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Ronan EA, Nagel M, Emrick JJ. The anatomy, neurophysiology, and cellular mechanisms of intradental sensation. Front Pain Res (Lausanne) 2024; 5:1376564. [PMID: 38590718 PMCID: PMC11000636 DOI: 10.3389/fpain.2024.1376564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
Somatosensory innervation of the oral cavity enables the detection of a range of environmental stimuli including minute and noxious mechanical forces. The trigeminal sensory neurons underlie sensation originating from the tooth. Prior work has provided important physiological and molecular characterization of dental pulp sensory innervation. Clinical dental experiences have informed our conception of the consequence of activating these neurons. However, the biological role of sensory innervation within the tooth is yet to be defined. Recent transcriptomic data, combined with mouse genetic tools, have the capacity to provide important cell-type resolution for the physiological and behavioral function of pulp-innervating sensory neurons. Importantly, these tools can be applied to determine the neuronal origin of acute dental pain that coincides with tooth damage as well as pain stemming from tissue inflammation (i.e., pulpitis) toward developing treatment strategies aimed at relieving these distinct forms of pain.
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Affiliation(s)
- Elizabeth A. Ronan
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Maximilian Nagel
- Sensory Cells and Circuits Section, National Center for Complementary and Integrative Health, Bethesda, MD, United States
| | - Joshua J. Emrick
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
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Grover V, Kumar A, Jain A, Chatterjee A, Grover HS, Pandit N, Satpathy A, Madhavan Pillai BR, Melath A, Dhruvakumar D, Thakur R, Joshi NV, Deshpande N, Dadlani H, Meenakshi AA, Ashok KP, Reddy KV, Bhasin MT, Salaria SK, Verma A, Gaikwad RP, Darekar H, Amirisetty R, Phadnaik M, Karemore V, Dhulipalla R, Mody D, Rao TS, Chakarpani S, Ranganath V. ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity. J Indian Soc Periodontol 2022; 26:307-333. [PMID: 35959314 PMCID: PMC9362809 DOI: 10.4103/jisp.jisp_233_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022] Open
Abstract
Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry “Dentin Hypersensitivity,” based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.
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Affiliation(s)
- Vishakha Grover
- Department of Periodontology, Dr. H. S. J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Ashish Kumar
- Department of Periodontology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Ashish Jain
- Department of Periodontology, Dental Institute, Regional Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anirban Chatterjee
- Department of Periodontology, Renupriya Dental Health Care, Bengaluru, Karnataka, India
| | | | - Nymphea Pandit
- Department of Periodontology, D. A. V Dental College and Hospital, Yamunanagar, Haryana, India
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha "O" Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | | | - Anil Melath
- Department of Periodontics, Mahe Institute of Dental Sciences and Hospital, Mahe, Puducherry, India
| | - Deepa Dhruvakumar
- Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - Roshani Thakur
- Department of Periodontics, Saraswati Dhanvantari Dental College and Hospital, Parbhani, India
| | - Nilesh V Joshi
- Department of Periodontology, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be) University, Navi Mumbai, India
| | - Neeraj Deshpande
- Department of Periodontology, K. M. Shah Dental College, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
| | - Himanshu Dadlani
- Department of Periodontology, Kalka Dental College, Meerut, Uttar Pradesh, India
| | - A Archana Meenakshi
- Department of Periodontology, Ragas Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - K P Ashok
- Department of Periodontics, GSL Dental College, Rajahmundry, India
| | - K Vinathi Reddy
- Department of Periodontics, Sri Sai College of Dental Surgery, Kaloji Narayana Rao University of Health Sciences, Vikarabad, Telangana, India
| | - Meenu Taneja Bhasin
- Department of Periodontics, Sudha Rustagi Dental College, Faridabad, Haryana, India
| | | | - Abhishek Verma
- Department of Periodontics, Sri Sai College of Dental Surgery, Kaloji Narayana Rao University of Health Sciences, Vikarabad, Telangana, India
| | | | | | - Ramesh Amirisetty
- Department of Periodontology, G. Pulla Reddy Dental College and Hospital, Dr. NTR University of Health Sciences, Kurnool, Andhra Pradesh, India
| | - Mangesh Phadnaik
- Department of Periodontology, Government Dental College and Hospital, Guntur, Andhra Pradesh, India
| | - Vaibhav Karemore
- Department of Periodontology, Government Dental College and Hospital, Guntur, Andhra Pradesh, India
| | - Ravindranath Dhulipalla
- Department of Periodontology, Sibar Institute of Dental Sciences, Dr. NTR University of Health Sciences, Guntur, Andhra Pradesh, India
| | - Dhawal Mody
- VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Tushar Shri Rao
- Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Swarna Chakarpani
- Department of Periodontics, Sibar Institute of Dental Sciences, Dr. NTR University of Health Sciences, Guntur, Andhra Pradesh, India
| | - V Ranganath
- Department of Periodontics, AECS Maaruti Dental College and Research Center, Bengaluru, Karnataka, India
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Butt K, Harris I. Making sense of sensibility: part 2. Br Dent J 2022; 232:379-384. [PMID: 35338287 DOI: 10.1038/s41415-022-4039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 11/09/2022]
Abstract
To reach an accurate endodontic diagnosis, it is important for clinicians to understand how to undertake pulpal sensibility tests correctly, how to interpret their results and how to understand their limitations. Part one of this series defined different terms relevant to pulp testing and detailed the diagnostic uses and diagnostic accuracy of pulp testing methods. This section describes clinical techniques for commonly used pulp tests and highlights their limitations and correct interpretation of their results. Applying these principles and techniques will enable accurate endodontic diagnosis in different clinical scenarios.
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Affiliation(s)
- Kasim Butt
- Specialty Registrar in Restorative Dentistry, Charles Clifford Dental Hospital, Sheffield, UK.
| | - Ian Harris
- Specialist in Restorative Dentistry, Endodontics and Prosthodontics, Consultant in Restorative Dentistry, Charles Clifford Dental Hospital, Sheffield, UK
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Aminoshariae A, Kulild JC. Current Concepts of Dentinal Hypersensitivity. J Endod 2021:S0099-2399(21)00516-1. [PMID: 34302871 DOI: 10.1016/j.joen.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although many clinical studies have reported on the prevalence of dental pain, far fewer studies have focused on the mechanisms of dental pain. This is an important gap because increased understanding of dental pain mechanisms may lead to improved diagnostic tests or therapeutic interventions. The aim of this study was to comprehensively review the literature on the mechanisms of dentinal sensitivity. METHODS PubMed and Ovid were searched for articles that addressed dentinal pain and or pulpal sensitivity. Because of the breadth of research ranging from cellular/molecular studies to clinical trials, a narrative review on the mechanisms of dentinal sensitivity was constructed based on the literature. RESULTS Five various mechanisms for dentinal sensitivity have been proposed: (1) the classic hydrodynamic theory, (2) direct innervation of dentinal tubules, (3) neuroplasticity and sensitization of nociceptors, (4) odontoblasts serving as sensory receptors, and (5) algoneurons. CONCLUSIONS These theories are not mutually exclusive, and it is possible that several of them contribute to dentinal sensitivity. Moreover, pulpal responses to tissue injury may alter the relative contribution of these mechanisms. For example, pulpal inflammation may lead to neuronal sprouting and peripheral sensitization. Knowledge of these mechanisms may prompt the development of therapeutic drugs that aim to disrupt these mechanisms, leading to more effective treatments for pulpal pain.
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Midha V, Midha V, Kochhar AS, Kochhar GK, Bhasin R, Dadlani H. Evaluating the efficacy of desensitizing dentifrices on dentinal hypersensitivity management: A scanning electron microscopic analysis. J Indian Soc Periodontol 2021; 25:283-287. [PMID: 34393397 PMCID: PMC8336776 DOI: 10.4103/jisp.jisp_247_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial treatment with a noninvasive prophylactic home care approach, followed by in-office treatment if desired result is not achieved. Aim The purpose of this study was to evaluate the effectiveness of four different pastes containing 5% NovaMin (Sensodyne Repair and Protect®), Propolis (Phytoshield Propolis®), 5% potassium nitrate (Sensodyne®), and 8% arginine (Colgate Sensitive Pro Relief®) based toothpastes in the treatment of DH. Materials and Methods One hundred dentin slices were cut from the crown section of molars. Etching with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 -5% NovaMin, Group 2 - Propolis, Group 3 - 5% potassium nitrate, and Group 4 - 8% arginine. Samples were brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration of tubules. Results 5% NovaMin group showed more completely occluded dentinal tubules when compared to other groups. The differences among all the groups were statistically significant (P ≤ 0.05). Conclusion In the present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties.
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Affiliation(s)
- Vasu Midha
- Department of Endodontics, National Dental College and Hospital, Dera Bassi, Punjab, India
| | - Vishu Midha
- Department of Pediatric and Preventive Dentistry, National Dental College and Hospital, Dera Bassi, Punjab, India
| | - Anuraj Singh Kochhar
- Former Orthodontist, Department of Dentistry, Max Hospital Gurgaon, Haryana, India
| | - Gulsheen Kaur Kochhar
- Department of Pediatric and Preventive Dentistry, National Dental College and Hospital, Dera Bassi, Punjab, India
| | - Ritasha Bhasin
- Faculty of Dentistry, University of Toronto, Toronto, Canada, India
| | - Himanshu Dadlani
- Department of Periodontology, Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India
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Byers MR, Calkins DF. Trigeminal sensory nerve patterns in dentine and their responses to attrition in rat molars. Arch Oral Biol 2021; 129:105197. [PMID: 34146928 DOI: 10.1016/j.archoralbio.2021.105197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our goal was to define trigeminal nerve ending quantities and patterns in rat molar dentine, their responses to attrition (tooth wear), and their associated odontoblasts and connections with pulpal plexuses. DESIGN Trigeminal ganglia were labeled for axonal transport of 3H-proteins to dentinal nerve endings in male rats (3-13 months old). Autoradiography detected radio-labeled dentinal tubules as indicators of nerve ending locations. Quantitative morphometry was done (ANOVA, t-tests), and littermates were compared for attrition and innervation. RESULTS There were six dentinal patterns, only two of which had an associated neural plexus of Raschkow and cell-free zone (Den-1, Den-2). Other nerves entered dentin from bush-like endings near elongated odontoblasts (Den-B), as single fibers (Den-X), as networks in predentine (PdN), or as single fibers in tertiary dentine at cusp tips (Den-S). There were at least 186,600 innervated dentinal tubules within the set of three right maxillary molars of the best-labeled rat, and similar densities were found in other rats. Attrition levels differed among cusps and in littermates (t-test p < 0.02-0.0001), but the matched right/left cusps per rat were similar. Innervations of tertiary and enamel-free dentine (Den-S, Den-X) were preserved in all rats. Den-B and Den-2 coronal patterns were unchanged unless displaced by dentinogenesis. Den-1 losses occurred in older cusps, while Den-2 patterns increased near cervical and intercuspal odontoblasts. CONCLUSIONS The extensive molar dentinal innervation had unique distributions per rat per cusp that depended on region (buccal, middle, palatal) and attrition, but only two of six patterns connected to a plexus of Raschkow.
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Affiliation(s)
- Margaret R Byers
- Department of Anesthesiology and Pain Medicine, Univ. Washington, Seattle, WA, 98195-6540, USA.
| | - Dianne F Calkins
- Department of Anesthesiology and Pain Medicine, Univ. Washington, Seattle, WA, 98195-6540, USA
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Yong D, Cathro P. Conservative pulp therapy in the management of reversible and irreversible pulpitis. Aust Dent J 2021; 66 Suppl 1:S4-S14. [PMID: 33818812 DOI: 10.1111/adj.12841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.
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Affiliation(s)
- D Yong
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
| | - P Cathro
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago Dental School, Dunedin, New Zealand
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Affiliation(s)
- J. R. Allison
- School of Dental Sciences Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - S. J. Stone
- School of Dental Sciences Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - M. Pigg
- Department of Endodontics Faculty of Odontology Scandinavian Centre for Orofacial Neurosciences (SCON) Malmö University Malmö Sweden
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Abstract
The field of neuroscience did not exist as such when the Journal of Dental Research was founded 100 y ago. It has emerged as an important scientific field relevant to dentistry in view of the many neurally based functions manifested in the orofacial area (e.g., pain, taste, chewing, swallowing, salivation). This article reviews many of the novel insights that have been gained through neuroscience research into the neural basis of these functions and their clinical relevance to the diagnosis and management of pain and sensorimotor disorders. These include the neural pathways and brain circuitry underlying each of these functions and the role of nonneural as well as neural processes and their "plasticity" in modulating these functions and allowing for adaptation to tissue injury and pain and for learning or rehabilitation of orofacial functions.
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Affiliation(s)
- K Iwata
- Department of Physiology, Nihon University, School of Dentistry, Tokyo, Japan
| | - B J Sessle
- Faculty of Dentistry and Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Xia Y, Yang ZY, Li YH, Zhou Z. The Effects of a Toothpaste Containing the Active Ingredients of Galla chinensis and Sodium Fluoride on Dentin Hypersensitivity and Sealing of Dentinal Tubules: An In Vitro Study and an Eight-Week Clinical Study in 98 Patients. Med Sci Monit 2020; 26:e920776. [PMID: 32307404 PMCID: PMC7191947 DOI: 10.12659/msm.920776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the desensitizing effect of toothpaste containing the active ingredients of an extract of Galla chinensis, both in vitro and in patients with dentin hypersensitivity. MATERIAL AND METHODS Ninety-eight patients with dentin hypersensitivity were divided into two study groups and given toothpaste containing either the active ingredients of Galla chinensis extract and sodium fluoride, or a control toothpaste containing only sodium fluoride. Assessments included the tactile stimulation test and the Schiff cold air sensitivity scale, which were conducted at the baseline examination and after 4 and 8 weeks of dental brushing. Twenty-five intact human premolars from 24 patients with dentin hypersensitivity were prepared and randomly divided into four groups, the untreated baseline group, the study group, the positive control group, and the control group. After brushing with different toothpaste for 7 days, the effects on dentinal tubule sealing in each group was determined by scanning electron microscopy (SEM), and the degree of dentinal tubule plugging and diameter of the open dentinal tubules were calculated. RESULTS Toothpaste containing the active ingredients of Galla chinensis and sodium fluoride significantly reduced the degree of dentin hypersensitivity when compared with toothpaste containing sodium fluoride alone after 4 weeks and 8 weeks of use. Toothpaste containing the active ingredients of Galla chinensis significantly reduced the number and diameter of the open dentinal tubules. CONCLUSIONS Toothpaste that contained the active ingredients of Galla chinensis and sodium fluoride reduced the symptoms of dentin hypersensitivity by sealing the dentinal tubules.
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Affiliation(s)
- Yu Xia
- The College of Stomatology, Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
| | - Zheng-Yan Yang
- The College of Stomatology, Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
| | - Yue-Heng Li
- The College of Stomatology, Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
| | - Zhi Zhou
- The College of Stomatology, Chongqing Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China (mainland).,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China (mainland)
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Ozdogan MS, Gungormus M, Ince Yusufoglu S, Ertem SY, Sonmez C, Orhan M. Salivary opiorphin in dental pain: A potential biomarker for dental disease. Arch Oral Biol 2019; 99:15-21. [DOI: 10.1016/j.archoralbio.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 01/20/2023]
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Amaechi BT, Lemke KC, Saha S, Gelfond J. Clinical Efficacy in Relieving Dentin Hypersensitivity of Nanohydroxyapatite-containing Cream: A Randomized Controlled Trial. Open Dent J 2018; 12:572-585. [PMID: 30288181 PMCID: PMC6142669 DOI: 10.2174/1874210601812010572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/11/2018] [Accepted: 08/10/2018] [Indexed: 12/22/2022] Open
Abstract
Objective:
The study aimed to investigate the effectiveness of Apadent Pro (Sangi) Nanohydroxyapatite (nHAP) dental cream to relieve Dentin Hypersensitivity (DHS), compared with a positive control cream containing 20% pure silica (Silica). Methods: In this double-blind, randomized, parallel-group clinical trial, patients diagnosed with DHS and qualified to participate were randomized into two groups, nHAP (n=25) and Silica (n=26). Subjects’ baseline and posttreatment sensitivity were assessed using two pain scales, a four-point Dental Pain Scale (DPS) followed by a linear Visual Analog Scale (VAS), after the application of ice-cold and air stimuli. Subjects used custom-fabricated trays to apply their respective cream for 5 minutes once daily following brushing with standard fluoride toothpaste. Posttreatment sensitivity (efficacy) was assessed every 2 weeks for 8 weeks. Mean treatment outcomes (percentage change from baseline) at each time point were compared using the Tukey HSD test for multiplicity (P<0.05). Results: With either air or cold stimulus, VAS and DPS indicated a significant (P<0.001) reduction in DHS at each time point with either nHAP or Silica. Comparing pain scales, VAS showed no significant difference in DHS reduction between the products with either air or cold. However, with DPS, DHS reduction was significantly (P<0.05) better with Silica than with nHAP at all time points with cold, and at 2, 4, and 8 weeks with air. Conclusion: Both Apadent Pro nHAP and Silica dental creams are effective at promoting the relief of DHS symptoms. When comparing the efficacy of the two compounds to relieve DHS, results of the two pain scales were conflicting.
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Affiliation(s)
- Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Kelly C Lemke
- Department of Developmental Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Shyamali Saha
- Department of Comprehensive Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas, USA
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Byers MR, Cornel LM. Multiple complex somatosensory systems in mature rat molars defined by immunohistochemistry. Arch Oral Biol 2017; 85:84-97. [PMID: 29035722 DOI: 10.1016/j.archoralbio.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Intradental sensory receptors trigger painful sensations and unperceived mechanosensitivity, but the receptor bases for those functions are only partly defined. We present new evidence here concerning complex endings of myelinated axons in rat molars. DESIGN We sectioned mature rat jaws in sagittal and transverse planes to analyze neural immunoreactivity (IR) for parvalbumin, peripherin, neurofilament protein, neurotrophin receptors, synaptophysin, calcitonin gene-related peptide (CGRP), or mas-related g-protein-receptor-d (Mrgprd). RESULTS We found two complex sensory systems in mature rat molar dentin that labeled with neurofilament protein-IR, plus either parvalbumin-IR or peripherin-IR. The parvalbumin-IR system made extensively branched, beaded endings focused into dentin throughout each pulp horn. The peripherin-IR system primarily made unbeaded, fork-shaped dentinal endings scattered throughout crown including cervical regions. Both of these systems differed from neuropeptide CGRP-IR. In molar pulp we found peripherin- and parvalbumin-IR layered endings, either near special horizontal plexus arrays or in small coiled endings near tangled plexus, each with specific foci for specific pulp horns. Parvalbumin-IR nerve fibers had Aβ axons (5-7μm diameter), while peripherin-IR axons were thinner Aδ size (2-5μm). Mechano-nociceptive Mrgprd-IR was only found in peripherin-IR axons. CONCLUSIONS Complex somatosensory receptors in rat molars include two types of dentinal endings that both differ from CGRP-IR endings, and at least two newly defined types of pulpal endings. The PV-IR neurons with their widely branched, synaptophysin-rich, intradentinal beaded endings are good candidates for endodontic non-nociceptive, low threshold, unperceived mechanoreceptors. The complex molar dentinal and pulpal sensory systems were not found in rat incisors.
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Affiliation(s)
- Margaret R Byers
- Department of Anesthesiology & Pain Medicine, Box 356540, University of Washington, Seattle, WA 98195-6540, USA.
| | - Leanne M Cornel
- Department of Anesthesiology & Pain Medicine, Box 356540, University of Washington, Seattle, WA 98195-6540, USA
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Awawdeh L, Hemaidat K, Al-Omari W. Higher Maximal Occlusal Bite Force in Endodontically Treated Teeth Versus Vital Contralateral Counterparts. J Endod 2017; 43:871-875. [DOI: 10.1016/j.joen.2016.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/25/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022]
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15
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Virdee SS, Seymour D, Bhakta S. Effective anaesthesia of the acutely inflamed pulp: part 1. The acutely inflamed pulp. Br Dent J 2015; 219:385-90. [DOI: 10.1038/sj.bdj.2015.812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/08/2022]
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16
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Chunhacheevachaloke E, Ajcharanukul O. Effects of conducting media and gender on an electric pulp test. Int Endod J 2015; 49:237-44. [DOI: 10.1111/iej.12446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Affiliation(s)
- E. Chunhacheevachaloke
- Department of Pediatric and Preventive Dentistry; Srinakharinwirot University; Bangkok Thailand
| | - O. Ajcharanukul
- Department of Stomatology; Faculty of Dentistry; Srinakharinwirot University; Bangkok Thailand
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17
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Lin M, Genin GM, Xu F, Lu T. Thermal Pain in Teeth: Electrophysiology Governed by Thermomechanics. Appl Mech Rev 2014; 66:0308011-3080114. [PMID: 25516631 PMCID: PMC4240033 DOI: 10.1115/1.4026912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/01/2014] [Indexed: 05/12/2023]
Abstract
Thermal pain arising from the teeth is unlike that arising from anywhere else in the body. The source of this peculiarity is a long-standing mystery that has begun to unravel with recent experimental measurements and, somewhat surprisingly, new thermomechanical models. Pain from excessive heating and cooling is typically sensed throughout the body through the action of specific, heat sensitive ion channels that reside on sensory neurons known as nociceptors. These ion channels are found on tooth nociceptors, but only in teeth does the pain of heating differ starkly from the pain of cooling, with cold stimuli producing more rapid and sharper pain. Here, we review the range of hypotheses and models for these phenomena, and focus on what is emerging as the most promising hypothesis: pain transduced by fluid flowing through the hierarchical structure of teeth. We summarize experimental evidence, and critically review the range of heat transfer, solid mechanics, fluid dynamics, and electrophysiological models that have been combined to support this hypothesis. While the results reviewed here are specific to teeth, this class of coupled thermomechanical and neurophysiological models has potential for informing design of a broad range of thermal therapies and understanding of a range of biophysical phenomena.
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Affiliation(s)
- Min Lin
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University , Xi'an 710049 , China
| | - Guy M Genin
- Department of Neurological Surgery, and School of Engineering, Washington University , St. Louis, MO 63110
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University , Xi'an 710049 , China
| | - TianJian Lu
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University , Xi'an 710049 , China e-mail:
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18
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Abstract
Pulp and periradicular testing is crucial to the initial trauma evaluation and to subsequent monitoring of the traumatized teeth and supporting structures. An accurate diagnosis serves as the basis for therapeutic intervention and helps to ensure that destruction of the dental structures will be minimized and function will be regained. The purpose of this review is to present the current best evidence for accurate diagnostic testing of the pulp and periapex of traumatized teeth. Five databases were searched for literature pertaining to pulpal testing and trauma. Widely recognized textbooks were also consulted. Currently used pulp vitality testing is constrained by its subjective character and by the fact that it is a measure of neuronal status and not true pulpal viability. Tests that measure tissue perfusion more accurately reflect pulpal vitality, but they are not available commercially. This review discusses the specificity, sensitivity, and accuracy of commonly used tests, with emphasis on the applicability of certain tests to specific patient presentations in trauma. Factors that influence test selection are discussed, and specific recommendations are made on the basis of best evidence. Although differences exist between the various studies as to the accuracy of commonly used pulpal and periradicular tests, most of these have acceptable predictive value. Pulpal and periradicular tests in the trauma patient should be used in conjunction with clinical and radiographic observations to arrive at a diagnosis and treatment plan.
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Affiliation(s)
- Linda Gibson Levin
- University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA.
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19
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Abstract
Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.
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Affiliation(s)
- Niharika Jain
- Department of Conservative Dentistry & Endodontics, Hitkarni Dental College & Hospital, Jabalpur, India
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20
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Rutsatz C, Baumhardt SG, Feldens CA, Rösing CK, Grazziotin-Soares R, Barletta FB. Response of Pulp Sensibility Test Is Strongly Influenced by Periodontal Attachment Loss and Gingival Recession. J Endod 2012; 38:580-3. [DOI: 10.1016/j.joen.2012.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/14/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
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21
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Abstract
Tooth pain, especially tooth thermal pain, is one of the most important symptoms and signs in dental clinic and daily life. As a special sensation, pain has been studied extensively in both clinic and experimental research aimed at reducing or eliminating the possible negative effects of pain. Unfortunately, the full underlying mechanism of pain is still unclear, because the pain could be influenced by many factors, including physiological, psychological, physical, chemical, and biological factors and so on. Besides, most studies on pain mechanisms in the literature are based on skin pain sensation and only few are based on tooth pain. In this paper, we present a comprehensive review on both neurophysiology of tooth pain mechanism, and corresponding thermal, mechanical, and thermomechanical behaviors of teeth. We also describe a multiscale modeling approach for quantifying tooth thermal pain by integrating the mathematic methods of engineering into the neuroscience. The mathematical model of tooth thermal pain will enable better understanding of thermal pain mechanism and optimization of existing diagnosis and treatment in dental clinic.
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Affiliation(s)
- Y. J. ZHU
- Stomatological Hospital, College of Medicine, Biomedical Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - F. XU
- Biomedical Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an 710049, P. R. China
- School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - J. H. SU
- Biomedical Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - H. ZHOU
- Stomatological Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an 710004, P. R. China
| | - T. J. LU
- Biomedical Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an 710049, P. R. China
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22
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Johns DA, Vidyanath S. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod 2011; 37:743; author reply 743-4. [PMID: 21787481 DOI: 10.1016/j.joen.2011.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 03/30/2011] [Indexed: 11/17/2022]
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23
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24
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Brajdić D, Virag M, Uglešić V, Aljinović-ratković N, Zajc I, Macan D. Evaluation of sensitivity of teeth after mandibular fractures. Int J Oral Maxillofac Surg 2011; 40:266-70. [DOI: 10.1016/j.ijom.2010.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 09/08/2010] [Accepted: 11/22/2010] [Indexed: 11/21/2022]
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25
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Abstract
The electric pulp test (EPT) is one type of pulp sensibility test that can be used as an aid in the diagnosis of the status of the dental pulp. However, like thermal pulp sensibility tests, it does not provide any direct information about the vitality (blood supply) of the pulp or whether the pulp is necrotic. The relevant literature on pulp sensibility tests in the context of endodontics up to January 2009 was reviewed using PubMed and MEDLINE database searches. This search identified articles published between November 1964 and January 2009 in all languages. The EPT is technique sensitive, and false responses may occur. Various factors can affect the test results, and therefore it is important that dental practitioners understand the nature of these tests and how to interpret them. Test cavities have been suggested as another method for assessing the pulp status; however, the use of this technique needs careful consideration because of its invasive and irreversible nature. In addition, it is unlikely to be useful in apprehensive patients and should not be required because it provides no further information beyond what thermal and electric pulp sensibility tests provide - that is, whether the pulp is able to respond to a stimulus. A review of the literature and a discussion of the important points regarding these two tests are presented.
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Affiliation(s)
- H Jafarzadeh
- Department of Endodontics, Faculty of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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26
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27
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Weigelt A, Terekhin P, Kemppainen P, Dörfler A, Forster C. The representation of experimental tooth pain from upper and lower jaws in the human trigeminal pathway. Pain 2010; 149:529-538. [DOI: 10.1016/j.pain.2010.03.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 03/04/2010] [Accepted: 03/19/2010] [Indexed: 11/15/2022]
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28
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Abstract
BACKGROUND One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations. AIM The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described.
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Affiliation(s)
- Velayutham Gopikrishna
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, India.
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29
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Owatz CB, Khan AA, Schindler WG, Schwartz SA, Keiser K, Hargreaves KM. The incidence of mechanical allodynia in patients with irreversible pulpitis. J Endod 2007; 33:552-6. [PMID: 17437870 DOI: 10.1016/j.joen.2007.01.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 01/24/2007] [Accepted: 01/31/2007] [Indexed: 01/20/2023]
Abstract
The mechanisms of odontogenic pain are complex and incompletely understood. Cases of irreversible pulpitis are thought to represent a localized inflammatory response to bacterial challenge in dental pulp tissue. The presenting symptoms are classically defined by exaggerated painful episodes to thermal stimuli that may linger after cessation of the stimulus. However, the associated incidence of mechanical allodynia, defined as reduced mechanical pain threshold to masticatory forces, has not been characterized. This study evaluated pain intensity ratings and the presence of mechanical allodynia reported by 993 consecutive dental patients presenting for tooth extraction in a community health center. After clinical and radiographic examinations, the pulpal/periradicular diagnostic categories were normal pulp/normal periradicular (n=792 patients), irreversible pulpitis/normal periradicular (n=86), or irreversible pulpitis/acute periradicular periodontitis (n=115). The rank order for the mean values of pain intensity ratings was irreversible pulpitis/acute periradicular periodontitis > irreversible pulpitis/normal periradicular > normal/normal (p<0.05 for all comparisons). The incidence of mechanical allodynia in patients presenting with irreversible pulpitis was 57.2%, indicating that periradicular mechanical allodynia contributes to early stages of odontogenic pain because of inflammation of vital pulpal tissue.
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Affiliation(s)
- Christopher B Owatz
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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31
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Abstract
Early changes in spontaneous behaviour (exploration, grooming, freezing, rearing, jaw motion, yawning) and body weight were measured at two and three days after pulp exposure injury and implantation of Fluorogold (FG) into molar teeth of rats. Rats with FG and injuries to three teeth gained weight less rapidly, explored less frequently and froze more often than sham-operated rats. Yawning was not observed in any rats prior to surgery and it was seen more frequently in tooth-injured rats than in sham-operated rats. These results suggest that careful observation of spontaneous behaviour after tooth injuries can be used to assess dental pain in rats and may provide behavioural markers to correlate with anatomical changes after injury. The dental nerve cell bodies that had accumulated transported FG were medium to large, and they only co-localized calcitonin gene-related peptide (CGRP) in a subset of the medium neurons. Chromatolytic or moribund FG-labelled neurons were also found.
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Affiliation(s)
- Eric H Chudler
- Department of Anesthesiology, University of Washington, Box 356540, Seattle, WA 98195-6540, USA.
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32
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Kvinnsland IH, Luukko K, Fristad I, Kettunen P, Jackson DL, Fjeld K, von Bartheld CS, Byers MR. Glial cell line-derived neurotrophic factor (GDNF) from adult rat tooth serves a distinct population of large-sized trigeminal neurons. Eur J Neurosci 2004; 19:2089-98. [PMID: 15090036 DOI: 10.1111/j.0953-816x.2004.03291.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glial cell line-derived neurotrophic factor (GDNF) mediates trophic effects for specific classes of sensory neurons. The adult tooth pulp is a well-defined target of sensory trigeminal innervation. Here we investigated potential roles of GDNF in the regulation of adult trigeminal neurons and the dental pulp nerve supply of the rat maxillary first molar. Western blot analysis and radioactive 35S-UTP in situ hybridization revealed that GDNF in the dental pulp and its mRNAs were localized with Ngf in the coronal pulp periphery, in particular in the highly innervated subodontoblast layer. Retrograde neuronal transport of iodinated GDNF and Fluorogold (FG) from the dental pulp indicated that GDNF was transported in about one third of all the trigeminal dental neurons. Of the GDNF-labelled neurons, nearly all (97%) were large-sized (> or =35 microm in diameter). Analysis of FG-labelled neurons revealed that, of the trigeminal neurons supporting the adult dental pulp, approximately 20% were small-sized, lacked isolectin B4 binding and did not transport GDNF. Of the large-sized dental trigeminal neurons approximately 40% transported GDNF. About 90% of the GDNF-accumulating neurons were negative for the high-temperature nociceptive marker VRL-1. Our results show that a subclass of large adult trigeminal neurons are potentially dependent on dental pulp-derived GDNF while small dental trigeminal neurons seems not to require GDNF. This suggests that GDNF may function as a neurotrophic factor for subsets of nerves in the tooth, which apparently mediate mechanosensitive stimuli. As in dorsal root ganglia both small- and large-sized neurons are known to be GDNF-dependent; these data provide molecular evidence that the sensory supply in the adult tooth differs, in some aspects, from the cutaneous sensory system.
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Affiliation(s)
- Inger Hals Kvinnsland
- Department of Anatomy and Cell Biology, University of Bergen, Jonas Liesvei 91, N-5009 Bergen, Norway.
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33
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Westenbroek RE, Anderson NL, Byers MR. Altered localization of Cav1.2 (L-type) calcium channels in nerve fibers, Schwann cells, odontoblasts, and fibroblasts of tooth pulp after tooth injury. J Neurosci Res 2004; 75:371-83. [PMID: 14743450 DOI: 10.1002/jnr.10863] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have determined the localization of Cav1.2 (L-Type) Ca2+ channels in the cells and nerve fibers in molars of normal or injured rats. We observed high levels of immunostaining of L-type Ca2+ channels in odontoblast cell bodies and their processes, in fibroblast cell bodies and in Schwann cells. Many Cav1.2-containing unmyelinated and myelinated axons were also present in root nerves and proximal branches in coronal pulp, but were usually missing from nerve fibers in dentin. Labeling in the larger fibers was present along the axonal membrane, localized in axonal vesicles, and in nodal regions. After focal tooth injury, there is a marked loss of Cav1.2 channels in injured teeth. Immunostaining of Cav1.2 channels was lost selectively in nerve fibers and local cells of the tooth pulp within 10 min of the lesion, without loss of other Cav channel or pulpal labels. By 60 min, Cav1.2 channels in odontoblasts were detected again but at levels below controls, whereas fibroblasts were labeled well above control levels, similar to upregulation of Cav1.2 channels in astrocytes after injury. By 3 days after the injury, Cav1.2 channels were again detected in nerve fibers and immunostaining of fibroblasts and odontoblasts had returned to control levels. These findings provide new insight into the localization of Cav1.2 channels in dental pulp and sensory fibers, and demonstrate unexpected plasticity of channel distribution in response to nerve injury.
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Affiliation(s)
- R E Westenbroek
- Department of Pharmacology, University of Washington, Seattle, USA.
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34
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35
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36
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Abstract
This review covers current information about the ability of dental nerves to regenerate and the role of tooth pulp in recruitment of regenerating nerve fibers. In addition, the participation of dental nerves in pulpal injury responses and healing is discussed, especially concerning pulp regeneration and reinnervation after tooth replantation. The complex innervation of teeth is highly asymmetric and guided towards specific microenvironments along blood vessels or in the crown pulp and dentin. Pulpal products such as nerve growth factor are distributed in the same asymmetric gradients as the dentinal sensory innervation, suggesting regulation and recruitment of those nerve fibers by those specific factors. The nerve fibers have important effects on pulpal blood flow and inflammation, while their sprouting and cytochemical changes after tooth injury are in response to altered pulpal cytochemistry. Thus, their pattern and neuropeptide intensity are indicators of pulp status, while their local actions continually affect that status. When denervated teeth are injured, either by pulp exposure on the occlusal surface or by replantation, they have more pulpal necrosis than occurs for innervated teeth. However, small pulp exposures on the side of denervated crowns or larger lesions in germ-free animals can heal well, showing the value of postoperative protection from occlusal trauma or from infection. Current ideas about dental neuroplasticity, neuro-pulpal interactions, and nerve regeneration are related to the overall topics of tooth biomimetics and pulp/dentin regeneration.
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Affiliation(s)
- Margaret R Byers
- Department of Anesthesiology, University of Washington, Seattle 98195-6540, USA.
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37
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Abstract
Tactile information from dental mechanoreceptors contributes to the perception of food bolus textures and the control of mastication. While numerous studies have measured the light-touch sensory thresholds of teeth, little information is available about the vibrotactile perception thresholds of teeth. This study uses an adaptive psychophysical procedure to determine thresholds of vibratory stimulation of maxillary and mandibular central incisors in 16 healthy human subjects. An electromechanical vibrator delivered labiolingual forces perpendicular to the long axis of the maxillary and mandibular incisors at 10 stimulation frequencies between 40 and 315 Hz. The median thresholds ranged between 44 and 104 mN. A linear regression analysis revealed a significant increase in the vibrotactile thresholds with increasing frequencies for stimulation of the maxillary and mandibular incisors. No significant differences were found between regression slopes of the thresholds of the maxillary and mandibular incisors. These results indicated that maxillary and mandibular incisors should be able to discriminate effectively among a variety of textures based on their ability to encode a wide range of vibration frequencies.
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Affiliation(s)
- Lee T Robertson
- Department of Biological Structure and Function, School of Dentistry, Oregon Health and Science University, 611 S.W. Campus Drive, Portland, OR 97201, USA.
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39
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Brown DC, Bernier N, Shofer F, Steinberg SA, Perkowski SZ. Use of noninvasive dental dolorimetry to evaluate analgesic effects of intravenous and intrathecal administration of morphine in anesthetized dogs. Am J Vet Res 2002; 63:1349-53. [PMID: 12371758 DOI: 10.2460/ajvr.2002.63.1349] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether changes in amplitude of the reflex-evoked muscle action potential (REMP) elicited by noninvasive dental dolorimetry (electrical stimulation of the tooth pulp) in anesthetized dogs may be used to objectively evaluate the effectiveness of IV and intrathecal (IT) administration of morphine. ANIMALS 6 male Beagles that were 2 to 6 years old. PROCEDURE Dogs were used in a crossover design with at least a 5-day washout period between treatments. Each dog received morphine, saline (0.9% NaCl) solution, and oxytocin via the IV and IT routes of administration; however, only results for morphine and saline treatments were reported here. Dogs were anesthetized and prepared for noninvasive dental dolorimetry. After IV or IT administration, electrical stimulation was applied to a tooth, and REMPs of the digastricus muscle were recorded at 5-minute intervals for 60 minutes. To determine differences in REMP amplitude between treatments, a linear regression line was fitted for each dog-treatment combination. RESULTS The IV administration of morphine significantly inhibited REMP amplitude, compared with IV administration of saline solution. Intrathecal administration of morphine significantly inhibited REMP amplitude, compared with IT administration of saline solution. CONCLUSIONS AND CLINICAL RELEVANCE Noninvasive dental dolorimetry in anesthetized dogs has promise as a technique for use in evaluating the analgesic potential of drugs administered IV and IT through evaluation of their effect on REMP amplitude recorded for the digastricus muscle.
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Affiliation(s)
- Dorothy C Brown
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010, USA
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40
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Abstract
Single nerve fibres innervating tooth pulp were isolated from filaments dissected from the inferior alveolar nerve in 17 anaesthetized cats. The fibres were studied to determine whether electrical stimulation of single units produced detectable changes in pulpal blood flow. Single pulpal nerve fibres were electrically stimulated at just above their thresholds and blood flow was recorded with a laser-Doppler flow meter from the pulp of the ipsilateral canine. The thresholds of single fibres in dissected filaments were determined either by recording antidromic action potentials from the tooth or by using a novel technique based on collision. Units that produced blood flow changes were further characterized by recording their response to hot, cold, osmotic and hydrostatic pressure, and mechanical stimulation of exposed dentine and to drying the dentine. Of 93 units isolated, 14 produced changes in pulpal blood flow when stimulated electrically at 1 or 10 Hz. All had conduction velocities (0.8-2.0 m s(-1)) in the C-fibre range. Ten produced vasodilatation and the remaining four, vasoconstriction. Five of the fibres that produced vasodilatation also responded to the hot stimulus, suggesting that they may form part of an axon reflex or similar mechanism. The four vasoconstrictor units did not respond to any form of stimulus other than electrical and were presumed to be sympathetic post-ganglionic fibres.
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Affiliation(s)
- D Andrew
- Department of Physiology, University of Bristol, Bristol BS8 1TD, UK.
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41
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Abstract
OBJECTIVES To examine the longitudinal changes in pulpal sensitivity to electrical stimulation and the relationship to pulpal sensitivity as measured by electrical stimulation and subjective reports of tooth pain after archwire insertion. DESIGN Non-randomized, prospective trial, with matched controls. SETTING AND SAMPLE POPULATION Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Eighteen adult subjects of age 13-37 years. Nine experimental subjects planned for orthodontic treatment. Nine control subjects matched for gender and age who did not have orthodontic treatment. EXPERIMENTAL VARIABLE Fixed orthodontic appliances and initial archwire placement in experimental subjects compared with 'no treatment' control subjects. OUTCOME MEASURE Subjective assessments of orthodontic tooth pain were made using visual analogue scales. Electrically evoked detection and pain thresholds were determined using a computer-controlled tooth stimulator. Data were gathered at five time points: after bracket placement (baseline), 1 h after placement of initial archwires, 1 day after archwire placement, 1 week after archwire placement, and 1 month after archwire placement. Comparable time intervals were used for the 'no treatment' control subjects. RESULTS Subjective ratings of treatment-evoked tooth pain in the experimental group were the greatest at the post-archwire day 1 observation and progressively decreased for the remaining observations. Control subjects reported little pain at any of these observation times. The detection and pain threshold changes from baseline showed no statistical differences over time or between groups. While not statistically significant, a trend was noted where reports of greater orthodontic tooth pain were associated with increased sensitivity to electrical stimulation (i.e. lower detection and pain thresholds). CONCLUSION Orthodontic patients experience significant pain and discomfort 1 day after initial archwire placement (i.e. activation). Future research should investigate whether self-reports of treatment-evoked tooth pain intensity are associated with pulpal sensitivity.
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Affiliation(s)
- A H Leavitt
- Department of Orthodontics, University of Washington School of Dentistry, Seattle 98195-3446, USA
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42
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Abstract
A novel in vitro TMJ-nerve preparation was developed to quantitatively study peripheral sensory mechanisms of temporomandibular joint (TMJ). The TMJ region on one side (including mandibular head, disc, retrodiscal tissue and mandibular fossa) of adult Wistar albino rats was excised together with the auriculo-temporal nerve. The block was preserved in a modified Krebs-Henseleit solution saturated with O(2)/CO(2) (95/5%) gas mixture. Using a calibrated von Frey type apparatus, mechanical noxious stimulation was applied directly to various sites within the TMJ region. In addition, thermal and chemical noxious stimuli were also attempted. Stable recordings of single unit activities from the auriculo-temporal nerve could be obtained for as long as 5 h, which was sufficient to analyze the response properties of the TMJ units to various stimuli. This new preparation would be useful for investigating TMJ peripheral sensory mechanisms, especially pain, and potentially makes it possible to reveal neural mechanisms of temporomandibular arthralgia, a syndrome that has recently shown an increased incidence in clinical dentistry.
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Affiliation(s)
- Y Takeuchi
- Division of Maxillofacial and Neck Reconstruction, Maxillofacial Surgery, Maxillofacial Reconstruction, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, 113-8549, Tokyo, Japan.
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43
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Kemppainen P, Forster C, Handwerker HO. The importance of stimulus site and intensity in differences of pain-induced vascular reflexes in human orofacial regions. Pain 2001; 91:331-338. [PMID: 11275391 DOI: 10.1016/s0304-3959(00)00462-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Studies in anaesthetized animals have indicated that noxious stimulation may produce marked blood flow changes in various orofacial structures, but the influence of painful stimulation on the blood flow regulation of the orofacial area of humans has been studied only to a limited extent. The purpose of this investigation was to study whether there are differences in temporal and spatial patterns of pain-induced vasoactive reflexes between various orofacial regions and hand in healthy human volunteers. Dynamic changes in blood flow in various orofacial regions elicited by painful stimulation of the tooth and finger were measured by means of Laser Doppler imaging (LDI) and computer-assisted infrared thermography (IRT). Blood flow of the finger was recorded by laser Doppler flowmetry (LDF) and plethysmography (PLET). During both stimulus paradigms there was a transient elevation in heart rate (HR) and blood pressure (BP). At the same time there was a significant blood flow decrease in the finger (LDF, PLET) and in the nose (LDI, IRT). In contrast to tooth stimulation, finger stimulation caused a more marked blood flow reduction in the finger. Only high intensity tooth stimulation, but not finger stimulation, caused a long-lasting vasodilatation both in lower and upper lip. The blood flow changes in the lips were not correlated with changes in systemic blood pressure or heart rate. In the cheek, there were no marked flow changes during either finger or tooth stimulation. These data indicate that painful tooth (regional) stimulation, but not finger (remote) stimulation, can induce a long-lasting vasodilatation in parts of orofacial tissues which cannot be explained by changes in central cardiovascular parameters. This tooth-stimulation-induced blood flow increase supports the hypothesis of a special vasodilator reflex mechanism in the orofacial area. Furthermore, tooth-stimulation-induced vasoconstriction in the nose and dilatation in the lips indicate that separate vasoactive reflex mechanisms may exist for different orofacial regions.
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Affiliation(s)
- P Kemppainen
- Department of Stomatognathic Physiology and Prosthetic Dentistry, University of Helsinki, and Finnish Student Health Service, Helsinki, Finland Department of Physiology and Experimental Pathophysiology, University of Erlangen/Nürnberg, Germany
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Abstract
The effect of jaw movements on pulpal sensory thresholds to electrical stimulation was studied in healthy humans. The movements consisted of repeated jaw opening and closing at two different frequencies (1 and 3 s(-1)). The detection/perception and pain thresholds of an upper or lower central incisor were determined by stimulation with monopolar constant current pulses at two different durations (0.5 and 5.0 ms). In the absence of jaw movement, the control (baseline) pain threshold was significantly higher than the detection threshold, and both thresholds were significantly decreased with an increase of the stimulus pulse duration. During jaw movement, pulpal detection and pain thresholds were significantly elevated, independent of the duration of the stimulus pulse. The jaw movement-related increase in detection thresholds was significantly dependent on the rate of cyclical jaw movements and on the site of stimulation. An increase in pulpal sensory thresholds was observed with stimulation of the lower incisor only; there was no change in thresholds for the upper incisor. Pulpal detection thresholds were significantly more elevated during jaw movement than pulpal pain thresholds. The results indicate that the reduction in pulpal sensitivity is related to the jaw movements. The effect of jaw movement on pulpal detection thresholds was segmentally restricted. In contrast, modulation of the pulpal pain thresholds was considerably weaker. The jaw movement-related suppression of pulpal sensitivity may be explained by activation of segmental afferent-induced inhibition, corollary efferent barrage from motor to sensory areas, or a combination of both.
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Affiliation(s)
- P Kemppainen
- Department of Prosthetic Dentistry, Institute of Dentistry, University of Helsinki, PO Box 41, FIN-00014 Helsinki, Finland.
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45
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Abstract
Experiments were performed on anaesthetized cats to test the hypothesis that fluid flow through dentinal tubules is part of the mechanism involved in the transduction of pain-producing stimuli in teeth. In 11 animals, fluid flow through dentine and single- and multi-unit activity in intradental nerves were recorded simultaneously during the application of changes in hydrostatic pressure (-500 to +500 mm Hg) to exposed dentine. Seventeen A-fibres (conduction velocity (CV), 10.6-55.1 m s(-1)) were isolated that were pressure sensitive. The thresholds of these units in terms of dentinal fluid flow were in the range 0.3-2.1 nl s(-1) mm(-2) during outward flow from the pulp and 2.0-3.5 nl s(-1) mm(-2) during inward flow. All the units were more sensitive to outward than inward flow. Twenty-eight units (CV, 0.6-48.8 m s-1) were not pressure sensitive, and 12 of these had conduction velocities in the C-fibre range (< 2.5 m s(-1)). The velocities of the tubular contents were calculated by estimating the number and diameters of dentinal tubules exposed. At the threshold of single-fibre responses these velocities were in the range 31.7-222.9 microm s(-1) during outward flow 211.4-369.6 microm s-1 during inward flow. Repetitive pressure stimulation of dentine resulted in a progressive reduction in the evoked discharge, which was probably due to pulp damage. In seven animals, 10 single intradental nerve fibres were selected that responded to hydrostatic pressure stimuli and their responses to the application of hot, cold, osmotic, mechanical and drying stimuli to exposed dentine were investigated. With these stimuli dentinal fluid flow could not be recorded in vivo for technical reasons and was therefore recorded in vitro after completion of the electrophysiological recordings. With each form of stimulus, the discharge evoked in vivo was closely related to the flow predicted from the in vitro measurements. The results were therefore consistent with the hypothesis that the stimuli act through a common transduction mechanism that involves fluid flow through dentine.
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Affiliation(s)
- D Andrew
- Department of Physiology, University of Bristol, Bristol BS8 1TD, UK
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Byers MR, Närhi MV. Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions. Crit Rev Oral Biol Med 2000; 10:4-39. [PMID: 10759425 DOI: 10.1177/10454411990100010101] [Citation(s) in RCA: 231] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent research has shown that peripheral mechanisms of pain are much more complex than previously thought, and they differ for acutely injured normal tissues compared with chronic inflammation or neuropathic (nerve injury) pain. The purpose of the present review is to describe uses of dental injury models as experimental tools for understanding the normal functions of polymodal nociceptive nerves in healthy tissues, their neuroinflammatory interactions, and their roles in healing. A brief review of normal dental innervation and its interactions with healthy pulp tissue will be presented first, as a framework for understanding the changes that occur after injury. Then, the different types of dental injury that allow gradation of the extent of tissue damage will be described, along with the degree and duration of inflammation, the types of reactions in the trigeminal ganglion and brainstem, and the type of healing. The dental injury models have some unique features compared with neuroinflammation paradigms that affect other peripheral tissues such as skin, viscera, and joints. Peripheral inflammation models can all be contrasted to nerve injury studies that produce a different kind of neuroplasticity and neuropathic pain. Each of these models provides different insights about the normal and pathologic functions of peripheral nerve fibers and their effects on tissue homeostasis, inflammation, and wound healing. The physical confinement of dental pulp and its innervation within the tooth, the high incidence of polymodal A-delta and C-fibers in pulp and dentin, and the somatotopic organization of the trigeminal ganglion provide some special advantages for experimental design when dental injury models are used for the study of neuroinflammatory interactions.
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Affiliation(s)
- M R Byers
- Department of Anesthesiology, University of Washington, Seattle 98195-6540, USA
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48
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Abstract
This double-blind split-mouth trial with 16 adult patients investigated the ability of a dentine bonding agent (DBA) to reduce cervical dentine sensitivity. Following stimulation of pairs of teeth by conventional tactile and air blast stimuli, together with controlled evaporative and cold fluid stimuli, sensitivity was recorded using tactile threshold, visual-analogue scale (VAS) and short-form McGill pain questionnaire (SFMPQ), prior to and 1 week following treatment with DBA. Prior to assessment, subjects recorded their perceived overall sensitivity using VAS and SFMPQ. Application of each stimulus was separated by 10 min. Sensitivity was recorded by a clinician blinded to the treatment status of each tooth. The control tooth was treated by applying DBA to coronal enamel. Dietary information was collected after the post-treatment assessment. There was a significant (p<0.05) improvement in tactile threshold and air flow and air blast VAS scores, together with reductions in sensitivity to evaporative stimuli when assessed by SFMPQ. Treatment response was not influenced by the subjects' age, gender, diet, use of fluoride-containing or silica-based toothpastes or fluoride mouthwashes, or a history of previous sensitivity treatment. It is concluded that topical application of DBA is an effective way to reduce cervical dentine sensitivity.
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Affiliation(s)
- M Ide
- Department of Periodontology and Preventive Dentistry, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, London, UK
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Abstract
Dentin sensitivity (DS) is a painful clinical condition which may affect 8-35% of the population. Various treatment modalities have claimed success in relieving DS, although at present there does not appear to be a universally accepted desensitizing agent. Current opinion based on Brännström's Hydrodynamic Theory would suggest that following exposure of the dentin surface (through attrition, abrasion, or erosion), the presence of open dentinal tubules, patent to the pulp, may be a prerequisite for DS. The concept of tubule occlusion as a method of dentin desensitization, therefore, is a logical conclusion from the hydrodynamic theory. The fact that many of the agents used clinically to desensitize dentin are also effective in reducing dentin permeability tends to support the hydrodynamic theory. This paper reviews the in vitro evaluation of desensitizing agents, the techniques used to characterize their effects on the prepared dentin surface, and the ability of these agents to reduce permeability through tubule occlusion, and presents recent findings from ongoing research based on the Pashley Dentin Disc model. It can be concluded that the use of this model to determine surface characteristics, and reductions in dentin permeability through tubule narrowing or occlusion, provides a useful screening method for evaluating potential desensitizing agents. Interpreting changes observed in vitro is difficult, and extrapolation to the clinical situation must be tempered with caution.
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Affiliation(s)
- D G Gillam
- Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University of London, United Kingdom
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Kemppainen P, Waltimo A, Waltimo T, Könönen M, Pertovaara A. Differential effects of noxious conditioning stimulation of the cheek by capsaicin on human sensory and inhibitory masseter reflex responses evoked by tooth pulp stimulation. J Dent Res 1997; 76:1561-8. [PMID: 9294490 DOI: 10.1177/00220345970760090801] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this study, we investigated whether selective activation of nociceptive primary afferent fibers by capsaicin would induce modulations on tooth-pulp-evoked sensory or inhibitory masseter reflex responses in healthy human subjects. The contribution of central N-methyl-D-aspartate (NMDA) receptor mechanisms in capsaicin-induced effects on sensory or reflex responses was evaluated by dextromethorphan, an NMDA-receptor antagonist. The inhibitory masseter reflex was evoked by electrical stimulation (constant current, single pulses) of the upper incisor while the subject was biting at 10% of his maximal force. The sensation of the tooth pulp stimulation was evaluated by visual analogue scale (VAS). The magnitude, duration, and the the latency of the reflex were determined by bite force measurements. The inhibitor masseter reflex could be induced by non-painful tooth pulp stimulation, and the inhibition was enhanced as a function of increasing stimulus intensity. Capsaicin (1%) applied topically to the skin of the cheek produced a spontaneous burning pain sensation. During capsaicin treatment, the VAS ratings for the sensation induced by tooth pulp stimulation were significantly reduced, whereas no significant changes were found in the tooth-pulp-induced masseter reflex responses. Double-blind treatment with dextromethorphan at a dose of 100 mg (= the highest does without side-effects) had no effect on sensory or reflex responses. These data indicate that noxious stimulation of the facial skin by capsaicin induces differential effects on tooth-pulp-evoked sensory and inhibitory masseter reflex responses: Sensory responses are strongly attenuated, while masseter reflex responses are not significantly changed. Dextromethorphan at a clinically applicable dose does not influence tooth-pulp-evoked sensory or reflex responses or their modulation by capsaicin. Furthermore, the lack of modulation of the masseter reflex response by capsaicin differs from the capsaicin-induced enhancement of a nocifensive limb flexion reflex described earlier.
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Affiliation(s)
- P Kemppainen
- Department of Prosthetic Dentistry, University of Helsinki, FInland
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