ANATOMY OF THE PULP

The pulp is the living tissue which occupies the pulp cavity.

Endodontia “inside a tooth”

Pulp canal (s) located in root or roots of teeth
_Pulp chamber–found under anatomical crown
_Pulp horns–elongations of the chamber which often
corresponds to the cusps or lobes
_Apical foramen–opening at or near the apex
–in/out
_Lateral canals–extend towards periodontal ligament
_Supplementary canal–not present in all teeth

Physiology–function
_Formation of Dentin: primary, secondary, reparative
_Nutrition
_Sensation
_Defense and Protection
_Pulp Canal Development
_Changes with age

The Pulp Latin - pulpa + flesh

1. Any soft, juicy animal or vegetable tissue.
2. A richly vascularized an innervated connective tissue of mesodermal origin, contained in the central
cavity of a tooth and delimited by the dentin, and having formative, nutritive, sensory and protective
functions.
a. Formative–odontoblasts produce dentin throughout the life of the tooth. This is called secondary
dentin.
b. Nutritive: from blood to odontoblast cytoplasmic extensions in dentin.
c. Sensory: pain from heat, cold, drilling, sweets, decay, trauma, infection.

Clinical Perspective
A. Remember, the pulp is your friend! Treat it with lots of respect. It's like having a diagnostic
computer planted in the tooth.

B. The slightest exposure to the outside elements (carious exposure, a fracture, idiopathic
procedures) will cause DEATH TO THE PULP the majority of the time.

C. A accurate diagnosis may be made by asking the patient the correct questions. An x-ray is
always another diagnostic tool. however many times the tooth will appear normal. Digital x-rays promise
to be even more definitive. The following symptoms can be used as guide lines to your diagnosis.

COLD- The tooth is being irritated. The list of irritations can be long.
Common irritations are decay, abrasion, erosion, overworked, improper brushing, whitening agents.

HOT- The tooth needs endodontic therapy or removal

HOT AND COLD- There is a internal fracture or stress line typically at the junction of the enamel-dentin
location. This can be corrected with a new restoration.

HURTS TO THE BITE- Necrotic tissue present or periodontally involved. 90% of the time when the
tooth hurts to percussion there is necrotic tissue in the pulp.

SWEET-Similar to cold, irritation. This tends to be a external source involving exposed dentin and
plaque.

d. Protective response to injury or decay by forming reparative dentin.

Dental Papilla is the undifferentiated
predecessor of the dental pulp. It is thought that
the ectomesenchymal (neural crest) cell provide
initiative for differentiation.
Cytodifferentiation begins at the bell stage
(not cap stage) under the influence of the internal
epithelium the peripheral cells of the papilla
differentiate into odontoblasts.
Age Changes of the Pulp
Developmental stage
**Synthetic activity of odontoblasts and
fibroblasts are high–protein synthesis
Mature stage
**Activity subsides to a low but constant level
**”ready state” to accelerate due to outside stimulus
Pulpal calcification
**Over 90% of old human teeth show signs
–diffuse
–pulp stones
– true denticles (have odontoblastic layer)
–false denticles (more frequent, no odontoblast layer)
–not associated with any symptoms

Regions of the Pulp

Odontoblast layer
Cell-free zone (of Weil)
**Sub-odontoblastic plexus of Raschkow
–Terminal and sub terminal branches of sensory fibers
Cell rich zone
**increased cell density
**blends into bulk of pulp
Pulp Anatomy
1. Chamber – anterior – in the crown
– Posterior–partly in the crown; mostly in the cervical part of the root.
Once pulp chamber in each tooth
Roof–incisal or occlusal border
Floor–in multi rooted teeth–the cervical portion with openings for each root canal
2. Root canal–also known as pulp canal found in root of a tooth. The root canal is a
continuation of the chamber.
Classifications: Type I, II, III, IV
3. a. Apical foramen–at or near the root apex
b. Accessory foramen–most commonly found near the apex.
Variations of Pulp Anatomy
Genetics
Age of Tooth
Function: Normal
Para function
Disease–Systemic
During Tooth Formation
 Local Trauma
– Caries
–Recession
–Tooth Damage
Chamber Variations
Pulp horns–projection beneath cusps or mamelons in the roof of the chamber.
Floor–flat in young teeth
convex with aging
Anatomy of the Pulp

Mandibular
*Incisors–70-90% 1 canal
*Canines
*Premolars
*First Molar
–follows crown contour
–two canals in M root
*Second Molar
*Third Molar–high variability

Maxillary
*Incisors–triangle to circular
*Canines–canal wider labio-lingually
*First Premolar–70% have two roots
*Second Premolar-split canal two foramina
*First Molar–60% of MB have two
canals
*Second Molar
*Third Molar–high variability
Young Teeth (see diagrams of types)
Maxillary central incisors, lateral incisors
and canines: Type I
Mandibular central incisors–1-2 canals
Type I, II
Mandibular lateral incisors–1-2 canals
Type I, II
Mandibular canines–Type I
Maxillary 1st premolar–approximately
60% have 2 roots; 90% have 2 canals:
Type I, or II, III
Maxillary 2nd premolar–one root-50%
have 2 canals Type I or II, III
Mandibular 1st and 2nd premolar-one root
1st Type I (70%) Type IV (24%) 2nd Type I
Maxillary 1st molar DB-1 canal, MB-2
canals-type III, P-1 canal
Maxillary 2nd molar MB-has 2 canals
17%
Mandibular 1st M-2 canals MB and ML
Type II, III D-2 Canals 35% Type II
Mandibular 2ns M-2 canals 64% Type II, III; 1 canal 27% D-1 canal