Inflammatory nerve responses in the dental pulp

Dental Pulp Cell Transplantation Combined with Regenerative Endodontic Procedures Promotes Dentin Matrix Formation in Mature Mouse Molars

Regenerative endodontic procedures (REPs) are promising for dental pulp tissue regeneration; however, their application in permanent teeth remains challenging. We assessed the potential combination of an REP and local dental pulp cell (DPC) transplantation in the mature molars of C57BL/6 mice with (REP + DPC group) or without (REP group) transplantation of DPCs from green fluorescent protein (GFP) transgenic mice. After 4 weeks, the regenerated tissue was evaluated by micro-computed tomography and histological analyses to detect odontoblasts, vasculogenesis, and neurogenesis. DPCs were assessed for mesenchymal and pluripotency markers. Four weeks after the REP, the molars showed no signs of periapical lesions, and both the REP and REP + DPC groups exhibited a pulp-like tissue composed of a cellular matrix with vessels surrounded by an eosin-stained acellular matrix that resembled hard tissue. However, the REP + DPC group had a broader cellular matrix and uniquely contained odontoblast-like cells co-expressing GFP. Vasculogenesis and neurogenesis were detected in both groups, with the former being more prominent in the REP + DPC group. Overall, the REP was achieved in mature mouse molars and DPC transplantation improved the outcomes by inducing the formation of odontoblast-like cells and greater vasculogenesis.

Proteomic analysis of human dental pulp in different clinical diagnosis

OBJECTIVES

The present study aimed to identify proteins obtained from pulp tissue and correlate with each clinical diagnosis (healthy pulp, inflamed pulp, and necrotic pulp).

MATERIALS AND METHODS

A total of forty-five molars were used. Three biological replicas were evaluated. Lysis and sonication were used for protein extraction. Protein quantification was assessed by using the Bradford technique, and shotgun proteome analysis was performed by nanoUPLC-MS^E using a Synapt G2 mass spectrometer. Mass spectra data were processed using the Waters PLGS software, and protein identification was done using the human Uniprot database appended to the PLGS search engine.

RESULTS

A total of 123 different proteins were identified in all evaluated pulp conditions. Among these, 66 proteins were observed for healthy pulp, 66 for inflamed pulp, and 91 for necrotic pulp. Most protein identification was related to immune response, multi-organism process, platelet activation, and stress in inflamed pulp samples compared to healthy pulp. Proteins related to cellular component organization or biogenesis, developmental process, growth, immune response, multi-organism process, response to stimulus, signaling, stress, and transport were identified in cases of apical periodontitis compared to inflamed pulp.

CONCLUSIONS

The progression of the disease to inflamed pulp promoted a high abundance of proteins related to the immune system and stress. Comparing the necrotic pulp with inflamed pulp conditions, a high abundance of proteins was noticed related to metabolism, transport, and response between organisms.

CLINICAL RELEVANCE

This finding may assist in future studies of new markers, understanding of tissue engineering, and development of future products.

Linear and nonlinear analysis of dental pulp blood flow oscillations in ageing

AIM

To investigate the effect of ageing on control mechanisms of pulpal microcirculation using wavelet analysis and to calculate linear and nonlinear parameters of blood flow oscillations, in a healthy general population.

METHODOLOGY

Pulpal blood flow (PBF) oscillations were recorded on right maxillary central incisors using laser Doppler Flowmeter (PeriFlux PF 5001, Perimed, Jarfalla, Sweden) on a group of 10 young participants (20-25 years) and a group of 10 older adults (60-70 years). In total, 20 recordings were obtained for at least 20 min (one recording on one tooth per subject). Using wavelet spectral analysis, the amplitude and power were calculated as a linear and Hurst exponent as a nonlinear parameter of PBF oscillations. Differences between the two groups were assessed with the independent Student t-test.

RESULTS

Mean PBF levels were significantly lower (P = 0.024) in older adults than in young participants. Relative amplitudes and powers corresponding to the myogenic (P = 0.046, P < 0.001, respectively) and neurogenic activity (P = 0.04, P = 0.01, respectively) were significantly higher, whereas values corresponding to the endothelial function (P = 0.04, P = 0.01, respectively) were significantly lower in older adults than in young participants. Hurst exponents of the total spectrum, myogenic and endothelial component (P < 0.001, P = 0.02, P < 0.001, respectively) of PBF oscillations were significantly lower in older adults in comparison to young participants.

CONCLUSIONS

At the level of pulpal microcirculation, ageing was associated with altered blood flow levels, the contribution of different control mechanisms to blood flow oscillations as well as the interaction of vascular smooth muscle and endothelium. Described changes of pulpal haemodynamics contribute to a better understanding of physiological behaviour and decreased adaptability of aged dental pulp to pathological stimuli.

Sensory Neuropeptides and Endogenous Opioids Expression in Human Dental Pulp with Asymptomatic Inflammation: In Vivo Study

Purpose. This study quantified the expression of substance P (SP), calcitonin gene-related peptide (CGRP), β-endorphins (β-End), and methionine-enkephalin (Met-Enk) in human dental pulp following orthodontic intrusion. Methods. Eight patients were selected according to preestablished inclusion criteria. From each patient, two premolars (indicated for extraction due to orthodontic reasons) were randomly assigned to two different groups: the asymptomatic inflammation group (EXPg), which would undergo controlled intrusive force for seven days, and the control group (CTRg), which was used to determine the basal levels of each substance. Once extracted, dental pulp tissue was prepared to determine the expression levels of both neuropeptides and endogenous opioids by radioimmunoassay (RIA). Results. All samples from the CTRg exhibited basal levels of both neuropeptides and endogenous opioids. By day seven, all patients were asymptomatic, even when all orthodontic-intrusive devices were still active. In the EXPg, the SP and CGRP exhibited statistically significant different levels. Although none of the endogenous opioids showed statistically significant differences, they all expressed increasing trends in the EXPg. Conclusions. SP and CGRP were identified in dental pulp after seven days of controlled orthodontic intrusion movement, even in the absence of pain.

An insight into neurophysiology of pulpal pain: facts and hypotheses

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.

Tooth injury increases expression of the cold sensitive TRP channel TRPA1 in trigeminal neurons

OBJECTIVE

Transient receptor potential (TRP) channels, a family of structurally related proteins have been implicated in the sensation of pain and hyperalgesia caused by exogenous and endogenous agonists, as well as touch, pH, and temperature. The objective of this study was to determine the effects of tooth injury on the expression of the cold sensitive channel TRPA1, in the trigeminal ganglion, the primary source of sensory and nociceptive innervation of teeth.

DESIGN

We analyzed TRPA1 expression in a rodent model of tooth injury, by Western blot analyses of proteins extracted from trigeminal ganglia.

RESULTS

We found that TRPA1 was selectively increased in trigeminal ganglia innervating injured teeth when compared to TRPA1 expression in trigeminal ganglia innervating healthy teeth.

CONCLUSIONS

Our results provide the first evidence of increased expression of a cold-sensitive TRP channel in trigeminal ganglia after pulp exposure, and are consistent with the possibility that increased expression and function of TRPA1 in trigeminal neurons contributes to hyperalgesia and allodynia following tooth injury.

Nicotinamide adenine dinucleotide phosphate/neuronal nitric oxide synthase-positive neurons in the trigeminal subnucleus caudalis involved in tooth pulp nociception

Sensory information on facial structures, including teeth pulp, periodontium, and gingiva, is relayed in the trigeminal complex. Tooth pulp inflammation constitutes a common clinical problem, and this peripheral injury can induce neuroplastic changes in trigeminal nociceptive neurons. There is considerable evidence that the trigeminal subnucleus caudalis (Vc) is the principal relay for trigeminal nociceptive information as well as modulation of the painful stimuli. Glutamatergic primary afferents innervating the tooth pulp project to the most superficial laminae of the Vc. N-methyl-D-aspartate receptor stimulation leads to the activation of the enzyme nitric oxide synthase (NOS), which synthesizes the free radical nitric oxide (NO). This enzyme is expressed mainly in lamina II interneurons, and in a small number of cells in lamina I as well as in deep laminae projection neurons of Vc. In the present study, we analyzed the temporal changes in neuronal NOS (nNOS) in Vc local circuitries after unilateral intermediate molar pulp injury. Our results demonstrate that a peripheral dental pulp injury leads to neuroplastic changes in the relative amount and activity of nNOS enzyme. Moreover, after a period of time, the nitrergic system shifts to the initial values, independently of the persistence of inflammation in the pulp tissues.

Experimental orthodontic tooth movement and extensive root resorption: periodontal and pulpal changes

Previous studies have reported changes both in dental pulp and in periodontal ligament (PDL) following orthodontic tooth movement. However, pulpal changes following extensive root resorption after orthodontic tooth movement have not been studied in detail. The aim of this study was therefore to evaluate inflammatory changes, both in the dental pulp and in the compressed PDL, after experimentally induced extensive root resorption. Extensive root resorption was induced in rats by the activation and re-activation of orthodontic force, with a short intervening period of no force application. The distribution of immune cells, nerve fibres and blood vessels was studied immunohistochemically using antibodies against CD68-immunoreactive (IR) cells, major histocompatibility complex (MHC) class II Ia-expressing cells, CD43-IR cells, protein gene product 9.5 (PGP 9.5), and laminin. In the compressed PDL of experimental first molars, significantly increased density of CD68-IR cells and MHC class II Ia-expressing cells were found, whereas the density of CD43-IR cells were unchanged when compared with control second molars. In the compressed PDL, there was an increased density of blood vessels, but no sprouting of nerve fibres. In the dental pulp, however, no increased density of immune cells or sprouting of nerve fibres was recorded. In conclusion, inflammation after extensive root resorption was confined to the compressed PDL, whereas the dental pulp was unaffected.