The prevalence of pulp stones in historical populations from the middle euphrates valley (Syria)

A comparison of dietary isotopes in pulp stones and incremental dentine from Early Neolithic individuals of the Whitwell Long Cairn, England

Objectives

This study investigates if palaeodietary information can be obtained from pulp stones through stable isotope analysis, presents a method for their extraction from tooth samples, and assesses their utility as a source of paleodietary information when coupled with the incremental dentine method.

Materials and Methods

Six tooth samples (2 per individual), four of which contained pulp stones, were selected from three Early Neolithic (3720–3650 cal BC) individuals from the Whitwell Long Cairn in Derbyshire, England. After demineralization, each tooth was divided into 1 mm increments. Stable isotope analysis of collagen was conducted on each dentine increment and a portion of each pulp stone.

Results

All samples met the quality control criteria for well‐preserved collagen. Excluding the pulp stones, the mean δ¹³C value of the teeth sampled was −21.5 ± 0.2‰ and the mean δ¹⁵N value was 9.9 ± 0.5‰, suggesting these individuals had a terrestrial‐based diet. The pulp stones produced similar δ¹³C values between −21.6 and −21.4‰ and δ¹⁵N values between 9.1 and 9.8‰.

Discussion

The results demonstrate that paleodietary information can be obtained from pulp stones through stable isotope analysis. There are, however, significant challenges in interpreting this data, particularly as to inferring the timing and duration of their formation. The pulp stone results were compared with the incremental dentine profiles for each person to further investigate when they might have formed. For two individuals, the pulp stones appear to reflect diet from a time period after childhood and adolescence. For the third individual, it could not be determined if the pulp stones reflect a contemporary or later time period than the incremental dentine series. All teeth with pulp stones have moderate to severe wear on the occlusal surface, which could have been a contributing factor to their development.

Dental pulp calcifications in prehistoric and historical skeletal remains

BACKGROUND

The prevalence of hard tissue formations in the dental pulp varies considerably. Beside ageing processes and irritations of the dental pulp, etiological associations with cardiovascular disease and dietary habits have been discussed, which are of particular research interest. The aim of this pilot study is to provide new insights on structural and etiological factors involved in the development of pulp calcifications by investigating skeletal remains from different (pre)historic periods.

METHODS

The jaws of 46 skeletons excavated in central Germany, were examined for the presence of pulp stones using digital volume tomography (DVT). A total of 1122 teeth were examined with all tooth types considered. To obtain information about the three-dimensional structure of pulp calcifications, micro-CT images were taken. Thin sections of three molars were histologically analysed. Potential dietary effects were studied by analysing stable isotope ratios of nitrogen (δ¹⁵N) in bone samples collected from each individual.

RESULTS

The analysis indicates that pulp stones affect molars in particular and increase slightly with age and dental wear. The micro-CT scans and the histological analysis show that the structures are much more complex than presumed on the basis of DVT imaging. Individuals with lower δ¹⁵N-isotope values and thus with a potentially lower proportion of animal protein in their diet appear to be less affected by pulp stones.

CONCLUSION

When comparing between archaeological and recent data, DVT analysis provides qualitatively comparable results. Micro-CT and histological images illustrate the excellent preservation of pulp calcifications and their complex structure. Differences in prevalence rates and δ¹⁵N-isotope values of Neolithic and historical individuals support the assumption that dietary habits and living conditions could have an influence on the development of pulp calcifications. Due to the small sample size these results require further validation.

Nestin and dental pulp stones - a case report-driven hypothesis

The dental pulp stem cells (DPSCs) are mesenchymal stem/stromal cells (MSCs) with multilineage potential of differentiation. Different studies investigated dental pulp stones (PS), the calcified masses in the dental pulp, in regard to their prevalence, topography and structure. The etiology of PS is still unclear and, to our knowledge, the DPSCs were not attributed yet specific roles in PS formation. We report here an immunohistochemical study of a PS-embedding dental pulp from an impacted third mandibular molar of an adult patient, in which we used antibodies against CD34, Ki67, glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA) and nestin. While endothelial cells expressed CD34 and pericytes or vascular smooth muscle cells expressed α-SMA, DPSCs and the osteoblasts coating the PS were exclusively labeled with nestin antibody. Stromal networks of nestin-expressing DPSCs were regarded as in situ providers of osteogenic progenitors involved in PS formation. Further experimental studies, with larger lots of tissue samples, as well as extended panels of markers, are needed in order to elucidate the DPSC hypothesis in the PS etiology.

Morphologic, Structural, and Chemical Properties of Pulp Stones in Extracted Human Teeth

INTRODUCTION

Pulp stones are mineral structures that develop in the pulp tissue triggered by several clinical conditions. The exact biochemical process behind the occurrence of pulp stones is uncertain. This study aimed to perform a structural and crystallographic characterization of pulp stones and dentin from extracted human teeth.

METHODS

The sample consisted of 13 erupted and unerupted permanent human teeth diagnosed with pulp stones. The teeth were analyzed with scanning electron microscopy with secondary and backscattered electrons, energy-dispersive spectroscopy, micro-Raman spectroscopy, micro-X-ray diffraction, and inductively coupled plasma atomic emission spectroscopy.

RESULTS

The pulp stones revealed a heterogeneous morphology and structure compared with each other. Compared with the adjacent dentin, the pulp stones had a similar structure. From a chemical point of view, oxygen, calcium, carbon, and phosphorus were the most prevalent chemical elements in the inner part of the stones, whereas on the surface carbon, nitrogen, sulfur, chlorine, aluminum, potassium, zinc, copper, and lead were the most prevalent. Copper, iron, and zinc were higher in the stones than the dentin (P < .05). Statistically significant differences between the chemical structure of stones from erupted and unerupted teeth were not detected (P > .05).

CONCLUSIONS

Pulp stones have structural and chemical properties that are similar to dentin. Variations in morphology are common.

Prevalence of pulp stones: A systematic review and meta-analysis

OBJECTIVE

During the last years, different prevalences of dental pulps had been reported from different parts of the world. Combining these original estimates will provide useful information for policymaking in the field of health, treatment and research. This study aims to estimate the global prevalence of pulp stones.

METHODS

Electronic databanks such as PubMed, Scopus, Science direct, Cochrane, and also Google scholar motor engine were searched by 2 researchers using related keywords. The heterogeneity between the results was assessed using Cochrane and I² indices. The initial estimates were represented by forest plot and were combined according to random effects models. Factors responsible for heterogeneity were investigated using meta-regression models, and studies responsible for heterogeneity were assessed following sensitivity analysis.

RESULTS

Prevalence of pulp stones had been reported in 16 studies including 14 093 subjects. The pooled prevalence (95% confidence interval) of pulp stones among the total population, men and women were estimated as of 36.53% (27.17-45.88), 32.58% (24-41.15), and 39.23% (28.73-49.73), respectively. In addition, of 193 687 teeth investigated during the primary studies, 9.57% (95% confidence interval: 7.05-12.08) were affected by pulp stones.

CONCLUSION

Our meta-analysis shows a considerable prevalence of pulp stones, especially among women.

Assessing pulp stones by cone-beam computed tomography

OBJECTIVES

The aim of this study was to evaluate the occurrence of pulp stones by cone-beam computed tomography (CBCT) and to correlate their prevalence with patient's gender, location of tooth (right or left of maxillary or mandibular arch), group of teeth, and restorations.

MATERIALS AND METHODS

CBCT images of 382 patients randomly selected from the database of the University Oral Radiology Department were retrospectively examined. A total of 2833 tooth images obtained using the i-CAT 3D Imaging System were evaluated. Image analysis was performed with the i-CAT software, and all teeth were evaluated in sagittal, axial, and coronal views. All the measurements were subjected to chi square test, odds ratio, and Fisher's exact tests (p < 0.05).

RESULTS

The prevalence of pulp stones was similar between patient's genders and tooth locations. Pulp stones were detected in 31.9% of patients and 9.5% of teeth. Maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. The presence of restorations increased the chance of occurrence of pulp stones by 2.1 times in all teeth examined (p < 0.0001) and by 4.7 times in maxillary teeth (p < 0.0001).

CONCLUSIONS

Pulp stones had a high prevalence with molar teeth showing the highest prevalence. The presence of restorations increased the chance of occurrence of these calcifications, specifically in maxillary teeth.

CLINICAL RELEVANCE

CBCT provides accurate anatomical details in three dimensions, offering the possibility to view an individual tooth in axial, sagittal, and coronal views. This study performed an investigation of the occurrence of pulp stones by CBCT.