Unveiling the Vital Role of Dental Nerves in Dental Pulp Immune Defence and Repair

BACKGROUND: Dental pulp sustains oral health through dentine formation, sensation, nutrition and defence. Beyond these classical roles, pulpal nerves have emerged as key coordinators of immune responses and tissue repair. While traditionally viewed as limited to sensory and vascular regulation, recent advances reveal that the nervous system interacts with immune mechanisms to manage inflammation and facilitate regeneration following injury or infection. OBJECTIVES: To synthesise evidence on the anatomy, distribution and functional diversity of dental pulp innervation, emphasising how nerves regulate innate/adaptive immunity and orchestrate pulp tissue repair and regeneration. METHOD: The review included studies up to the search period, utilising PubMed and Google Scholar. Search terms covered nervous-system concepts ("nerves", "neuropeptides", "nervefibres", "Schwann cells") and immune/repair concepts ("immune response", "inflammation", "immune cells", "fibroblasts", "odontoblasts", "dental pulpstem cells", "dentine regeneration", "odontogenic differentiation"). Key termswere combined with Boolean operators: [nervous-system terms] AND [immune/repairterms] AND [dental], to capture studies on the role of dental nerves in pulpimmune defence and repair. RESULTS: In innate immunity, dental nerves recognise pathogens, undergo sprouting in inflamed pulp, mediate neurogenic inflammation and engage in dynamic crosstalk with immune cells. In adaptive immunity, they influence antigen presentation and regulate T-cell activation through neuropeptides, highlighting their central role in immune modulation. Furthermore, dental nerves are indispensable for tissue repair, facilitating key processes such as progenitor cell recruitment, proliferation, differentiation and reparative dentine formation. Schwann cells and sensory and sympathetic innervation play distinct yet interconnected roles throughout these stages. CONCLUSION: The neuro-immune-endodontic axis is central to the pulp's ability to defend and repair itself, offering insights into innovative therapeutic strategies for managing dental pulp diseases. By integrating neural regulation into endodontic therapies, we can develop more effective treatments that leverage the complex interplay between the nervous and immune systems, enhancing outcomes for dental health and regeneration.