Post-mitotic odontoblasts in health, disease, and regeneration

•The four stages in odontoblast cell life cycle from pre-odontoblast to old odontoblast stage.•An update of odontoblasts’ role in innate immunity.•An update on the potential roles of biological markers used in diagnosis and treatment of the diseased pulp.•An overview of current trends in regenerative dental medicine used in pulp therapy in vital and non-vital teeth. Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the current and future management strategies on vital and non-vital teeth. A literature search of the electronic databases included MEDLINE (1966-April 2019), CINAHL (1982-April 2019), EMBASE and EMBASE Classic (1947-April 2019), and hand searches of references retrieved were undertaken using the following MESH terms ‘odontoblast*’, ‘inflammation’, ‘dental pulp*’, ‘wound healing’ and ‘regenerative medicine’. Odontoblasts have a sensory and mechano-transduction role so as to detect external stimuli that challenge the dental pulp. On detection, odontoblasts stimulate the innate immunity by activating defence mechanisms key in the healing and repair mechanisms of the tooth. A better understanding of the role of odontoblasts within the dental pulp complex will allow an opportunity for biological management to remove the cause of the insult to the dental pulp, modulate the inflammatory process, and promote the healing and repair capabilities of the tooth. Current strategies include use of conventional dental pulp medicaments while newer methods include bioactive molecules, epigenetic modifications and tissue engineering. Regenerative medicine methods are in their infancy and experimental stages at best. This review highlights the future direction of dental caries management and consequently research.