Introduction
The anatomy of the tooth essentially consists of three layers. In the crown area the outermost layer is the enamel, the hardest substance of the body. This is followed by the dentin or dentin bone and inside is the pulp.
The root of the tooth is the outermost layer and surrounds a third hard substance called cement, which serves to anchor the tooth and is therefore counted as part of the periodontium. Then follows the dentin and inside the root canal with the root pulp. The pulp fills the inner cavities of the tooth.
It adapts approximately to the shape of the dentin. A distinction is made between the crown pulp and the root pulp. The pulp is well protected by the dentin and enamel.
The pulp cavity and the root canals are initially very spacious in young people. With age, both become more and more constricted due to continued dentin production (secondary dentin). The internal structure of the pulp consists of connective tissue, blood vessels and nerve fibers.
At the edge of the pulp there is a layer of odontoblasts, cells that form new dentine and thus cause the narrowing of the cavity. Blood is supplied to the pulp through blood vessels that enter and exit through the opening at the tip of the root. This opening at the tip of the root also supplies nerve cells that originate from a nerve called the trigeminal nerve.
The pulp is connected to the entire organism through the opening at the root tip. The pulp can become diseased due to various influences. Mostly, an inflammatory reaction of the pulp occurs as a result of progressive caries.
However, thermal stimuli, such as heating by grinding the tooth or chemical and toxic stimuli from tooth filling can also lead to a reaction of the pulp. Even through the opening at the root tip, the pulp can become inflamed during very deep periodontological processes. The inflammatory reactions of the pulp can occur in different stages.
First only the crown pulp may be affected and then spread to the entire pulp. As the disease progresses, the pulp can either become necrotic, i.e. dead, or it can turn into a purulent decay of the pulp tissue, called gangrene. Since an inflammation is always accompanied by edema, it causes great pain, since the inflammatory tissue in the pulp cavity cannot expand and therefore presses on the nerve fibers.
Pain is therefore the main symptom of an inflammation of the pulp. Occasionally, pain can also be caused by a so-called denticle. This is a hard structure similar to dentine, which is located inside the pulp cavity, either free or attached to the pulp wall. The dental diagnosis can be made mainly by X-ray.
