Dynamic Aspects of Dental Pulp

Dynamic Aspects of Dental Pulp

Molecular biology, pharmacology and pathophysiology

REIZO INOKI Professor of Dentistry Osaka University

TERUOKUDO Associate Professor of Dentistry Osaka University

LEIF M. OLGART Professor of Endodontics University of Lund

CHAPMAN AND HALL LONDON • NEW YORK • TOKYO • MELBOURNE • MADRAS

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First edition 1990

© 1990 Chapman and Hall Softcover reprint of the hardcover 1st edition 1990

Typeset in lOpt Palatino by Photoprint, Torquay, Devon

ISBN -13 :978-94-010-6675-4

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in any retrieval system of any nature, without the written permission of the copyright holder and the publisher, application for which shall be made to the publisher.

British Library Cataloguing in Publication Data

Dynamic aspects of dental pulp. 1. Man. Teeth. Pulp I. Inoki, Reizo II. Kudo, Teruo III. Olgart, Leif 617.6'342

ISBN-13:978-94-010-6675-4 e-ISBN-13:978-94-009-0421-7 DOl: 10.1007/978-94-009-0421-7

Library of Congress Cataloging-in-Publication Data

Inoki, Reizo, 1929-Dynamic aspects of dental pulp: molecular biology, pharmacology

and pathophysiology / Reizo Inoki, Teruo Kudo, Leif Olgart. p. cm.

ISBN-13:978-94-010-6675-4 1. Dental pulp-Physiology. 2. Dental pulp-Pathophysiology.

3. Dental pulp-Effect of drugs on. I. Kudo, Teruo, 1929- . II. Olgart, Leif, 1938-. III. Title. QP88.6.156 1990 612.3'1l-dc20 89-25249

CIP

Contents

Contributors

Foreword J.K. AVERY

Preface R. INOKI, T. KUDO and L.M. OLCART

Part One Cells and Development

1 Innervation of teeth: developmental aspects D.C JOHNSEN

2 Odontoblasts: developmental aspects J.V. RUCH

3 Dental pulp fibroblasts in culture CA. SHUTTLEWORTH

4 Concluding remarks CA. SHUTTLEWORTH

Part Two Anatomical Aspects of the Pulp - Odontoblast and Vascular Architecture

5 Role of the odontoblast process C.R. HOLLAND

6 Change of vascular architecture of dental pulp with growth Y. IGSHI and K. TAKAHASHI

7 Concluding remarks K. TAKAHASHI

ix

xiii

xvii

3

29

51

69

73

97

131

vi Contents

Part Three Physiological Aspects of the Pulp -Microcirculatory and Sensory Functions

8 Intradental sensory units M. V. O. NARHI 137

9 Microcirculation: function and regulation in microvasculature E. OKABE, K. TODOKI and H. ITO 151

10 Haemodynamic regulation of the dental pulp S. KIM and J. DORSCHER-KIM 167

11 Interstitial fluid pressure and trans microvascular fluid flow K. J. HEYERAAS 189

12 Concluding remarks S. KIM 199

Part Four Biochemical Aspects of the Pulp - Enzymes and Matrix

13 Enzymes of the glycolytic pathway­phosphofructokinase, pyruvate kinase and lactate dehydrogenase N. NAKANISHI, K. OZAWA and S. YAMADA 203

14 Collagenase synthesis by odontoblast-like cells (RP cells) preparation of monoclonal antibodies against RP cell collagenase and characterization of the enzyme S. SAKAMOTO, Y. BOLENDER and M. SAKAMOTO 221

15 Dental pulp matrix - collagens and glycoproteins C. A. SHUTTLEWORTH 239

16 Glycosaminoglycans in dental pulp J. P. VAN AMERONGEN, A. G. LEMMENS and G. J. M. TONINO 259

17 Concluding remarks S. YAMADA 277

Part Five Neuroregulators - Classic Neurotransmitters

18 The adrenergic system and dental pulp J. DORSCHER-KIM and S. KIM 283

Contents vii

19 The cholinergic system and the dental pulp J. K. AVERY and D. CHIEGO, JR 297

20 Concluding remarks J. K. AVERY 333

Part Six Neuroregulators - Neuropeptides

21 Distribution of peptidergic nerves M. AKAI and S. WAKISAKA 337

22 Functions of peptidergic nerves L. M. OLGART 349

23 Concluding remarks L. M. OLGART 363

Part Seven Bioactive Substances

24 Neurotrophic substances J. P. NAFTEL

25 Bradykinin and enkephaIins R. INOKI and T. KUDO

26 Prostaglandins and leukotrienes in dental pulp: their possible roles in pulp pathophysiology M. HlRAFUJI and Y. OGURA

27 Concluding remarks R. INOKI

Part Eight Pathological Aspects of the Pulp and Medication

28 Reactions of dental sensory innervation to injury and inflammation M. R. BYERS and P. E. TAYLOR

29 Proteases in inflammation T. KUDO, E. -Q. WEI and R. INOKI

30 Arachidonic acid metabolism and antiseptics T. DOHI, H. OKAMOTO and A. TSUJIMOTO

31 Concluding Remarks T. KUDO

Index

369

385

403

417

425

445

471

489

493

Contributors

M. AKAI First Department of Oral Anatomy, Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565, Japan

J.K. AVERY Department of Biological and Material Science, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA

Y. BOLENDER Faculty of Dental Surgery, Louis Pasteur University, 1 Place de L'Hopital 67000 Strasbourg, France

M.R. BYERS Departments of Anaesthesiology, Biological Structure and Endodontics, University of Washington, Seattle, Washington 98195, USA

D.J. CHIEGO Jr Department of Biological and Material Science, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA

T. DOHI Department of Pharmacology, Hiroshima University School of Dentistry, 1-2-3 Kasumi 1-chome, Minami-Ku, Hiroshima 734, Japan

J. DORSCHER-KIM Laboratory of Oral Physiology and Department of Endodontics, School of Dental and Oral Surgery, Columbia University, 630 West 168th Street, New York 10032, USA

K.J. HEYERAAS Department of Physiology, University of Bergen, 5009 Bergen, Norway

x Contributors

M. HIRAFUJI Department of Pharmacology, Tohoku University School of Dentistry, 4-1 Seiryo-machi, Sendai 980, Japan

G.R. HOLLAND Faculty of Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 2N8

R.INOKI Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565, Japan

H. ITO Department of Pharmacology, Kanagawa Dental College, 82Inaoka­cho, Yokosuka, Kanagawa 238, Japan

D.C. JOHNSEN Department of Pediatric Dentistry, School of Dentistry, Case Western Reserve University, Cleveland, Ohio 44106, USA

S. KIM Laboratory of Oral Physiology and Department of Endodontics, School of Dental and Oral Surgery, Columbia University, 630 West 168th Street, New York 10032, USA

Y. KISHI Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238, Japan

T. KUDO Department of Pharmacology, Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565, Japan

A.G. LEMMENS Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam, Louwesweg I, Amsterdam 1066EA, The Netherlands

J.P. NAFTEL Department of Anatomy, University of Mississippi Medical Centre, 2500 North State Street, Jackson, Mississippi 39216, USA

N. NAKANISHI Department of Biochemistry, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-02, Japan

Contributors xi

M.V.O. NARHI Department of Physiology, University of Kuopio, P.o. Box 6, SF-70211 Kuopio, Finland

Y.OGURA

Department of Pharmacology, Tohoku University School of Dentistry, 4-1 Seiryo-machi, Sendai 980, Japan

E. OKABE Department of Pharmacology, Kanagawa Dental College, 82Inaoka­cho, Yokosuka, Kanagawa 238, Japan

H. OKAMOTO Department of Endodontology and Periodontology, Hiroshima University School of Dentistry, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734, Japan

L.M.OLGART Department of Pharmacology, Karolinska Institute, S-104 01 Stockholm, Sweden

K. OZAWA Meikai University School of Dentistry, Sakado, Saitama 350-02, Japan

J.V. RUCH Faculte de Medecine, Universite Louis Pasteur, Strasbourg, France

M. SAKAMOTO Laboratory for the Study of Connective Tissue Metabolism, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA

S. SAKAMOTO Laboratory for the Study of Connective Tissue Metabolism, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA

c.A. SHUTTLEWORTH Department of Biochemistry and Molecular Biology, Manchester University Medical School, Stopford Building, Oxford Road, Manchester M13 9PT, UK

K. TAKAHASHI Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238, Japan

xii Contributors

P.E. TAYLOR Department of Endodontics, University of Washington, Seattle, Washington 98195, USA

K. TODOKI Department of Pharmacology, Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238, Japan

G.J.M. TONINO Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam, Louwesweg 1, I066EA Amsterdam, The Netherlands

A. TSUJIMOTO Department of Pharmacology, Hiroshima University School of Dentistry, 1-2-3 Kasumi I-chome, Minami-Ku, Hiroshima 734, Japan

J.P. VAN AMERONGEN Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam, Louwesweg 1, 1066EA Amsterdam, The Netherlands

S. WAKISAKA First Department of Oral Anatomy, Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565, Japan

E.-Q. WEI Osaka University Faculty of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565, Japan

S. YAMADA Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-02, Japan

Foreword

This book presents a circumspective overview and update of the present existing knowledge of the biology, chemistry and pathophysiology of the dental pulp. It details numerous observations of a group of highly specialized investigators who have united in the common purpose of presenting their observations for the benefit of clinicians, teachers, researchers and students. Fortunately, the dental literature presents abundant research findings about pulp biology and the pulp's responses to various stimuli. This abundance has resulted in an increased interest and expansion of research on this subject. For example, publications abound on the response of pulp tissue to various medications and to a variety of types of dental materials which may be placed near to or at some distance from the pulp through the medium of dentine. One of the reasons the pulp is of such interest is that it not only provides the vitality to the teeth but also produces the dentine - both the primary and secondary, as well as reparative. The latter-type dentine is a result of the pulp's functions in response to disease as the former dentine is in response to health. As an example, some investigators have reported the effects of cutting of dentine and the placement of restorations in dentine which in turn reflect changes on the pulp tissue. These reports have raised a number of questions, which in turn have created a need for answers. Many of these questions and some of the possible answers are discussed in this book. Another advantage this book offers is the grouping together of a series of topics which are in turn discussed relative to many of the clinical and basic problems as we understand them today. This clever organizational plan allows each scientist to present his or her work appropriately grouped by subject into parts, which are then summarized for clarity.

Part One pertains to development and discusses such questions as differentiation of the cells of the dental papilla into odontoblasts and fibroblasts, the potential role of the basement membrane on cell­mediated interactions, and the role of nerves in the development and maintenance of the primary and permanent tooth pulps. Part Two con­siders the morphological aspects of the pulp, such as the odontoblasts and their processes and the vascular systems. It includes discussion on

xiv Foreword

the possible mechanism of the internal resorptive process and a descrip­tion of the three major vascular networks of the pulp: the terminal and perpendicular capillary network and the deeper venular network. Part Three in logical sequence, links the microcirculatory and sensory sys­tems of the pulp. Haemodynamic regulation in the pulp is found to be as complex as in any other major organ. The complex interplay between blood flow regulation and tissue pressure is discussed and noted to have an effect on the sensory nerve activity. Included in this section is a description of the role of A- and C-fibres in specific clinical problems.

The need for discussion of the biochemical aspects of pulp ftinction is met by the logical sequencing of Part Four, which is concerned with enzymes important in synthetic activities, such as collagenase, giycolytic enzymes, and collagens, glycoproteins and glycosaminoglycans. Their significance in the health and disease process of the pulp is stressed. Next, in Part Five the neuroregulators, both adrenergic and cholinergic as well as neuropeptides, are examined. Also the important relationship of adrenergics in regulation of pulpal haemodynamics and homeostasis is presented in the light of recently obtained information. The surprising determination that pain fibres have a 'motor' function is shown by their effects on vascularity when pain or noxious stimuli are applied to the tooth. An important finding is that both A- and C-nerve endings have both been observed in a position at the predentine border, where they can receive external stimuli. The work in this section leads to a theory that sensory peptides may exert a continuous influence on pulpal vessels without external stimuli.

Part Six approaches the subject of bioactive substances, such as neurotrophic factors, bradykinin, enkephalins, prostaglandins and leukotrienes in the dental pulp. The role of nerve growth factor in development of the innervation as well as regeneration of nerves in the pulp is another area of discussion. Inflammation of the pulp is viewed in regard to the possible role that prostaglandins and leukotrienes may play. The metabolism of arachidonic acid is also described in relation to pulpal pathophysiology. Part Seven is a logical final section as it considers the dynamics of pulp pathology and the use of medicaments. It was found that CGRP (calcitonin gene-related peptide) coexists with and synergizes the action of substance P in the sensory nerve. Its presence in the chronic inflamed pulp may relate to hypersensitivity and the difficulty of obtaining anaesthesia. Again proteases are examined and viewed in the light of the possibility of an endogenous regulatory system of pain or inflammation in the pulp. The final chapter discusses arachidonic metabolism and antiseptics. It has been found that the action of phenol on the pulp tissue may not be as a protein denaturant,

Foreword xv

as formerly believed, but as an inhibitor of the action of cyclooxygenase and lipogenase. The action of eugenol as an inhibitor is similar.

As we consider the extensive advances described in this book, we are reminded of the statement of Drs Samuel Seltzer and LB. Bender when they so appropriately included two comments about the pulp in the preface of their book The Dental Pulp: 'This is a big issue about a little tissue' and 'This little tissue has caused a big issue' - remarkable progress as we look at the increase in knowledge of the pulp biologists in just the past decade. When we consider how difficult it is to study this very small organ encased in a hard shell of dentine, the advances in knowledge are seen as even greater. According to K.B. Fanbunda, the total volume of the pulps of the human permanent dentition is 0.38 ml and the mean volume of a single adult tooth is 0.02 ml (personal communication, University of Newcastle upon Tyne).

Not long ago, 'toothache' was the primary cause that brought people to the dentist to have that painful tooth removed. Today we have other choices, which increase in number with the growth of new information as provided by the scientific literature and by books such as this one.

My continuing gratitude is due to the editors, Drs Reizo Inoki and Teruo Kudo of the University of Osaka in Suita, Japan, and Dr Leif Olgart of Karolinska Institute in Stockholm, Sweden who have spent two years of planning and collaboration in developing this book. My gratitude also to all the authors who have worked so diligently in their science and in their writing to make this book a success.

James K. Avery The University of Michigan

Preface

Progress in pulp biology research has been rapid during the past decade. Thanks to an increasing number of devoted scientists and the adoption of a variety of new methods, distinct advances in our know­ledge of the fundamental qualities of this encapsulated organ have been achieved. Special techniques used in physiological and pharmacological sciences have generated new and detailed knowledge about basal functions such as control of pulpal blood flow and dental pain mechan­isms. At the same time advanced biochemical and histochemical methods have increased the understanding of local defence mechanisms and the nature of immediate and delayed reactions in the dental pulp when it is subjected to insulting stimulations. Our own experience has found that it is difficult for the individual scientist to grasp all the new information and to gain an overview since dental research is published in such a wide variety of journals, many of them non-dental.

The main aim of this book is to condense into one source a large variety of aspects of pulp functions which enables basic science investi­gators and clinicians to obtain a comprehensive view of the latest progress and current concepts in pulp biology. It is our belief that insights into the dynamic interplay between fundamental functions should be of great interest to those involved in basic and clinical research. In addition, the book could serve as a reference in postgradu­ate education, and we are hopeful that it will provide a substrate for continuing research towards finding new methods of prevention and treatment.

Many distinguished scientists have contributed to this book. Each part contains a number of related chapters written by one or several authors presenting the frontiers in their respective fields. 'Concluding remarks' examines critically what has been achieved and what is to be expected of future research. We are greatly indebted to all authors for their enthusiasm and co-operation and particularly to Dr J.K. Avery for writing the foreword, whetting the reader's appetite to make selections from the dynamic repertoire of pulp functions. Finally, we are very grateful to the editor Ms S.K. Hemmings for co-operation and support

xviii Preface

in the planning of this book, sub-editor Ms H. Watson and everyone else at Chapman and Hall who guided this book so patiently through to publication.

R. Inoki T. Kudo

L.M. Olgart