Jaya's Pulp.1

Dental pulp
By :Dr. ANNUPRIYA KHANNA MDS STUDENT DEPARTMENT OF PEDODONTICS HIMACHAL DENTAL COLLEGE Free Powerpoint Templates
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DEFINITION
Free Powerpoint Templates
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Dental pulp is richly vascularised and innervated connective tissue inside the pulp cavity of a tooth.
Dorland's Medical Dictionary for Health Consumers..
Dental pulp is a tissue derived from dental papilla responsible for the formation of dentine
oral anatomy , histology , and embryology-B.K.B BERKOVITZ G.R. HOLLAND B.J. MOXHAM
Dental pulp is a delicate specialized connective tissue containing thin walled blood vessels, nerves& nerve endings enclosed within dentin
Grossman
The organ made up of blood vessels , nerves, and cellular elements including odontoblast , that forms dentin.
Mosby
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Pulp is of mesenchymal origin with specialized cells,
the odontoblast
Houses a number of tissue elements. microcirculation system - lacks true collateral supply
Unique sensory organ
Retains its ability to form dentin
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Contents
Development Anatomy Structural features Functions Primary and permanent pulp organs Regressive changes Clinical considerations
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Development of the pulp

The precursor of the pulp is the dental papilla It develops as a ball of proliferating cells filling the concavity of the cap stage of tooth development Histologically the dental papilla consists of undifferentiated mesenchymal cells, moderate ground substance and sparse delicate fibers
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The dental papilla
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The dental pulp is said to be existent as soon as The first dentin is laid down or The papilla is surrounded by dentin
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Anatomy of pulp
General features Pulps of maxillary teeth Pulps of mandibular teeth Coronal pulp Radicular pulp Apical foramen Accesory canals
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General features
Occupies centre of each tooth and consists of soft connective tissue Every person normally has 52 pulp organs 32 in permanent 20 in primary teeth Total volume of all permanent teeth pulp is 0.38cc Mean volume of single adult human pulp is 0.02cc
ORBANS ORAL HISTOLOGY AND EMBRYOLOGY (11TH EDITION)
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Picture depicts anatomy of pulp in maxillary central incisor and 1st molar Free Powerpoint Templates Page 11
Pulp organs of deciduous human teeth
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Pulp organs of permanent human teeth
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Coronal pulp
Located centrally in the crowns It has six surfaces
The roof or occlusal The mesial The distal The buccal The lingual The floor
With continuous deposit of dentin, pulp becomes smaller and non uniform. Deposits faster on floor than roof or side walls.
ORBANS ORAL HISTOLOGY AND EMBRYOLOGY(11TH EDITION)
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Radicular pulp
Extend from cervical region of crown to root apex. In anterior teeth: single in posterior teeth: multiple Continuous with periapical tissue through apical
foramen.
Tubular in shape.
ORBANS ORAL HISTOLOGY AND EMBRYOLOGY (11TH EDITION)
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Coronal and radicular pulp
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Apical foramen
In anatomy the apical foramen is the opening at the apex of the root of a tooth through which the nerve and blood vessels that supply the dental pulp pass. Thus it represents the junction of the pulp and the periodontal tissue.
Textbook of Oral Anatomy, Histology, and Embryology by B. K. Berkovitz, G. R. Holland, B. J. Moxham.
Also known as major diameter Average size in mature permanent maxillary teeth is 0.4mm in diameter Average size in mature permanent mandibular teeth is 0.3 mm
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Significantly, the foramen usually does not exit at the true (anatomic) root apex" , -' but is offset approximately 0.5 mm and seldom more than 1.0 mm from the true apex The anatomy of the apical foramen changes with age.
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There are variations in size and shape and location of apical foramen.
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Accesory canals and lateral canals

Accessory canals are secondary canals that emanate from the main canal and travel at an angle alongside it before exiting into the periodontal ligament space. In contrast, lateral canals are canals that emanate from the main canals but take a perpendicular course to exit into the periodontal ligament space
Cohen S, Burns RC. Pathways of the pulp. 8th edition
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Accesory canal
Cross section of tooth showing lateral canal
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Numerous in apical 3rd of root.

Mechanism of formation
Premature loss of root sheath cell Blood vessel may be located in place of dentin formation area.
Clinical Significance: can spread infection either from pulp to periodontal tissue or vice versa.
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Structural features
Intercellular substance Fibroblasts Fibers Undifferentiated mesenchymal cells Odontoblasts Defense cells Blood vessels Lymph vessels Nerves Nerve endings
Free Powerpoint Templates Page 23
Central region of both radicular and coronal pulp consists of large nerve trunks and blood vessels Peripherally, the pulp is circumscribed by specialized odontogenic region composed of odontoblasts (dentin-forming cells) Cell free zone(weils zone) - beneath the odontoblasts,which is prominent in the coronal pulp. Cell rich zone- cell density is high , which again is seen easily in coronal pulp adjacent to cell free zone Pulp core Principal cells of pulp are odontoblasts , fibroblasts , undiferrentiated ectomesenchymal cells, macrophages and other immunocompetent cells
Ten cates oral histology(6th edition) Free Powerpoint Templates Page 24
Zones of pulp
Odontoblast layer
Outermost layer, located subjacent to predentin. Composed of cell bodies of odontoblast In coronal pulp more cells per unit area than in radicular pulp. In coronal pulp cells are columnar, in mid portion of radicular pulp are cuboidal , near apical portion are flattened cell layer.
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Cell Poor Zone

Narrow zone approximately 40 nm in width that is free of cells. Traversed by blood capillaries, unmyelinated nerve fibers and slender cytoplasmic processes of fibroblast. Subodontoblastic vascular plexus-Plexus of Raschkow
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Cell Rich Zone

Contain relatively high proportion of fibroblast and undifferentiated mesenchymal cells. More prominent in coronal pulp than radicular pulp.
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Pulp Proper
Central mass of the pulp Contains large blood vessels and nerves Connective tissue cell consist of fibroblast and pulpal cells
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Intercellular substance
Dense gel like in nature Appearance varies from finely granular to fibrillar Composed ofAcid mucopolysaccharide Protein polysaccharides (glycosaminoglycans and proteoglycans) Chondroitin A and chondroitin B(during early development) Hyaluronic acid Glycoproteins
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Fibroblasts
Most numerous cell type in pulp Active in collagen synthesis. Have typical stellate shape. In the older pulp they appear rounded or spindle shaped with short processes . they are then termed as fibrocytes Have ability to synthesize and phagocytose collagen (DUAL FUNCTION)
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Apoptotic cell death of pulpal fibroblasts especially in the cell rich zone indicates that some turn over of these cells is occuring Desmosomes are often present between these cells
Fibrocytes (fibroblasts of older pulp)
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Fibers
Principal fibrous component of dental pulp is a combination of Type I (60%) Type II(40%) Type I collagen synthesized by odontoblast and Type I, III, V, VII are synthesized by fibroblast Present as fibrils 50nm in diameter grouped into fibers thinly and irregularly scattered throughout the tissue.
Depending on appearance o Diffused collagen o Bundle collagen (prevalent in apical third of root )
Textbook of Oral Anatomy, Histology, and Embryology by B. K. Berkovitz, G. R. Holland, B. J. Moxham.
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A-BUNDLE FIBRES B-DIFFUSE FIBRES
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In very young pulp fine fibres of small size are present (FIBRILLIN) Cross striations at 64nm and rage in length from 10100nm
ORBANS ORAL HISTOLOGY AND EMBRYOLOGY(11TH EDITION) collagen fiber-blue elastic fiber red
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Undifferrentiated mesenchymal cells

Represent the pool from which connective tissue cells of pulp are derived
Ten cates oral histology(6th edition)
primary cells in very young pulp but a few are seen in pulp after root completion Larger than fibroblasts Polyhedral in shape with peripheral processes and large oval staining nuclei Found along pulp vessels in cell rich zone
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Undifferentiated ectomesenchymal cells
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Odontoblasts
An odontoblast is a biological cell of neural crest origin that is part of the outer surface of the dental pulp, and whose biological function is dentinogenesis, which is the creation of dentin, the substance under the tooth enamel.
Matrix biology : journal of the International Society matrix biology 19(5) of
second most prominent cells of pulp
reside adjacent to predentin

Also synthesize type I and II collagen fibers along with dentin sialoproteins and phosphoryns. Also secrete alkaline phosphate enzyme linked to mineralization
ODONTOBLAST PROCESSES:
Also called dentinal fibers or Tomes fibers. Transverse the predentin and fills the dentin tubule.
histologic section showing odontoblast processes
Low magnification View of odontoblasts
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Defense cells
T- lymphocytes are present in small numbers in normal dental pulp Their number increase enormously when pulp is injured or subjected to toxins They are Histiocytes/macrophages Mast cells Plasma cells Neutrophils Eosinophils Basophils Lymphocytes Monocytes
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Macrophages
Macrophages are white blood cells produced by the differentiation of monocytes in tissues. Irregularly shaped cells with blunt processes Associated with small blood vessels and capillaries Distinguishing feature-contains aggregates of vesicles or phagosomes which contain dense phagocytized irregular bodies
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Lymphocytes and eosinophils

Lymphocyte is a type of white blood cell in the vertebrate immune system Eosinophils are white blood cells that are one of the immune system components responsible for combating multicellular parasites and certain infections in vertebrates
Dorlands Medical Dictionary
Found extravascularly in normal pulp During infection increase enormously in number

Lymphocyte Eosinophil
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Plasma cells
Seen during inflammation of pulp Nucleus appears small and concentric in the cytoplasm Pushed to the periphery of the cell The chromatin is adherent to the nuclear membrane Plasma cell function is production of antibodies
plasma cell
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Dendritic antigen presenting cells

An important component of normal dental pulp 50 m long and have three or more main dendritic processes which branch Stimulate activity and division of nave Tlymphocytes
Antigen presenting cells
Textbook of Oral Anatomy, Histology, and Embryology by B. K. Berkovitz, G. R. Holland, B. J. Moxham
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Blood vessels
Microcirculation system. Primary function of microcirculation is to maintain physiology of the tissue. Architecture of microvascular network o Major vessels are arterioles, capillaries and the venules. o True microvascular subdivision are arterioles. o Arterioles : 50 m in diameter Blood vessels arise from inferior or superior alveolar artery and drains into the same veins in both mandibular and the maxillary region Small arteries and arterioles enter the apical canal and pursue a direct route to the coronal pulp.
Textbook of Oral Anatomy, Histology, and Embryology by B. K. Berkovitz, G. R. Holland, B. J. Moxham
.
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The largest diameter of arteries in pulp is 50-100m The blood vessel has three layers.Tunica intima - squamous or cuboid epithelial cells surrounded by a closely associated basal lamina Tunica media approx 5m thick and consist of three layers of smooth muscle cells Tunica adventitia- outermost layer . made up of few collagen fibers forming a loose network around large arteries
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Among oral tissue pulp has highest blood flow rate but substantially lower than major visceral organs
Blood flow rate in coronal pulp is twice that in radicular pulp In arterioles-0.3mm per sec Venules-0.15mm per sec Capillaries-0.08mm per sec
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Fenestrated capillaries
Fenestrated capillaries have pores in the endothelial cells (60-80 nm in diameter) that are spanned by a diaphragm of radially oriented fibrils and allow small molecules and limited amounts of protein to diffuse.
Functional Ultrastructure: An Atlas of Tissue Biology and Pathology.
4-5% in pulp More permeable and play imp role in rapid supply of substrate to synthesizing cells
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Lymph vessels
Second circulatory system

Primary function is recirculation interstitial fluid to the blood stream. Presence of lymphatic in dental pulp is a controversy because of close resemblance of lymphatic vessels to veins and capillaries.
Anterior teeth drain into - submental lymph nodes

Posterior teeth - submandibular and deep cevical lymph nodes.
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Clinical correlations
A.
Local Anesthetics: Vasoconstrictor added to prolong anesthetic effect. Epinephrine being the commonest. Lidocaine with 5g to 20 g epinephrine decreases blood flow by 30 % Dose of epinephrine above 10-8 M pulp vessels collapse due to total ischemia. Reduce vasoconstriction effect of epinephrine as a result of vasodilation effect of some anesthetic.
(Scott et al,1976)
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B.
Ligament Injection:
Anesthetic solution must contain epinephrine to make it effective for ligament ingestion. Pulpal blood flow decreases by 85% in comparison to control (plane L.A.)
C.
General anesthesia:
G.A. effect velocity of blood flow, with G.A. blood flow falls to zero in first 30 sec. which disappears in a period of an hr.
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D.
Temperature changes:
Temperature Elevation: 10oC to 15oC increase in pulp temperature, causes arteriole dilatation and linear increase in intrapulpal pressure by 2.5 mm Hg per oCelsius. Irreversible changes occur if pulp heated to 45oC for prolong period. Temperature Reduction: Intermediate application of subfreezing temp. produce a transient fall in intrapulpal blood pressure. At temp. lower than 2oC, pulp tissue exhibit immediate pulpal pathology such as vascular engorgement and necrosis.
(Van Hassel and Brown 1969).
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E. Endodontic Therapy:
If only a part of pulp extirpated, profuse hemorrhage occur because of increased diameter of vessels. Less hemorrhage if pulp extirpated closer to apex. Excessive bleeding during instrumentation indicate pulp tissue remaining in apical 3rd .
F.
Aging: Decreased circulation is due to artheriosclerotic changes which cause narrowing of blood vessels and increase calcification.
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G. Inflammation Injured cells release chemical mediators, which excite sensory nerve fibers resulting in dilation.
In chronic inflammation pulp pressure is low as compared to the acute inflammation. . In severe inflammation, lymphatic vessels closed, leads to increased fluid and pulp pressure result in pulp necrosis
(Bernick,1977)
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Nerve supply
Abundant nerve supply in the pulp follows the distribution of blood vessels Two types of sensory nerve fibers Myelinated A fibers 90% are narrow A fibers ( Matthews B et al , 1994 ) 10% are wider A fibers Unmyelinated C fibers Enter pulp through apical foramen Run coronally & divide into smaller branches until single axons form dense network near pulp-dentin margin, the Plexus of Raschkow Individual axons may branch into numerous terminal filaments & enter the dentinal tubules Almost all afferent impulses from pulp result in pain
TYPE OF NERVE FIBRE
SIZE
VELOCITY OF CONDUCTIO N
FUNCTION
A ( Myelinated )
A ( Myelinated ) A ( Myelinated ) A ( Myelinated ) B ( Myelinated ) C ( NonMyelinated )
12-20 m
5-12 m 3-6 m 2-5 m
70-120 m/sec proprioception.

30-70 m/sec 15-30 m/s ec 12-30 m/sec transmission of touch and pressure. for motor function to the spinal nerves transmission of pain, temperature, and touch. preganglionic autonomic function postganglionic sympathetic pain and possibly heat, cold, and pressure Page 56
1-3 m 0.2-2 m
3-15 m/sec 0.5-2 m/sec
Trigeminal nerve sensory impulses from teeth to CNS Maxillary division upper teeth Mandibular nerve lower teeth Sympathetic innervation superior cervical ganglion
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Plexus of raschkow
Nerves in radicular pulp
Myelinated and unmyelinated nerve Free Powerpoint Templates fibres
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Clinical consideration:
Electric pulp tester delivers current sufficient
to overcome the resistance of enamel and dentin, Stimulates sensory A fibers. C fibers dont respond as significant more current is needed.
Cold test using CO2 snow and Heat test using
gutta percha activates hydrodynamic forces in dentinal tubules which in turn excite intradental A fibers. C fibers are not activated by these cells unless they produce injury to the pulp.
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Nerve endings
Nerve terminals Round and oval enlargements of terminal filaments Contain microvesicles , small dark granular bodies and mitochondria Nerve terminals are very close to the odontoblastic plasma membrane gap of 20m substanceP 5-hydroxytryptamine ,vasoactive intestinal peptide,somatostatin prostaglandins acetylcholine nor epinephrine have been found throughout the pulp. These transmitters have been shown to affect the vascular tone and modify the excitability of nerve endings
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Terminal nerve endings located among odontoblasts

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Functions
INDUCTIVE: Induces oral epithelial differentiation into dental lamina & enamel organ. Enamel organ to differentiate into a particular type of tooth morphology FORMATIVE: pulpal odontoblasts produce dentin which surrounds & protects it NUTRITIVE: nourishes dentin through odontoblast by means of blood vascular system of pulp PROTECTIVE: recognizes stimuli like heat, cold, pressure, chemicals through sensory nerve fibers. Vasomotor innervation controls muscular wall of blood vessels. Regulates blood volume & rate of blood flow & hence intrapulpal pressure. DEFENSE OR REPARATIVE: responds to irritation by producing reparative dentin and mineralizing any affected dentinal tubules.
ORBANS ORAL HISTOLOGY AND EMBRYOLOGY(11TH Free Powerpoint Templates EDITION) Page 62
PRIMARY PULP
Function for a shorter period of time than do the permanent pulp Average length of time primary pulp functions in oral cavity is 8.3 yrs

This amount of time is divided into 3 time periods:

PULP ORGAN GROWTH: CROWN AND ROOT ARE DEVELOPING (ABOUT 1 YR) PULP MATURATION: ROOT COMPLETION TO BEGINNING OF ROOT RESORPTION (3YRS 9 MONTHS) PULP REGRESSION: BEGINNING OF ROOT RESORPTION TO EXFOLIATION (3YRS 6 MONTHS) Free Powerpoint Templates
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PERMANENT PULP
Crown completion, formation and calcification 5yrs 5 months. Crown completion to eruption 3yrs 6 months. Eruption to root completion 3 yrs 11months. Thus the pulp of permanent teeth undergo development for about 12 years 4 months (time from beginning prenatal crown calcification to root completion). This is in contrast to 4yrs 2months it takes in primary teeth.
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Difference
Primary teeth
Large in relation to crown.
Permanent teeth
Smaller in relation to crown.
Pulp chamber
Outline
Pulpal outline follows DEJ more closely. Pulpal outline follows DEJ less closely.
Pulpal horn
They are closer to outer The pulp horns are surface. Mesial pulp horn comparatively away from the extends to a closer outer surface. approximation to surface Free Powerpoint Templates than does the distal horn. Page 65
Primary teeth
Permanent teeth
Cellularity
High degree of cellularity & vascularity in tissue.
Comparatively less degree of cellularity & vascularity in tissue.
Potential of repair
High Low
Shape of root canal

Root canals are ribbon shaped. The radicular pulp follows a thin branching path. Root canals are well defined with less branching.
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Primary teeth
Roots have enlarged apical foramen.Thus abundant blood supply demonstrates a more typical inflammatory response
It passes to odontoblastic area where they terminate as free nerve endings
Permanent teeth
Foramens are restricted .Thus reduced blood supply favours calcific response & healing by calcific scarring.
Apical foramen
Pulp nerve fibers

They terminate mainly among the odontoblast & even beyond the predentin
Density of innervations of nerve fibers

It is less so teeth are less Density of innervations is more. sensitive to operative Free Powerpoint Templates procedure. Page 67
Primary teeth
It is thin, tortuous & branching path canals which leads directly to inter radicular furcation.
Permanent teeth
It does not have have any accessory canals.
Floor of pulp chamber
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Regressive changes
Cell changes Fibrosis Pulp stones or denticles Diffuse calcifications
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Cell changes
Appearance of fewer cells in the aging pulp.
The cells are characterized by a decrease in size and a number of cytoplasmic organelles.
Fibroblast: Reduction in number of cells, possible because of reduced circulation. Diminish in size and in number of cytoplasmic structure associated with fibrogenesis. Intracellular organelles such as RER and mitochondria are smaller. With aging, decrease in oxygen uptake
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Odontoblast:
Undergo degenerative changes More of vacuoles are present. Gradually odontoblast atrophy and disappear over some area or all area of the pulp.
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FIBROSIS
In the aging pulp accumulation of both diffuse fibrillar components as well as bundles of collagen fibers usually appears.
The increase in fibers in the pulp organ is gradual and is generalized throughout the organ. Vascular changes occur in the aging pulp organ as they do in any organ.
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VASCULAR CHANGES
Atherosclerotic plaques may appear in pulpal vessels. Calcifications may be seen

Blood flow decreases with age
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PULP STONES
Definition -Pulp stones are nodular , calcified masses appearing in either or both the coronal or radicular portions of the pulp organ.
larger mineralizations fusion of several smaller ones. Asymptomatic, unless impinge on nerves or blood vessels Seen in functional / embedded unerupted teeth.
Free Powerpoint Templates Pulp stones (denticles)
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CLASSIFICATION
Composition ( KRONFELD ) True False
Diffuse
Relation to dentin Free Attached Embedded
True Denticles
made up of dentin and is lined by odontoblasts. found in the apical portion of the tooth. Resemble dentin Inclusion of HERS
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False Denticles
Concentric layer of calcified tissues
Formed from degenerating cells of the pulp that tend to mineralize. The mineralizing cells coalesce. Concentrically there after layer upon layer mineral salts are laid down.
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Diffuse calcification
Irregular calcific deposits Seen near blood vessels & collagen fibres
found more frequently in radicular pulp
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Embedded
formed originally in the pulp
Surrounded completely by dentin mostly tertiary found most frequently in the apical portion of the
root
get dislodged and block the apex during endodontic therapy.
Attached
Attached to the dentin & not completely embedded.
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Free
Found lying free in the pulp tissue. present in a large percentage of teeth present in young as well as old people
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Pulp stones
Formed free in pulp and later become attached or
embedded as dentin formation progresses.
66% of teeth in persons 10 to 30yrs of age

80% in those between 30 and 50 years 90% in those over 50 years of age contain calcifications of some type.
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Clinical considerations
Shape of the pulp chamber and its extensions into the cusps pulpal horns is important.The pulpal horns project high into the cusps exposure of pulp can occur
With the advancing age the size of pulp chamber

decreases whereas in young age pulp horns are wider & high.
Cavity preparation: speed, heat, pressure & coolant may

all cause pulp irritation. Thickness & nature of remaining dentine may affect pulp response to dental material. Remaining dentin thickness: 2 mm
Shape of the apical foramen and its location may play an
important part in treatment of root canals. Accessory canals & multiple canals are rarely seen in IOPA 10-15 degree - increase in intrapulpal pressure to 2.5 mm Hg per degree centigrade although its transient in nature. Irreversible changes occur at temperatures higher than 45 degrees centigrade It has been noticed that at a temperature lower than -2 degrees centigrade the pulpal necrosis can occur.
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Pulp Irritants
They can be living or non living. Various pulp irritants are
1. 2. 3. 4. 5.
Microbial irritants. Mechanical and Thermal irritants. Chemical irritants. Permanent restoration irritants. Radiant irritants.
The Dental Pulp (Seltzer)
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Microbial Irritants
Dental caries is one of the local cause classified as microbial irritant.
Carious dentin consist of 2 layers: Infected Dentin: irreversible denaturation and infection. Affected Dentin: denaturation is reversible and no infection. Microorganisms and their products impinge the dental pulp, commonly found microorganism are streptococcus mutans , lactobacilli and actinomyces.
Defense against caries: Pulp defense by Dentinal changes. Elaborating new dentin. Inflammatory and immunological reaction.
Dentinal changes: Dentinal tubules of primary dentin mineralize. Sclerosis of dentin( increase in peritubular dentin). Reparative dentin formation. Inflammation under Caries: Chronic inflammatory cells increases. Degree of inflammatory changes directly proportional to depth of dentinal lesion. Immunological reaction: Formation of antibodies against antigenic component of dental caries Immunoglobulin formed are IgG, IgM, IgA, complement components C3 and C4.
Dynamics of Development of Pulpitis from Dental Caries
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Mechanical and Thermal Irritants

Dentistogenic ( Iatrogenic ) Pulpitis -dentist induced pulpitis
Following factors should be kept in mind: 1. Depth of Cavity Preparation: Cavity preparation causes increase rate of dentin collagen turnover and odontoblast cell damage Superficial cavity preparation : mild irritation, so as regular reparative dentin produced Degree of inflammation increases proportionally to depth of cavity preparation
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2.
Speed of Rotation: Greater amount of odontoblast damage: 50,000rpm Least amount damage at :1,50,000 to
2,50,000rpm (coolant used)

Ultra high speed used for removal of enamel and superficial dentin.
Low speed recommended for finishing of

preparation
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3.
Dry Cavity Preparation: Cause great trauma to the pulp Prolong dehydration with air cause odontoblast displacement and edema , condition which
cannot be reversed
Circulation of pulp affected by elevation of temperature, above 46oC cause irreversible
changes( stasis and thrombosis occur ).

Intrapulpal pressure increases with initial drop, possible due to release of chemical mediators causing vasodilation.
4.
Nature of Cutting Instrument: Thermal damage is greater with steel bur than carbide burs.
5. Size of wheels and burs: Larger size bur produce greater pulp damage because a)Peripheral speed of larger disk is higher b)Greater area cut at a time c)Coolant cant get to tooth bur interface readily. 6. Hand instrument: Damage of pulp is more because of great pressure induced
7.Coolants:
Used to eliminate heat generated Coolants used are 1. Air Spray (compressed air for 10 sec. displace odontoblast) 2. Combination of water and air 3. Water Spray 4. Water applied through hollow bur 5. Water as a jet stream Water coolant advantages are 1. Temperature reduction 2. Improved debris removal Quantity alone of coolant is not significant but contact at bur and dentin interface is also important
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8.Traumatic Injury: Cause hemorrhage resulting in nutritional disturbances, hyalinization of pulp tissue, excessive mineralization and tooth discoloration 10.Crown fracture: Pulp not exposed in facture have chances of survival than traumatic teeth without crown fracture
11.Root fracture: Favorable fracture repair by deposition of cementum More apical the fracture more favorable pulp prognosis
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12.Traumatic occlusion: Excessive occlusal forces cause pulp changes such as increased pulp stones , pulpitis , necrosis.
13.Polishing of restoration: Pulp damage due to heat produced by friction Heat damage can cause enamel fracture Should be done on slow speed and with use of coolant
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Chemical irritants:
Temporary filling materials and bases:
1. ZOE: Of all temporary materials considered to be safest. Greater amount of Eugenol in mix, greater chances of pulpal irritation. Sedative effect of ZOE is due to Eugenol ability to block or reduce impulse activity. 2. ZnPO4 Cement: Severe pulpal damages because of inherent irritating properties Toxicity more pronounced when placed in deep cavity preparation
3.
Gutta percha:
Poor marginal seal , so fluid and bacteria move into dentin Heat and pressure associated with insertion may cause sensitivity.
Permanent Restoration
A. Silicates : Popularity decreased due to Relatively high solubility Color instability Produce severe damage to pulp when used as liner When applied to dentin liquid penetrates, liberates CO2 in pulp, results in thrombosis of vascular system of pulp. Cause centrifugal flow of fluid in dentin, result in displacement of odontoblast
Effect on pulp influenced by depth of cavity preparation, chronic inflammation may persist for 6 months to 1 yr. Effect on pulp is progressive, continuous (as remain in gel state) Have persistent marginal leakage.
B.
Restorative Resins: Pulp damage due to Marginal leakage Monomer irritation Cause mild irritation Cavity should be lined with Ca(OH)2 and covered with Zn(PO4) prior to insertion of filling material. Polycarboxylate or Zn(PO4) cement have no adverse effect on polymerization but ZOE should not be used
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C.
Gold inlays: Reasons of damage are Thinner mix of ZnPO4 cement acts as irritant Large pressure generated in sealing inlay Marginal leakage due to poor adapted margins
D.
Gold Foil: Excellent marginal sealing but pulp irritation occur
due to mechanical malleting

Recovery is rapid as malleting is cause of inflammation.
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E.
Amalgam: One of the safest material even though minor inflammatory pulp response occur. Least irritant even though liners are not employed. Lines necessary to prevent thermal conduction and reduce pressure during amalgam condensation Microleakage can cause some irritation but as corrosion occur space is plugged
Marginal Leakage: Causative factor in i.Tooth hypersensitivity ii.Tooth discoloration iii.Bacterial growth iv.Recurrent caries v.Pulp pathosis None material exhibit perfect margin seal Greatest leakage occur around Gutta Percha and least around ZOE. Also contributed due to difference in coefficient of expansion of tooth and restoration- fluid movement is Free Powerpoint Templates called Percolation
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Radiant Irritants
Irradiation:
Damage to teeth depend on dose, source, and type of radiation, exposure factors and stage of tooth development at time of exposure. During developing stage exposure causes poor formation and even fail to develop. In pulp odontoblast are injured leading to osteodentin and dentinal niche formation. Heavy doses cause complete failure of tooth development. Mild doses cause Root end distortion and Dilacerations. Decrease in mitotic activity of pulp cells Odontoblast produce abnormal dentin Later stages fibrosis or atrophy may occur
Osteoradionecrosis in bone may occur
Severe root sensitivity may occur.

Reduced salivary flow along with change in organic and inorganic constituent and pH result teeth become dry and brittle and more prone to decay. Laser: Lasers cable of mobilizing immense heat and pressure. Damage to pulp depends on intensity of energy. 20 joules slight affect after 3 days
40 joules degenerative changes
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Diseases of the pulp

ACUTE PULPITIS
Bacterial invasion,trauma ,chemical or mechanical injury Severe throbbing pain , either spontaneous or on thermal stimulation , lying down Root canal therapy if tooth is restorable
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CHRONIC PULPITIS
Slow , progressive carious exposure Usually asymptomatic , pain when there is interference with drainage Root canal therapy if tooth is restorable
REVERSIBLE PULPITIS
Trauma , dehydration , amalgam occludimg with gold restoration , chemical stimulus Sharp pain , it does not occur spontaneously , subsides after removal of stimulus Prevention - liner , varnish , base and careful cavity preparation with proper coolant , sedative dressing.
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IRREVERSIBLE PULPITIS
caries, clinical, thermal or mechanical injury, reversible pulpitis may deteriorate into irreversible.
Spontaneous pain & persists after removal of stimulus, bending or lying down, referred to other sites.
Root canal therapy if tooth is restorable
NECROSIS
Noxious insult injurious to pulp such as bacteria, trauma & chemical irritation slow, progressive carious exposure, large open cavity, young resistant pulp unknown, usually patients have H/O trauma.
discoloration of tooth, Dull, opaque, crown, Asymptomatic Usually symptomless, pressure may cause discomfort.
Root canal therapy if tooth is restorable
CHRONIC HYPERPLASTIC PULPITIS { PULP POLYP}
Elimination of polyploid tissue extirpation of pulp, provided the tooth can be restored
RCT, obturation preferably plasticized g.p. root perforated: ca(oH)2 paste is sealed in root canal & is periodically renewed until the defect is repaired.
INTERNAL RESORPTION
Asymptomatic, pink spot in crown, granulation tissue showing through resorbed area of crown
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Refrences
The Pathway of Pulp (Cohen) ORBANS ORAL HISTOLOGY AND EMBRYOLOGY(11TH EDITION) Oral histology Ten Cates Textbook of Oral Anatomy, Histology, and Embryology by B. K. Berkovitz, G. R. Holland, B. J. Moxham. Sturdevants Art & Science of operative dentistry, 4th edition A textbook of oral pathology, Shafer 5th edition The Dental Pulp (Seltzer)
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Jaya's Pulp.1

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Jaya's Pulp.1

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Dental pulp

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Pulp is of mesenchymal origin with specialized cells,

Unique sensory organ

Retains its ability to form dentin

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Development of the pulp

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The dental papilla

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ORBANS ORAL HISTOLOGY AND EMBRYOLOGY (11TH EDITION)

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Pulp organs of deciduous human teeth

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Pulp organs of permanent human teeth

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ORBANS ORAL HISTOLOGY AND EMBRYOLOGY (11TH EDITION)

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Coronal and radicular pulp

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Accesory canals and lateral canals

Cohen S, Burns RC. Pathways of the pulp. 8th edition

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Cross section of tooth showing lateral canal

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Numerous in apical 3rd of root.

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Cell Poor Zone

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Cell Rich Zone

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Fibrocytes (fibroblasts of older pulp)

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A-BUNDLE FIBRES B-DIFFUSE FIBRES

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Undifferrentiated mesenchymal cells

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Undifferentiated ectomesenchymal cells

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second most prominent cells of pulp

reside adjacent to predentin

Low magnification View of odontoblasts

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Lymphocytes and eosinophils

Found extravascularly in normal pulp During infection increase enormously in number