PATHOPHYSIOLOGY OF DENTAL PULP: CLINICAL FEATURES, ETIOLOGY AND PATHOGENESIS

Abstract

Dental pulp is a specialized connective tissue located within the rigid confines of the dentin–enamel complex, responsible for vascular, neural, immune, and formative functions essential to tooth vitality. Pathological alterations in the pulp arise from a combination of microbial, mechanical, chemical, and thermal insults that induce a cascade of inflammatory, vascular, and neurogenic responses. This article provides a comprehensive overview of the clinical presentation, etiological determinants, and underlying pathophysiological mechanisms associated with pulp disease. A narrative review methodology was employed, analyzing contemporary scientific sources published between 2015–2024. The results reveal that pulp inflammation progresses through reversible and irreversible phases characterized by shifts in vascular permeability, cytokine expression, and extracellular matrix degradation, ultimately leading to necrosis if untreated. Clinically, pulp pathology manifests as thermal hypersensitivity, spontaneous pain, and altered response to vitality testing, corresponding to distinct histopathological stages. Understanding these mechanisms is crucial for early diagnosis and biologically based treatment approaches, including pulp preservation and regenerative therapies. The findings underscore the need for integrative diagnostic strategies that combine clinical evaluation, microcirculation assessment, and biomarker-based technologies. Future research should focus on immunomodulatory interventions and stem cell-based regenerative endodontics to preserve pulpal vitality.