Normal loss of milk teeth causes degeneration in brain stem

Changes in the Distribution of Periodontal Nerve Fibers during Dentition Transition in the Cat

The periodontal ligament has a rich sensory nerve supply which originates from the trigeminal ganglion and trigeminal mesencephalic nucleus. Although various types of mechanoreceptors have been reported in the periodontal ligament, the Ruffini ending is an essential one. It is unknown whether the distribution of periodontal nerve fibers in deciduous teeth is identical to that in permanent teeth or not. Moreover, morphological changes in the distribution of periodontal nerve fibers during resorption of deciduous teeth and eruption of successional permanent teeth in diphyodont animals have not been reported in detail. Therefore, in this study, we examined changes in the distribution of periodontal nerve fibers in the cat during changes in dentition (i.e., deciduous, mixed and permanent dentition) by immunohistochemistry of protein gene product 9.5. During deciduous dentition, periodontal nerve fibers were concentrated at the apical portion, and sparsely distributed in the periodontal ligament of deciduous molars. During mixed dentition, the periodontal nerve fibers of deciduous molars showed degenerative profiles during resorption. In permanent dentition, the periodontal nerve fibers of permanent premolars, the successors of deciduous molars, increased in number. Similar to permanent premolars, the periodontal nerve fibers of permanent molars, having no predecessors, increased in number, and were densely present in the apical portion. The present results indicate that the distribution of periodontal nerve fibers in deciduous dentition is almost identical to that in permanent dentition although the number of periodontal nerve fibers in deciduous dentition was low. The sparse distribution of periodontal nerve fibers in deciduous dentition agrees with clinical evidence that children are less sensitive to tooth stimulation than adults.

Molecular signaling and pulpal nerve development

The purpose of this review is to discuss molecular factors influencing nerve growth to teeth. The establishment of a sensory pulpal innervation occurs concurrently with tooth development. Epithelial/mesenchymal interactions initiate the tooth primordium and change it into a complex organ. The initial events seem to be controlled by the epithelium, and subsequently, the mesenchyme acquires odontogenic properties. As yet, no single initiating epithelial or mesenchymal factor has been identified. Axons reach the jaws before tooth formation and form terminals near odontogenic sites. In some species, local axons have an initiating function in odontogenesis, but it is not known if this is also the case with mammals. In diphyodont mammals, the primary dentition is replaced by a permanent dentition, which involves a profound remodeling of terminal pulpal axons. The molecular signals underlying this remodeling remain unknown. Due to the senescent deterioration of the dentition, the target area of tooth nerves shrinks with age, and these nerves show marked pathological-like changes. Nerve growth factor and possibly also brain-derived neurotrophic factor seem to be important in the formation of a sensory pulpal innervation. Neurotrophin-3 and -4/5 are probably not involved. In addition, glial cell line-derived neurotrophic factor, but not neurturin, seems to be involved in the control of pulpal axon growth. A variety of other growth factors may also influence developing tooth nerves. Many major extracellular matrix molecules, which can influence growing axons, are present in developing teeth. It is likely that these molecules influence the growing pulpal axons.

Teeth and tooth nerves

(1) Although our knowledge on teeth and tooth nerves has increased substantially during the past 25 years, several important issues remain to be fully elucidated. As a result of the work now going on at many laboratories over the world, we can expect exciting new findings and major break-throughs in these and other areas in a near future. (2) Dentin-like and enamel-like hard tissues evolved as components of the exoskeletal bony armor of early vertebrates, 500 million years ago, long before the first appearance of teeth. It is possible that teeth developed from tubercles (odontodes) in the bony armor. The presence of a canal system in the bony plates, of tubular dentin, of external pores in the enamel layer and of a link to the lateral line system promoted hypotheses that the bony plates and tooth precursors may have had a sensory function. The evolution of an efficient brain, of a head with paired sense organs and of toothed jaws concurred with a shift from a sessile filter-feeding life to active prey hunting. (3) The wide spectrum of feeding behaviors exhibited by modern vertebrates is reflected by a variety of dentition types. While the teeth are continuously renewed in toothed non-mammalian vertebrates, tooth turnover is highly restricted in mammals. As a rule, one set of primary teeth is replaced by one set of permanent teeth. Since teeth are richly innervated, the turnover necessitates a local neural plasticity. Another factor calling for a local plasticity is the relatively frequent occurrence of age-related and pathological dental changes. (4) Tooth development is initiated through interactions between the oral epithelium and underlying neural crest-derived mesenchymal cells. The interactions are mediated by cell surface molecules, extracellular matrix molecules and soluble molecules. The possibility that the initiating events might involve a neural component has been much discussed. With respect to mammals, the experimental evidence available does not support this hypothesis. In the teleost Tilapia mariae, on the other hand, tooth germ formation is interrupted, and tooth turnover ceases after local denervation. (5) Prospective dental nerves enter the jaws well before onset of tooth development. When a dental lamina has formed, a plexus of nerve branches is seen in the subepithelial mesenchyme. Shortly thereafter, specific branches to individual tooth primordia can be distinguished. In bud stage tooth germs, axon terminals surround the condensed mesenchyme and in cap stage primordia axons grow into the dental follicle.(ABSTRACT TRUNCATED AT 400 WORDS)

Epidemiology of chronic facial pain: diagnostic usefulness in patient care

Three chronic facial pain conditions--temporomandibular pain and dysfunction syndrome, phantom tooth pain and burning mouth syndrome--can puzzle dentists trying to provide diagnoses and treatment plans. Epidemiologic data and their usefulness in providing diagnostic criteria for these conditions are explored.

Central representation of dental structures in the kitten, including projections to the mesencephalic trigeminal nucleus

Horseradish peroxidase (HRP) was injected into either a single maxillary or a single mandibular primary (deciduous) cuspid tooth of 8- to 10-week-old kittens. The large apex of the primary cuspid allowed for some leakage of the HRP from the pulpal chamber to the periodontal ligament (PDL). Thus, the injection procedure resulted in the application of HRP to the PDL as well as to the pulpal tissues. The transganglionic transport of HRP resulted in discrete terminal fields within the spinal trigeminal nucleus (STN) and the main sensory nucleus (MSN). These projections were clearly somatotopically organized within the STN, but less so within MSN. Within pars oralis (PO) and pars interpolaris (PI), mandibular cuspid dental structures (MdCDS) were represented in a dorsal position relative to the maxillary cuspid dental structures (MxCDS), whereas within pars caudalis (PC) and the adjacent reticular formation the somatotopic representation was not dorsoventral, but rather mediolateral, with the MdCDS represented more medially than the MxCDS. Areas of overlap between MxCDS and MdCDS were found within MSN and to a lesser degree within the superficial laminae of PC. In addition, the fiber pathway leading to labeled somata in the mesencephalic trigeminal (Mes V) nucleus was clearly identified. The majority of the fibers traced to the Mes V nucleus exited the spinal trigeminal tract at the level of the transition from PO to the MSN and traversed the nuclear region in a position dorsal to and separate from the trigeminal motor tract. As in STN, fibers within the caudal Mes V tract appeared to be somatotopically organized, with the fibers from the MdCDS generally more dorsal than the ones from the MxCDS. Labeled fibers, some with terminal arbors, were also identified in close association with the trigeminal motor tract. The findings show a complex pattern of central representation in the immature feline central nervous system for deciduous dental structures.

A comparison of pulpal and tactile detection threshold levels in young adults

Pulpal and tactile sensory detection threshold (SDT) values of the maxillary and mandibular incisor and canine teeth were determined and recorded for young adult subjects at three test sessions. A commercially available monopolar pulp-testing device was used to determine pulpal SDT values, and von Frey hairs were used to determine the tactile SDT values. Statistical analysis of the data indicated that the pulpal and tactile test procedures were sufficiently reliable in identifying what is defined as the true SDT value for both parameters. The study confirmed the constancy of these SDT values over days and the independence of the values for jaw, side, and sex. SDT values were influenced, however, by tooth type, with canine teeth displaying higher tactile and pulpal values than the central and lateral incisor teeth. These data should provide a suitable baseline for a longitudinal study to identify the SDT fluctuations known to occur in tooth pulp and dental supporting tissues in a growing human population.

Ultrastructure of degenerative changes following ricin application to feline dental pulps

The ultrastructure of degenerative changes within the ipsilateral trigeminal ganglion, and partes caudalis and interpolaris of the spinal trigeminal nucleus in the cat is described following the application of the potent toxin ricin to the tooth pulps of unilateral maxillary and mandibular posterior teeth, including the cuspids. Survival times ranged from 6 to 10 days. Typical changes identified within the ipsilateral trigeminal ganglion included myelin fragmentation and 'compartmentalization' of the axoplasm of medium-sized myelinated axons, while small myelinated and unmyelinated axons underwent a more variable response ranging from electron-lucent to electron-dense changes. The affected cell body was characterized by the presence of swollen, electron-lucent mitochondria, a reduction of cytoplasmic ribosomes and a filamentous hyperplasia. Other changes often included an eccentric nucleus and satellite cell proliferation. Degenerative changes often occurred in isolated elements surrounded by normal profiles, suggesting specificity of ricin within the trigeminal ganglion. Changes within brainstem axons showed both an electron-dense and a lucent, fragmenting type of axonal alteration. Terminal changes ranged from electron-dense to lucent and also included filamentous hyperplasia and 'hyperglycogenesis'. The altered axonal knobs contained round synaptic vesicles that were presynaptic to dendritic profiles and postsynaptic to terminals containing flattened synaptic vesicles. The above brainstem alterations were identified specifically in the following areas: ventrolateral, medial and dorsomedial pars interpolaris; the ventrolateral and mid-dorsal to dorsomedial areas of the marginalis and outer substantia gelatinosa layers of pars caudalis; and in ventral pockets corresponding to lamina V of the medullary dorsal horn. Dense alterations within terminals containing flattened synaptic vesicles that are typically presynaptic to primary afferents in these areas were rare findings, but along with vacuolization of dendritic profiles suggest a trans-synaptic effect possibly due to the exocytosis of ricin. The results are discussed in relation to different reports of dental projections and with regards to patterns of transganglionic degeneration.

Transganglionic degenerative atrophy in the substantia gelatinosa of the spinal cord after peripheral nerve transection in rhesus monkeys

The effect of sciatic nerve transection on its centrally located terminals in the spinal cord was analyzed by electron microscopy in adult rhesus monkeys one and three months following lesion. Although the peripheral and intermediate portions of the dorsal roots, where the axons are enveloped by Schwann cells were normal, their central portion and their terminals in the substantia gelatinosa were remarkably altered. Transganglionic degenerative atrophy (TDA) is characterized by three distinct types of electron-microscopic alterations. The first type exhibits a conspicuous electron density of the terminal and pre-terminal axoplasm. Importantly, shrinkage replaces fragmentation and glial engulfement of the terminal seen in the course of Wallerian degeneration. The second type is characterized by the disappearance of synaptic vesicles from the terminals. The third type of TDA consists of intricate labyrinthine structures, composed of flattened profiles of axonal, dendritic and glial elements. The complex and diverse cellular changes that occur in the upper dorsal horn following peripheral nerve injury may provide the structural basis of plasticity of the primary nociceptive system.

Innervation of the dental pulp during tooth succession in the cat

The possibility that axons branch to supply the pulps of both the upper deciduous canine tooth and its permanent successor has been investigated by stimulating the pulp of one tooth and recording from the pulp of the other. In cats less than about 14 weeks of age, the permanent canine was too poorly developed to allow electrodes to be applied to it satisfactorily. In 5 of 14 preparations in cats aged 14-23 weeks, compound action potentials were recorded in one canine during stimulation of the other. These responses were not abolished by sectioning the infraorbital nerve or its canine branch in the floor of the orbit or by paralysing the animal, but they were abolished by sectioning the pulp of the permanent canine, indicating that they were due to branched axons. In preparations in which there was no tooth-to-tooth response, there was usually evidence that the pulp of one or other of the teeth did not have a functional innervation. The results indicate that at least some of the nerves which supply the pulp of a deciduous tooth are retained to supply its permanent successor.

Light- and electron-microscopic localization of primary dental afferents to medullary dorsal horn (pars caudalis)

Light-microscopic (LM) and ultrastructural (electron-microscopic, or EM) identification of primary dental afferents to medullary dorsal horn (MDH) was demonstrated in the cat following injections of horseradish peroxidase (HRP) into pulpal chambers of unilateral maxillary and mandibular posterior teeth, including the cuspids. Use of a new osmication protocol improved and simplified the EM localization of reaction product within the brain stem terminals. LM examination showed that the projection pattern varied between the different levels of MDH. At caudal levels, the labeling was primarily confined to a narrow band consisting of a dense projection to the dorsomedial portion of laminae I and superficial II and a less intense projection to lamina V. The pattern to rostral levels became increasingly more dense and extensive within these same laminae. LM examination of the tooth apex region showed that a limited spread to the periodontal ligament occurred in some cases. EM investigation of the ipsilateral MDH demonstrated reaction product in terminals with synaptic vesicles that are presynaptic to small and medium-sized dendrites. Labeled axonal endings in close association with cell bodies were also observed. No labeled structures were identified in the contralateral MDH. Some of the reaction product found with EM was below the LM limit of resolution, and thus ultrastructural investigation is necessary for a complete analysis of any pathway when using HRP.

Toxic ricin demonstrates a dual dental projection

Toxic ricin was used to study the central distribution of dental afferents in the cat. Following intrapulpal ricin injections ganglion cell degeneration is seen in the II and III ganglion divisions. Central argyrophilic degeneration occurs in the dorsal portion of all ipsilateral trigeminal nuclei. Ventral degeneration is seen in the pars interpolaris and pars caudalis. No contralateral degeneration was observed. The results are discussed with regard to previous studies of the central location of dental afferents.

A morphometric study of the effects of maturation and aging on synaptic patterns in the spinal trigeminal nucleus of the cat

Morphometric methods have been used to study the synaptic and terminal patterns in cat trigeminal nucleus, pars interpolaris, during development and aging. Ages 1, 3, 6, 11, 16, 21, 27, 110, 600 days and 8 and 11 years were studied. Both proportions and densities (number per unit area) of certain terminals and synapses showed significant changes with age. Axoaxonic synapses especially showed two major periods of increase (3-6 days and 21-27 days). The values of most parameters increased in the 21-27 day period to peak levels and then decreased gradually with age. The results indicate two separate critical synaptogenic periods of development and a loss of synaptic elements in aging. Factors contributing to these changes are discussed as is the potential for plasticity in the different afferents at each period.

The reaction of primary sensory neurons to peripheral nerve injury with particular emphasis on transganglionic changes

This paper reviews light- and electron microscopic, histochemical and physiological evidence which demonstrate that peripheral nerve injury in mammals is followed by profound structural and functional changes in the central terminals of the affected primary sensory neurons. Available evidence indicates that at least some of these so-called transganglionic changes are the result of ganglion cell degeneration and death, although other mechanisms are probably in effect as well. Existing data suggest that this ganglion cell death does not effect all types of ganglion cells equally, but do not permit a clearcut answer to the question of which kinds of ganglion cells are affected more than others. Results from studies with microtubule inhibitors and antibodies to nerve growth factor are compatible with the notion that depletion of retrogradely transported trophic factors is involved in the production of certain transganglionic changes. This issue needs further examination, however. Physiological studies indicate marked alterations in certain primary afferent synaptic connections after peripheral nerve lesions. So far, these changes have not been satisfactorily correlated with the structural changes induced by similar lesions. Further studies on the structural and functional response of primary sensory neurons to peripheral nerve injury are likely to contribute to the understanding of the frequent failure to regain normal sensory functions after peripheral nerve lesions in man, as well as of the basic aspects of lesion-induced changes in general in the peripheral and central nervous system.

Ultrastructure of transganglionic HRP transport in cat trigeminal system

The ultrastructure of transganglionic transport of horseradish peroxidase (HRP) from the inferior alveolar (IA) nerve to the brainstem is being studied in the cat. The IA nerve was soaked in an HRP solution and following a two-day survival the animal was perfused transcardially with a paraformaldehyde-glutaraldehyde solution. The tissue was immediately dissected and postfixed for 1-3 h in perfusate. Sections of 75 micron thickness were cut with a Vibratome and reacted utilizing tetramethyl benzidine (TMB) as the chromagen. Optimum results for electron microscopy were obtained by osmication in a pH 6.0, 1% osmium tetroxide solution for 45 min at 45 degrees C, followed by rapid dehydration and embedment in Epon. The resulting HRP-TMB reaction product was characterized and identified ultrastructurally in ganglion cells, peripheral and central axons and in brainstem terminals. The HRP-TMB reaction product varied in density but had consistent crystalline-like laminations of a repeating unit and characterized by a membrane 4-5 nm in diameter. Some of the HRP-TMB reaction product found in terminals and axons was below the limit of resolution of the light microscope.

Development of sensory and reflex responses to tooth-pulp stimulation in children

Electric stimulation was applied to the tooth-pulp and tongue in 12 children divided into 3 groups according to the development of the roots of the upper first incisors, i.e. 1/2, 3/4 and fully formed. The masseter inhibitory periods (MIP) could be evoked by electric stimulation of the tongue at sensory threshold current levels in all children, but only for incisors with fully-formed roots. Stimulation of incisors with 3/4 formed roots at detection-threshold currents produced sensation 56 per cent of the time and detectable MIP on 65 per cent of stimuli. No sensation was obtained with stimuli up to 100 microA in incisors with 1/2-formed roots, but MIP was recorded with 31 per cent of stimuli. The findings indicate that reflex activity precedes sensation in the normal development of teeth, and that segmental, reflex, connections appear to be established before the cortical, sensory, projections are fully functional.

Ultrastructure of transganglionic degeneration in brain stem trigeminal nuclei during normal primary tooth exfoliation and permanent tooth eruption in the cat

Electron microscopy is used to study changes in the axons and terminals in the cat brain stem trigeminal nuclei, main sensory, and partes interpolaris and caudalis, during the process of natural tooth shedding. Areas previously showing light optical argyrophilic degeneration products and adjacent areas lacking this degeneration are included. Various types of alteration occur early during tooth loss, including increased presumed glycogen, increased cytoplasmic density, flocculence, lucency, and neurofilamentous hyperplasia. By the stage of maximum exfoliation, terminals and axons of marked density become prominent in areas showing argyrophilia, whereas nondense forms occur elsewhere. By late eruption ages, all forms of degenerated terminals and axons are rare, but phagocytes are heavily laden with similar forms of debris. The sequence of ultrastructural events is discussed in light of recent studies of transganglionic degeneration, their correlation with light microscopic findings, and the potential implications for central plasticity in this system.

Chronic peripheral nerve injuries alter the somatotopic organization of the cuneate nucleus in kittens

The effect of chronic peripheral nerve injuries on the somatotopic organization of the cuneate nucleus was examined in kittens, using electrophysiological techniques. In normal kittens, most cells in the dorsal part of the nucleus possessed small receptive fields on the ipsilateral front paw. Several weeks after paw denervation in young kittens, however, many cells in the corresponding dorsal part of the nucleus responded to tactile stimulation of the wrist, forearm, or trunk. Consistent with this change in receptive fields, the neurons in the dorsal part of the nucleus were more responsive to electrical stimulation of the medial cutaneous nerve, which innervates part of the forearm, in kittens after paw denervation than in control kittens. These somatotopic changes were not an artifact of severe atrophy of the dorsal part of the nucleus. This experiment confirms that after chronic peripheral nerve injuries, central somatosensory neurons can begin to respond to ascending afferent volleys originating from other undamaged peripheral axons, which were previously incapable of exciting the cells. Moreover, this change in functional connectivity is evident at the first synapse central to the injury site.

Pulpal axons in developing, mature, and aging feline permanent incisors. A study by electron microscopy

The ingrowth, maturation, and aging of pulpal axons was followed by electron microscopy in permanent mandibular incisors of 44 cats aged 35 days-11 years. The first axons entered the incisor pulps about 2 months after birth. Cells resembling Schwann cells, but lacking an axonal relation, were also observed at this time. Axonal ingrowth and maturation continued until 7 months, when the pulps contained 92-394 axons, 81-88% of which were unmyelinated. Between month 7 and 20 months the character of the incisor pulpal axons remained largely unchanged. In adult cats the myelinated pulpal axons had diameters of 1-6 micrometer. The relation between the number of myelin lamellae and the axon size correlated better with linear + logarithmic than linear functions. The g-ratios were higher than in most peripheral nerves, and tended to increase with axon diameter. In the old adult this tendency was more evident and the g-ratios were generally lower. From 3 years on the incisors displayed various age-related or pathological alterations. These were accompanied by axonal changes and axon loss. In contrast to earlier stages perineuriumlike sheaths were frequent in old teeth. The findings are discussed in relation to axon development in the inferior alveolar nerve and in primary incisor pulps.

Changes in primary afferent depolarization of sensory neurones during peripheral nerve regeneration in the cat

1. Micro-electrode recordings were made from normal and regenerating sural nerve fibres in cats. Increases in the excitability of the central terminals of these fibres after conditioning stimulation of other sural nerve fibres were taken as evidence for primary afferent depolarization. 2. At all recovery times studied the excitability changes seen were significantly less than those seen in control animals. Two factors contributed to the changes in primary afferent depolarization. First, the proportion of fibres that showed no evidence of primary afferent depolarization increased significantly. This proportion became smaller as recovery progressed. Secondly, where primary afferent depolarization was present, the magnitudes of the effects were slightly but significantly decreased compared with control values. 3. Excitability changes of the central terminals of sural nerve fibres were also measured after conditioning stimulation of the ipsilateral, unlesioned accessory sural nerve. One month after sural nerve transection there was a significant increase in the proportion of fibres showing no evidence of excitability changes following accessory sural nerve conditioning stimulation compared with control animals. Thus, the loss of primary afferent depolarization of regenerating sural nerve fibres was neither simply a consequence of desynchronization of the volley of impulses entering the spinal cord after conditioning stimulation of other regenerating sural fibres, nor due to fewer fibres being activated during conditioning stimulation of the lesioned nerves. 4. A possible explanation of these results is that after peripheral nerve crush or transection the central terminals of the damaged fibres retract or atrophy. Then as regeneration of the nerve proceeds, the central terminals of the fibres re-form.

Brain stem degeneration patterns following tooth extractions: visualization of dental and periodontal afferents

The terminal central nervous system distribution of those primary afferent neurons from the teeth and periodontium in cats was studied by degeneration methods. Lesions were created by combinations of tooth extractions and the brain stem was examined at 14, 30 and 60 days survival for degeneration patterns, with 30 days being the optimal survival time. Degenerating axons and terminals are seen bilaterally, but somewhat less on the side contralateral to the lesions and are concentrated in the ventral half of pars interpolaris and pars caudalis near obex. The results are discussed with regard to the current controversies concerning the primary central termination of these trigeminal neurons.