Central connections of trigeminal primary afferent neurons: topographical and functional considerations

Mesencephalic trigeminal neuron dendritic structures in the macaque

It is presumed that the unusual central location of mesencephalic trigeminal neurons is a specialization that allows them to receive synaptic input. However, relatively few synaptic terminals were observed on the somata of mesencephalic trigeminal neurons in macaque monkeys via electron microscopy. This leaves the question of dendritic synaptic terminals open. Unlike the pseudounipolar neurons found in the trigeminal ganglion, some mesencephalic trigeminal neurons have been reported to be multipolar cells exhibiting a number of dendritic processes in non-primate species. To examine whether this morphological feature was also present in macaque monkeys, we retrogradely filled these cells with biotinylated dextran amine by injecting it into the trigeminal nerve entry zone. A portion of the mesencephalic trigeminal neurons exhibited short, poorly branched, dendritic processes. They also exhibited very fine, short processes believed to be somatic spines. Thus, primate trigeminal mesencephalic neurons appear to have specializations aimed at increasing the membrane surface area available for synaptic input.

Distinct expression profile reveals glia involvement in the trigeminal system attributing to post-traumatic headache

BACKGROUND

Post-traumatic headache (PTH) is a common comorbid symptom affecting at least one-third of patients with mild traumatic brain injury (mTBI). While neuroinflammation is known to contribute to the development of PTH, the cellular mechanisms in the trigeminal system crucial for understanding the pathogenesis of PTH remain unclear.

METHODS

A non-invasive repetitive mTBI (4 times with a 24-h interval) was induced in male mice and effect of mTBI was tested on either bregma or pre-bregma position on the head. Periorbital allodynia and spontaneous pain behavior were assessed using von Frey test and grimace score, respectively. Quantitative PCR was used to assess extent of mTBI pathology. RNA sequencing was performed to obtain transcriptomic profile of the trigeminal ganglion (TG), trigeminal nucleus caudalis (Sp5C) and periaqueductal gray (PAG) at 7 days post-TBI. Subsequently, quantitative PCR, in situ hybridization and immunohistochemistry were used to examine mRNA and protein expression of glia specific markers and pain associated molecules.

RESULTS

The repetitive impacts at the bregma, but not pre-bregma site led to periorbital hypersensitivity, which was correlated with enhanced inflammatory gene expression in multiple brain regions. RNA sequencing revealed mTBI induced distinct transcriptomic profiles in the peripheral TG and central Sp5C and PAG. Using gene set enrichment analysis, positive enrichment of non-neuronal cells in the TG and neuroinflammation in the Sp5C were identified to be essential in the pathogenesis of PTH. In situ assays also revealed that gliosis of satellite glial cells in the TG and astrocytes in the Sp5C were prominent days after injury. Furthermore, immunohistochemical study revealed a close interaction between activated microglia and reactive astrocytes correlating with increased calretinin interneurons in the Sp5C.

CONCLUSIONS

Transcriptomics analysis indicated that non-neuronal cells in peripheral TG and successive in situ assays revealed that glia in the central Sp5C are crucial in modulating headache-like symptoms. Thus, selective targeting of glia cells can be a therapeutic strategy for PTH attributed to repetitive mTBI.

Separation of Oral Cooling and Warming Requires TRPM8

Cooling sensations arise inside the mouth during ingestive and homeostasis behaviors. Oral presence of cooling temperature engages the cold and menthol receptor TRPM8 (transient receptor potential melastatin 8) on trigeminal afferents. Yet, how TRPM8 influences brain and behavioral responses to oral temperature is undefined. Here we used in vivo neurophysiology to record action potentials stimulated by cooling and warming of oral tissues from trigeminal nucleus caudalis neurons in female and male wild-type and TRPM8 gene deficient mice. Using these lines, we also measured orobehavioral licking responses to cool and warm water in a novel, temperature-controlled fluid choice test. Capture of antidromic electrophysiological responses to thalamic stimulation identified that wild-type central trigeminal neurons showed diverse responses to oral cooling. Some neurons displayed relatively strong excitation to cold <10°C (COLD neurons) while others responded to only a segment of mild cool temperatures below 30°C (COOL neurons). Notably, TRPM8 deficient mice retained COLD-type but lacked COOL cells. This deficit impaired population responses to mild cooling temperatures below 30°C and allowed warmth-like (≥35°C) neural activity to pervade the normally innocuous cool temperature range, predicting TRPM8 deficient mice would show anomalously similar orobehavioral responses to warm and cool temperatures. Accordingly, TRPM8 deficient mice avoided both warm (35°C) and mild cool (≤30°C) water and sought colder temperatures in fluid licking tests, whereas control mice avoided warm but were indifferent to mild cool and colder water. Results imply TRPM8 input separates cool from warm temperature sensing and suggest other thermoreceptors also participate in oral cooling sensation.

Role of Neurotrophins in Orofacial Pain Modulation: A Review of the Latest Discoveries

Orofacial pain represents a multidisciplinary biomedical challenge involving basic and clinical research for which no satisfactory solution has been found. In this regard, trigeminal pain is described as one of the worst pains perceived, leaving the patient with no hope for the future. The aim of this review is to evaluate the latest discoveries on the involvement of neurotrophins in orofacial nociception, describing their role and expression in peripheral tissues, trigeminal ganglion, and trigeminal nucleus considering their double nature as "supporters" of the nervous system and as "promoters" of nociceptive transmission. In order to scan recent literature (last ten years), three independent researchers referred to databases PubMed, Embase, Google Scholar, Scopus, and Web of Science to find original research articles and clinical trials. The researchers selected 33 papers: 29 original research articles and 4 clinical trials. The results obtained by the screening of the selected articles show an interesting trend, in which the precise modulation of neurotrophin signaling could switch neurotrophins from being a "promoter" of pain to their beneficial neurotrophic role of supporting the nerves in their recovery, especially when a structural alteration is present, as in neuropathic pain. In conclusion, neurotrophins could be interesting targets for orofacial pain modulation but more studies are necessary to clarify their role for future application in clinical practice.

The Mechanistic Pathways of Periodontal Pathogens Entering the Brain: The Potential Role of Treponema denticola in Tracing Alzheimer’s Disease Pathology

Alzheimer’s Disease (AD) is a complex neurodegenerative disease and remains the most common form of dementia. The pathological features include amyloid (Aβ) accumulation, neurofibrillary tangles (NFTs), neural and synaptic loss, microglial cell activation, and an increased blood–brain barrier permeability. One longstanding hypothesis suggests that a microbial etiology is key to AD initiation. Among the various periodontal microorganisms, Porphyromonas gingivalis has been considered the keystone agent to potentially correlate with AD, due to its influence on systemic inflammation. P. gingivalis together with Treponema denticola and Tannerella forsythia belong to the red complex consortium of bacteria advocated to sustain periodontitis within a local dysbiosis and a host response alteration. Since the implication of P. gingivalis in the pathogenesis of AD, evidence has emerged of T. denticola clusters in some AD brain tissue sections. This narrative review explored the potential mode of spirochetes entry into the AD brain for tracing pathology. Spirochetes are slow-growing bacteria, which can hide within ganglia for many years. It is this feature in combination with the ability of these bacteria to evade the hosts’ immune responses that may account for a long lag phase between infection and plausible AD disease symptoms. As the locus coeruleus has direct connection between the trigeminal nuclei to periodontal free nerve endings and proprioceptors with the central nervous system, it is plausible that they could initiate AD pathology from this anatomical region.

Dyspnea

The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.

Pathophysiological mechanisms of oromandibular dystonia

Oromandibular dystonia (OMD) is a rare form of focal idiopathic dystonia. OMD was clinically identified at the beginning of the 20th century, and the main clinical features have been progressively described over the years. However, OMD has several peculiarities that still remain unexplained, including the high rate of oral trauma, which is often related to the onset of motor symptoms. The purpose of this paper was to formulate a hypothesis regarding the pathophysiology of OMD, starting from the neuroanatomical basis of the masticatory and facial systems and highlighting the features that differentiate this condition from other forms of focal idiopathic dystonia. We provide a brief review of the clinical and etiological features of OMD as well as neurophysiological and neuroimaging findings obtained from studies in patients with OMD. We discuss possible pathophysiological mechanisms underlying OMD and suggest that abnormalities in sensory input processing may play a prominent role in OMD pathophysiology, possibly triggering a cascade of events that results in sensorimotor cortex network dysfunction. Finally, we identify open questions that future studies should address, including the effect of abnormal sensory input processing and oral trauma on the peculiar neurophysiological abnormalities observed in OMD.

Cortical Hub for Flavor Sensation in Rodents

The experience of eating is inherently multimodal, combining intraoral gustatory, olfactory, and somatosensory signals into a single percept called flavor. As foods and beverages enter the mouth, movements associated with chewing and swallowing activate somatosensory receptors in the oral cavity, dissolve tastants in the saliva to activate taste receptors, and release volatile odorant molecules to retronasally activate olfactory receptors in the nasal epithelium. Human studies indicate that sensory cortical areas are important for intraoral multimodal processing, yet their circuit-level mechanisms remain unclear. Animal models allow for detailed analyses of neural circuits due to the large number of molecular tools available for tracing and neuronal manipulations. In this review, we concentrate on the anatomical and neurophysiological evidence from rodent models toward a better understanding of the circuit-level mechanisms underlying the cortical processing of flavor. While more work is needed, the emerging view pertaining to the multimodal processing of food and beverages is that the piriform, gustatory, and somatosensory cortical regions do not function solely as independent areas. Rather they act as an intraoral cortical hub, simultaneously receiving and processing multimodal sensory information from the mouth to produce the rich and complex flavor experience that guides consummatory behavior.

A Step further-The Role of Trigeminocardiac Reflex in Therapeutic Implications: Hypothesis, Evidence, and Experimental Models

The trigeminocardiac reflex (TCR) is a well-recognized brainstem reflex that represents a unique interaction between the brain and the heart through the Vth and Xth cranial nerves and brainstem nuclei. The TCR has mainly been reported as an intraoperative phenomenon causing cardiovascular changes during skull-base surgeries. However, it is now appreciated that the TCR is implicated during non-neurosurgical procedures and in nonsurgical conditions, and its complex reflex pathways have been explored as potential therapeutic options in various neurological and cardiovascular diseases. This narrative review presents an in-depth overview of hypothetical and experimental models of the TCR phenomenon in relation to the Vth and Xth cranial nerves. In addition, primitive interactions between these 2 cranial nerves and their significance are highlighted. Finally, therapeutic models of the complex interactions of the TCR and areas for further research will be considered.

Transcutaneous trigeminal nerve stimulation modulates the hand blink reflex

The hand-blink reflex (HBR) is a subcortical response, elicited by the electrical stimulation of the median nerve, whose magnitude is specifically modulated according to the spatial properties of the defensive peripersonal space (DPPS) of the face. For these reasons, the HBR is commonly used as a model to assess the DPPS of the face. Little is known on the effects induced by the activation of cutaneous afferents from the face on the DPPS of the face. Therefore, we tested the effect of non-painful transcutaneous trigeminal nerve stimulation (TNS) on the amplitude of the HBR. Fifteen healthy participants underwent HBR recording before and after 20 min of sham- and real-TNS delivered bilaterally to the infraorbital nerve in two separate sessions. The HBR was recorded bilaterally from the orbicularis oculi muscles, following non-painful median nerve stimulation at the wrist. The HBR amplitude was assessed in the "hand-far" and "hand-near" conditions, relative to the hand position in respect to the face. The amplitudes of the hand-far and hand-near HBR were measured bilaterally before and after sham- and real-TNS. Real-TNS significantly reduced the magnitude of the HBR, while sham-TNS had no significant effect. The inhibitory effect of TNS was of similar extent on both the hand-far and hand-near components of the HBR, which suggests an action exerted mainly at brainstem level.

Morphologic Characterization of Trigeminothalamic Terminal Arbors Arising From the Principal Nucleus in the Macaque

The ventral posterior medial nucleus (VPM) is amandatory relay for orofacial sensory information targeting the primary somatosensory cortex. We characterized the morphology of VPM axons arising in the principal trigeminal sensory nucleus (pV) through injections of biotinylated dextran amine (BDA) placed in pV of Macaca fascicularis and mulatta monkeys. Labeled terminals formed a patchy bilateral distribution. Within contralateral VPM, patches were found primarily, but not exclusively, within the laterally located, vertical segment, and in ipsilateral VPM, primarily, but not exclusively, in the medially located, horizontal segment. Two fiber types were labeled: thin and thick. Thin fibers were poorly branched and diffusely distributed. They were studded with small en passant boutons. Most labeled fibers were thick and they branched extensively to form distinctive terminal arbors decorated with numerous boutons that varied in size and shape. Quantitative analysis of thick fiber arbor features showed little difference between the sides, although contralateral boutons were significantly larger than ipsilateral ones. Bouton distribution with respect to counterstained somata suggests that proximal dendrites are their main target. Indeed, ultrastructural examination demonstrated that they provide large diameter dendrites with numerous contacts. Direct comparison of thick fiber terminal arbors to cytochrome oxidase (CO) staining revealed that these arbors are much smaller than individual CO-rich patches believed to designate rods containing discrete body area representations. Thus, each terminal arbor appears to heavily innervate a small number of VPM neurons within a rod. This relationship would serve to maintain relatively small receptive fields within the topographic representation of the face.

Partial Similarity Reveals Dynamics in Brainstem-Midbrain Networks during Trigeminal Nociception

Imaging studies help us understand the important role of brainstem and midbrain regions in human trigeminal pain processing without solving the question of how these regions actually interact. In the current study, we describe this connectivity and its dynamics during nociception with a novel analytical approach called Partial Similarity (PS). We developed PS specifically to estimate the communication between individual hubs of the network in contrast to the overall communication within that network. Partial Similarity works on trial-to-trial variance of neuronal activity acquired with functional magnetic resonance imaging. It discovers direct communication between two hubs considering the remainder of the network as confounds. A similar method to PS is Representational Similarity, which works with ordinary correlations and does not consider any external influence on the communication between two hubs. Particularly the combination of Representational Similarity and Partial Similarity analysis unravels brainstem dynamics involved in trigeminal pain using the spinal trigeminal nucleus (STN)—the first relay station of peripheral trigeminal input—as a seed region. The combination of both methods can be valuable tools in discovering the network dynamics in fMRI and an important instrument for future insight into the nature of various neurological diseases like primary headaches.

Effects of Chronic and Experimental Acute Masseter Pain on Precision Biting Behavior in Humans

Chronic pain in the orofacial region is common worldwide. Pain seems to affect the jaw motor control. Hence, temporomandibular disorders (TMD) are often accompanied by pain upon chewing, restricted mouth opening and impaired maximal bite forces. However, little is known on the effects of pain, in particular the effects of chronic jaw muscle pain on precision biting. The aim of the study was to investigate the effect of chronic and acute jaw muscle pain on oral motor control during precision biting in humans. Eighteen patients with chronic masseter muscle pain and 18 healthy participants completed the experiment. All participants were examined according to the Diagnostic Criteria for TMD. Experimental acute pain was induced by bilateral, simultaneous sterile hypertonic saline infusions into the healthy masseter muscles. A standardized hold and split biting task was used to assess the precision biting. The data was analyzed with non-parametric statistical tests. The results showed no significant differences in the hold forces, split forces, durations of split or peak split rates within or between the pain and pain-free conditions. The mean split rate increased significantly compared to baseline values both in the chronic patients and the pain-free condition. However, this increase was not evident in the experimental acute pain condition. Further, there were no significant differences in the mean split rates between the conditions. The data suggest that jaw muscle pain does not seem to alter precision biting in humans, however, the possibility that a nociceptive modulation of spindle afferent activity might have occurred but compensated for cannot be ruled out.

Central connections of the trigeminal motor command system in the weakly electric Elephantnose fish (Gnathonemus petersii)

The highly mobile chin appendage of Gnathonemus petersii, the Schnauzenorgan, is used to actively probe the environment and is known to be a fovea of the electrosensory system. It receives an important innervation from both the trigeminal sensory and motor systems. However, little is known about the premotor control pathways that coordinate the movements of the Schnauzenorgan, or about central pathways originating from the trigeminal motor nucleus. The present study focuses on the central connections of the trigeminal motor system to elucidate premotor centers controlling Schnauzenorgan movements, with particular interest in the possible connections between the electrosensory and trigeminal systems. Neurotracer injections into the trigeminal motor nucleus revealed bilateral, reciprocal connections between the two trigeminal motor nuclei and between the trigeminal sensory and motor nuclei by bilateral labeling of cells and terminals. Prominent afferent input to the trigeminal motor nucleus originates from the nucleus lateralis valvulae, the nucleus dorsalis mesencephali, the cerebellar corpus C1, the reticular formation, and the Raphe nuclei. Retrogradely labeled cells were also observed in the central pretectal nucleus, the dorsal anterior pretectal nucleus, the tectum, the ventroposterior nucleus of the torus semicircularis, the gustatory sensory and motor nuclei, and in the hypothalamus. Labeled terminals, but not cell bodies, were observed in the nucleus lateralis valvulae and the reticular formation. No direct connections were found between the electrosensory system and the V motor nucleus but the central connections identified would provide several multisynaptic pathways linking these two systems, including possible efference copy and corollary discharge mechanisms.

Orofacial Movements Involve Parallel Corticobulbar Projections from Motor Cortex to Trigeminal Premotor Nuclei

How do neurons in orofacial motor cortex (MCtx) orchestrate behaviors? We show that focal activation of MCtx corticobulbar neurons evokes behaviorally relevant concurrent movements of the forelimb, jaw, nose, and vibrissae. The projections from different locations in MCtx form gradients of boutons across premotor nuclei spinal trigeminal pars oralis (SpVO) and interpolaris rostralis (SpVIr). Furthermore, retrograde viral tracing from muscles that control orofacial actions shows that these premotor nuclei segregate their outputs. In the most dramatic case, both SpVO and SpVIr are premotor to forelimb and vibrissa muscles, while only SpVO is premotor to jaw muscles. Functional confirmation of the superimposed control by MCtx was obtained through selective optogenetic activation of corticobulbar neurons on the basis of their preferential projections to SpVO versus SpVIr. We conclude that neighboring projection neurons in orofacial MCtx form parallel pathways to distinct pools of trigeminal premotor neurons that coordinate motor actions into a behavior.

Dental occlusion as one cause of tinnitus

There is large support in literature linking tinnitus to dental occlusion and temporomandibular joint disorders (TMD). However, there is no model to explain such a link. This hypothesis explains how the fusimotor system of the muscles innervated by the trigeminal motor nucleus is affected by inadequacies in the occlusion of the teeth that cause changes in posture and movement of the mandible. Reptile to mammal evolution shows that stomatognathic structures underwent changes related to mastication. Among several changes, there was the appearance of a new articulation between the mandible and skull: the temporomandibular joint. The bones of the old reptile joint, quadrate-articular, have detached from the mandible and are part of the middle ear bone chain. The former becomes the incus and the latter the malleus. This bone change also carried the tensor tympani and its trigeminal motor innervation. Inadequate occlusal contacts give rise to an adapted function of the mandible and the most common compensatory muscular response is hypertonia involving all mandibular muscles, including the tensor tympani. A fundamental clinical feature that demonstrates the involvement of the trigeminal fusimotor system is the characteristic pain by palpation, but no pain on the mandibular movement. Muscle pain is always felt in the dermatome innervated by the mandibular branch of the trigeminal nerve, which carries the motor fibers, reported as tightening, similar to cramp, and has regular behavior in intensity, duration and frequency. In addition, the patient has increased musculature volume, detected by palpation of certain anatomical landmarks, but with loss of functional efficiency. The neuromotor control of the mandibular movements is poor and when asked to make lateral jaw movement touching the teeth, it is common to observe that the patient moves the lips, eyes, and even turns the head in the same direction as the movement. There is also difficulty eating hard foods and talking fast. Tongue biting while chewing is frequent, meaning that these non-physiological events surpass protective reflex circuits. The report of ear pain, tinnitus, blocked ear sensation and sudden hearing loss is common in such patients, compatible with the tonic contraction of the tensor tympani. The fusimotor system hypothesis is able to explain all events related to the symptoms and helps to establish a correct diagnosis for certain types of hearing disorders.

Visualizing the trigeminovagal complex in the human medulla by combining ex-vivo ultra-high resolution structural MRI and polarized light imaging microscopy

A trigeminovagal complex, as described in some animals, could help to explain the effect of vagus nerve stimulation as a treatment for headache disorders. However, the existence of a trigeminovagal complex in humans remains unclear. This study, therefore investigated the existence of the trigeminovagal complex in humans. One post-mortem human brainstem was scanned at 11.7T to obtain structural (T1-weighted) and diffusion magnetic resonance images ((d)MR images). Post-processing of dMRI data provided track density imaging (TDI) maps to investigate white matter at a smaller resolution than the imaging resolution. To evaluate the reconstructed tracts, the MR-scanned brainstem and three additional brainstems were sectioned for polarized light imaging (PLI) microscopy. T1-weighted images showed hyperintense vagus medullar striae, coursing towards the dorsomedial aspect of the medulla. dMRI-, TDI- and PLI-images showed these striae to intersect the trigeminal spinal tract (sp5) in the lateral medulla. In addition, PLI images showed that a minority of vagus fibers separated from the vagus trajectory and joined the trigeminal spinal nucleus (Sp5) and the sp5. The course of the vagus tract in the rostral medulla was demonstrated in this study. This study shows that the trigeminal- and vagus systems interconnect anatomically at the level of the rostral medulla where the vagus fibers intersect with the Sp5 and sp5. Physiological and clinical utility of this newly identified interconnection is a topic for further research.

Influence of Temperature on Motor Behaviors in Newborn Opossums (Monodelphis domestica): An In Vitro Study

External thermosensation is crucial to regulate animal behavior and homeostasis, but the development of the mammalian thermosensory system is not well known. We investigated whether temperature could play a role in the control of movements in a mammalian model born very immature, the opossum (Monodelphis domestica). Like other marsupials, at birth the opossum performs alternate and rhythmic movements with its forelimbs (FLs) to reach a teat where it attaches in order to continue its development. It was shown that FL movements can be induced by mechanical stimulation of the snout in in vitro preparations of newborns consisting of the neuraxis with skin and FLs intact. In the present study, we used puff ejections of cold, neutral (bath temperature) and hot liquid directed toward the snout to induce FL responses in such preparations. Either the responses were visually observed under a microscope or triceps muscle activity was recorded. Cold liquid systematically induced FL movements and triceps contractions, but neutral and hot temperatures were less potent to do so. Sections of the trigeminal nerves and removal of the facial skin diminished responses to cold and nearly abolished those to hot and neutral stimulations. Transient receptor potential melastatin 8 (TRPM8) being the major cold receptor cation channel in adult mammals, we employed immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) to test for its expression, but found that it is not expressed before 13 postnatal days. Overall our results indicate that cold thermosensation exerts a strong influence on motor behaviors in newborn opossums.

THE ANATOMY OF OROFACIAL INNERVATION

The whole human body receives rich sensory innervation with only one exception and that is the brain tissue. The orofacial region is hence no exception. The head region consequently receives a rich network of sensory nerves making it special because the two types of sensory fibres, visceral and somatic overlap, especially in the pharynx. Also, different pain syndromes that affect this region are rather specific in comparison to their presentation in other body regions. With this review article we wanted to show the detailed anatomy of the peripheral sensory pathways, because of its importance in everyday body functions (eating, drinking, speech) as well as the importance it has in pathological conditions (pain syndromes), in diagnostics and regional analgesia and anaesthesia.

Mastication as a tool to prevent cognitive dysfunctions

Mastication as we all know has always been related to its primary function of digestion, but little do we know that it produces an enhancing effect on general health, especially the cognitive performance related aspects of memory. Recent studies have shown its association with activation of various brain regions, however little is known about its effects on neuronal activity in these specified regions. According to the enormous evidences collected so far, mastication has proved to be effective in conducting huge amount of sensory information to the brain, and maintaining learning and memory functions of hippocampus. Therefore it is essential that we maintain normal occlusion and preserve the masticatory function as long as possible to prevent the attenuation of hippocampus, caused by occlusal disharmony and reduced mastication. We provide an overview on how mastication activates various cortical areas of the brain and how an increase in the cerebral blood oxygen level of hippocampus and prefrontal cortex (PFC) accentuates the learning and memory process. We also justify why maintaining and establishing a normal occlusion is important from neurological point of view.

Neurophysiological aspects of the trigeminal sensory system: an update

The trigeminal system is one of the most complex cranial nerve systems of the human body. Research on it has vastly grown in recent years and concentrated more and more on molecular mechanisms and pathophysiology, but thorough reviews on this topic are lacking, certainly on the normal physiology of the trigeminal sensory system. Here we review the current literature on neurophysiology of the trigeminal nerve from peripheral receptors up to its central projections toward the somatosensory cortex. We focus on the most recent scientific discoveries and describe historical relevant research to substantiate further. One chapter on new insights of the pathophysiology of pain at the level of the trigeminal system is added. A database search of Medline, Embase and Cochrane was conducted with the search terms ‘animal study’, ‘neurophysiology’, ‘trigeminal’, ‘oral’ and ‘sensory’. Articles were manually selected after reading the abstract and where needed the article. Reference lists also served to include relevant research articles. Fifty-six articles were included after critical appraisal. Physiological aspects on mechanoreceptors, trigeminal afferents, trigeminal ganglion and central projections are reviewed in light of reference works. Embryologic and anatomic insights are cited where needed. A brief description of pathophysiology of pain pathways in the trigeminal area and recent advances in dental stem cell research are also discussed. Neurophysiology at the level of the central nervous system is not reviewed. The current body of knowledge is mainly based on animal and cadaveric studies, but recent advancements in functional imaging and molecular neuroscience are elucidating the pathways and functioning of this mixed nerve system. Extrapolation of animal studies or functioning of peripheral nerves should be warranted.

Brain encoding of saltatory velocity through a pulsed pneumotactile array in the lower face

Processing dynamic tactile inputs is a primary function of the somatosensory system. Spatial velocity encoding mechanisms by the nervous system are important for skilled movement production and may play a role in recovery of sensorimotor function following neurological insult. Little is known about tactile velocity encoding in mechanosensory trigeminal networks required for speech, suck, mastication, and facial gesture. High resolution functional magnetic resonance imaging (fMRI) was used to investigate the neural substrates of velocity encoding in the human orofacial somatosensory system during unilateral saltatory pneumotactile stimulation of perioral and buccal hairy skin in 20 neurotypical adults. A custom multichannel, scalable pneumotactile array consisting of 7 TAC-Cells was used to present 5 stimulus conditions: 5cm/s, 25cm/s, 65cm/s, ALL-ON synchronous activation, and ALL-OFF. The spatiotemporal organization of whole-brain blood oxygen level-dependent (BOLD) response was analyzed with general linear modeling (GLM) and fitted response estimates of percent signal change to compare activations associated with each velocity, and the main effect of velocity alone. Sequential saltatory inputs to the right lower face produced localized BOLD responses in 6 key regions of interest (ROI) including; contralateral precentral and postcentral gyri, and ipsilateral precentral, superior temporal (STG), supramarginal gyri (SMG), and cerebellum. The spatiotemporal organization of the evoked BOLD response was highly dependent on velocity, with the greatest amplitude of BOLD signal change recorded during the 5cm/s presentation in the contralateral hemisphere. Temporal analysis of BOLD response by velocity indicated rapid adaptation via a scalability of networks processing changing pneumotactile velocity cues.

The Molecular Fingerprint of Dorsal Root and Trigeminal Ganglion Neurons

The dorsal root ganglia (DRG) and trigeminal ganglia (TG) are clusters of cell bodies of highly specialized sensory neurons which are responsible for relaying information about our environment to the central nervous system. Despite previous efforts to characterize sensory neurons at the molecular level, it is still unknown whether those present in DRG and TG have distinct expression profiles and therefore a unique molecular fingerprint. To address this question, we isolated lumbar DRG and TG neurons using fluorescence-activated cell sorting from Advillin-GFP transgenic mice and performed RNA sequencing. Our transcriptome analyses showed that, despite being overwhelmingly similar, a number of genes are differentially expressed in DRG and TG neurons. Importantly, we identified 24 genes which were uniquely expressed in either ganglia, including an arginine vasopressin receptor and several homeobox genes, giving each population a distinct molecular fingerprint. We compared our findings with published studies to reveal that many genes previously reported to be present in neurons are in fact likely to originate from other cell types in the ganglia. Additionally, our neuron-specific results aligned well with a dataset examining whole human TG and DRG. We propose that the data can both improve our understanding of primary afferent biology and help contribute to the development of drug treatments and gene therapies which seek targets with unique or restricted expression patterns.

Novel trigeminal slice preparation method for studying mechanisms of nociception transmission

BACKGROUND

The trigeminal subnucleus caudalis (Vc) plays a critical role in transmission and modulation of nociceptive afferent inputs, and exhibits a similar layer construction to the spinal dorsal horn. However, afferent inputs enter the brainstem and project to a separately located nucleus. It has previously been difficult to record responses of the Vc to afferent fiber activation in a brainstem slice preparation. The aim of the present study was to establish a novel brainstem slice preparation method to study trigeminal nociceptive transmission mechanisms.

NEW METHOD

Thirty adult 6-7-week-old C57/BL6J male mice were included in the study. Obliquely sliced brainstem sections at a thickness of 600μm, which included the Vc and the root entry zone to the brainstem, were prepared. The Vc response to electrical stimulation of afferent fibers was observed as a change in intracellular calcium concentration by fluorescence intensity response.

RESULTS

Electrical stimulation of afferent inputs to the trigeminal nerve increased fluorescent intensity in the Vc, which was completely diminished by tetrodotoxin and significantly suppressed by the AMPA/kainate antagonist CNQX (paired t-test, P<0.001), although the non-competitive NMDA antagonist (+)-MK801 maleate resulted in no changes. These results suggested a glutamate receptor-mediated response.

COMPARISON WITH EXISTING METHODS/CONCLUSION

This brainstem slice preparation will be useful for investigating nociceptive transmission mechanisms of the trigeminal nerve.

The Modulatory Role of Orexin 1 Receptor in CA1 on Orofacial Pain-induced Learning and Memory Deficits in Rats

Introduction:

Cognitive impairment is commonly associated with pain. The modulatory role of orexin 1 receptor (OX1R) in pain pathways as well as learning and memory processes is reported in several studies. The current study was designed to investigate the possible role of CA1-hippocampal OX1R on spatial learning and memory of rats following capsaicin-induced orofacial pain.

Methods:

Orofacial pain was induced by subcutaneous intra lip injection of capsaicin (100 μg). CA1 administration of orexin A and its selective antagonist (SB-334867-A) were performed 20 minutes prior to capsaicin injection. Learning and spatial memory performances were assessed by Morris Water Maze (MWM) task.

Results:

Capsaicin treated rats showed impairment in spatial learning and memory. In addition, pretreatment with orexin A (20 and 40 nM/rat) significantly attenuated learning and memory impairment in capsaicin-treated rats. Conversely, blockage of OX1R via SB-334867-A (40 and 80 nM/rat) significantly exaggerated learning and memory loss in capsaicin-treated rats.

Conclusion:

The obtained results indicated that CA1 OX1R may be involved in modulation of capsaicin –induced spatial learning and memory impairment.

Evaluation of sphenopalatine ganglion blockade via intra oral route for the management of atypical trigeminal neuralgia

Background

The sphenopalatine ganglion (SPG) may be involved in persistent idiopathic facial pain and unilateral headaches. The role of SPG blockade via intra oral route in the management of trigeminal neuralgia (TN) is worthy of study.

Methods

In this retrospective study, patient records included patients with atypical TN (type 2) that persisted in spite of conservative treatment for at least 2 years, and an average pain intensity from the craniofacial region visual analogue scale (VAS) before examination. In group I the patients received carmapazepin 800 mg a day for at least 2 years. In group II 3 ml of local anesthetic agent consisting 2 ml bupivacaine and 1 ml prilocain in addition to 1 ml fentanyl, 0.5 ml betametasone disodium phosphate and 0.5 ml opaque was injected by the intraoral route. In this group, injection procedures were performed under local anesthesia with fluoroscopic guidance. The Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction were used for intergroup analysis. Age and sex differences were evaluated with one-way ANOVA and Fisher’s exact tests, respectively.

Results

Significant differences were found between pre-op and 3rd day VAS values and also pre-op and 1st month VAS values. No significant differences were found between pre-op and 6th month VAS values.

Conclusion

The SPG blockade improves the quality of life of patients and a minimally-invasive procedure to management of TN, when compared to other methods.

New Insights in Trigeminal Anatomy: A Double Orofacial Tract for Nociceptive Input

Orofacial pain in patients relies on the anatomical pathways that conduct nociceptive information, originating from the periphery towards the trigeminal sensory nucleus complex (TSNC) and finally, to the thalami and the somatosensorical cortical regions. The anatomy and function of the so-called trigeminothalamic tracts have been investigated before. In these animal-based studies from the previous century, the intracerebral pathways were mapped using different retro- and anterograde tracing methods. We review the literature on the trigeminothalamic tracts focusing on these animal tracer studies. Subsequently, we related the observations of these studies to clinical findings using fMRI trials. The intracerebral trigeminal pathways can be subdivided into three pathways: a ventral (contralateral) and dorsal (mainly ipsilateral) trigeminothalamic tract and the intranuclear pathway. Based on the reviewed evidence we hypothesize the co-existence of an ipsilateral nociceptive conduction tract to the cerebral cortex and we translate evidence from animal-based research to the human anatomy. Our hypothesis differs from the classical idea that orofacial pain arises only from nociceptive information via the contralateral, ventral trigeminothalamic pathway. Better understanding of the histology, anatomy and connectivity of the trigeminal fibers could contribute to the discovery of a more effective pain treatment in patients suffering from various orofacial pain syndromes.

A 1-Diopter Vertical Prism Induces a Decrease of Head Rotation: A Pilot Investigation

Clinical studies in non-specific chronic arthralgia and back pain seem to indicate an association between vertical heterophoria (VH - latent vertical retinal misalignment) and asymmetrical head rotation. Such clinical observations suggest a link between VH and head rotation, but this was never tested. The purpose of this study was to simulate a VH in healthy subjects and examine its influence on the amplitude of active head rotation during 3D motion capture in upright stance. Subjects were asked to rotate their head three times from the straight ahead position and then to the right, back to straight ahead, to the left, and back to the straight ahead again. Three randomized conditions were run: normal viewing, with a 1-diopter prism base down on the dominant eye, or the non-dominant eye. The most important finding is that the experimental VH whichever the eye with the prism induces a significant decrease in the mean angle of head rotation compared to the normal viewing condition. This decrease was significant for rotation to the left. We suggest that the prism-induced VH modifies the reference posture and thereby affects head rotation; further studies are needed to confirm this effect and to extend to other types of dynamic activities.

An astrocyte-dependent mechanism for neuronal rhythmogenesis

Communication between neurons rests on their capacity to change their firing pattern to encode different messages. For several vital functions, such as respiration and mastication, neurons need to generate a rhythmic firing pattern. Here we show in the rat trigeminal sensori-motor circuit for mastication that this ability depends on regulation of the extracellular Ca(2+) concentration ([Ca(2+)]e) by astrocytes. In this circuit, astrocytes respond to sensory stimuli that induce neuronal rhythmic activity, and their blockade with a Ca(2+) chelator prevents neurons from generating a rhythmic bursting pattern. This ability is restored by adding S100β, an astrocytic Ca(2+)-binding protein, to the extracellular space, while application of an anti-S100β antibody prevents generation of rhythmic activity. These results indicate that astrocytes regulate a fundamental neuronal property: the capacity to change firing pattern. These findings may have broad implications for many other neural networks whose functions depend on the generation of rhythmic activity.

More a finger than a nose: the trigeminal motor and sensory innervation of the Schnauzenorgan in the elephant-nose fish Gnathonemus petersii

The weakly electric fish Gnathonemus petersii uses its electric sense to actively probe the environment. Its highly mobile chin appendage, the Schnauzenorgan, is rich in electroreceptors. Physical measurements have demonstrated the importance of the position of the Schnauzenorgan in funneling the fish's self-generated electric field. The present study focuses on the trigeminal motor pathway that controls Schnauzenorgan movement and on its trigeminal sensory innervation and central representation. The nerves entering the Schnauzenorgan are very large and contain both motor and sensory trigeminal components as well as an electrosensory pathway. With the use of neurotracer techniques, labeled Schnauzenorgan motoneurons were found throughout the ventral main body of the trigeminal motor nucleus but not among the population of larger motoneurons in its rostrodorsal region. The Schnauzenorgan receives no motor or sensory innervation from the facial nerve. There are many anastomoses between the peripheral electrosensory and trigeminal nerves, but these senses remain separate in the sensory ganglia and in their first central relays. Schnauzenorgan trigeminal primary afferent projections extend throughout the descending trigeminal sensory nuclei, and a few fibers enter the facial lobe. Although no labeled neurons could be identified in the brain as the trigeminal mesencephalic root, some Schnauzenorgan trigeminal afferents terminated in the trigeminal motor nucleus, suggesting a monosynaptic, possibly proprioceptive, pathway. In this first step toward understanding multimodal central representation of the Schnauzenorgan, no direct interconnections were found between the trigeminal sensory and electromotor command system, or the electrosensory and trigeminal motor command. The pathways linking perception to action remain to be studied.

The mesencephalic nucleus of the trigeminal nerve and the SIDS

Sudden infant death syndrome (SIDS) is a major cause of infant mortality throughout the world, yet its cause and mechanism of action remain poorly understood. Here, we discuss a novel model of the etiology of SIDS which ties together what is known about the brain regions thought to be affected in SIDS infants with a defined neuroanatomical circuit and a documented preventative factor in young children. We propose that SIDS occurs due to a lack of sufficient development and plasticity of glutamatergic synapses in the mesencephalic nucleus of the trigeminal nerve (Me5) and reticular formation (RF) of the brainstem. This model is supported by evidence of brainstem dysfunction in SIDS as well as evidence of signaling through the Me5 and RF in another means of regulating cortical arousal. Furthermore, long-term plasticity of glutamatergic synapses is well known to play a critical role in learning and memory in other regions of the brain, implying that those mechanisms may also be relevant in the development of brainstem circuitry. This model clearly explains why SIDS deaths appear so suddenly with little pathological explanation and suggests a potentially novel way to prevent these deaths from occurring.

Palisade endings and proprioception in extraocular muscles: a comparison with skeletal muscles

This article describes current views on motor and sensory control of extraocular muscles (EOMs) based on anatomical data. The special morphology of EOMs, including their motor innervation, is described in comparison to classical skeletal limb and trunk muscles. The presence of proprioceptive organs is reviewed with emphasis on the palisade endings (PEs), which are unique to EOMs, but the function of which is still debated. In consideration of the current new anatomical data about the location of cell bodies of PEs, a hypothesis on the function of PEs in EOMs and the multiply innervated muscle fibres they are attached to is put forward.

Generation of the masticatory central pattern and its modulation by sensory feedback

The basic pattern of rhythmic jaw movements produced during mastication is generated by a neuronal network located in the brainstem and referred to as the masticatory central pattern generator (CPG). This network composed of neurons mostly associated to the trigeminal system is found between the rostral borders of the trigeminal motor nucleus and facial nucleus. This review summarizes current knowledge on the anatomical organization, the development, the connectivity and the cellular properties of these trigeminal circuits in relation to mastication. Emphasis is put on a population of rhythmogenic neurons in the dorsal part of the trigeminal sensory nucleus. These neurons have intrinsic bursting capabilities, supported by a persistent Na(+) current (I(NaP)), which are enhanced when the extracellular concentration of Ca(2+) diminishes. Presented evidence suggest that the Ca(2+) dependency of this current combined with its voltage-dependency could provide a mechanism for cortical and sensory afferent inputs to the nucleus to interact with the rhythmogenic properties of its neurons to adjust and adapt the rhythmic output. Astrocytes are postulated to contribute to this process by modulating the extracellular Ca(2+) concentration and a model is proposed to explain how functional microdomains defined by the boundaries of astrocytic syncitia may form under the influence of incoming inputs.

The role of trigeminal interpolaris-caudalis transition zone in persistent orofacial pain

Previous studies have established the role of the medullary dorsal horn or the subnucleus caudalis of the spinal trigeminal complex, a homolog of the dorsal horn of the spinal cord, in trigeminal pain processing. In addition to the medullary dorsal horn, recent studies have pointed out increased excitability and sensitization of trigeminal interpolaris and caudalis transition zone (Vi/Vc) following deep orofacial injury, involving neuron-glia-cytokine interactions. The Vi/Vc transition zone accesses rostral brain regions that are important for descending pain modulation, and somatovisceral and somatoautonomic processing and plays a unique role in coordinating trigeminal nocifensive responses.

Face Piercing (Body Art): Choosing Pleasure vs. Possible Pain and Posture Instability

Piercings (body art, i.e., with jewelry) are more and more widespread. They can induce various complications such as infections, allergies, headaches, and various skin, cartilage, or dental problems, and represent a public health problem. We draw attention to possible side effects resulting from face piercing complications observed on four young adults such as eye misalignment, decreased postural control efficiency, and non-specific chronic back pain with associated comorbidity. We found that the origin was pierced jewelry on the face. Removing the jewelry restored eye alignment, improved postural control, and alleviated back pain in a lasting way. We suggest that pierced facial jewelry can disturb somaesthetic signals driven by the trigeminal nerve, and thus interfere with central integration processes, notably in the cerebellum and the vestibular nucleus involved in postural control and eye alignment. Facial piercings could induce sensory–motor conflict, exacerbate, or precipitate a pre-existing undetermined conflict, which leads pain and complaints. These findings are significant for health; further investigations would be of interest.

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.

Behavioral and immunohistochemical evidence for central antinociceptive activity of botulinum toxin A

Botulinum toxin A (BTX-A) is approved for treatment of different cholinergic hyperactivity disorders, and, recently, migraine headache. Although suggested to act only locally, novel observations demonstrated bilateral reduction of pain after unilateral toxin injection, and proposed retrograde axonal transport, presumably in sensory neurons. However, up to now, axonal transport of BTX-A from periphery to CNS was identified only in motoneurons, but with unknown significance. We assessed the effects of low doses of BTX-A injected into the rat whisker pad (3.5 U/kg) or into the sensory trigeminal ganglion (1 U/kg) on formalin-induced facial pain. Axonal transport was prevented by colchicine injection into the trigeminal ganglion (5 mM, 2 μl). To find the possible site of action of axonally transported BTX-A, we employed immunohistochemical labeling of BTX-A-truncated synaptosomal-associated protein 25 (SNAP-25) in medullary dorsal horn of trigeminal nucleus caudalis after toxin injection into the whisker pad. Both peripheral and intraganglionic BTX-A reduce phase II of formalin-induced pain. Antinociceptive effect of BTX-A was prevented completely by colchicine. BTX-A-truncated SNAP-25 in medullary dorsal horn (spinal trigeminal nucleus) was evident 3 days following the peripheral treatment, even with low dose applied (3.5 U/kg). Presented data provide the first evidence that axonal transport of BTX-A, obligatory for its antinociceptive effects, occurs via sensory neurons and is directed to sensory nociceptive nuclei in the CNS.

The trigeminal circuits responsible for chewing

Mastication is a vital function that ensures that ingested food is broken down into pieces and prepared for digestion. This review outlines the masticatory behavior in terms of the muscle activation patterns and jaw movements and gives an overview of the organization and function of the trigeminal neuronal circuits that are known to take part in the generation and control of oro-facial motor functions. The basic pattern of rhythmic jaw movements produced during mastication is generated by a Central Pattern Generator (CPG) located in the pons and medulla. Neurons within the CPG have intrinsic properties that produce a rhythmic activity, but the output of these neurons is modified by inputs that descend from the higher centers of the brain, and by feedback from sensory receptors, in order to constantly adapt the movement to the food properties.

Temporomandibular joint inflammation activates glial and immune cells in both the trigeminal ganglia and in the spinal trigeminal nucleus

BACKGROUND

Glial cells have been shown to directly participate to the genesis and maintenance of chronic pain in both the sensory ganglia and the central nervous system (CNS). Indeed, glial cell activation has been reported in both the dorsal root ganglia and the spinal cord following injury or inflammation of the sciatic nerve, but no data are currently available in animal models of trigeminal sensitization. Therefore, in the present study, we evaluated glial cell activation in the trigeminal-spinal system following injection of the Complete Freund's Adjuvant (CFA) into the temporomandibular joint, which generates inflammatory pain and trigeminal hypersensitivity.

RESULTS

CFA-injected animals showed ipsilateral mechanical allodynia and temporomandibular joint edema, accompanied in the trigeminal ganglion by a strong increase in the number of GFAP-positive satellite glial cells encircling neurons and by the activation of resident macrophages. Seventy-two hours after CFA injection, activated microglial cells were observed in the ipsilateral trigeminal subnucleus caudalis and in the cervical dorsal horn, with a significant up-regulation of Iba1 immunoreactivity, but no signs of reactive astrogliosis were detected in the same areas. Since the purinergic system has been implicated in the activation of microglial cells during neuropathic pain, we have also evaluated the expression of the microglial-specific P2Y12 receptor subtype. No upregulation of this receptor was detected following induction of TMJ inflammation, suggesting that any possible role of P2Y12 in this paradigm of inflammatory pain does not involve changes in receptor expression.

CONCLUSIONS

Our data indicate that specific glial cell populations become activated in both the trigeminal ganglia and the CNS following induction of temporomandibular joint inflammation, and suggest that they might represent innovative targets for controlling pain during trigeminal nerve sensitization.

Occlusion and brain function: mastication as a prevention of cognitive dysfunction

Research in animals and humans has shown that mastication maintains cognitive function in the hippocampus, a brain area important for learning and memory. Reduced mastication, an epidemiological risk factor for the development of dementia in humans, attenuates spatial memory and causes hippocampal neurons to deteriorate morphologically and functionally, especially in aged animals. Active mastication rescues the stress-attenuated hippocampal memory process in animals and attenuates the perception of stress in humans by suppressing endocrinological and autonomic stress responses. Active mastication further improves the performance of sustained cognitive tasks by increasing the activation of the hippocampus and the prefrontal cortex, the brain regions that are essential for cognitive processing. Abnormal mastication caused by experimental occlusal disharmony in animals produces chronic stress, which in turn suppresses spatial learning ability. The negative correlation between mastication and corticosteroids has raised the hypothesis that the suppression of the hypothalamic-pituitary-adrenal (HPA) axis by masticatory stimulation contributes, in part, to preserving cognitive functions associated with mastication. In the present review, we examine research pertaining to the mastication-induced amelioration of deficits in cognitive function, its possible relationship with the HPA axis, and the neuronal mechanisms that may be involved in this process in the hippocampus.

Stomatognathic adaptive motor syndrome is the correct diagnosis for temporomandibular disorders

Temporomandibular disorder is a generic and inadequate conception to be used as a diagnosis. It fails to express the etiology or the pathophysiology and it is mainly associated with the anatomical site. Moreover, the clinical condition presents a mandibular motor problem and not a joint problem. The hypothesis presents the new diagnosis stomatognathic motor adaptive syndrome, which comprehend a motor response and the adaptive processes it induces. Inadequate occlusal contacts cause the mandible to shift in order to reach an ideal intercuspal position. The condylar displacements are proportional to such movements. Temporomandibular joint (TMJ) receptors respond to the capsular mechanical stress and the information reaches the trigeminal sensory nuclei. The mandibular modified position seems to be relevant information and may interfere with catecholaminergic neurotransmission in basal ganglia. The main motor responses comprise increased jaw muscle tone, decreased velocity of movements and incoordination. The overload of muscle function will produce adaptive responses on many stomatognathic structures. The muscle adaptive responses are hypertonia, pain, fatigue and weakness. Temporomandibular joint presents tissue modification, disc alteration and cracking noise. Periodontium show increased periodontal membrane, bone height loss and gingival recession. Teeth manifest increased wear facets, abfraction and non-accidental fractures. The periodontal and teeth adaptive processes are usually identified as occlusal trauma. The altered stomatognathic functions will show loss of velocity during mastication and speech. Fatigue, weakness in jaw muscle and difficulties to chew hard food are related to hypertonia. Incoordination between stomatognathic muscles groups is found, causing involuntary tongue/cheek biting and lateral jaw movements on speech. Otologic complaints, as aural fullness and tinnitus, are related to the tensor tympani muscle, innervated by the trigeminal nerve.

Characterization of mouse orofacial pain and the effects of lesioning TRPV1-expressing neurons on operant behavior

Background

Rodent models of orofacial pain typically use methods adapted from manipulations to hind paw; however, limitations of these models include animal restraint and subjective assessments of behavior by the experimenter. In contrast to these methods, assessment of operant responses to painful stimuli has been shown to overcome these limitations and expand the breadth of interpretation of the behavioral responses. In the current study, we used an operant model based on a reward-conflict paradigm to assess nociceptive responses in three strains of mice (SKH1-Hr^hr, C57BL/6J, TRPV1 knockout). We previously validated this operant model in rats and hypothesized in this study that wild-type mice would demonstrate a similar thermal stimulus-dependent response and similar operant pain behaviors. Additionally, we evaluated the effects on operant behaviors of mice manipulated genetically (e.g., TRPV1 k.o.) or pharmacologically with resiniferatoxin (RTX), a lesioning agent for TRPV1-expressing neurons. During the reward-conflict task, mice accessed a sweetened milk reward solution by voluntarily position their face against a neutral or heated thermode (37–55°C).

Results

As the temperature of the thermal stimulus became noxiously hot, reward licking events in SKH1-Hr^hr and C57BL/6J mice declined while licking events in TRPV1 k.o. mice were insensitive to noxious heat within the activation range of TRPV1 (37–52°C). All three strains displayed nocifensive behaviors at 55°C, as indicated by a significant decrease in reward licking events. Induction of neurogenic inflammation by topical application of capsaicin reduced licking events in SKH1-Hr^hr mice, and morphine rescued this response. Again, these results parallel what we previously documented using rats in this operant system. Following intracisternal treatment with RTX, C57BL/6J mice demonstrated a block of noxious heat at both 48 and 55°C. RTX-treated TRPV1 k.o. mice and all vehicle-treated mice displayed similar reward licking events as compared to the pre-treatment baseline levels. Both TRPV1 k.o. and RTX-treated C57BL/6J had complete abolishment of eye-wipe responses following corneal application of capsaicin.

Conclusion

Taken together, these results indicate the benefits of using the operant test system to investigate pain sensitivity in mice. This ability provides an essential step in the development of new treatments for patients suffering from orofacial pain disorders.