Teeth are an integral part of the body, which helps to chew food to saturate it with necessary energy. One of the elements of their structure is pulp. Its features, functions, meaning and structure are described below.
Definition
Pulp is a connective tissue that has a fibrous and loose base. It originates from the dental papilla formed by ectomesenchyma. Such tissue is located in the cavity of the tooth and completely repeats its external contours. The arch of the coronal cavity, depending on the age of the patient, can remain at different levels in relation to the neck of the tooth.
In the pulp are nerve endings, fibrous structures and blood vessels. Another feature of the structure of the pulp is that it contains intercellular substances. They just fill the root canals and crown parts. In the area of the tooth, where crown tubercles appear on the surface, the "horns" of the pulp are located. In a multi-rooted tooth, the line between such zones is clearly visible, but in single-rooted teeth it is smoother.
Functions
The structure of the pulp is quite complicated, because it performs many functions.
1. Plastic - odontoblasts take part in the work, they are responsible for the formation of the pulp layer and are involved in the formation of dentin. It makes sense to talk about the primary production of dentin, even before teething, and then a secondary one that histologically resembles the primary one is born. As such a substance appears, a decrease in the cavity of the tooth can be observed.
2. Due to the structure of the pulp, a protective function is performed, for which microphages are created that take part in:
- activation of immune processes;
- removal of dead cells;
- the formation of lymphocytes and their varieties;
- the appearance of fibroblasts responsible for the production and maintenance of the optimal composition of the intercellular substance in the required amount, due to this, metabolic processes occur;
- the production of tertiary dentin, which also performs a protective function.
3. Trophic - it is carried out thanks to a well-developed vascular system, which has some specific features:
- in the pulp, all processes occur at a higher rate compared to other tissues;
- very thin vessels are observed;
- in the structure of the tooth pulp there is such a feature that the pressure there is much higher than in other organs;
- in the intermediate layer there is a huge number of capillaries that are rapidly activated at the time of inflammation;
- due to the presence of anastomoses, there is the possibility of a direct shunt of blood flow.
4. Sensory - the presence of this function is characterized by the work of many nerve fibers that are located in the tooth cavity due to the existing apical opening and fan-shaped diverging in the peripheral direction of the tissues in the crown area.
Anatomical structure
If we consider the structure of the tooth from the anatomy, then the tissue is divided into two zones.
- The coronal flesh is a fairly loose flesh involved in dentogenesis. All layers of which the pulp consists are penetrated by a huge number of nerve cells and capillaries.
- The root pulp is more dense, since it does not contain such a large number of cellular elements, but there are collagen fibers.
Due to the structure of the coronal and root pulp, a sufficiently strong tooth structure is formed. Hard tissue retains the flesh, which in turn is responsible for the formation of dentin.
Through the apical opening, the channels are connected to the periodontal tissues, thereby helping nutrients and minerals enter the walls of the tooth.
Pulp of the front tooth smoothly redirects from the crown to the root. The molar tooth pulp has clearer borders.
Histological structure of the pulp
- Collagen and elastin fibers provide the organ with hyaluronic acid, reduce susceptibility to bacteria and toxins.
- Fibroplasts, lymphocytes and white blood cells contribute to the vital activity of the epithelium and form a connection between them.
- Stellate cells and monoblasts are responsible for pulp regeneration.
- Capillaries and blood vessels provide blood supply to the pulp necessary for tissue nutrition.
- A huge network of nerve endings contributes to the formation of Rozhkov plexus and is responsible for pain when exposed to stimuli. Tissue innervation occurs due to the presence of the ternary nerve.
Pulp composition
74% of the fabric consists of water, and the remaining part is inorganic and organic layers. In the cells are acids, protein compounds, various enzymes and glucose, which helps the epithelium to actively consume and process oxygen.
Vessels
- Arterioles and arteries - they are redirected from the apical part of the pulp to the coronal, in which they branch into a huge number of capillaries. They are in close contact with odontoblasts, thereby providing them with the required nutrients.
- If we consider the structure of the pulp, then there are also veins - thanks to their presence, the output of the vital products of the body occurs.
- Lymphatic vessels - produce blind sacs near odontoblasts, in which metabolism occurs.
- Apical foramen - formally it cannot be called a part of pulp vessels, but it is precisely through it that the entrance and exit of lymphatic vessels, arteries and veins from pulp tissues is formed.
Nerves
The structure of the pulp is such that the dental nerves pass through the apical opening along with the vessels. They are redirected to the coronary part and form a huge network. Not far from the odontoblasts, the nerves create the so-called Rozhkov plexus, from which they are redirected without the myelin sheath, which makes it possible to innervate odontoblasts. Together with the peripheral processes, the nerves pass into the dentinal tubules, dentin and predentin.
Pulp of temporary teeth
- Differences in the structure of the pulp of the coronal and root zones are slightly expressed.
- In general, connective tissue is more loose and hydrophilic with a reduced fiber content and a more diverse number of cellular elements.
- The most significant number of nerves and blood vessels is observed in children aged 2–3.5 years. The structure of the pulp in children 4-6 years old changes significantly. The number of ratios between collagen and pre-collagen substrate grows in favor of the first, along with this an increase in amorphous intercellular substance is formed.
- Well-defined neurovascular bundle.
- The pulp of temporary teeth is tightly connected with the periodontium through the openings of the tooth root.
- The structural features of the pulp of temporary teeth is that the nerve fibers are directed to the area of odontoblasts, where the nerve endings end.
- With the growth of the pulp, the nervous tissue develops last, and at the moment of the resorption of the temporary tooth, it first degenerates, so when the roots are resorbed, the sensitivity decreases significantly.
- When the resorption of temporary teeth occurs, their pulps serve as a source of formation of clusters - huge multinucleated cells, which, in turn, resemble osteoclasts. In the future, dentin and predentin are resorbed, starting from the root.
- Insignificant cavities appear in the periodic layer - vacuoles; they contain a homogeneous mass.
Changes with age
Due to the fact that the formation of physiological secondary dentin is constantly happening, this over time leads to a decrease in the volume of the root canal and the pulp chamber. The main features of the structure of the pulp of permanent teeth are the following processes:
- Thin odontoblast layer or its complete absence. The presence of tissue fibrosis is also observed with a decrease in the number of cellular elements.
- There are atherosclerotic changes in the vessels of the pulp. There is a calcification of capillaries and nerve endings.
- With age, pulpar tissue is more mineralized, which is often manifested by diffuse calcification.
- The older the patient, the more tissue possibilities are reduced. All this guarantees people in this category a not very favorable prognosis when using direct coverage or vital amputation.
Inflammation
The structural features of the pulp are that when pathogenic bacteria invade through the enamel, they begin to adversely affect the tooth, moving to the soft tissues. When the destruction process reaches the nerves, a pathogenic inflammation is formed - pulpitis. Such a pathology occurs in 20 of 100% of patients who require medical care for acute pain.
The main cause of the pathology is the infectious component of the disease. Nevertheless, the impetus for pulpitis can be a mechanical damage to the enamel, as well as poor-quality tooth treatment.
If we talk about the most characteristic signs of pulpitis, then it is paramount to note cutting and acute pain, very often paroxysmal. After a period of time, the intervals can be reduced, and soon the pain becomes constant. In any position, even when lying down, there is no respite from unpleasant sensations, which can intensify during periods, most often at night, not allowing the patient to fall asleep.
At the time of diagnosis, unfortunately, with the help of x-rays there is no way to identify the disease. Therefore, the main method for recognizing an ailment is a routine examination by a specialist. Pulpitis also has certain signs by which a doctor can diagnose the presence of inflammation. For example, when bitten in a tooth, almost no reaction is caused, but the cold provokes more acute and intolerable feelings.
The only way to treat this is to remove the pulp. It is performed exclusively under complete anesthesia, often in several stages. At the first stage, a drug is laid in the tooth that helps to restore the inflamed tissue, as well as an anesthetic. At the second stage, the tooth cavity is thoroughly cleaned, and then is filled. All of the above activities are best done on time, since the pain accompanying this ailment is simply unbearable.
Pulp diseases
All pulpitis most often occurs in acute form. A chronic course is also detected, but its symptoms are not so pronounced as in the case of acute manifestation, and are most often characterized by a perception of thermal effects - hot and cold food. Quite often it is inherent in halitosis. In the case of an exacerbation, paroxysmal pain occurs. Basically, pulpitis is divided into:
- gangrenous - there is pressure in the tooth in contact with hot food, when the tooth cavity is opened, you can observe the release of gray matter with a pungent odor;
- proliferative - pain occurs at the moment of contact with food, which begins to penetrate into the open cavity of the tooth, all this can cause pulp bleeding;
- fibrous - pain manifests itself on mechanical, thermal and chemical irritants.
All concrematous inflammatory processes, depending on the structure of the tooth pulp, are characterized by sudden attacks that are caused by:
- sharp movements;
- vibrations
- lift in the elevator.