Pulp (tooth)

The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.

Anatomy The pulp is the neurovascular bundle central to each tooth, permanent or primary. It is composed of a central pulp chamber, pulp horns, and radicular canals. The large mass of the pulp is contained within the pulp chamber, which is contained in and mimics the overall shape of the crown of the tooth. Because of the continuous deposition of the dentine, the pulp chamber becomes smaller with the age. This is not uniform throughout the coronal pulp but progresses faster on the floor than on the roof or sidewalls. Radicular pulp canals extend down from the cervical region of the crown to the root apex. They are not always straight but vary in shape, size, and number. They are continuous with the periapical tissues through the apical foramen or foramina. The total volume of all the permanent teeth organs is 0.38cc, and the mean volume of a single adult human pulp is 0.02cc. Accessory canals are pathways from the radicular pulp. These canals, which extend laterally through the dentin to the periodontal tissue, are seen especially in the apical third of the root. Accessory canals are also called lateral canals because they are usually located on the lateral surface of the roots of the teeth.

Development The pulp has a background similar to that of dentin because both are derived from the dental papilla of the tooth germ. During odontogenesis, when the dentin forms around the dental papilla, the innermost tissue is considered pulp.

There are 4 main stages of tooth development:

Bud stage Cap stage Bell stage Crown stage The first sign of tooth development is known to be as early as the 6th week of intrauterine life. The oral epithelium begins to multiply and invaginates into ectomesenchyme cells, which gives rise to dental lamina. The dental lamina is the origin of the tooth bud. The bud stage progresses to the cap stage when the epithelium forms the enamel organ. The ectomesenchyme cells condense further and become dental papilla. Together the epithelial enamel organ and ectomesenchymal dental papilla and follicle form the tooth germ. The dental papilla is the origin of dental pulp. Cells at the periphery of the dental papilla undergo cell division and differentiation to become odontoblasts. Pulpoblasts form in the middle of the pulp. This completes the formation of the pulp. The dental pulp is essentially a mature dental papilla. The development of dental pulp can also be split into two stages: coronal pulp development (near the crown of the tooth) and root pulp development (apex of the tooth). The pulp develops in four regions from the periphery to the central pulp:

Odontoblast layer Cell-free zone – likely to be an artefact Cell-rich zone Pulp core

Internal structure

The central region of the coronal and radicular pulp contains large nerve trunks and blood vessels. This area is lined peripherally by a specialized odontogenic area which has four layers (from innermost to outermost):

Pulpal core, which is in the center of the pulp chamber, with many cells and an extensive vascular supply; except for its location, it is very similar to the cell-rich zone. Cell-rich zone, which contains fibroblasts and undifferentiated mesenchymal cells. Cell-free zone (zone of Weil, which is rich in both capillaries and nerve networks. Odontoblastic layer, the outermost layer which contains odontoblasts and lies next to the predentin and mature dentin. Cells found in the dental pulp include fibroblasts (the principal cell), odontoblasts, defence cells like histiocytes, macrophages, granulocytes, mast cells, and plasma cells. The nerve plexus of Raschkow is located central to the cell-rich zone.

The plexus of Raschkow The plexus of Raschkow monitors painful sensations. By virtue of their peptide content, they also play important functions in inflammatory events and subsequent tissue repair. There are two types of nerve fibers that mediate the sensation of pain: A-Fibres conduct rapid and sharp pain sensations and belong to the myelinated group, whereas C-Fibres are involved in dull aching pain and are thinner and unmyelinated. The A-Fibres, mainly of the A-delta type, are preferentially located in the periphery of the pulp, where they are in close association with the odontoblasts and extend fibers to many but not all dentinal tubules. The C-Fibres typically terminate in the pulp tissue proper, either as free nerve endings or as branches around blood vessels. Sensory nerve fibers that originate from inferior and superior alveolar nerves innervate the odontoblastic layer of the pulp cavity. These nerves enter the tooth through the apical foramen as myelinated nerve bundles. They branch to form the subodontoblastic nerve plexus of Raschkow, which is separated from the odontoblasts by a cell-free zone of Weil. This plexus lies between the cell-free and cell-rich zones of the pulp.

Pulp innervation As the dental pulp is a highly vascularised and innervated region of the tooth, it is the site of origin for most pain-related sensations. The dental pulp nerve is innervated by one of the trigeminal nerves, otherwise known as the fifth cranial nerve. The neurons enter the pulp cavity through the apical foramen and branch off to form the nerve plexus of Raschkow. Nerves from the plexus of Raschkow provide branches to form a marginal plexus around the odontoblasts, with some nerves penetrating the dentinal tubules. The dental pulp is also innervated by the sympathetic division of the autonomic nervous system. These sympathetic axons project into the radicular pulp, where they form a plexus along the blood vessels. Their function is mainly related to blood vessel constriction within the dental pulp. A sharp fall in pulpal blood flow may be caused by stimulation of these nerves. There is no evidence for a parasympathetic pulpal innervation. There are two main types of sensory nerve fibres in the pulp, each densely placed at different locations. The differing structural features of the two sensory nerve fibres also result in different types of sensory stimulation.

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