DOI QR코드

DOI QR Code

An Insight Into Neurophysiology of Pulpal Pain: Facts and Hypotheses

  • Jain, Niharika (Department of Conservative Dentistry & Endodontics, Hitkarni Dental College & Hospital) ;
  • Gupta, Abhishek (Department of Orthodontics & Dentofacial Othopaedics, Hitkarni Dental College & Hospital) ;
  • Meena, N. (Department of Conservative Dentistry & Endodontics, V.S Dental College & Hospital)
  • Received : 2013.08.26
  • Accepted : 2013.09.03
  • Published : 2013.10.01

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.

Keywords

References

  1. Sessle BJ. Recent developments in pain research: central mechanisms of orofacial pain and its control. J Endod 1986; 12: 435-44. https://doi.org/10.1016/S0099-2399(86)80196-0
  2. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993; 124: 115-21.
  3. Estrela C, Guedes OA, Silva JA, Leles CR, Estrela CR, Pecora JD. Diagnostic and clinical factors associated with pulpal and periapical pain. Braz Dent J 2011; 22: 306-11. https://doi.org/10.1590/S0103-64402011000400008
  4. Byers MR. Dental sensory receptors. Int Rev Neurobiol 1984; 25: 39-94. https://doi.org/10.1016/S0074-7742(08)60677-7
  5. Byers MR, Narhi MV. Dental injury models: experimental tools for understanding neuroinflammatory interactions and polymodal nociceptor functions. Crit Rev Oral Biol Med 1999; 10: 4-39. https://doi.org/10.1177/10454411990100010101
  6. Bergenholtz G, Horsted-Bindslev P, Reit C. Textbook of endodontology. 2nd ed. Oxford, Wiley-Blackwell Pub. 2010, pp 33-5.
  7. Ingle JI, Bakland LK, Baumgartner JC. Ingle's endodontics 6. Ontario, BC Decker. 2008, pp 136-7.
  8. Figdor D. Aspects of dentinal and pulpal pain. Pain of dentinal and pulpal origin--a review for the clinician. Ann R Australas Coll Dent Surg 1994; 12: 131-42.
  9. Narhi MV, Hirvonen TJ, Hakumaki MO. Responses of intradental nerve fibres to stimulation of dentine and pulp. Acta Physiol Scand 1982; 115: 173-8. https://doi.org/10.1111/j.1748-1716.1982.tb07062.x
  10. Narhi M, Jyvasjarvi E, Virtanen A, Huopaniemi T, Ngassapa D, Hirvonen T. Role of intradental A- and C-type nerve fibres in dental pain mechanisms. Proc Finn Dent Soc 1992; 88 Suppl 1: 507-16.
  11. Matthews B, Vongsavan N. Interactions between neural and hydrodynamic mechanisms in dentine and pulp. Arch Oral Biol 1994; 39 Suppl: 87S-95S. https://doi.org/10.1016/0003-9969(94)90193-7
  12. Pashley DH. Mechanisms of dentin sensitivity. Dent Clin North Am 1990; 34: 449-73.
  13. Vongsavan N, Matthews B. The relationship between the discharge of intradental nerves and the rate of fluid flow through dentine in the cat. Arch Oral Biol 2007; 52: 640-7. https://doi.org/10.1016/j.archoralbio.2006.12.019
  14. Braennstroem M, Astroem A. A study on the mechanism of pain elicited from the dentin. J Dent Res 1964; 43: 619-25. https://doi.org/10.1177/00220345640430041601
  15. Gomez N. Bibliographic update work: dental pulp sensory function. Pain Electron J Endod Rosario 2011; 10: 540-52.
  16. Närhi M, Yamamoto H, Ngassapa D. Function of intradental nociceptors in normal and inflamed teeth. In: Dentin/pulp complex. Edited by Shimono M, Maeda T, Suda H, Takahashi K. Tokyo, Quintessence Pub. Co. 1996, pp 136-40.
  17. Dong WK, Chudler EH, Martin RF. Physiological properties of intradental mechanoreceptors. Brain Res 1985; 334: 389-95. https://doi.org/10.1016/0006-8993(85)90239-2
  18. Jyvasjarvi E, Kniffki KD. Cold stimulation of teeth: a comparison between the responses of cat intradental A delta and C fibres and human sensation. J Physiol 1987; 391: 193-207. https://doi.org/10.1113/jphysiol.1987.sp016733
  19. Trowbridge HO. Review of dental pain--histology and physiology. J Endod 1986; 12: 445-52. https://doi.org/10.1016/S0099-2399(86)80197-2
  20. Hargreaves KM, Goodis HE, Seltzer S. Seltzer and Bender's dental pulp. Chicago (IL), Quintessence Pub. Co. 2002, pp 148-50.
  21. Narhi MV. The characteristics of intradental sensory units and their responses to stimulation. J Dent Res 1985; 64 Spec No: 564-71. https://doi.org/10.1177/002203458506400411
  22. Bender IB. Pulpal pain diagnosis--a review. J Endod 2000; 26: 175-9. https://doi.org/10.1097/00004770-200003000-00012
  23. Narhi M, Virtanen A, Kuhta J, Huopaniemi T. Electrical stimulation of teeth with a pulp tester in the cat. Scand J Dent Res 1979; 87: 32-8.
  24. Torebjork HE, Hallin RG. Perceptual changes accompanying controlled preferential blocking of A and C fibre responses in intact human skin nerves. Exp Brain Res 1973; 16: 321-32.
  25. Narhi M, Yamamoto H, Ngassapa D, Hirvonen T. The neurophysiological basis and the role of inflammatory reactions in dentine hypersensitivity. Arch Oral Biol 1994; 39 Suppl: 23S-30S. https://doi.org/10.1016/0003-9969(94)90184-8
  26. Byers MR. Effects of inflammation on dental sensory nerves and vice versa. Proc Finn Dent Soc 1992; 88 Suppl 1: 499-506.
  27. Rutz JC, Hatton JF, Hildebolt C, Wells JE, Rowland KC. Localized increases in corticotropin-releasing factor receptors in pulp after dental injury. J Endod 2007; 33: 1319-24. https://doi.org/10.1016/j.joen.2007.08.009
  28. Jaber L, Swaim WD, Dionne RA. Immunohistochemical localization of mu-opioid receptors in human dental pulp. J Endod 2003; 29: 108-10.
  29. Dionne RA, Lepinski AM, Gordon SM, Jaber L, Brahim JS, Hargreaves KM. Analgesic effects of peripherally administered opioids in clinical models of acute and chronic inflammation. Clin Pharmacol Ther 2001; 70: 66-73. https://doi.org/10.1067/mcp.2001.116443
  30. Chao D, Bazzy-Asaad A, Balboni G, Xia Y. delta-, but not mu-, opioid receptor stabilizes K(+) homeostasis by reducing Ca(2+) influx in the cortex during acute hypoxia. J Cell Physiol 2007; 212: 60-7. https://doi.org/10.1002/jcp.21000
  31. Fristad I, Bletsa A, Byers M. Inflammatory nerve responses in the dental pulp. Endod Topics 2010; 17: 12-41.
  32. Kim S, Dorscher-Kim JE, Liu M. Microcirculation of the dental pulp and its autonomic control. Proc Finn Dent Soc 1989; 85: 279-87.
  33. Kim S, Dorscher-Kim JE, Lipowsky HH. Quantitative assessment of microcirculation in the rat dental pulp in response to alpha- and beta-adrenergic agonists. Arch Oral Biol 1989; 34: 707-12. https://doi.org/10.1016/0003-9969(89)90077-0
  34. Wakisaka S, Ichikawa H, Akai M. Distribution and origins of peptide- and catecholamine-containing nerve fibres in the feline dental pulp and effects of cavity preparation on these nerve fibres. J Osaka Univ Dent Sch 1986; 26: 17-28.
  35. Nup C, Rosenberg P, Linke H, Tordik P. Quantitation of catecholamines in inflamed human dental pulp by high-performance liquid chromatography. J Endod 2001; 27: 73-5.
  36. Hargreaves KM, Swift JQ, Roszkowski MT, Bowles W, Garry MG, Jackson DL. Pharmacology of peripheral neuropeptide and inflammatory mediator release. Oral Surg Oral Med Oral Pathol 1994; 78: 503-10. https://doi.org/10.1016/0030-4220(94)90045-0
  37. Sacerdote P, Levrini L. Peripheral mechanisms of dental pain: the role of substance P. Mediators Inflamm 2012; 2012: 951920.
  38. Kido MA, Ibuki T, Danjo A, Kondo T, Zhang JQ, Yamaza T, et al. Immunocytochemical localization of the neurokinin 1 receptor in rat dental pulp. Arch Histol Cytol 2005; 68: 259-65. https://doi.org/10.1679/aohc.68.259
  39. Caviedes-Bucheli J, Gutierrez-Guerra JE, Salazar F, Pichardo D, Moreno GC, Munoz HR. Substance P receptor expression in healthy and inflamed human pulp tissue. Int Endod J 2007; 40: 106-11. https://doi.org/10.1111/j.1365-2591.2006.01189.x
  40. Bowles WR, Withrow JC, Lepinski AM, Hargreaves KM. Tissue levels of immunoreactive substance P are increased in patients with irreversible pulpitis. J Endod 2003; 29: 265-7. https://doi.org/10.1097/00004770-200304000-00009
  41. Caviedes-Bucheli J, Azuero-Holguin MM, Gutierrez-Sanchez L, Higuerey-Bermudez F, Pereira-Nava V, Lombana N, et al. The effect of three different rotary instrumentation systems on substance P and calcitonin gene-related peptide expression in human periodontal ligament. J Endod 2010; 36: 1938-42. https://doi.org/10.1016/j.joen.2010.08.043
  42. Buck SH, Burks TF. The neuropharmacology of capsaicin: review of some recent observations. Pharmacol Rev 1986; 38: 179-226.
  43. Ichikawa H, Sugimoto T. Vanilloid receptor 1-like receptorimmunoreactive primary sensory neurons in the rat trigeminal nervous system. Neuroscience 2000; 101: 719-25. https://doi.org/10.1016/S0306-4522(00)00427-9
  44. Caviedes-Bucheli J, Azuero-Holguin MM, Munoz HR. The effect of capsaicin on substance P expression in pulp tissue inflammation. Int Endod J 2005; 38: 30-3. https://doi.org/10.1111/j.1365-2591.2004.00893.x
  45. Lin SK, Kuo MY, Wang JS, Lee JJ, Wang CC, Huang S, et al. Differential regulation of interleukin-6 and inducible cyclooxygenase gene expression by cytokines through prostaglandin-dependent and -independent mechanisms in human dental pulp fibroblasts. J Endod 2002; 28: 197-201. https://doi.org/10.1097/00004770-200203000-00013
  46. Sundqvist G, Rosenquist JB, Lerner UH. Effects of bradykinin and thrombin on prostaglandin formation, cell proliferation and collagen biosynthesis in human dental-pulp fibroblasts. Arch Oral Biol 1995; 40: 247-56. https://doi.org/10.1016/0003-9969(95)98813-E
  47. Coon D, Gulati A, Cowan C, He J. The role of cyclooxygenase- 2 (COX-2) in inflammatory bone resorption. J Endod 2007; 33: 432-6. https://doi.org/10.1016/j.joen.2006.12.001
  48. Tani-Ishii N, Wang CY, Stashenko P. Immunolocalization of bone-resorptive cytokines in rat pulp and periapical lesions following surgical pulp exposure. Oral Microbiol Immunol 1995; 10: 213-9. https://doi.org/10.1111/j.1399-302X.1995.tb00145.x
  49. Wisithphrom K, Murray PE, Windsor LJ. Interleukin-1 alpha alters the expression of matrix metalloproteinases and collagen degradation by pulp fibroblasts. J Endod 2006; 32: 186-92. https://doi.org/10.1016/j.joen.2005.10.055
  50. Ueda L, Matsushima K. Stimulation of plasminogen activator activity and matrix metalloproteinases of human dental pulp-derived cells by tumor necrosis factor-alpha. J Endod 2001; 27: 175-9. https://doi.org/10.1097/00004770-200103000-00008
  51. D'Souza R, Brown LR, Newland JR, Levy BM, Lachman LB. Detection and characterization of interleukin-1 in human dental pulps. Arch Oral Biol 1989; 34: 307-13. https://doi.org/10.1016/0003-9969(89)90102-7
  52. Hosoya S, Ohbayashi E, Matsushima K, Takeuchi H, Yamazaki M, Shibata Y, et al. Stimulatory effect of interleukin-6 on plasminogen activator activity from human dental pulp cells. J Endod 1998; 24: 331-4. https://doi.org/10.1016/S0099-2399(98)80129-5
  53. Barkhordar RA, Hayashi C, Hussain MZ. Detection of interleukin-6 in human dental pulp and periapical lesions. Endod Dent Traumatol 1999; 15: 26-7. https://doi.org/10.1111/j.1600-9657.1999.tb00744.x
  54. Proctor ME, Turner DW, Kaminski EJ, Osetek EM, Heuer MA. Determination and relationship of C-reactive protein in human dental pulps and in serum. J Endod 1991; 17: 265-70. https://doi.org/10.1016/S0099-2399(06)81864-9
  55. Guven G, Altun C, Günhan O, Gurbuz T, Basak F, Akbulut E, et al. Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study. J Endod 2007; 33: 18-20.
  56. Holt CI, Hutchins MO, Pileggi R. A real time quantitative PCR analysis and correlation of COX-1 and COX-2 enzymes in inflamed dental pulps following administration of three different NSAIDs. J Endod 2005; 31: 799-804. https://doi.org/10.1097/01.don.0000158239.97520.de
  57. Spoto G, Fioroni M, Rubini C, Tripodi D, Perinetti G, Piattelli A. Aspartate aminotransferase activity in human healthy and inflamed dental pulps. J Endod 2001; 27: 394-5. https://doi.org/10.1097/00004770-200106000-00005
  58. Spoto G, Fioroni M, Rubini C, Tripodi D, Di Stilio M, Piattelli A. Alkaline phosphatase activity in normal and inflamed dental pulps. J Endod 2001; 27: 180-2. https://doi.org/10.1097/00004770-200103000-00010
  59. Warren CA, Mok L, Gordon S, Fouad AF, Gold MS. Quantification of neural protein in extirpated tooth pulp. J Endod 2008; 34: 7-10. https://doi.org/10.1016/j.joen.2007.09.014
  60. Wells JE, Rose ET, Rowland KC, Hatton JF. Kv1.4 subunit expression is decreased in neurons of painful human pulp. J Endod 2007; 33: 827-9. https://doi.org/10.1016/j.joen.2007.03.013

Cited by

  1. Association between dental pain and depression in Korean adults using the Korean National Health and Nutrition Examination Survey vol.43, pp.1, 2016, https://doi.org/10.1111/joor.12343
  2. Anti-inflammatory and antioxidant properties of Schisandrin C promote mitochondrial biogenesis in human dental pulp cells pp.01432885, 2017, https://doi.org/10.1111/iej.12861
  3. Pain Control by Proprioceptive and Exteroceptive Stimulation at the Trigeminal Level vol.9, pp.1664-042X, 2018, https://doi.org/10.3389/fphys.2018.01037
  4. Postnatal periodontal ligament as a novel adult stem cell source for regenerative corneal cell therapy vol.22, pp.6, 2018, https://doi.org/10.1111/jcmm.13589
  5. Relationship between post‐extraction pain and acute pulpitis: a randomised trial using third molars vol.66, pp.6, 2016, https://doi.org/10.1111/idj.12249
  6. Potential Novel Strategies for the Treatment of Dental Pulp-Derived Pain: Pharmacological Approaches and Beyond vol.10, pp.None, 2013, https://doi.org/10.3389/fphar.2019.01068
  7. Ion Channels Involved in Tooth Pain vol.20, pp.9, 2013, https://doi.org/10.3390/ijms20092266
  8. In Vivo Evaluation of Effect of Preoperative Ibuprofen on Proinflammatory Mediators in Irreversible Pulpitis Cases vol.46, pp.9, 2013, https://doi.org/10.1016/j.joen.2020.06.009
  9. The clinical significance of intrapulpal anesthesia for painless dental procedure vol.36, pp.82, 2013, https://doi.org/10.5937/asn2082117b
  10. The Genetic and Epigenetic Mechanisms Involved in Irreversible Pulp Neural Inflammation vol.2021, pp.None, 2013, https://doi.org/10.1155/2021/8831948