basic pulp & its clinical considerations

2. PULP
GUIDED BY :
DR.P.KARUNAKAR (PROF & HOD)
DR.M.S.RANGA REDDY (PROF)
DR.B.S.KARTEEK (SENIOR LECTURER)
Presented by :
C.L.Charan
Pg 1st Year
2

3. Contents :
 Introduction
 Definition
 Development of Pulp
 Anatomy of Pulp
 Differences b/w primary and permanent Pulp
 Histology of Pulp
 Cells of the Pulp
 Blood supply
 Lymphatics
3

4.  Metabolism
 Nerve supply
 Neuropeptides
 Functions of Pulp
 Age changes in Pulp
 Clinical considerations
 Pulp vitality tests
 Conclusion
4

5. Introduction
 “Pulpa” – Latin – animal or plant tissues which are moist & soft
which occurs in the form of cohering mass.
5

6. Definition :
 It is defined as a richly vascularized and innervated connective tissue
of mesodermal origin enclosed by dentin with communications to the
Periodontal ligament.
(ORBANS – 14TH EDITION)
 “A richly vascularized and innervated specialized connective tissue
of ectomesenchymal origin; contained in the central space of a tooth,
surrounded by the dentin,with inductive, formative, nutritive,
sensory and protective functions”.
(Glossary of Endodontic terms 2016)
6

7. Development
 During the 8th week of IUL, there is condensation of the
mesenchyme under the enamel organ-Dental papilla.
 The enamel organ enlarge and enclose the dental papilla in their
central portion.
 Dental papilla controls the morphology & type of tooth to be
formed.
 Dental papilla shows :
Extensive proliferation of cells
High vascularity
7

8. 8
Video

9. Anatomy of pulp
General features :
9
 Occupies the center of each tooth
& consists of soft connective tissue.
 Coronal pulp – Pulp chamber of
the crown
 Radicular pulp – pulp in root canal
 Total volume of all permanent teeth pulp – 0.38cc.
 Mean volume of single adult human pulp – 0.02cc.
 Molar pulps are 3-4 times larger than incisor pulps.

10. 10
Highest
Lowest

11. 11
Coronal pulp :
 Six surfaces.
 Pulp horns – protrusions that
extend into cusps
of each crown.
 Pulp horns – cuspal number.
 Smaller with age – Continuous deposition of dentin.
 Constricts at cervical region and joins radicular pulp.

12. Radicular pulp :
 Anterior teeth – single.
 Posterior teeth – multiple.
 Varies in size, shape, & number and not always straight.
 Radicular portions of the pulp is continuous with the
periapical tissues through apical foramen.
12

13. Apical foramen :
 Size of maxillary teeth in adult = 0.4mm
 Size of mandibular teeth in adult = 0.3mm
Apical delta :
 Two or more foramina separated by a portion of dentin and cementum
or by cementum only.
13
 Found to be frequent by seltzer et al 1966 and Hess et al 1983.

14. 14

15. 15
Accessory canals :
 Lateral branching of main canal located in apical third of root &
furcation of multirooted teeth.
 Numerous in apical third of root.
 Premature loss of HERS cells.
Lateral canals:
 Can be found anywhere along the length of a root at right angle
to main root canal.

16. 16

17. 17
Primary pulp vs Permanent pulp
Primary pulp :
 Average length of time in oral cavity = 8.3 years.
 3 periods :
 Pulp organ growth.
 Pulp maturation.
 Pulp regression.
 The maximum life including both prenatal, postnatal times of
development & period of regression = 9.6 years.
 Every person normally has 52 Pulp organs

18. 18
PRIMARY PULP PERMANENT PULP
Pulp chamber is larger in relation to crown
size
Pulp chamber is smaller in relation to
crown size
Pulpal outline follows DEJ more closely Pulpal outline follows DEJ less closely
Pulp horns are closer to the outer
surfaces. Mesial pulp horn extends to a
closer approximation of surface than distal
pulp horn
Pulp horns are comparatively away from
the outer surface
High degree of cellularity and vascularity
in tissue
Less degree of cellularity and vascularity
in tissue
High potential for repair Less potential for repair
Root canals are more ribbon like ( hour
glass appearance )
Root canals well defined
Accessory canals – present towards
furcation area
Accessory canals – present towards
apical portion

19. 19
Histology of pulp

20. 16
Layers in dental pulp Constituents
Capillaries, nerve fibers, dendritic
cells.
Cell-free zone or zone of weil Plexus of Raschkow, capillaries,
fibroblast processes.
Cell-rich zone High density of fibroblasts,
undifferentiated mesenchymal cells.
Pulp proper Blood vessels, nerve fibers,
fibroblasts, undifferentiated
mesenchymal cells,
immunocompetent cells, fibers and
ground substance.
Odontoblast layer

21. Odontoblastic zone :
 A layer of odontoblasts are found along the pulp periphery.
 They are dentin forming cells.
Cell free zone :
 It is also called weil’s zone
 40 microns wide & relatively free of cells
 This zone is found below the odontoblastic zone
 Represents the space into which odontoblasts move during tooth
development.
21

22. Cell rich zone :
 Present after the cell free zone
 Zone formed due to migration of cells from pulp proper
 Mitosis seen when dead odontoblasts are to be replaced
 Also contain young collagen fibres during early dentinogenesis.
Pulp core :
22
 It is central region of the pulp
 Contains major blood vessels and nerve of the pulp
 Pulpal cells and fibroblasts are also seen

23. 23
Cells of the Pulp
Cellular
 Fibroblast / Fibrocyte
 Odontoblast
 Undifferentiated mesenchymal cells
 Defense cells
neutrophils
basophils
eosinophils
lymphocytes
blood monocytes
macrophages
dendritic cells
plasma cells
 Pulpal stem cells
Extra cellular
Collagen fibers
type 1
type 3
fibrillin
Ground substance
Glycosaminoglycans
Proteoglycans :
syndecan, versican
Glycoproteins :
laminin, tenascin,
fibronectin, integrins

24. Odontoblasts :
 A peripheral area of the pulp where the odontoblasts reside is termed
odontogenic zone.
 Arranged in palisading pattern cells with tall columnar forming a layer of 3 to
5 cells in thickness.
 Shape may vary coronal pulp- columnar
Midportion – Cuboidal
Apical region - Flattened
24
 These cells have large process extending into dentin.
 The no of odontoblasts corresponds to the number of dentinal tubules.

25. 25
 Shape of the odontoblasts also reflect the functional activity of the
cell.
 During active phase, cells show increase in endoplasmic reticulum
golgi apparatus and secretory vesicles.
 Resting (or) Non active phase cells are flattened with little cytoplasm,
condensed chromatin and decrease no of ER
Average no of odontoblasts estimated to 45,000 per Sq.mm of
odontogenic zone.
Odontoblasts in the crown are larger than in the root.

26.  Numerous junctions such as gap junctions, tight junction and
desmosomes are found between odontoblasts.
 Indicating exchange of ions and small molecules.
 They promote cell to cell adhension and play a role in maintaining polarity
of odontoblasts
26
Junctional complexes:

27. Odontoblastic process :
27
 Odontoblasts give off a single process that extends into dentin and
housed within dentinal tubules
 These process devoid of major organelles
 They contain abundance of microtubular filaments and coated
vesicles
 Mainly composed of protein-tubulin, actin and vimentin

28.  Synthesis & degradation of organic matrix
 Synthesis of non collagenous substances like sialoprotein,
phosphophoryn, osteocalcin, osteonectin & osteopontin
 Intracellular accumulation of calcium
28
Functions of odontoblasts :
Fate of odontoblasts :
 Resting odontoblasts – odontocytes (participates during reactionary
dentinogenesis)

29.  Cells that occur in greatest number in the pulp
 Function is to form, maintain the matrix that consists of collagen fibers
and ground substance throughout the pulp
 The fibroblasts are stellate shaped cells having extensive process.
Fibroblasts :
29

30.  Young pulp - Fibroblasts have abundant cytoplasm having numerous cell
organelles.
 Older pulp - Fibroblasts appear spindle shaped posses short processes having
few cytoplasmic organelles such cells are called fibrocytes
 Dual function :
- they synthesis and also degrades collagen
30

31. Undifferentiated mesenchymal cells :
31
 These mesenchymal cells are distributed throughout the pulp,
frequently around the perivascular area - believed to be totipotent
cell
 They are polyhedral shaped with peripheral processes and large oval
nuclei
 Under stimulus they may differentiate into odontoblast or fibroblast
or macrophages.
 In older pulp, their number and ability to differentiate comes down

32.  They play a major role in local inflammation and immunity.
 They are recruited from blood stream and remain as transient inhabitants in
pulp
 These cells are
1. Macrophages
2. Mast cells
3. Plasma cells
4. Lympocytes, Neutrophils,Eosinophils,
Basophils and Monocytes.
Defense cells or Immunocompetent cells :
32

33.  Described as histiocytes (or) as resting wandering cells
 Located close to blood vessel and derived from monocytes
 Have several phenotypes
 Macrophages are phagocytes, function of which are engulfment and
digestion of foreign material
 During inflammation they appear in large number to aid in defense the host
 In all they constitute 8-9% of the pulpal cell population
33
Macrophages :

34. Plasma cells :
 Plasma cells are seen during chronic inflammation of the pulp.
 They are derived from lymphocytes.
 The plasma cells function in the production of antibodies.
 Plasma cells may be present in coronal pulp
 They have small nuclei with radiating chromatin that appears like a
cart wheel.
34

35.  Occur in small groups in relation to blood vessels
 Present only during pulpal inflammation
 Have round nucleus and contain many dark staining granules in the
cytoplasm.
 Their number increase during inflammation
Mast cells :
35

36. 36
 Neutrophils usually found extravascularly in the normal pulp
(Diapedesis)
 During acute inflammation they increase in number.
Neutrophils :
Lymphocytes :
 Lymphocyte present along the walls of blood vessels
 Involved in initial immunodefense
 They are transported to such sites in response to tissue injury (bacteria or
virus or parasites) and then present directly in the involved tissue as well
as in blood.
 They phagocyte foreign material .

37.  Eosinophils are present in some allergic types of inflammation
 In pulp they are found in an inflammatory exudate
Eosinophils :
Dendritic cells :
 Similar to langerhans cells
 Present antigen to the T cells
37
 Contact with cell membranes of endothelial cells

38. Pulpal stem cells :
38
 Dental pulp stem cells (DPSCs) & stem cells from Human Exfoliated
Deciduous teeth (SHED)
 Coronal pulp > Radicular pulp
 Pluripotential – angiogenic , chondrogenic , osteogenic ,
adipogenic & neurogenic differentiation.
 Source = Exfoliated deciduous teeth & permanent third molars
because viable after cryopreservation.

39. 39
 Connective tissue fibers
-Collagen
-Elastin
-Fibronectin
 Ground substance
-Proteoglycans
-Glycosaminoglycans
 Basement membrane
Extracellular matrix :

40. 40
Collagen fibres :
 Range in length 10-100nm or more.
 Typical cross-striations at 64nm (640 A).
 Type I – mainly
Type III
 Fibrillin – fine fibres (10 – 20nm) in very young pulp.

41.  Type I:
- Present as thick striated fibrils
-Responsible for pulp architecture
 Type III:
-Thinner fibrils, mainly distributed in cell free and cell rich zones
- Contributes to the elasticity of pulp
 Type IV:
-Present along the basement membrane of blood vessels
 Type V and VI:
-Seen to form dense meshwork of thin microfibrils through out the
stroma
41

42.  Collagen turnover is maintained by fibroblasts
 During bacterial infection & inflammation, collagenolytic activity is
accelerated following collagenase produced by bacteria, PMN & fibroblasts
 Collagen synthesis is accelerated during reparative dentin formation
42

43.  This has the ability to expand and contract like a rubber band
 Elastic fibers are first formed in bundles of thin micro filaments called
Oxytalan fibers
 Elastin is then deposited in between oxytalan fibers.
 Always associated with larger blood vessels
Elastic fibers :
43

44.  It plays a role in cell-cell & cell-matrix adhesion
 Has a major effect on the proliferation, differentiation & organization of
cells.
 Seen around the blood vessels
 Also found in odontoblast layer with fibers passing into predentin
Fibronectin :
44

45.  It is a structureless mass, makes up the bulk of the pulp
 Consists of complexes of proteins, carbohydrate and water.
 Broadly classified as
- Glycosaminoglycans
- Proteoglycans
 Serves as means for transport of nutrients from blood vessels to
cells and transport of metabolites from cells to blood vessels.
Ground substance :
45

46.  GAG found in pulp is mainly chondroitin sulphate, dermatan sulphate &
hyaluronic acid.
 GAG – hydrophilic, forms gel & contributes to high tisssue fluid
pressure.
 Proteoglycans occupy larger area and they provide protection against
compression.
 Syndecan – acts as adhesion molecule between fibroblast & collagen.
Glycosaminoglycans :
46

47.  It is a sheet like arrangement of extra cellular protein matrix at the
epithelial-mesenchymal interface
 Composed of 2 layers
- lamina densa
- lamina lucida
Basement membrane :
 Basement membrane is a product of connective tissue and epithelium
 It is composed of
- Collagen type IV
- Laminin-adhesive glycoprotein
- Fibronectin
- Heparin sulfate
47

48.  Collagen IV provides binding sites for the rest of basement membrane
components
 Laminin binds to both cells of connective tissue and epithelium
 In mature pulp, basement membrane forms interface along endothelial cells &
schwann cells
 Act as sieve between epithelium and connective tissue
 Helps in organisation and differentiation by enabling interactions between
extra cellular molecules and cell surface receptors
Eg: Odontoblasts during tooth
development
Functions :
48

49. 49
Circulation of Pulp
 The pulp organ is extensively vascularized.
 They are supplied by the superior and the inferior alveolar
arteries.
 The blood vessels gain entry into the pulp through the apical
foramen and at times through accessory foramen

50.  The arterioles on entering the pulp show a reduction in thickness of vessel wall
musculature and therefore lumen size increases.
 Pulpal blood flow is more rapid than in most area of the body
 So pulpal pressure is among highest of body tissues
 The flow of blood in Arterioles - 0.3 to 1mm/sec
Venules - 0.15mm/sec
Capilaries -0.08mm/sec
50

51.  Pulp is a micro circulatory system which lacks true arteries and veins
 The largest vessels are arterioles & venules which regulate the local
interstitial environment
 They enter the tooth through the apical foramen
Organisation of Pulp vasculature :
51

52.  Arterioles(50μm - 100µm diameter)
-Terminal arterioles (10µm - 15µm diameter)
-- Precapillaries (8µm - 12µm diameter)
---Metarterioles
----Capillaries (8μ)
52
 The branching point of terminal arterioles is characterized by smooth muscle
clumps that act as sphincters which are under the local cellular & neuronal
control
 Thus pulpal inflammation elicits a localised circulatory response restricted
to the area of inflammation
 Arteriolar pressure – 43mm Hg

53. 53
 Function as exchange vessels regulating the transport of diffusion
of substances between blood and local interstitial tissue elements
 They consists of single layer of endothelium surrounded by
basement membrance
 Capillary pressure –35 mmHg
 Capillary wall is 0.5μ thick & acts as semipermeable membrane
Capillaries :

54.  Based on the property of semi permeability capillaries may be grouped as
Class I : Fenestrated capillaries
Class II: Continuous capillaries
(nonfenestrated)
Class III : Discontinuous capillaries
Class IV : Tight junction capillaries
 Class I & II are present in the dental pulp
54

55. 1.Terminal capillary network located in the “odontoblastic layer”
2. “Capillary network” present adjacent to the odontoblastic layer & consists
of pre capillary & post capillary vessels
3. Venular network of vessels
-During aging & decreased metabolism these layers appear as single
layer
55
Capillary network organized in 3 layers :

56. SEM showing extensive arborization of capillaries from the metaarterioles
56

57.  Collecting venules receive pulpal blood flow from the capillaries & transfer
it to the venules
 Arterio-venous anastomosis permits direct shunting from arterioles to
venules
 Venular pressure –19mm Hg
Venules :
57

58. Regulation of pulpal blood flow :
 Metabolic
 Neuronal
-sympathetic
-parasympathetic
- peptidergic
 Endocrinal/Paracrinal
58

59.  Using the laser doppler technique to study pulpal blood flow in dogs,
suggested that an increase or decrease in pulpal blood flow is more
dependent on systemic blood pressure than on local vasoconstriction
or vasodilation.
59

60. Stealing theory :
 Any vasodilation in tissues that receive their blood supply through side
branches of the end arteries feeding the pulp will, according to the
Poisseuille law, steal blood pressure from the pulp.
60

61. Low compliance system theory :
 Normally = venular pressure > tissue pressure in pulp
 Vasodilators = initial increase in blood flow causes sudden increase in tissue
pressure.
 If tissue pressure exceeds that of venular pressure a passive compresion can
cause a decrease in pulpal blood flow.
61

62. Transcapillary fluid flow :
62

63. 63
Lymphatics
 Lymphatic vessels are formed from fine meshwork of small, thin
walled lymph capillaries
 Lymph capillaries coalesce to form larger lymphatic vessels with
valves
 They start as blind openings near Weil’s zone & odontoblastic
layer
 The larger lymphatic vessels run along the blood vessels & nerves

64.  Multiple collecting lymph vessels exit though the apical foramen & drain
lymph from pulp
 Role in pulp:
-They remove high molecular solutes from the interstital fluids
 -They transport lymph to the regional lymph node before it enters into
the blood vessels. This provides an immuno surveillance function.
64

65. 65
Metabolism
 Metabolism has been studied by measuring the rate of O2
consumption & production of Co2 or lactic acid by pulp tissue
 Radiospirometry is also used to evaluate the metabolism.
 During active dentinogenesis, rate of O2 consumption is high than
after crown completion.
 Odontoblasts consumed O2 at the rate of 3.2 ± 0.2 ml/min/100 g
of pulp tissue

66.  Greatest metabolic activity is seen in the odontoblast layer.
 Reduced pH of pulp causes decreases in O2 consumption as in pulp abscess.
 In addition to the glycolytic pathway, the pulp has the ability to produce
energy through Pentose shunt pathway, suggesting that the pulp can
function under varying degrees of ischemia
 Several commonly used dental materials (e.g. eugenol, zinc oxide and
eugenol, Calcium hydroxide, silver amalgam) inhibit oxygen consumption
by pulp tissue, indicating that these agents may be capable of depressing
the metabolic activity of pulpal cells.
66

67. Nerves in the Pulp (Innervation)
58

68. 59
Type of Fiber Function Diameter(µm) Conduction
velocity
(m/sec)
A-alpha Motor,proprioce
ption.
12-20 70-120
A-beta Pressure,touch 5-12 30-70
A-gamma Motor,to muscle
spindles
3-6 15-30
A-delta Pain,temperatur
e,touch
1-5 6-30
B Preganglionic
autonomic
<3 3-15
C dorsal root Pain 0.4-1.0 0.5-2.0
Sympathetic Postganglionic
sympathetic
0.3-1.3 0.7-2.3

69. Subjacent to the cell rich zone, the nerves branch extensively forming a parietal
layer of nerves
- NERVE PLEXUS OF RASHKOW. This layer contains both A delta and
C fibers.
69

70. 70
Fiber Myelination Location of
terminals
Pain
characteristi
cs
Stimulation
threshold
A-delta Yes Principally in
region of
pulp-dentin
junction.
Sharp,prickin
g
Relatively
low
C No Probably
distributed
throughout
pulp
Burning,
aching,less
bearable
than A-delta.
Relatively
high, usually
associated
with tissue
injury.

71. 62
Neuropeptides
Neuropeptides Released from Actions Receptors
Substance P Sensory Vasodilation,
increases vascular
permeability
NK1
Neurokinin A Sensory Increases vascular
permeability
NK2
Calcitonin gene-
related peptide
Sensory Vasodilation CGRP1 and
CGRP2
Neuropeptide Y Sympathetic Vasoconstriction,
pain
modulation,immune
function.
NPY Y1-6
Vasoactive
intestinal peptide
Parasympathetic Vasodilation,
immune functions
VIP 1 and 2

72. 72
Functions
 Formative – formation of dentin by odontoblast cells during the
developmental period.
 Nutritive – the high blood supply of the dental pulp transfer the
nutrients to the tooth.
 Sensory – the complex sensory system within the dental pulp controls
the blood flow and is responsible for at least mediation of the sensation
of pain.

73.  Defensive or reparative – formation of reparative or secondary
dentin represents defensive response to
any form of irritation.
73
 Inductive – oral epithelial differentiation into dental lamina and
enamel organ formation. Also induces developing enamel
organ to become a particular type of tooth.
 Protective – recognition of stimuli like heat, cold, pressure and
chemicals by way of sensory nerve fibers.

74. 74
Age changes in pulp
Cell Changes:
 Volume of pulp decreases with age due to continuous deposition of
secondary dentin throughout life.
 Changes may be seen in both cellular and extracellular components of
pulp.
 Number, nature, properties and capabilities of the cells change.
 Decrease in pulp cell density is greater in root compared to crown.
 Rate of deposition of dentin in root is greater as compared to
crown.

75.  Accumulation of both
1-Diffuse fibrillar components
2-Bundles of collagen fibres
 Fiber bundles may appear arranged longitudinally in the radicular pulp and
more diffuse in coronal pulp.
 Increase in fibers in the pulp organ is gradual and generalized.
 Any external trauma such as dental caries or deep restorations usually
causes localized fibrosis or scarring effect.
Fibrosis :
75

76. Vascular changes :
76
 Atherosclerotic plaques may appear in pulpal vessels.
 Calcifications are found that surround vessels.
 Calcification is found most often in the region near the apical foramen.

77. 77
Pulp stones (Denticles) :
 Nodular, calcified masses appearing in either or both coronal and
root portions of the pulp organ
 Develop in teeth that appear to be normal in other respects.
 Asymptomatic unless they impinge on nerves (or)blood vessels
 Seen in functional as well as embedded unerupted teeth.

78. 1. True denticles
2. False denticles
Classification :
78

79.  True denticles are similar in structure to dentin
 They have dental tubules and contain processes of the odontoblasts
 Usually located close to the apical foramen
 Development of true denticles is caused by the inclusion of remnants of the
epithelial root sheath with in the pulp
 Epithelial remnants induce the cells of pulp to differentiate into odontoblasts
then form the dentin mass.
79
True denticles :

80.  They do not exhibit dentinal tubules
 They appear as concentric layers of calcified tissue
 Some cases these calcification sites appear within a bundle of collagen
fibers.
 Some cases they appear in pulp free of collagen accumulations
False denticles :
80

81.  Some cases arises around vessels
 Center of these concentric layers of calcified tissues there may be remnants of
necrotic and calcified cells
 Calcification of thrombi in blood vessels called phleboliths, may also serve as
nidi for false denticles
81

82.  Classified as free, attached (or) embedded depending on their relation to the
dentin
a) Free denticle – entirely surrounded by pulp
tissue
b) Attached denticle – Partly fused with the
dentin
c) Embedded denticles – Entirely surrounded
by dentin
 Incidence as well as the size of pulp stones increase with age.
82

83. 83
Diffuse calcifications :
 Appear as irregular calcific deposits in the pulp tissue, following
collagenous fiber bundles, blood vessels.
 Sometimes they develop into larger mass, persist as calcified
spicules
 These calcifications are usually found in the root canal and less often
in coronal area
 These calcification surrounds blood vessels
 These calcifications may be classified as dystrophic calcification

84. 84
Pulpitis or Pulpal inflammation :
 Response of traumatized pulp with trauma being a result of bacterial
infection (dental caries) or physical trauma to tooth structure.
Clinical considerations

85. 85

86. 86
Operative procedures :
Anatomic considerations :
1) Shape of the pulp chamber and its extensions into the cusps
pulpal horns is important.
2) Wide pulp chamber into tooth of young person will make a deep
cavity preparation hazardous
3) The pulpal horns project high into the cusps, and exposure of
pulp can occur
4) If opening a pulp chamber for treatment its size and variation in
shape must be taken into consideration

87. 5) The pulp is highly responsive to stimuli, even slight stimulus cause
inflammatory cell infiltration.
6) Dehydration causes pulpal damage, operative procedures producing this
condition should be avoided.
87

88. 88
1) Age advance , the pulp chamber becomes smaller difficult to locate
the root canals.
2) Shape of the apical foramen and its location may play an important
part in treatment of root canals.
3) Accessory canals, and multiple canals are rarely seen in radiographs.
Endodontic procedures :

89. 89
Pulp capping :
 Non infected or minimally infected, accidentally exposed pulps
 Dentin is formed at the site of the exposure, and dentin bridge is
developed and pulp retains vitality.
Bioactive molecules like
- bone morphogenic protein
- TGF-beta1
- purified dentin protein fractions
- tissue cultured dentin
- stem cells

90.  GIC – Well tolerated by pulp
 Calcium hydroxide – includes dentin bridge formation.
 Zinc oxide – eugenol- has an anesthetic, antiseptic and anti-bacterial effect.
 Formocresol – Cause chronic inflammation of the pulp.
 Acid etchants – induce inflammatory response.
Effect of dental materials on pulp :
90

91. Pulp reactions :
 Blushing of dentin – frictional heat.
Thermal injury :
 Result of vascular stasis in the subodontoblastic capillary plexus flow
 Pinkish hue – reversible under favourable conditions.
 Purplish colour – thrombosis (poor prognosis)
 Tooth preparation should be performed using an ultra highspeed handpeice
(2,50,000 – 4,00,000 rpm) with an air water spray from multidirectional
Water ports.
91

92. Desiccation :
 Aspiration of odontoblastic nuclei into dentinal tubules.
 It is transient within 7 to 30 days there is autolysis of the aspirated
cells and formation of reactionary dentin.
 The pulp in cases with aspirated odontoblasts following desiccation
for 1 minute was not sensitive to clinical scraping with an explorer.
92

93. Pulp vitality tests
Neural sensibility tests :
 Thermal tests
- heat test
- cold test
 Electric pulp test
 Anesthetic test
 Test cavity

94. Pulp vascularity tests :
 Pulse oximetry
 Laser doppler flowmetry
 Others:
- Dual-wavelength spectrophotometry
- Thermography
- Crown surface temperature
- Transmitted light photoplethysmography
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95. Dental anomalies
Dentin dysplasia (rootless teeth) :
Type 1 (radicular) : Roots are short.
Pulp chambers and root canals usually
Completely obliterated.
Regional odontodysplasia (ghost teeth) :
Enamel and dentin appears very thin and pulp chamber is exceedingly large.
95

96. Conclusion :
 The presevation of a healthy pulp during operative
procedures and successful management in cases of
diseases are two of most important challenge to the
clinical dentist.
96

97. “The pulp is a small tissue with a big issue”.
- I.B.Bender.
“The pulp lives for the dentin and the dentin lives by the
grace of the pulp. Few marriages in nature are marked
by a greater affinity”.
- Alfred L. Ogilvie.
97

98. References :
1) Orbans oral histology & embryology – 14th edition.
2)Tencates oral histology – 8th edition.
3)Ingle’s endodontics – 6th edition.
4)Cohens pathways of pulp – 10th edition.
5)Shafers textbook of oral pathology – 8th edition.
6)A method of measuring the volume of human dental pulp cavities.
K.B.FANIBUNDA,july 1986, IEJ,vol 19, issue 4.
7)Arterial Blood Pressure Regulation of Pulpal Blood Flow as Determined by
Laser DopplerT. Sasano, S. Kuriwada and D. SanjoJ DENT RES 1989 68: 791
98