Module 2 Biology of the Pulp-Dentine Complex

Intro and Odontogenesis/Embryology of the Pulp

 Endodontics is the branch of dentistry which is
involved with the morphology, physiology, and the
pathology of the human dental pulp and
periradicular tissues (around the root of the tooth)
 There are two sections of the pulp which includes the
coronal pulp (in the tooth crown) and the radicular
pulp (in the root of the tooth)
 The dental pulp is important in the overall dental
health; may be associated with the:
- Periodontium (group of structures which support the tooth, cementum
periodontal ligament, alveolar bone and gingiva): apical periodontitis, periodontal
disease
- Central nervous system: orofacial pain
- Restorative dentistry: interaction between dentine and the pulp
- Periodontics: interaction between dental pulp and periodontium
 Pulp-dentine complex: are closely related to each other embryologically,
structurally, and functionally; they are histologically distinct from each other
- Anything which affects the dentine will also affect the pulp, vice-versa

Odontogenesis
 Development of the primary dentition starts at the 5th week while permanent dentition
starts at 14th week of gestation
1. After the egg is fertilized by the sperm, it develops into a zygote and starts dividing
(from 2 cells  32 cells) then into a
ball of cells, called a morula
2. Morula becomes compacted and the
outer layer of cells become the
trophoblasts; inner layer of cells
become the embryoblasts
3. Morula becomes even more
compacted, creating a cavity known as
the “blastocoel” to become the
blastocyst  blastocyst inner cell
mass differentiates even more by
creating a cavity known as the
amniotic cavity and differentiating
into hypoblast and epiblast
4. these two types of cells become a flat “pancake” known as the “bilaminar disk”  at
the middle of the bilaminar disk, the
“primitive streak” starts to form, indicating
the start of the gastrulation process (forming
of the three germ layers)  cells in the
 primitive streak on the epiblast migrate and forms another layer (ectoderm,
mesoderm, and endoderm)
5. neurulation occurs; in the centre of the
mesoderm, differentiation occurs and the
notochord is formed  formation of the
notochord induces a change in the ectoderm,
ectoderm thickens to become the neural plate
 neural plate cells dip down to the
notochord and forms the neural tube
 Top of the neural tube develops into the brain while the end
of the tube becomes the spinal cord; side of the neural tube
becomes the somites which develop into muscles
 The neural crest cells develops into the PNS, adrenal
medulla, connective tissue of the head and face, and
ectomesenchyme (migrates under the oral epithelium) which develops into the pulp,
dentine, periodontal
ligament, alveolar bone
 The enamel is the only part
of the tooth which is
derived from the epidermis
of the embryo
 -
 During the 6th week of the developing
embryo, thickening of the ectodermal oral
epithelium of the embryo occurs; this
thickening is known as the primary
epithelial band. Directly underneath this
band is the ectomesenchyme.

- Primary epithelial band on both the

maxillary/mandibular eminence will
develop into the future maxillary and
mandibular arch of the dentition.
- the stomodeum within the embryo will
develop into the oral cavity; the
maxillary and mandibular prominence
will develop into the maxilla and mandibles respectively
 During the 7th week of the developing embryo. The primary epithelial band will
grow deeper and split into vestibular lamina and dental lamina
- Vestibular lamina will develop into depression between the teeth and the
cheek/the lips
1. Lamina Stage: The dental lamina (part of the primary epithelial
band/ectodermal oral epithelium) will invaginate into the ectomesenchyme
due to the oral epithelial cells changing orientation and thickening, forming
the dental placode
 Dental placode is the signalling centre which determines what kind of
tooth it will develop into (e.g incisor, premolar, molar etc.)
2. The dental lamina continues to grow, thickening into a bud (AKA bud stage
8th week) ectomesenchyme will proliferate and condense under the dental
placode

3. Forms the dental papilla, the enamel organ and dental follicle/sac (AKA
cap stage 9th to 10th week). The dental follicle, dental papilla and enamel
organ is known as the tooth germ
  Dental follicle sac will develop into the cementum, periodontal
ligaments and alveolar bone
 Dental papilla will develop into dentin and pulp
 Enamel organ will develop the enamel

- During the early bell stage (11th to 12th week), the final shape of the tooth is
being formed and differentiation of the cells occur. The enamel organ will
differentiate into the inner, outer enamel epithelium, stellate reticulum and
stratum intermedium. The area where the outer and inner epithelium meet is
known as the cervical loop. At the late bell stage, secondary enamel knot is
formed (signalling centre; marks the location of future cusps)
 - The inner enamel epithelium will differentiate into the ameloblast (cells which
secrete enamel) in the late bell stage
- The outer enamel epithelium, stellate reticulum, stratum intermedium
differentiates into the junctional epithelium
- The cervical loop forms the root of the tooth (Hertwig’s root sheath determines
the size and shape of the root)
- The dental papilla differentiates into odontoblasts (cells which secrete dentine)
in the late bell stage and the pulp
- The dental follicle will differentiate into cementoblast (cells which form the
cementum), periodontal ligaments, alveolar bone, gingiva
 The four stages (lamina, bud, cap, bell stages) are a continuous process which is
distinguished histologically
 After these four stages, eruption occurs which marks the end of odontogenesis
Dental Pulp
 The pulp horn follows the cusp tip
 Root canal orifice may sometimes be obscured due to
calcification
 Accessory canals are formed during the
mineralization of the Hertwig’s root sheath; they are
hollow as they are formed due to the entrapment of
the periodontal vessels
 Accessory canals can be a pathway of bacteria to
infect the periodontium via the root canal system;
they cannot be detected radiographically
 Younger tooth have a large apical foramen and have a better prognosis for pulp
survival
Composition of the dental pulp
 Cells
- Mesenchymal cells (undifferentiated)
- Odontoblasts
- Fibroblasts
- Immunocompetent cells (Macrophages, Dendritic cells, Lymphocytes)
 Extracellular matrix
- Ground substance (proteoglycan)
- Collagen fibres (Type I and III)
- Interstitial fluid
 Blood vessels and nerves
- Arterioles and venules
- Sensory afferent nerve fibres/Sympathetic efferent nerve fibres
Odontoblasts
 Odontoblasts functions
- Secrete dentine/provides vitality to
the dentine
- Preserve the pulp
- Allows the tooth to respond to a
wide range of stimuli
 Odontoblasts are columnar cells and are located at
the interface between the pulp and the dentine
- The cell body portion is located at the pulp
(synthesizes the dentine/ECM material); the
odontoblastic process (secretion of the
dentine) extends through the dentinal tubules
- Odontoblasts survive for the life of the tooth

 Odontoblasts is highly polarized (asymmetric organisation of

several cellular components for specialized function). Since
odontoblast is a secretory cell:
- it contains rough ER which is organized in parallel stacks
- prominent golgi complex/numerous mitochondria
- secretory granules move to odontoblastic processes
- one or more nucleoli
 Odontoblasts are linked to each other/other cells via three types
of connections:
- Desmosomes: for mechanical connections between
odontoblasts at apical part of the cell body
- Gap junctions: for intercellular communication/regulation
of cell activity (e.g synchronizing secretion); also connects
odontoblasts with fibroblasts
- Tight junctions: forms the predentine-pulp barrier which restricts passage of
molecules/fluid; controls the permeability of the odontoblast layer
 The morphology of the odontoblast differs throughout its lifespan (preodontoblast 
secretory transitionalaged); the older the cell is:
- Less polarized the odontoblast becomes
- Shorter it becomes
- Decreased size/number of cellular organelles
- At its final stage, organelles are not present in supernuclear regions but is located
at the infranuclear region
 Comparison of osteoblast VS odontoblast
- Cell process is close to cell body VS cell process extends from cell body (forms
dentinal tubules)
- Cell body resides in the mineralized matrix VS cell body resides outside of the
mineralized matrix
  Secretion of odontoblasts
- Proteins
 Collagenous proteins: structural proteins for support/type 1 collagen
(high collagen cross-linking and high hydroxylysine content)
 Non-collagenous proteins: proteoglycans (for ECM organization),
glycoproteins (control mineralization)
- Growth factors: TGF beta (for cell growth/proliferation/differentiation/apoptosis)
- Enzymes: acid phosphatase (digests material from predentine matrix) and
alkaline phosphatase (associated with mineralization)
Fibroblasts (mostly found in pulp)
 Functions of the fibroblasts
- Produces Type I, III collagen and proteoglycan to maintain the ECM
- Has the ability to phagocytose collagen fibrils/secreting proteolytic enzymes
for remodelling the ECM
- Participates in the signalling pathway during inflammation
 Produces nerve growth factor in response to injury of
odontoblast/neurons
 Produces proinflammatory cytokines (e.g IFN beta which enhances the
expression of MHCI and presents more antigens to lymphocytes to inhibit
viral replication)
 Produces colony stimulating factors (CSF) (stimulates the growth of
neutrophil G-CSF/monocyte progenitors M-CSF)
Undifferentiated mesenchymal cells (found mostly in pulp core)
 Functions of the undifferentiated mesenchymal cells
- Migrates to the site of injury and differentiates into odontoblasts
Immunocompetent cells
 Dendritic cells
- The most prominent type of immune cell in the pulp
- Constantly expresses MHCII which presents antigens to T4 helper lymphocytes
without provocation
- Located in near the odonotoblast layer/around blood vessels
 Macrophages
- Resting as monocytes in the healthy pulp
- Phagocytes which can devour antigens
- Expresses MHCII when provocated by bacteria/antigen to T4 helper
lymphyocytes
- Located near central pulp/around blood vessels
 Lymphocytes
- T4 works together with dendritic and macrophages
- T8 lymphocytes is the predominant type
- B lymphocyte is scarce in the pulp
Extracellular matrix
 Collagen fibres: mainly type I and III collagen for structural support
 Ground substance: proteoglycan and hyaluronan
- Forms an amorphous gel which gives the shape of the pulp
- supports cells as it acts as a channel for transporting nutrients and waste
- acts as a sieve: filters out large proteins and regulates diffusion of substances
 Interstitial fluid: surrounds all the cells and acts as a transport medium for delivery
of waste and nutrients

Histology of the Pulp

 The pulp contains four morphologic zones:
- Odontoblast zone: the outermost layer which is closest to the dentine
 Consists of:
Cell bodies of odontoblasts
Capillaries
Terminal nerve axons
Dendritic cells
 Distribution of odontoblasts varies among the radicular (less) and coronal
(more) pulp
 Size and shape of odontoblasts varies
Coronal pulp: tall columnar
Mid root: cuboidal
Near apical foramen: flat
- Cell-poor zone: fewer cells than the odontoblastic zone
 Consists of:
Unmyelinated nerve fibres (Plexus of Raschkow)
Capillary plexus
- Cell-rich zone:
 Consists of:
Undifferentiated mesenchymal cells
Fibroblasts
Macrophages/dendritic cells
Capillary plexus
- Pulp proper: located at the centre of the
pulp chamber
 Consists of:
Undifferentiated
mesenchymal cells
Fibroblasts
Macrophages/dendritic
cells/lymphocytes
Blood vessels
Nerve axons bundles
 The dental pulp is actually an unique
connective fibrous tissue
Dentine
Anatomical Location and Boundaries
 The dentine is bounded by the
- Dentinoenamel junction (the border
is unevenly scalloped i.e crescent-
shaped which increases the adherence
between the dentine and the enamel)
- Dentinocemental junction (the
cementum meets the dentine at the
apical foramen where the pulp tissue is
connected to the periodontal tissues)
- Cementoenamel junction
Chemical composition of dentine
 Inorganic component 70% (harder than alveolar bone and shows up whiter in
radiographs; softer than enamel)
- Carbonated hydroxyapatite Ca10(PO4)6(OH)2
- More prone to carious lesions and demineralization
 Organic component 20%
- Collagen type 1
- Proteoglycans
- Growth factors
 Water 10%
- Free fluid 75% (near DEJ/pulp)
- Bonded fluid 25% (in apatite crystals/collagen)
Tissue composition of dentine
Dentine is mainly a calcified connective tissue which is composed of:

 Odontoblastic process
- Secretion of collagenous/non-collagenous proteins/dentine
- Makes dentine a living tissue
 ECM
- Collagen type I (provides tensile strength to support enamel)
- Non-collagenous protein (structural support of ECM, control of mineralization,
regulation of growth factor and cytokine signalling)
Proteoglycan
glycoproteins
- Enzymes/growth factors
Matrix metalloproteinases (for degrading components of the ECM)
TGF beta (stimulates stem cell to differentiate after demineralization of
dentine)
- Ground substance
 - Apatite crystal filler particles (provides tensile strength to dentine)
Dentine is a porous biological composite material composed of
hydroxyapatite crystal filler particles in a collagen matrix
Dentine tubules are surrounded by collagen fibres with hydroxyapatite
crystal filler particles
Hydroxyapatite crystal filler particles (HAP platelet) may either be in
between collagen fibres (interfibrillar mineralization) or within collagen
fibres (intrafibrillar mineralization)
 This mineralization is controlled by the dentine phosphoprotein
 calcium is transported from blood vessels by the odontoblasts into
the collagen fibril network

 Calcospherites (globules of hydroxyapatite) are present between

the dentine and predentine layer
- Dentinal fluid
Ultrafiltrate of blood from the pulp capillaries
Slowly flows outward from dentine when dentine is exposed
Resembles plasma fluid, but with less plasma protein and more calcium
concentration
 Nerves (terminal nerve axons)
Dentine Microstructure
 Dentine is penetrated by millions of dentine tubules
 These dentine tubules extends through the entire
dentine (denser near pulp); their shape is decided by the
course of odonotoblasts during odontogenesis
 Dentine tubules branch off; branching off is more
prominent at DEJ (causes more sensitivity)
 Peritubular dentine surrounds each dentinal tubule;
while intertubular dentine surrounds the peritubular
dentine
- Intertubular dentine constitutes the bulk of
dentine (primary product of odontoblasts); made up
of collagen fibres with apatite crystals (provides
tensile strength)
- Peritubular dentine is deposited at the inner wall
of the dentinal tubule; less collagen fibres and is
more mineralized (hence harder, but is more readily
dissolved by acid than intertubular dentine)
Type of dentine targeted in
restorative/endodontic procedures in order
to enlarge the opening of the dentinal
tubules and makes the dentine more
permeable

 The secretion of the odontoblasts will be

deposited at
- The predentine (including proteoglycans
and collagen)
- The mineralization front (just after
predentine but before intertubular
dentine)
Non-collagenous matrix, proteoglycans
Sclerotic dentine (dentine tubules are filled with mineral deposits in response to
irritating stimuli such as caries, attrition, erosion)
 Reduces the permeability of the dentine/tertiary dentine
 The mineral deposits may come from the peritubular dentine; odontoblasts via
diffusion, intraluminal deposition
 Occurs more often as age increases; most commonly found in the apical third of the
root & crown midway between the DEJ and pulp
Interglobular dentine (calcospherites did not fuse together)
 A defective dentine with incomplete mineralization
 No matrix formation; occurs most frequently under the mantle dentine
Types of Dentine
 Mantle dentine
- First dentine formed by unfully differentiated odontoblast
- Irregular matrix; less mineralized than primary dentine
- Does not have dentine phosphoprotein (hence cannot control apatite crystal
growth)
- Rich in enzymes (ATPase)
 Predentine
- Between the odontoblastic layer and the dentine
- Protein (collagen type 1 and 3; proteoglycan; dentine phosphoprotein; TGF beta)
 Primary dentine (formed prior to eruption)
- Exclusive secretory products of the primary odontoblasts
- Outlines the pulp chamber
 Secondary dentine (formed after eruption)
- Slower growth rate than primary dentine
- Deposited asymmetrically (mainly floor and roof of pulp chamber)
- Exclusive secretory products of the primary odontoblasts
- Survives for the life of the tooth
- Responds to wide variety of stimulus
 Tertiary dentine (formed in response to noxious stimuli/damaged odontoblasts)
- Reparative tertiary dentine or reactionary tertiary dentine
- Formed in order to protect the pulp by increasing the thickness of dentine, reduces
the permeability of dentine
- Disorganized, appearance differs depending on the severity of stimuli
Pulp Microenvironment
 Pulp of the maxillary teeth are innervated by the superior alveolar nerve (branch of
the maxillary nerve); pulp of the mandibular teeth are innervated by the inferior
alveolar nerve (branch of the mandibular nerve)
 Inferior and superior alveolar artery are both branches of the maxillary artery (branch
of the external carotid artery)
 Microcirculation of the pulp is composed of the arterioles and venules; there are no
collaterals (i.e alternatives) which supply the pulp; hence the apical foramen is a
critical region in which the arterioles and venules enter the pulp
- Capillaries branch out and forms a network in the subodonotoblast region
- Venules progressively get larger when coursing to the central pulp; these venules
drain into the maxillary vein and the facial vein
 Lymphatic vessels are in the periphery of the pulp and anastomoses (link between two
blood vessels/channels in the body) with the lymph vessels of periodontal ligaments
and alveolar bone; these lymphatic vessels:
- Drains the fluid/proteins to remove inflammatory exudates (mass of cells/fluid
seeped out from blood vessels)
- Gives the pulp interstitial fluid pressure
- Provides immune defense (contains dentritic cells)
- They drain into the submental, submandibular, cervical
lymph nodes which empties into the internal jugular and
subclavian vein
 The functional coupling between the cellular activity and the
capillary blood flow to maintain pulp homeostasis (needed to
transport nutrients/gas to cells; removing waste/CO2 from
cells)
Mechanisms which the pulp use to control the local blood flow to the functional unit in
the terminal capillary networks
 Precapillary sphincter: controlled by local cellular and sympathetic neuronal control
- Norephinephrine: vasoconstriction
- Nitric oxide: vasodilation
 Anastomosis: shunting blood away from the site of inflammation/injury
- AVA (arteriovenous anastomosis): links arteriole to venule
- VVA (venous-venous anastomosis): links venule to venule

 The pulp has relatively

- High blood volume
- High capillary density
- High resting blood flow (highest in pulp
horn)
- High pressure in pulp (hence dentinal fluid
flows outward when dentine is exposed)
Pulp innervation
 The pulp gets both sensory afferent innervation and sympathetic efferent
innervation
- Afferent from the maxillary and inferior alveolar nerve from the trigeminal
ganglion
- Efferent from the superior cervical ganglion;
- Both efferent and afferent nerve bundles enter/leave the pulp via the apical
foramen

- The nerve fibres form the plexus of Raschkow in the subodontoblastic region
 - Each individual myelinated axons sends branches to form the plexus which
innervates a hundred of dentinal tubules (makes the pulp one of the most densely
innervated tissues in the body)

 A fibres: mechanical nociceptors (activated by hydrodynamic stimulants; movement

of fluid)
 C fibres: polymodal nociceptors (activated by thermal, mechanical, chemical)
Functions of the Pulp
 A tooth can function without a pulp; a pulpless tooth does not mean it is a dead tooth!
 The pulp can help the tooth to resist bacterial infection
 The pulp gives pain and proprioceptive feedback to prevent
overloading/damaging (e.g fracture) the tooth while chewing (pulpless tooth requires
2.5x more load than normal tooth to register pain) or inflammatory reactions (no
pulp = no pain symptoms)
 The pulp contains free water to provide mechanical integrity (no pulp = brittle
tooth)
 Pulp diseases can lead to oral sepsis; starting from infection of the root canal system
Functions of dentine

 Upon tensile load; the load is carried by the mineral crystal platelets and the protein
matrix distributes the load
 Dentine has a higher tensile strength (maximum stress that a material can withstand
before breaking) than enamel
 Dentine also has a higher fracture toughness (total energy that a material can absorb
before fracture) than enamel
 The water in the collagen within the dentine is crucial as to why dentine has both a
higher fracture toughness and a higher tensile strength

 Water within the pulp space and dentinal tubules also contribute to increased strength
in dentine
Physiological interactions between the pulp and the dentine
 Integrity of the dentine is dependent on the health of the
pulp; the health of the pulp is reliant on the permeability of
the dentine
 The density and the size of the dentinal tubules increases
near the pulp (i.e the permeability of the dentine also
increases near the pulp)
- The permeability of the dentine affects the pathogenicity
of the pulp
- The overall permeability of the dentine is proportional to
the amount of surface area of the dentine exposed (more
exposure = more chances of potential noxious stimuli to
enter the pulp)
- Coronal dentine is more permeable than radicular
dentine due to decreased density of dentinal tubules in radicular dentine (hence
less permeable to bacterial toxins)
 The microhardness of the dentine decreases
going from the DEJ to the pulp
 The pulp-dentine complex is a fluid-filled
continuum via dentinal tubules
 Efficient pulp microcirculation will increase the
permeability of the dentine and allow substances
to pass through; if the circulation is ceased then
dentine permeability of the dentine decreases as
well
  Dead tracts increases the permeability of the dentine: bacteria causes the early death
of odontoblasts which causes the formation of hollow dentinal tubules and leads
directly to the pulp
- This enhances carious processes
- Pulp defense response activated as it is highly vascularized
 The permeability of dentine decreases
- As the dentinal fluid flows outward to prevent substances in entering the
dentine/outward flow of immunoglobulins and fibrinogen
- Dentine sclerosis decreases permeability due to intraluminal crystal deposits in the
tubules
The integrity of the pulp is also reliant on the formation of tertiary dentine
 Tertiary dentine is formed in response to noxious
stimuli in order to protect the pulp by increasing the
thickness of the dentine (reduces the dentine
permeability of protection)
- Noxious stimuli includes attrition, erosion,
trauma, caries, cavity preparation
 Tertiary dentine is also formed when odontoblasts
are damaged/replaced
 The appearance of the tertiary dentine differs
depending on the noxious stimuli
- Regular tubular
- Dysplastic
- Atubular (odontoblasts do not have a process)

 Mild insults (e.g attrition)

causes the reactionary dentine
with intratubular crystal
deposits to form; the primary
odontoblasts are injured and
forms this type of tertiary
dentine
 Strong insults (e.g cavity
preparation) causes the
atubular reparative dentine to
form; newly differentiated
odontoblasts forms this type
of tertiary dentine which does
not line up with the primary
dentine
  Dentine bridge and caries also trigger the formation of tertiary dentine

- Dentine bridge is a type of reparative dentine with tunnel defects at a site of pulp
exposure
- Early stage caries where enamel is still intact  reactionary dentine is deposited
- Advanced stage caries where enamel is cavitated/bacteria invades dentinal tubules
 reparative dentine is deposited

The integrity of the pulp is also reliant on the dentine sensitivity

 Pain (thermal, mechanical, chemical,
electrical pain) is the main sensory
modality of dentine
 Pain is seldomly felt despite the tooth
being in a hostile environment unless the
dentine is exposed
- Pain can be produced by cold/heat,
probing on dentine, air blasts, hyper-
osmotic solution, sweets
 Mechanisms of pain include:
- Direct stimulation of the nerve (abandoned theory)  nerve rarely reach the DEJ
from the pulp and not all
dentine are innervated
- Direct stimulation of the
odontoblasts (unsure)  no
evidence that odontoblasts have
synapses to nerve & nerve
impulse in the odontoblasts are
too small to permit impulse
transduction
- Through hydrodynamic
stimulation via the dentinal
fluid (well established theory)
 dentinal fluid moves through
the dentinal tubules which
distorts the pulp
microenvironment and the free
nerve endings in the plexus of Raschkow
- Stimulants such as temperature (thermal)/probing on dentine
(mechanical)/air blasts (dehydration) will cause the dentinal fluid to flow
outwards even more rapidly (flows outwards because the pulp pressure is higher
than the environmental pressure)  mechanoreceptor nerve endings will be
activated and elicits pain response
- Dentinal tubules are like capillary tubes since the diameter is very small; this
produces a large fluid force and the dentinal fluid flow speed will be very rapid 
deformation of nerve endings occur  sharp pain carried by A fibres
 Both A fibres and C fibres transmit pain
- A fibres: connected to mechanical nociceptors; activated by the hydrodynamic
stimulants (i.e the flow of dentinal fluid); responsible for sharp pain as nerve fibre
receptors overlap in a region of dentine
- C fibres: connected to polymodal receptors and hence is activated by different
stimulants (thermal, mechanical, chemical); responsible for dull pain
 Pathway of pain transmission from nociceptor to the
brain
- Afferent nerve fibre (Aδ; fast pain!) of a nociceptor
in molar is activated by stimulant  trigeminal
ganglion (first order neurons)  trigeminal spinal
tract nucleus (secondary order neurons) neothalamic
tract  thalamus (tertiary order neurons) 
cerebral cortex
- Aδ fibres do not have other interneurons from other
regions of the brain hence the pain location is
precise. Unlike the C fibres which is responsible for
dull, inflammatory pain
 How air blasts (desiccation/dehydration) trigger pain

 How sweets (hyperosmotic solutions) trigger pain

  How occlusal overloading causes pain in dentine

1. Biting something unexpectedly hard will cause the deformation of the dentine
2. Rapid flow of dentinal fluid through the dentine/deformation of the
mechanoreceptor at the pulp dentine border
3. Pain response
4. Nociceptive reflex response is activated in order to protect the tooth from
overloading to fracture by masticatory forces (jaw-elevating muscles are inhibited
by interneurons while jaw-depressing muscles are excited)

Pulp sensibility tests

 Includes electric, cold, and heat sensibility tests
 Tests are used on intact tooth with no dentinal tubules exposure
 Pulp cold test (used to test if the pulp responds to stimulus):
Thermal stimuli applied to intact enamel surface which causes the rapid movement of
dentinal fluid in the dentinal tubules  activates the mechanoreceptors  causes
rapid painful response (1-2 seconds)
- The cold test is more effective than the heat test (cold causes the dentinal fluid to
flow outwards; warmth causes the dentinal fluid to flow inwards)
 Pulp electric test: generates a current to stimulate the Aβ (prepain response) or Aδ
(pain response) fibres; C fibres are not activated by the electric test