of odontoblasts Increased pulp pressure Increased pulp interstitial fluid

Release of inflammatory agents?

Increased blood viscosity and rbc congestion in capillary bed

SP, CGRP Axon reflex Pulp venules

Vasodilation, Increased permeability

CNS, Pain, Reflexes

Without infection, Vascular changes could be resolved.

References

Nanci A. Dentin-Pulp Complex. In: Ten Cate's Oral Histology: Development, Structure, and Function. St. Louis: Mosby, 2003. Garant PR. Oral Cells and Tissues. Chicago:Quintessence, 2003.

Synthesis of collagen and its assembly into fibrils and fiber

Some types (of 15) of known collagen

Type
Fibril-forming
I

Molecular
[a 1(I)]2 a 2(I)

Tissue distribution
bone, skin, tendon, ligaments
(90%) of body collagen

II

[a 1(II)]3

cartilage, intervertebral disc, notochord, vitreous humor of eye

III V XI

[a 1(III)]3 [a 1(V]2 a 2(V) [a 1(XI] a 2(XI) a 3(XI) [a 1(IX] a 2(IX) a 3(IX) [a 1(XII)]3 [a 1(IV)]2 a 2(IV) [a 1(VII)]3

skin, blood vessels, internal organs as type I as type II cartilage (with type II) tendon, ligaments (with some type I) basal laminae anchoring fibrils beneath stratified squmous epithelia

Fibril-associated IX
XII

Network-forming IV
VII

The structure of a fibronectin dimer.

RGD = cell-binding domain

Structure of a GAG

Structure of proteoglycans

Some known proteoglycans:

Aggrecan
(cartilage)

mechanical support

Betaglycan
(cell surface*, matrix)

binds TGF-beta

Decorin
(CNT)

binds type I and TGF-beta basal laminae binds FGF

Perlecan
(basal laminae)

Syndecan-1
(cell surface*)

* = Integral membrane proteoglycan