Dandan Shao, Zhenyu Yao
Inflammatory immune responses in the dental pulp are shaped by interacting cellular and molecular processes, and microRNAs (miRNAs) are important post-transcriptional regulators. However, an integrated understanding of how miRNA networks orchestrate the balance between pulpitis progression and tissue repair remains incomplete. This review examines the differential expression profiles of miRNAs in inflamed dental pulp, and evaluates their potential as adjunctive biomarkers of pulpitis status. We also summarize how miRNAs regulate key inflammatory signaling cascades, including the TLR/NF-κB, mitogen-activated protein kinase, and cGAS-STING pathways, and discuss their integration within broader epigenetic crosstalk networks involving lncRNAs and circRNAs. We further analyze how the inflammatory microenvironment and physicochemical stresses alter the osteogenic/odontogenic differentiation potential of dental pulp stem cells through miRNA-dependent regulation. We then assess the translational prospects of exosome-delivered miRNAs as cell-free therapeutics and highlight unresolved challenges in sampling feasibility, donor heterogeneity, delivery specificity, and clinical validation. By synthesizing evidence on miRNA regulatory networks in pulpal inflammation and regeneration, this review provides a framework for evaluating miRNA-based diagnostic tools and targeted therapies for pulpitis.