Pulp Biology and Tooth Pain

1. Nerves + Blood vessels + lymphatics
2. Fibroblasts

   Annotations:

   • Secrete fibrous connective tissue
3. Odontoblasts

   Annotations:

   • Secrete dentin
   1. Primary dentin

      Annotations:

      • Before root formation is complete
   2. Secondary dentin

      Annotations:

      • After root formation is complete
4. Undifferentiate mesenchymal cells
   1. Secondary odontoblast
      1. Tertiary dentin

         Annotations:

         • Protects the pulp from injury
5. Surrounded by hard dentin
   1. Limits ability to expand
6. Lacks collateral circulation
   1. Limits ability to cope with infection

Annotations:

• against infection

1. Sclerotic dentin
   1. Calcification of tubules in response to slowly advancing caries or aging
   2. PHYSIOLOGICAL proces

      Annotations:

      • Dentin gets harder over time 
   3. SLOWLY advancing caries
2. Reactionary Dentin

   Annotations:

   • Secondary dentin
   1. Reaction to MINOR damage
3. Reparative dentin

   Annotations:

   • Tertiary dentin
   1. Repair for MAJOR damage
      1. New odontoblasts must be formed
4. Pulpal necrosis
   1. response to rapidly advanciing caries or other severe damage

1. Dentinal
   1. Aδ fibers
      1. First pain
         1. Coronal
2. Pulpitis
   1. C fibers
      1. Second pain
         1. Centrally pulp stroma
3. Referred Pain
   1. Preauricular pain
      1. Mandibular molars
         1. V3 innervation