ORAL MIC ANA LEC FINALS (1) PULP

A specialized soft connective tissue Endodontium Well vascularized Consists of lymphatics and nervous tissue Occupies the center space of the tooth (pulp cavity) Very important tissue because the vitality of the tooth depends to its vitality PULP is from: DENTAL PAPILLA (+dentinw/c protect the pulp)

Root Canals o Extends from the cervical region to the apex o Very greatly in form and number, and course is difficult to predict o May be round, elliptical (often with one canal) or flattened (often have more than one) APICAL FORAMEN The opening of the root pulp into the periodontium Open wide in newly erupted teeth; narrow in older teeth ACCESSORY CANALS Canals that extends laterally from the root canals Numerous in the apical third of the root (apical ramification) AKA: Lateral canals Very small side branching May result from: 1. Presence of blood vessels obstructing dentin formation 2. Lack of root sheath needed to induce root formation FUNCTIONS OF PULP Inductive Tooth formation Early in the development, the pulp interacts and initiates formation Formative Formation of secondary dentin by odontoblastic cells Performed by the odontoblasts (found at the peripheral areas of the pulp) Nutritive Highly vascular (blood vessels are present); nourishes dentin Receives its nutrients from the blood stream Protective or sensory Sensation (nerve fibers); pain=FREE NERVE ENDING Sensitive to external stimuli Expressed in several ways:

TWO FORMS OF PULP TISSUE Coronal pulp Radicular pulp Coronal Pulp Occupies the crown of the tooth (pulp chamber) Much larger than root pulp Follows the contour of the outer surface of the crown Has PULP HORNS that extends to the cusps of the teeth (# depends on the # of cusps) - more prominent in younger people. (extension of the pulp chamber under cuspal ares) At the cervical region it joins the root pulp Radicular Pulp Pulp that extends from the cervical region of the crown to the root apex Occupies the root canal Tapered or conical in shape Anterior teeth-single Posterior- multiple PULP CAVITY The center space housing the pulpal tissue Divided into: Pulp Chamber o Pulp cavity located in the crown o Shape corresponds to that of the crown with extensions

**Morphotic Response - formation of additional dentin (reparative dentin) or change in the character of the existing dentin (sclerosis) as protective barrier as a response to the external stimuli of the tooth **Inflammatory Reaction - the participation of defense cells (histiocytes, ameboid wandering cells, and undifferentiated mesenchymal cells) where there is inflammatory process - aid in the process of repair in the pulp *PULPITIS- inflammation of the pulp STRUCTURAL COMPONENTS OF THE PULP

Ex: Fibroblasts (collagen-forming) and

Undifferentiated mesenchymal cells (pluripotential cells found in young pulp) Pulp Core/Pulp Proper Inner zone Central zone Contains large arteries, veins, and nerve trunks that enter the pulp from the apical canal through the apical foramen and proceed to the pulp chamber * apical foramen-opening where the vessels enter and leave the pulp PRINCIPAL CELLS OF THE PULP 1. Odontoblasts 2. Fibroblasts 3. Defense Cells a) Histiocytes b) Undifferentiated Mesenchymal Cells c) Ameboid Wandering Cells 4. Pericytes (Rougets Cells) Fibroblasts Most numerous Functions are: o collagen fiber formation throughout the pulp during the life of the tooth o forms the pulp matrix o capable of ingesting and degrading the pulp matrix In embryonic and immature pulp, cellular elements predominate In mature pulp, fibrous components predominate Odontoblasts Second most numerous Reside adjacent to predentin with cell bodies in the pulp and cell processes in the dentinal tubules Undifferentiated Mesenchymal Cells Primary cells in very young pulp Few are seen after root formation

4 Distinct Areas of the Pulp o Odontoblastic zone o Cell-free zone o Cell-rich zone o Pulp Core/Pulp proper
Odontoblastic Zone Formed by a layer of the cell bodies of the odontoblasts appearing as of varying thickness at the periphery of the pulp Peripheral layer Odontoblasts are: o Crown- tall columnar o Middle- cuboidal o Near Apical- spindle/flat o Apical (foramen)-absent Cell-Free Zone Zone of Weil or Weil's basal layer Subodontoblastic zone- below the odontoblastic zone Free of cells, but are fibrous in appearance No cells are found Cell-Rich Zone Bipolar zone Characterized by numerous densely packed bipolar cells with spindle shaped nuclei

 Found along pulp vessels, in the cell-rich

zone and scattered throughout the central pulp Believed to the totipotent cells, when need arises they become odontoblasts, fibroblasts, or macrophages Decrease in the number in old age

Function is thought to be that they serve

as contractile cells capable of reducing the size of the vessels lumen Aka: Rougets Cells

Defense Cells Important for the defense of the pulp Includes the histiocytes, undifferentiated mesenchymal cells and ameboid wandering cells In addition, blood vascular elements such as neutrophils, eosinophils, basophils, lymphocytes, and monocytes emigrate from the pulpal blood vessels in response to inflammation

VASCULAR SUPPLY Pulp organ is extremely vascularized Arise from the inferior and superior alveolar arteries and veins These blood vessels enter and exit by way of the apical and accessory foramen NERVE SUPPLY Pulp organ is richly innervated and follows the distribution of the blood vessels Consists primarily of sensory afferents o maxillary and mandibular branches of the trigeminal nervesupplies the upper and the lower teeth o sympathetic branches from the superior cervical ganglion Majority of the nerves are nonmyelinated o are close associated with the blood vessels o function is for vasoconstriction Large myelinated fibers mediate the sensation of pain that may be caused by external stimuli LYMPHATIC VESSELS Presence in the dental pulp is questioned by some and agreed upon by other investigators Lymph vessels draining the pulp and periodontal ligaments have a common outlet Anterior teeth pass to the subment lymph nodes Posterior teeth pass to the submandibular and deep cervical lymph nodes REGRESSIVE CHANGES (AGE CHANGES) Narrowing of the Pulp Space Happens both in the pulp chamber and root canal

(a) Histiocytes
-aka: Adventitial Cells, Rest Wandering Cells, Clasmatocytes -found: along the capillaries -during inflammation, the histiocytes withdraw the cytoplasmic brances and assume rounded appearance and migrate to the site of inflammation and develop into macrophages *macrophage-engulf bacteria, cellular debris, and other matters like hemosiderin. It serves as scavengers. (b) Undifferentiated Mesenchymal Cells -they are called Pluripotential Cells because under proper stimulus, they can develop to any type of connective tissue elements -In inflammatory reaction, they turn into macrophages or plasma cells, or after loss of odontoblast, they migrate to the dentinal wall, through the zone of Weil and differentiate into cells that produce reparative dentin (c) Ameboid Wandering Cells -aka: lymphoid wandering cells -these are cells that escaped from the blood stream and migrate to the site of inflammation -exact function is not fully known Pericytes Located on the periphery of the capillaries

 Brought about by continued dentin OLD- narrow, obliterated

Formation of Pulp Stones or Denticles Nodular, calcified masses appearing in either both the coronal or root portions of the pulp organ Classification According to histologic structure o True- has the structure of true dentin, with regularly arranged dentinal tubules o False- consist only of concentric lamellas of calcified tissues (calcium salts) o Mixed- combination of true and false pulp stones According to location in relation to the dentinal wall o Free - surrounded by pulp tissue o Attached - partly attached to dentin tissue o Embedded - surrounded by dentin deposition

Fibrosis of the Pulp Fibrous elements increase in amount but cellular elements decreases Believed to be due more to injury than aging Atrophy of the pulp Decrease in the size of the pulp due to decrease in structural contents May assume the appearance of a net referred to as reticular atrophy Paralyzation of the Functional Capacity Caused by o Chronic pathological processed, such as deep carious lesions, pulpal abscesses, chronic cellular infiltrations o Injudicious, nonbiological dental therapeutic or restorative measures

According to form o Nodular round o Amorphous - indefinite or no definite form o Fibrillar - elongated calcification following the course if blood and nerves. - appear more often in the root canal

CLINICAL CONSIDERATIONS Shape of Pulp Chamber and Pulp Horns Wide pulp chamber in young person will make deep cavity preparation hazardous, and should be avoided if possible Pulpal horns may project high and exposure can occur Radiographs will help determine the size of a pulp chamber and the extent of the pulpal horns Opening of a Pulp Chamber With advancing age, pulp chamber becomes smaller, making it difficult to locate root canals in RCT pulpstones lying at the opening of the root canal may cause considerable difficulty when locating the root canals Shape of the Apical Foramen and Its Location Apical foramen is narrowed by cementum, making it more readily located When apical opening is at the side, may lead to misjudgment of the length of the canal in RCT Accessory Canals Rarely seen in radiographs Not treated in RCT when located near the coronal part of the root or in the bifurcation area, a deep periodontal pocket may cause inflammation of the dental pulp A necrotic pulp can cause spread of disease to the periodontium through an accessory canal Pulpal Exposure Non-infected or minimally infected pulpal exposure tooth can be preserved if proper pulp capping procedures are applied, due to the presence of defense cells in the pulp and formation of Reparative dentin

Operative Procedures Dehydration causes pulpal damage, procedures causing this should be avoided Cavity liners should be used prior to insertion or restorations containing harmful chemicals (acids in silicate cements, zinc phosphate, etc) Pulp Vitality Non-vital tooth (RCT tooth) becomes brittle and is subjected to fracture Every precautions should be taken to preserve the vitality of a pulp Pulp testers test the reaction of the pulp to electrical or thermal stimuli (hot and cold), which provide information about the nerves supplying the pulpal tissue, thus testing its sensitivity and not its vitality Vitality depends on its blood supply, one can have teeth with damaged nerve but normal blood supply as in traumatized teeth Apical Ramification canals that extends laterally from the root canals