Effect of vasodilating drugs on external carotid and pulpal blood flow in dogs: "stealing" of dental perfusion pressure

Effect of Orthognathic Surgery On Pulp Blood Flow and Pulp Sensibility: A Prospective Control Trial

INTRODUCTION

Orthognathic surgery has the potential to compromise the vitality of the teeth. This paper aims to assess changes in pulp blood flow (PBF) and pulp sensibility (PS) of the anterior dentition following orthognathic surgery and to assess the influence of the proximity of the surgical osteotomy on the PBF and/or PS.

METHODS

Twenty-six patients undergoing orthognathic surgery (Le Fort I or bilateral sagittal split osteotomy [BSSO]) were compared to sixteen control patients treated by fixed appliances only using Laser Doppler flowmeter (LDF) and thermal testing (CO2 snow). Surgery patients were tested at T1 (presurgery), T2 (4-5 weeks postsurgery), T3 (3 months postsurgery), and T4 (6 months postsurgery). Control patients were tested at T1 (pretreatment), T2 (6 months posttreatment), T3 (12 months posttreatment), and T4 (18 months posttreatment). Differences between the maxilla and mandible were assessed.

RESULTS

No differences in PBF or PS were recorded in the control group. In the surgery group, both jaws followed the same pattern after surgery, an initial decrease at T2 followed by a gradual recovery to pretreatment PBF levels with no significant difference between T1 versus T4 in both jaws. No difference in PBF was observed between the maxilla and mandible at any testing time interval.

CONCLUSIONS AND CLINICAL IMPLICATIONS

PBF and PS of the anterior dentition was severely affected immediately postsurgery, followed by a gradual increase to full recovery. This pattern of recovery was exhibited in both jaws. A negative sensibility response or discoloration should not be seen as an indication of irreversible ischemic pulp changes. Monitoring for at least 6 months or using LDF as a confirmatory test is required before any irreversible endodontic treatment is to be considered.

Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis

OBJECTIVE

The aim of this study was to assess the effects of dentoalveolar distraction osteogenesis (DD) on the pulpal blood flow (PBF) of maxillary canines.

MATERIALS AND METHODS

A laser Doppler flowmeter (LDF) was used to measure PBF in maxillary canines of 10 patients undergoing DD (study group) and 10 nonsurgical subjects who received no orthodontic treatment (control group). PBF was measured at baseline, at 4 and 7 days postoperatively, at the end of distraction and at the end of consolidation in the study group and at similar time-points in nonsurgical control subjects. Data were analyzed using paired and Student t tests, with the significance level set at 0.05.

RESULTS

Study findings showed that baseline PBF values did not differ significantly between groups. PBF in the control group did not vary over time; however, in the study group, an initial decrease in PBF was observed at 4 days postoperatively and was followed by a gradual increase to preoperative levels at the end of distraction.

CONCLUSIONS

During the DD latency period, there appears to be a short-lived ischemic phase when perfusion of pulp tissue declines; however, blood-flow returns to normal by the end of distraction.

An overview of the dental pulp: its functions and responses to injury

The dental pulp is a unique tissue and its importance in the long-term prognosis of the tooth is often ignored by clinicians. It is unique in that it resides in a rigid chamber which provides strong mechanical support and protection from the microbial rich oral environment. If this rigid shell loses its structural integrity, the pulp is under the threat of the adverse stimuli from the mouth, such as caries, cracks, fractures and open restoration margins, all of which provide pathways for micro-organisms and their toxins to enter the pulp. The pulp initially responds to irritation by becoming inflamed and, if left untreated, this will progress to pulp necrosis and infection. The inflammation will also spread to the surrounding alveolar bone and cause periapical pathosis. The magnitude of pulp-related problems should not be underestimated since their most serious consequence is oral sepsis, which can be life threatening, and hence correct diagnosis and management are essential. Clinicians must have a thorough understanding of the physiological and pathological features of the dental pulp as well as the biological consequences of treatment interventions.

Effects of local injections of vasoactive drugs on eruption rate of incisor teeth in anaesthetized rats

OBJECTIVES

Previous studies have suggested that the vasculature in the dental pulp and periodontal tissues plays an important role in producing the eruptive force in continuously erupting incisors. The aim of the present study was to investigate the effects of local injections of vasoactive drugs on regional blood flow within the socket in association with axial tooth movements to clarify the role of the local vascular system on tooth eruption.

DESIGN

Twenty-two male Wistar rats, weighing 309+/-21 g (S.D.), were immobilized with halothane anaesthesia. We measured the regional blood flow within the socket using a laser Doppler flowmeter, and the axial movements of the mandibular incisor using a displacement detector. The local injections of the vasoactive drugs, adrenaline (0.001, 0.01, and 0.1 microg/kg body weight) and acetylcholine (0.05, 0.5, and 5 microg/kg), into the base of the incisor were performed by a microinjector at a rate of 1 microl/kg body weight.

RESULTS

The injections of various doses of adrenaline decreased the mean regional blood flow and eruption rate dose-dependently, while those of acetylcholine increased the mean regional blood flow and eruption rate dose-dependently. The changes in the regional blood flow and eruption rate were transient. Significant correlations (p<0.001) were obtained between the maximum and minimum values in the regional blood flow and in the eruption rate following injections of various doses of adrenaline and acetylcholine.

CONCLUSION

These results support the hypothesis that the eruptive force of the rat incisor is closely related to the vasculature within the socket.

Relationship between the tooth eruption and regional blood flow in angiotensin II-induced hypertensive rats

OBJECTIVE

The mechanism of action of vasoactive drugs on tooth movement is unknown. The purpose of the present study was to measure simultaneously the axial movement of the mandibular incisor, regional blood flow at the base of the incisor, and systemic arterial blood pressure in angiotensin II-induced hypertensive rats to determine the possible cause of tooth displacement.

DESIGN

The measurements were made under artificial respiration with halothane anaesthesia. In the experimental animals, 2.5 microg of angiotensin II in 1 ml of Ringer's solution was infused at 0.83 ml/h for 12 h from the femoral vein. In the control animals, only Ringer's solution was infused.

RESULTS

Angiotensin II caused an increase of the mean arterial blood pressure from 86 to 119 mm Hg, and decreases of the eruption rate from 667 to 494 microm/24 h and the regional blood flow from 262 to 214 mV. There was a positive correlation between the eruption rate and regional blood flow, and a negative correlation between the blood pressure and regional blood flow.

CONCLUSION

These results suggest that angiotensin II caused constriction of the peripheral vascular smooth muscle resulting in an increase of arterial blood pressure and a decrease of regional blood flow, followed by a decrease of fluid volume and then a reduction of either the pressure within the socket or of the eruptive force. We assume that the regional vascular pressure within the socket plays an important role in determining the position of the rat incisor.

Blood-flow and neurosensory changes in the maxillary dental pulp after differing Le Fort I osteotomies

PURPOSE

The objective of this study was to examine changes in blood flow and the recovery of sensibility in the maxillary dental pulp after two different types of maxillary osteotomies. Study design Nine patients (C-group) who underwent a combined of Le Fort I and horseshoe osteotomy and 14 patients (NC-group) who underwent a single-segment Le Fort I osteotomy were compared. Thirty-two (C-group) and 54 (NC-group) maxillary incisors were examined preoperatively and at 1-7 days, 14 days, and 3, 6, and 12 months postoperatively. The pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and the pulpal sensibility (PS) was investigated by electrodiagnostics.

RESULTS

In both groups, the PBF dropped to its lowest value at 1 day after surgery and increased thereafter. Though a temporary drop of the PBF was observed in the NC-group on day 4, the PS recovered earlier in the NC-group than in the C-group.

CONCLUSION

These results suggest that the method of maxillary osteotomy influences the postoperative change of the PBF and recovery of the PS in the maxillary teeth.

Blood-flow change and recovery of sensibility in the maxillary dental pulp after a single-segment Le Fort I osteotomy

OBJECTIVE

To examine blood-flow change and recovery of sensibility in the dental pulp of maxillary incisors in patients undergoing a single-segment Le Fort I osteotomy.

STUDY DESIGN

Fifty-four maxillary incisors in 14 patients were examined preoperatively and at 1 to 7 days, 14 days, 3 months, 6 months, and 12 months postoperatively. The pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and the pulpal sensibility (PS) was investigated by electrodiagnostics.

RESULTS

The mean PBF dropped to its lowest value at 1 day postoperatively and subsequently increased except for a temporary drop on day 4. The PS was negative in all the examined teeth from 1 day to 14 days after surgery. Subsequently, the rate of the teeth with positive PS increased. At 3 months postoperatively, the PS recovered in half of the examined teeth. The PBF value on day 1 was significantly higher in the teeth with positive PS at 3 months postoperatively than in those with negative PS at 3 months postoperatively.

CONCLUSION

These results suggest that the decrease of the PBF in the maxillary incisors on 1 day after a single-segment Le Fort I osteotomy may affect the recovery of the PS in the short term after surgery.

Centrally mediated reflex vasodilation in the gingiva induced by painful tooth-pulp stimulation in sympathectomized human subjects

This study was designed to determine whether painful electrical stimulation of the tooth pulp induces centrally mediated reflex vasomotor changes in human gingiva and whether the sympathetic nervous system is involved in the vasomotor responses. Dynamic changes in maxillary gingival blood flow (GBF) following painful electrical stimulation of the mandibular lateral incisor were investigated, by means of laser-Doppler flowmetry, in both healthy volunteers and patients undergoing sympathetic blockade for hyperhidrosis. Increases in GBF were observed in both healthy volunteers and patients on the ipsilateral side without an increase in systemic blood pressure, but the evoked GBF increase disappeared when pain sensation was abolished by local anesthetization with 2% xylocaine solution. The vasodilator responses did not differ in amplitude between before and after the sympathectomy. These results suggest that painful tooth stimulation evokes centrally mediated reflex vasodilation, presumably via parasympathetic efferent fibers, in the human gingiva and that sympathetic vasomotor mechanisms are not involved in these responses.

beta 2-Adrenoceptor regulation of CGRP release from capsaicin-sensitive neurons

Previous studies have suggested that neurotransmitter substances from the sympatho-adrenomedullary system regulate pulpal blood flow (PBF), in part, by the inhibition of vasoactive neuropeptide release from pulpal sensory neurons. However, no study has evaluated the role of beta-adrenoceptors. We evaluated the hypothesis that activation of beta-adrenoceptors inhibits immunoreactive calcitonin gene-related peptide (iCGRP) release from capsaicin-sensitive nociceptive neurons via in vitro superfusion of bovine dental pulp. Either norepinephrine or epinephrine inhibited capsaicin-evoked iCGRP. The norepinephrine effect was blocked by the selective beta(2)-adrenoceptor antagonist, ICI 118,551, but not by pre-treatment with the selective beta(1)-adrenoceptor antagonist, atenolol. In addition, application of albuterol, a selective beta(2)-adrenoceptor agonist, significantly blocked capsaicin-evoked release of iCGRP. Collectively, these studies demonstrate that activation of beta(2)-adrenoceptors in dental pulp significantly reduces exocytosis of neuropeptides from capsaicin-sensitive nociceptors. This effect may have physiologic significance in regulating PBF. Moreover, since capsaicin selectively activates nociceptors, beta(2)-adrenoceptor agonists may have clinical utility as peripherally acting therapeutics for dental pain and inflammation.

An in vivo and in vitro comparison of the effects of vasoactive mediators on pulpal blood vessels in rat incisors

The effects of endogenous vasoactive substances were evaluated in anaesthetized rats using a laser Doppler flowmeter to monitor changes in pulpal blood flow, as well as directly in isolated pulpal arteriole preparations utilising a microperfusion and monitoring system to observe changes in vessel diameter. In anaesthetized rats, while systemic arterial blood pressure remained relatively stable, intra-arterial delivery of adrenaline (epinephrine) (A), noradrenaline (norepinephrine) (NA), phenylephrine (PHE), dopamine (DOPA), 5-hydroxytryptamine (5-HT), or endothelin-1 (ET-1) produced a dose-dependent reduction in pulpal blood flow (order of potency: ET-1>>A=NA>PHE=DOPA=5-HT); acetylcholine induced a dose-dependent increase in pulpal blood flow; histamine, isoproterenol and adenosine produced no significant changes. In isolated arteriole preparations, intraluminal delivery of A, NA, PHE, DOPA or 5-HT produced dose-dependent vasoconstriction (A=NA>PHE=DOPA=5-HT). Acetylcholine relaxed NA-precontracted vessels dose-dependently. Histamine and isoproterenol produced a small vasodilatation. Intraluminal ET-1 produced a small vasoconstriction at 10(-8)M, whereas extraluminal ET-1 produced a dose-dependent vasoconstriction from 10(-10)M and above. Intraluminal adenosine failed to dilate vessels precontracted with ET-1, whereas extraluminal adenosine caused a complete relaxation. These combined in vivo and in vitro data suggest that, in the rat incisor, the pulpal microcirculation is capable of functional regulation and that pulpal blood flow may be modulated by endothelium-related factors, metabolic (tissue-related) factors, as well as humoral (blood-borne) factors.

Dependence of pulpal blood-flow responses on baseline blood-flow in the cat

It has been shown earlier that electrical stimulation of the distal cut end of the inferior alveolar nerve (IAN) in the cat evokes three different patterns of pulpal blood-flow (PBF) response in the ipsilateral mandibular canine tooth (a decrease, a biphasic response, or an increase). The response to a given stimulus sometimes changed to another pattern even in one and the same experimental animal during the course of the experiment. It is known that the evoked decrease is due to activation of the sympathetics and that the increase is due to antidromic activation of sensory fibres; but, it is unknown why the response varies so much. It is hypothesised that the baseline blood-flow (BBF) modulates vasomotor responses in the dental pulp. To test this hypothesis, the effects of BBF on PBF responses elicited by the IAN stimulation mentioned above were investigated. Dynamic changes in PBF in cat mandibular canine teeth were elicited by electrical stimulation of the distal cut end of the IAN, at various BBF, with blood-flow monitored by laser Doppler flowmetry. The amplitude of the PBF vasodilator response increased as BBF was adjusted downwards (by cooling the tooth). In contrast, the amplitude of the PBF vasoconstrictor response increased as the BBF rose. Vasodilator responses could be transformed into vasoconstrictor responses, and vice versa, by alterations in the BBF. No systemic blood-pressure changes were elicited throughout the experiment. These results indicate that a consideration of baseline vascular tone is important, whenever the size of PBF responses to various stimuli is discussed or calculated.

Agonist-induced vasoactive responses in isolated perfused porcine dental pulpal arterioles

A novel isolated perfused pulpal arteriole preparation and microperfusion system was used to evaluate the direct vasoactive responses of pulpal arterioles to selected agonists. Short lengths of porcine pulpal arterioles (101.7+/-2.2 microm o.d., n=105) were dissected out and placed in an environment-controlled bath on the stage of an inverted microscope. Both ends of the vessel were cannulated and perfused at a controlled rate through the lumen. The diameter of the vessel was measured online. Following equilibration, the vessel was challenged with various agonists: adrenaline (epinephrine), noradrenaline (norepinephrine), phenylephrine, dopamine, isoproterenol, 5-hydroxytryptamine, histamine and adenosine. The endothelium-dependent vasodilator acetylcholine was used to evaluate endothelial cell function. Adrenaline, noradrenaline, phenylephrine, 5-hydroxytryptamine and dopamine caused dose-dependent contractions (adrenaline=noradrenaline>phenylephrine>dopamine>5-hydroxytryptamine). Isoproterenol and histamine provoked a dose-dependent dilation. Adenosine produced pronounced vasodilatation in vessels precontracted with 10(-8)M endothelin-1. Functional adrenergic, histamine, 5-hydroxytryptamine and adenosine receptors are, therefore, present in porcine pulpal arterioles. The isolated perfused pulpal arteriole preparation may prove valuable in understanding local control mechanisms of pulpal microcirculation.

Blood flow changes in human dental pulps when capsaicin is applied to the adjacent gingival mucosa

OBJECTIVE

The purpose of this study was to determine whether changes occur in pulpal blood flow when capsaicin is applied to the adjacent gingival or alveolar mucosa in human beings.

STUDY DESIGN

Laser Doppler flowmetry was used to measure changes in pulpal blood flow (PBF) after applying capsaicin to adjacent gingival mucosa in 20 human volunteers. The procedure was repeated on 10 subjects after administration of an ipsilateral inferior alveolar nerve block and on the other 10 subjects after application of topical anesthetic to their adjacent gingival and alveolar mucosa.

RESULTS

PBF increased in 16 subjects and did not change in 4 subjects after capsaicin application. Ipsilateral inferior alveolar nerve block did not alter this effect. Pretreatment with topical lidocaine resulted in no change or decreased PBF in 8 subjects and increased PBF in 2 subjects.

CONCLUSION

Changes occur in the PBF of the mandibular canine teeth of some humans when capsaicin is applied to the adjacent gingival or alveolar mucosa.

Acetylcholine-induced vasodilation of isolated pulpal arterioles

The presence of cholinergic mechanisms in the control of pulpal microcirculation has been a controversial issue. In this study, we aimed to determine the direct vasoactive responses of isolated pulpal arterioles to acetylcholine, and to investigate whether such responses are endothelium-dependent. Using an in vitro micro-perfusion system, we isolated pig pulpal arterioles, cannulated and perfused them intraluminally, and monitored the diameter. Following equilibration, the vessels were contracted with 10(-5) M noradrenaline, and the effect of increasing doses of acetylcholine was determined. The influence of the muscarinic antagonist, atropine, or the loss of endothelial cell function following saponin treatment was also determined. Acetylcholine induced a dose-dependent vasodilation, reaching 94.6+/-1.4% (n = 22) of the uncontracted diameter at 10(-4) M. The vascular relaxation effect of acetylcholine was abolished in the presence of atropine, and by saponin treatment. Analysis of these data suggests that, in the pig, the acetylcholine-induced vasodilation of incisor pulpal arterioles is endothelium-dependent and mediated by muscarinic receptors.

Dose-response effects of adrenergic drugs on axial movements of the rat mandibular incisor and on arterial blood pressure

Axial tooth movements and arterial blood pressure were measured following the intravenous injection of 0, 0.01, 0.1, 1, or 10 micrograms/kg of adrenaline, noradrenaline or isoprenaline. Adrenaline caused a dose-dependent, rapid, extrusive tooth movement with a nearly simultaneous increase in blood pressure, followed by a marked intrusive tooth movement and a decrease in blood pressure. Noradrenaline caused a dose-dependent, rapid, extrusive tooth movement and an increase in blood pressure, but a subsequent intrusive tooth movement and decrease in blood pressure were not so marked. Isoprenaline caused a marked intrusive tooth movement and a decrease in blood pressure, without an extrusive tooth movement and increase in blood pressure. The time required to reach the maximum intrusive tooth movement was delayed after that to reach the maximum decrease in blood pressure. The recovery time of the intrusive tooth movement was much more delayed than that of blood pressure. These results suggest that the extrusive movement of the rat incisor was primarily related to the rise of arterial blood pressure due to stimulation of vascular alpha-receptors. It is also suggested that stimulation of beta-receptors would probably cause vasodilatation of arteries that would make the pressure in the small vessels in the microcirculation of the socket fall, so reducing the volume of blood and interstitial fluid in the socket followed by a marked and continuing intrusive tooth movement.

Environmental effects on laser Doppler pulpal blood-flow measurements in man

The increasing number of experiments using laser Doppler flowmetry in man for pulpal blood-flow recordings leads to questioning of the experimental recording conditions. The present study focused on three points: the design of the laser probe holder, the isolation of the tooth, and the influence of the recording site. A rigid polyurethane splint used in addition to different isolation devices (cotton roll, metal shield, rubber dam) was compared with a silicone splint. The silicone resulted in significantly higher values (+341%) than the polyurethane splint. The combination of the polyurethane splint with isolation devices decreased, in all cases, the flux values. The polyurethane/rubber-dam combination was the most efficient in individualizing the pulpal blood flow (-69% decrease). Recordings on non-vital teeth confirmed the hypothesis that there was periodontal contamination of the recorded flow, as the signal was abolished when using the polyurethane/rubber-dam combination. Cervical recording sites gave significantly higher values than occlusal sites (+42%). It is concluded that, in man, the part played by the periodontium may have been underestimated in previous recordings of pulpal blood flow. The use of a rubber dam in combination with a rigid splint to enhance the validity of recordings is proposed.

Neural control of pulpal blood flow

Blood flow of mammalian dental pulp is under both remote and local control. There is evidence for the existence of parasympathetic nerves in the pulp, but functionally the cholinergic influence is weak, and the physiological significance of this autonomic system seems to be low. The evidence for sympathetic vasoconstrictor nerves in the pulp is robust, and there is convincing support for the contention that these nerves play a physiological role, operating via release of noradrenaline and neuropeptide Y. However, there is no significant functional evidence in support of sympathetic beta-adrenoceptor-mediated vasodilation in the pulp. The local control of blood flow involves a subset of intradental sensory nerves. By virtue of their neuropeptide content, these afferent fibers cause vasodilation and inhibit sympathetic vasoconstriction in response to painful stimulation of the tooth. Such locally governed control may serve to meet immediate demands of the pulp tissue. A locally triggered reflex activation of sympathetic nerves in the pulp may modulate this control and limit its magnitude. Thus, there are competitive interactions between local and remote vascular controls which may be put out of balance in the injured and inflamed dental pulp.

Absence of parasympathetic vasodilatation in cat dental pulp

The existence and nature of parasympathetic nerve fibers in the dental pulp have long been a subject for discussion; indeed, vasodilator responses mediated by such nerve fibers have yet to be conclusively demonstrated in the dental pulp. This study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat dental pulp. Dynamic changes in pulpal blood flow (PBF), with mandibular lip blood flow (LBF) recorded as a control, were investigated in cat mandibular canine teeth by means of laser Doppler velocimetry. Peripheral trigeminal afferents (see below) were stimulated electrically to confirm that somato-parasympathetic reflex vasodilatation could be induced. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were then stimulated intracranially. Electrical stimulation of trigeminal afferents (in the infraorbital nerve or the maxillary buccal gingiva) caused no change in PBF but did increase ipsilateral LBF. Neither facial nor glossopharyngeal nerve root stimulation caused a PBF increase, though both elicited increases in ipsilateral LBF. The vasodilator responses in the lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilatation via activation of parasympathetic vasodilator fibers. In contrast, intracranial stimulation of the trigeminal nerve root induced increases in both PBF and LBF which were reduced by pre-treatment with tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that a parasympathetic vasodilator mechanism is not present in feline dental pulp.

An immunohistochemical and ultrastructural study of vasomotor nerves in the microvasculature of human dental pulp

Immunohistochemical methods for S-100 protein and neurone-specific enolase showed two types of nerve endings around the pulp microvasculature: the free endings, which comprise the major neural component and are distributed in all types of microvessel such as arterioles, venules and capillaries; and the varicose endings. The varicose ending was a less frequent, minor component observed only in the arterioles. Both immunohistochemical and ultrastructural observations confirmed that the varicose endings were the terminal axons of efferent vasomotor nerves. Further extensive ultrastructural examinations on the vasomotor nerves added the following new findings to our previous reports. Vasomotor nerves sometimes ramified into more than two terminal axons around arterioles, and most of these ramified axons ended in the adventitia-media junction of the arteriolar wall; however, nerve endings occasionally penetrated into the media. These findings suggest an intimate structural association between vasomotor nerves and arterioles in regulating the arteriolar microcirculation in human dental pulp by stimulating smooth-muscle cells not only of the outermost but also of the inner layers. Furthermore, the deep penetration of terminal axons into the arteriolar wall seems to provide effective regulation of pulpal blood flow under physiological and pathological conditions.

Endogenous vasoactive substances and oxygen-derived free radicals in pulpal haemodynamics

An adequate blood supply to the dental pulp is essential to the health of the tooth. A recent concept is that repeated stimulation of sensitive teeth may induce pulpal changes; this could occur through induction of neurogenic inflammation and alteration of pulpal blood flow. One possibility is that production of oxygen-derived free radicals at sites of inflammation contributes to alterations in local blood flow. The first target of free radicals, generated in several pathological processes, is the vascular system (essentially the endothelium). Although the exact mechanism by which free radicals induce changes in vascular conductance is still uncertain, they may act directly on vascular smooth muscle or modify vascular tone by interacting with the production and/or biological activity of endogenous vasoactive mediators. Recent data indicate that the oxygen-derived, free radical-generating system can decrease pulpal blood flow in the dog via endothelial dysfunction when applied locally in deep dentinal cavities. In addition to the part played by oxygen-derived free radicals, the measurement of pulpal blood flow and the effects of endogenous vasoactive substances on flow are discussed.

A study of cholinergic and beta-adrenergic components in the regulation of blood flow in the tooth pulp and gingiva in man

In 10 subjects, laser Doppler flowmetry was used to study whether cholinergic or beta-adrenergic pathways are involved in the control of tooth pulp blood flow (PBF) in response to isometric hand grip and the cold pressor test. We also examined if differences exist between the regulation of blood flow in the tooth pulp and the nearby gingiva (GBF). Isometric hand grip (35% of maximum force, 2 min) and the subsequent ischaemia (2 min) induced a brief rise in PBF and a more long-lasting rise in GBF. Atropine increased heart rate about by 40% and changed the pulpal response to a fall in flow, without altering gingival flow. Propranolol, causing a 20% reduction in heart rate, had no effect on either flow during the actual test, but induced a rise in GBF after the ischaemic period. The cold pressor test (2 min at 0.5 degrees C) resulted in a reduction in PBF and GBF, unaffected by the blocking drugs. With atropine, however, PBF increased immediately after this test. The relative changes in arterial pressure and heart rate were unaffected by the drugs. Our study has demonstrated the existence of cholinergic nervous vasodilation in vessels serving the tooth pulp. Non-adrenergic non-cholinergic mechanisms probably contribute to the evoked rise in GBF during exercise. Beta-adrenoceptors are involved in the control of GBF immediately after isometric exercise. While the two tests under control conditions evoked mostly parallel changes in PBF and GBF, the use of blocking agents showed that blood flow is controlled by different mechanisms in the two adjacent vascular beds.

Activation of sympathetic nerves exerts an inhibitory influence on afferent nerve-induced vasodilation unrelated to vasoconstriction in rat dental pulp

In order to elucidate a possible influence of the sympathetic nervous system on afferent nerve function, rat mandibular incisors were electrically stimulated and blood flow changes monitored in the incisor pulp of untreated and sympathectomized animals by a laser Doppler flowmeter. Monopolar electrical stimulation of the tooth (200 microA, 5 ms, 40 Hz, 1 s) in normal animals resulted in a transient reduction in pulpal blood flow (PBF) (16% reduction, n = 10) followed by a small but long-lasting increase (11% increase). After administration of phenoxybenzamine or phentolamine (3 mg kg-1, i.v.) the initial dip in PBF was reduced by 59% (P < 0.001) while the subsequent increase was enhanced by 185% (P < 0.001). Similarly, infusion of prazosin (50 micrograms kg-1, i.v.) and idazoxan (0.5 mg kg-1, i.v.) significantly enhanced the increase in PBF by 118 and by 79%, respectively. In chronically sympathectomized animals the increase in PBF was 250% larger than that seen in untreated animals (P < 0.001). This increase in PBF was not further enhanced after alpha-adrenergic blockade. Acute resection of the superior cervical sympathetic ganglion, also resulted in some enhancement (by 56%) of the stimulation-induced increase in PBF (P < 0.01, n = 6). The increase in PBF was unaffected by infusion of timolol (150 micrograms kg-1) and atropine (1 mg kg-1) but was totally abolished by intravenous pre-treatment with capsaicin (1-3 mg kg-1). The present results suggest that activation of sympathetic nerves exerts inhibitory effects on the afferent nerve-induced vasodilation in the rat incisor pulp unrelated to sympathetic vasoconstriction.

Effects of autonomic reflexes on tooth pulp blood flow in man

In 15 subjects, laser-Doppler flowmetry (LDF) was used to investigate whether the nervous control of pulpal blood flow (PBF) is affected by three tests known to excite the sympathetic nervous system. For comparison, skin blood flow was similarly recorded. Dynamic exercise (bicycle ergometer, 5 min, 90-100 W) in eight subjects was accompanied by a rise in PBF. PBF was increased by the cold pressor test (2 min) in eight subjects, while in five the flow decreased or remained unaffected. The isometric hand grip (2 min, 30% MVC) and the subsequent muscle ischaemia (2 min) led to a rise in PBF in two subjects and a fall in four. Following unilateral anesthesia of the mandibular nerve, PBF in five subjects became unresponsive to dynamic exercise or the cold pressor test, indicating pressure autoregulation. All three tests triggered increases in mean arterial pressure (MAP) and heart rate (HR). Skin blood flow usually increased in response to the tests, but could also decrease, and often changed in a direction opposite to that of PBF. It is concluded that the circulation of blood in the human tooth is affected by evoked changes in autonomic nerve activity, involving activation of both vasodilator and vasoconstrictor nerves to vessels serving the tooth.

Activation of sympathetic fibres in the pulp by electrical stimulation of rat incisor teeth

Previous studies of the sympathetic nerve supply of the rat mandibular incisor pulp have shown conflicting results. Here, the neurovascular control of the rat lower incisor pulp was investigated by stimulating the tooth crown and the cervical sympathetic trunk electrically and monitoring blood-flow changes in the pulp by laser Doppler flowmetry. In addition the presence of noradrenaline (NA) in the pulp and gingiva was examined biochemically in untreated and sympathectomized animals by high-performance liquid chromatography. The tissue concentrations of NA in the pulp were 11-fold greater than those of gingiva. Surgical sympathectomy significantly reduced the NA content in the pulp by 76%. Monopolar electrical stimulation of teeth (25-50 microA) for 1 min resulted in a frequency-dependent reduction followed by an increase in pulpal blood flow. At 16 Hz the reduction in blood flow was 65% and the subsequent increase was 9%. After intravenous administration of the alpha-adrenoceptor antagonist phentolamine, the stimulation-induced reduction in pulpal blood flow was diminished by 94% while the increase was significantly enhanced (from 9 to 40%). Infusion of the beta-adrenoceptor antagonists propranolol and timolol significantly reduced this increase in blood flow by 53 and 55%, respectively. Preganglionic sympathetic nerve stimulation also induced a frequency-dependent reduction followed by a slight increase in pulpal blood flow. This reduction in blood flow was almost abolished after alpha-adrenergic blockade and there was no subsequent increase. These findings suggest that there are sympathetic nerve fibres in rat incisor pulp and that they are activated upon monopolar electrical stimulation of teeth resulting in alpha- and beta-adrenoceptor mediated blood-flow responses.

Effects of angiotensin II on blood flow in rat submandibular gland

The effect of angiotensin II (Ang II) was studied on blood flow in the submandibular gland and tongue in male rats. Blood flow changes were determined with laser Doppler flowmetry and Ang II was infused into the common carotid artery before and after i.v. doses (18 nmol kg-1) of the angiotensin II antagonist saralasin. Angiotensin II (10-60 pmol min-1) dose-dependently increased blood pressure and tongue blood flow, whereas glandular blood flow decreased at all of the doses used. After saralasin administration the angiotensin II effects on blood pressure, tongue and glandular blood flow were significantly diminished (glandular blood flow reduction was diminished from 29%-3%, P less than 0.005, n = 9). However, the responsiveness of these 3 parameters to local infusions with noradrenaline (0.75-3.0 pmol min-1) was unaffected by saralasin. The dose of saralasin used in the present study did not affect any of the parameters on it's own. Our results show that vascular receptors sensitive to angiotensin II operate in the submandibular gland but not in the tongue.

Comparison of the effects of intra-arterial and locally applied vasoactive agents on pulpal blood flow in dog canine teeth determined by laser Doppler velocimetry

The vasoactive agents norepinephrine, 5-hydroxytryptamine, isoproterenol and bradykinin, at concentrations which changed local arterial pressure without changing systemic arterial pressure significantly, were injected intra-arterially (i.a.) into the maxillary artery or applied directly in a deep dentinal cavity on the buccal surface of canine teeth. The probe of a laser Doppler velocimeter was placed in the cavity to monitor pulpal blood flow. Bolus i.a. injections of the vasoconstrictors norepinephrine and 5-hydroxytryptamine produced a statistically significant (p less than 0.05) reduction in pulpal blood flow, 21.1 +/- 3.7 and 30.7 +/- 15.2%, and the local arterial pressure from the lateral nasal artery increased with norepinephrine but decreased with 5-hydroxytryptamine. The i.a. injections of the vasodilators isoproterenol and bradykinin were found to decrease both local arterial pressure and pulpal blood flow, 17.7 +/- 6.0 and 22.7 +/- 4.2%, respectively (p less than 0.05). However, local application of isoproterenol and bradykinin caused a biphasic response: an increase in pulpal blood flow, 8.6 +/- 1.6 and 9.4 +/- 1.1% (p less than 0.05), followed by a decrease, 19.1 +/- 11.9 and 5.3 +/- 2.1% (p greater than 0.005). Local application of norepinephrine and 5-hydroxytryptamine caused a decrease in pulpal blood flow, 23.7 +/- 5.2% (p less than 0.05) and 9.3 +/- 5.2% (p less than 0.05), respectively. These findings were in accordance with those from other reliable methods, such as injections of radioisotope-labelled 15 microns microspheres and the 133Xe washout technique, making laser Doppler flowmetry a reliable alternative. In addition, the biphasic response to the locally applied vasodilators and the reduction of pulpal blood flow after i.a. injection of vasodilators suggest that regulation of pulpal blood flow is determined by the combined effects of the low compliance environment and the stealing of perfusion to the pulp by the neighbouring tissues.

Direct pharmacological action of vasoactive substances on pulpal blood flow: an analysis and critique

An adequate blood supply to the dental pulp is essential to the health of the tooth; therefore, there have been a number of efforts to study pulpal blood flow and the factors which influence it. However, blood flow to the dental pulp is relatively inaccessible and apparently quite low. Consequently, it is difficult to obtain accurate flow measurements, partly owing to methodological difficulties with the small size of the tissue and its enclosure within rigid walls. In this study, the effects of locally applied vasoactive substances and their specific antagonists on pulpal blood flow have been examined by laser Doppler flowmetry. It is the purpose of this article to examine, in-depth, the involvement of endogenous vasoactive substances in the regulatory mechanism of blood flow within the dental pulp and expand our knowledge of pulpal microcirculatory hemodynamics.

Hemodynamic regulation of the dental pulp in a low compliance environment

Pulpal hemodynamic regulation has been investigated in experimental animals using 133Xe washout, 15-microns radioisotope-labeled microsphere injection, and intravital microscope methods. Three distinct types of pulp blood flow reductions were observed. Type I was characterized by reduction in response to direct stimulation of the sympathetic nerve; intraarterial infusion of norepinephrine, 5-HT, or prostaglandin F2 alpha; and indirect stimulation of the sympathetic nerve. The Type II response, an initial increase in flow followed by a decrease, was observed with isoproterenol, prostaglandin E2, substance P, and bradykinin. This biphasic flow response is caused by the low compliance environment of the tooth and may play a role in pulp inflammatory processes. The Type III response follows administration of histamine and is characterized by a gradual decrease in pulpal blood flow.

Arterial blood pressure regulation of pulpal blood flow as determined by laser Doppler

Dynamic changes of pulpal blood flow (PBF) and gingival blood flow (GBF) induced by intra-venous injection of two kinds of vasoactive drugs were observed in dogs by means of Laser Doppler Velocimetry. Intra-venous injection of norepinephrine caused PBF to increase, corresponding to the blood pressure (BP) increase, while GBF decreased. Orciprenaline sulfate caused PBF to decrease parallel to the BP decrease, as compared with a GBF increase. The effects of these vasoactive drugs lasted longer on GBF than on PBF and BP. These results indicate that the regulation of blood flow in the dental pulp is more dependent on systemic blood pressure than on local vasoconstriction or vasodilation.

Biphasic pulp blood-flow response to substance P in the dog as measured with a radiolabelled, microsphere injection method

A dose of the vasoactive substance P (SP), affecting local circulation only (0.0001-0.001 micrograms/kg body weight) when given by a close injection into the maxillary artery, caused a biphasic flow response in pulpal blood flow (PBF), as measured by a radioisotope-labelled 15 micron microsphere injection technique. Immediately after the SP injection, PBF increased some 66 per cent (p less than 0.02) and vascular hindrance (Z) decreased to 40 per cent against control values (p less than 0.02), indicating vasodilation. Thirty seconds after the SP injection, PBF decreased by 53 per cent (p less than 0.05), and pulpal Z increased 139 per cent against control values (p less than 0.02), indicating decreased blood flow. This biphasic flow response may be due to the active vasodilation of arterioles by SP, which causes a compression of venules and hence a reduction of PBF in what is a low-compliance system.

Blood flow changes in the dental pulp of the cat and rat measured simultaneously by laser Doppler flowmetry and local 125I clearance

Blood flow changes in the dental pulp of lower canine teeth of mature cats and incisors of mature rats were investigated with simultaneous laser Doppler flowmetry and local 125I-clearance (wash-out) during electrical sympathetic stimulation, efferent stimulation of n. alveolaris inferior (IAN) (cats) and i.a. infusions of substance P (SP) (cats). Stimulation (1-4 Hz, 4 V., 1.5 ms) of the cervical sympathetic trunk produced frequency-dependent decreases in both laser Doppler output and disappearance rate of iodine tracer from the dental pulp. For the effects of sympathetic stimulation, the correlation (r2) between the results obtained by the two methods was 0.89 (12 observations, six animals). Blood flow measurements by both methods were increased following i.a. infusions of SP (r2 = 0.64, six observations, three animals). However, upon stimulation of IAN (10 Hz 10 V, 5 ms) the laser Doppler flow values showed an increase while the local 125I clearance rate was unaffected or even decreased. The discrepancy between the results obtained following IAN stimulation indicates that the two methods reflect blood flow changes in different parts of the pulpal vascular bed and that the flow is unevenly distributed to these parts during antidromic IAN stimulation. The laser Doppler flowmetry seems to reflect the total blood flow in the coronal pulp and therefore this non-invasive method may be useful for monitoring blood flow changes in the tooth.

Pulpal blood flow in immature permanent dog teeth after replantation

Pulpal blood flow (PBF) was measuring by H2-gas clearance in 35 replanted (incisors and premolars) and 22 contralateral control dog teeth. The PBF measurements were taken 6, 10, 16, 21 and 28 days after replantation. At 6, 10 and 16 days after replantation there was no measurable blood flow in the coronal pulp of either replanted incisors or premolars. 21 days after replantation a considerable reduction in PBF was measured in all replanted teeth. On average, PBF was reduced to about one fifth of PBF in the simultaneously measured contralateral controls. Four weeks after replantation, a more than threefold increase in PBF was measured in premolars with two roots, while PBF in premolars with one root and incisors was consistently reduced to an average of 40% of the controls. The vascular pattern of the teeth 4 wk after replantation was identified with perfusion of silicon rubber. The measurements suggest that replanted multirooted teeth revascularize more easily than single-rooted teeth, and that pulpal repair is restored by a gradual replacement and proliferation of new tissue.

Regulation of pulpal blood flow

The regulation of blood flow of the dental pulp was investigated in dogs and rats anesthetized with sodium pentobarbital. Pulpal blood flow was altered by variations of local and systemic hemodynamics. Variation in pulpal hemodynamics was attained by means of close intra-arterial injections of adrenergic agonists (NE and ISO) and their antagonists (PBZ and Propranolol). Variation in systemic hemodynamics was achieved by hemodilution, hemo-concentration, hemorrhage, and SNP infusion. Macrocirculatory blood flow (ml/min/100 g) in the dental pulp was measured with both the 133Xe washout and the 15-microns radioisotope-labeled microsphere injection methods on the canine teeth of dogs, to provide a comparison of the two methods in the same tooth. Microcirculatory studies were conducted in the rat incisor tooth with microscopic determination of the vascular pattern, RBC velocity, and intravascular volumetric flow distribution. Pulpal resistance vessels have alpha- and beta-adrenergic receptors. Activation of alpha-receptors by intra-arterial injection of NE caused both a reduction in macrocirculatory Qp in dogs and decreases in arteriolar and venular diameters and intravascular volumetric flow (Qi) in rats. These responses were blocked by the alpha-antagonist PBZ. Activation of beta-receptors by intra-arterial injection of ISO caused a paradoxical reduction of Qp in dogs. In rats, ISO caused a transient increase in arteriolar Qi followed by a flow reduction; arteriolar dilation was accompanied by venular constriction. These macrocirculatory and microcirculatory responses to ISO were blocked by the alpha-antagonist propranolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular reactions in the dental pulp during inflammation

This article deals with blood flow and tissue pressure changes in the inflamed dental pulp. While detailed patho-physiological studies of the circulation in the inflamed pulp are still partly lacking, available data from studies of the normal pulp tissue are also discussed. Knowledge of the normal physiological adjustments may indicate which circulatory changes would take place during inflammation. One of the focal points in the present article is how a localized increased tissue pressure may persist in the inflamed area without a circumferential spread to the rest of the pulp. The article is organized in the following manner: First a short review is given of the vascular changes during inflammation in general. Then available data from morphological and functional studies of the pulpal circulation are treated in some detail. Particular attention is given to the transcapillary fluid flow and the so-called 'self-strangulation theory'. The effect of a localized increased tissue pressure on pulpal blood flow is thereafter discussed.

Vasodilatation in the dental pulp produced by electrical stimulation of the inferior alveolar nerve in the cat

The effects of nerve stimulation on blood flow were studied in the dental pulp of anesthetized cats. Changes in iodide disappearance rate (k-value) from dentinal cavities were used to determine changes in pulpal blood flow. Electrical stimulation of the distal end of the cut inferior alveolar nerve after alpha-adrenoceptor blockade (phentolamine, 3 mg/kg) consistently resulted in a rapid increase in disappearance rate. The first stimulation produced the greatest response (an average increase in k-values of 60%) and repeated stimulations showed a successive attenuation in response, the fourth stimulation usually having no effect. A progressive decrease in resting k-values was observed after the first stimulation, indicating an impaired exchange function of the capillary vessels. Systemic pretreatment with propranolol (0.5--1 mg/kg), atropine (3 mg/kg), mepyramine (3 mg/kg) and cimetidine (3 mg/kg) did not influence the rapid increase in k-values produced by the nerve stimulation. The experiments show that vasodilatation in the cat dental pulp produced by stimulation of the inferior alveolar nerve is not mediated by common efferent vasodilatory mechanisms and strengthen the hypothesis that the sensory nerve axon reflex mechanism is involved.

Influences of axial load and blood pressure on the position of the rabbit's incisor tooth

Changes in the axial position of the left upper incisor in response to loading by 5-20 g were measured with ultrasonic technique in anesthetized rabbits. The time-response of the load-induced intrusion described a biphasic curve, with a steep initial part followed by a slower part. Maximum amplitudes after 20 s increased with increasing loads. A rise in arterial blood pressure (aortic balloon inflation) resulted in extrusion, while i.v. injection of noradrenaline or papaverine caused intrusion and extrusion, respectively. The responses to loading and changes in blood pressure were largely unaffected by transection of the root, but the effects of pressure changes were severely diminished by local infiltration of the periodontium with noradrenaline. Participation of periodontal blood vessels in the damping of load-induced intrusion was excluded by the finding of roughly equal intrusion curves at low, normal and high blood pressure and up to 38 h after death. We conclude that the resting position of the rabbit's incisor is greatly influenced by arterial blood pressure, via the periodontal vessels. The intrusion in response to loading by up to 20 g is resisted by periodontal fibers only, the blood vessels or the pulpal and periapical tissues and pressure taking no part.

Microvascular pressure in the dental pulp and gingiva in cats

Pressure in selected microvessels was measured directly on the exposed coronal or apical pulp in one of the upper canine teeth or on the gingiva in a total of 36 cats. The vessels were punctured with glass micropipettes, diameter 1-4 micrometer, and the pressure measured with a modified Wiederhielm servocontrolled counter-pressure technique. Pressures in corresponding vessels in coronal and apical pulp were similar. The pressure in pulpal arterioles, diameter 10-70 micrometer averaged 43 mm Hg, or 36% of mean systemic arterial pressure (PA), while pressure in the pulpal venules, diameter 10-80 micrometer, was on an average 19 mm Hg or 16% of PA. Capillary pressure measured in the coronal pulp averaged 35 mm Hg. Mean arterial systemic pressure was 124 mm Hg. The total vascular pressure drop within the pulp was only 20% of the total systemic arteriovenous pressure difference. Accordingly, only one fifth of the vascular resistance governing pulpal blood flow is situated within the pulp itself. This means that blood flow in the dental pulp in cats may be influenced by mechanisms located extrapulpally. In gingiva only venular pressure was measured, which averaged 19 mm Hg.