Thresholds to electrical stimulation of nerves in cat canine tooth-pulp with A beta-, A delta- and C-fibre conduction velocities

Teeth and tooth nerves

(1) Although our knowledge on teeth and tooth nerves has increased substantially during the past 25 years, several important issues remain to be fully elucidated. As a result of the work now going on at many laboratories over the world, we can expect exciting new findings and major break-throughs in these and other areas in a near future. (2) Dentin-like and enamel-like hard tissues evolved as components of the exoskeletal bony armor of early vertebrates, 500 million years ago, long before the first appearance of teeth. It is possible that teeth developed from tubercles (odontodes) in the bony armor. The presence of a canal system in the bony plates, of tubular dentin, of external pores in the enamel layer and of a link to the lateral line system promoted hypotheses that the bony plates and tooth precursors may have had a sensory function. The evolution of an efficient brain, of a head with paired sense organs and of toothed jaws concurred with a shift from a sessile filter-feeding life to active prey hunting. (3) The wide spectrum of feeding behaviors exhibited by modern vertebrates is reflected by a variety of dentition types. While the teeth are continuously renewed in toothed non-mammalian vertebrates, tooth turnover is highly restricted in mammals. As a rule, one set of primary teeth is replaced by one set of permanent teeth. Since teeth are richly innervated, the turnover necessitates a local neural plasticity. Another factor calling for a local plasticity is the relatively frequent occurrence of age-related and pathological dental changes. (4) Tooth development is initiated through interactions between the oral epithelium and underlying neural crest-derived mesenchymal cells. The interactions are mediated by cell surface molecules, extracellular matrix molecules and soluble molecules. The possibility that the initiating events might involve a neural component has been much discussed. With respect to mammals, the experimental evidence available does not support this hypothesis. In the teleost Tilapia mariae, on the other hand, tooth germ formation is interrupted, and tooth turnover ceases after local denervation. (5) Prospective dental nerves enter the jaws well before onset of tooth development. When a dental lamina has formed, a plexus of nerve branches is seen in the subepithelial mesenchyme. Shortly thereafter, specific branches to individual tooth primordia can be distinguished. In bud stage tooth germs, axon terminals surround the condensed mesenchyme and in cap stage primordia axons grow into the dental follicle.(ABSTRACT TRUNCATED AT 400 WORDS)

Nerve growth factor depletion reduces collateral sprouting of cutaneous mechanoreceptive and tooth-pulp axons in ferrets

1. Electrophysiological experiments were carried out to determine whether or not collateral sprouting of cutaneous low-threshold mechanoreceptive fibres could be detected and to investigate the effect of nerve growth factor (NGF) deprivation on the sprouting of these fibres and the fibres innervating tooth pulps. 2. In twenty-one ferrets (eleven of which had been autoimmunized against NGF) the right inferior alveolar nerve (IAN) was sectioned and prevented from regenerating. After 12 weeks, transmedian innervation from the left IAN was determined by stimulating the nerve whilst recording from electrodes implanted in the contralateral anterior teeth and also by single unit recordings from the nerve whilst mechanically and electrically stimulating the skin. The results were compared with those from ten control animals. 3. Transmedian innervation of contralateral teeth was found in none of the control animals; in all ten of the animals which had undergone denervation without immunization (4/10 canines, 17/20 incisors); but in only six of the eleven immunized and denervated animals (0/11 canines, 7/22 incisors). 4. Of 270 cutaneous mechanoreceptive units sampled in the controls, only four units had transmedian receptive fields, extending a maximum of 1 mm across the mid-line. After denervation, significantly more units (42 of 274) crossed the mid-line and extended up to 4 mm. After immunization and denervation only eleven of 305 units crossed the midline by a maximum of 1 mm. 5. These data show that cutaneous low-threshold mechanoreceptive A beta and A delta fibres, as well as A delta tooth pulp fibres, are able to undergo collateral sprouting. This sprouting is partially blocked by NGF depletion, suggesting that NGF plays an essential role in the process.

Encoding of the subjective intensity of sharp dental pain

This paper is a review and a discussion of our own pain research over the last decade. It is of a methodological and theoretical character and deals with preparation technique, choice of electrodes, control experiments involving pulpotomy and reliability tests of psychophysical methods for pain measurements, and the neuronal population encoding of sharp dental pain. The electrophysiological recording technique selectively picks up electrical activity induced in pulpal A-delta nerve fibers. The sensation of pain was quantified by means of an intermodal matching technique, finger span (PAS), in combination with sensory verbal descriptors covering a range from very, very weak to maximal pain. When a cold stimulus, ethyl chloride, was applied on the tooth surface a close agreement was demonstrated between intradental A-delta nerve activity (INA) and the sensation magnitude of pain (PAS) with respect to curve amplitude and time course. The high covariation of the neural and perceptual response measures indicated a good internal validity and confirmed also the basic soundness and the applicability of the procedures employed. For the purpose of further analyzing the functional relation of INA to PAS we studied specifically the effect of cold stimuli of different intensity on the integrated nerve response. Only sharp, shooting pain was accepted as a sensorial, perceptual correlate of the intradental A-delta nerve activity. Since an increase in amplitude was generally accompanied by an increase in duration of the responses, the fundamental question was raised how to best describe and characterize the neural and perceptual responses so that they most adequately reflect the information processing of the intensive aspect of sharp dental pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of postnatal anti-nerve growth factor serum exposure on development of apical nerves of the rat molar

The present study was undertaken to test the hypothesis that development of the pulpal innervation is dependent on nerve growth factor (NGF). Newborn rats were given subcutaneous injections of a rabbit anti-mouse NGF serum on alternate days for the first 24 days postnatally. Control animals were untreated and normal rabbit serum-treated litter mates. The animals were deeply anesthetized on postnatal day 26, perfused with fixative and the first mandibular molars were processed for transmission electron microscopy to obtain a complete census of axons entering the four roots. The composition of the mental nerve was also examined. Compared to control animals, the apical innervation of molars from anti-NGF-treated rats had only 62% as many myelinated fibers and 41% as many unmyelinated axons. Those myelinated fibers present in antiserum-treated animals were slightly, but significantly, smaller in average diameter than controls. In teeth of control animals, about 20% of all unmyelinated axons were located in fibers coursing outside of nerve fascicles; these isolated fibers were disproportionately rare after antiserum exposure. The average number of unmyelinated axons per Schwann cell unit was also significantly lower. Postnatal exposure to anti-NGF had milder effects on mental nerve composition compared to the tooth innervation. Numbers of myelinated fibers were 83% of controls, unmyelinated axons were 74% of controls and there was no change in the average number of unmyelinated axons per Schwann cell unit. We conclude that development of dental innervation is highly susceptible to postnatal NGF deprivation. This may be a consequence of the mostly nociceptive composition of dental nerves and their late development.

Neural parvalbumin and calretinin in the tooth pulp

Parvalbumin- and calretinin-immunoreactivities (CR-irs) were examined in the molar tooth pulp of the rat using immunohistochemical methods. CR-ir fibers were further classified based on the tachykinin-ir revealed by a double immunofluorescence method. The rat root pulp contained three types of nerve fibers; parvalbumin-ir smooth fibers, CR-ir (TK-negative) smooth fibers and CR-ir (TK-ir) varicose fibers. These fibers projected toward the roof of the pulp chamber and pulp horn without marked ramification. In the subodontoblastic layer at the roof of the pulp chamber and pulp horn, parvalbumin-ir smooth fibers repeatedly ramified and extended varicose terminals into the odontoblastic layer. CR-ir (TK-negative) smooth fibers reached the subodontoblastic layer without marked ramification and gave rise to varicose terminals that appeared to terminate within the subodontoblastic layer. On the other hand, CR-ir (TK-ir) varicose fibers proceeded to the subodontoblastic layer at the roof of the pulp chamber and pulp horn, where they ramified and penetrated the odontoblastic layer. The present study indicates that the rat tooth pulp contains myelinated parvalbumin-ir and CR-ir (TK-negative) fibers, and unmyelinated CR-ir (TK-ir) fibers, and that they project varicose terminals to the subodontoblastic and odontoblastic layers. The central projection sites of these sensory fibers have yet to be revealed.

Effect of interstimulus interval on perceived sensation and intradental nerve activity during thermal tooth stimulation in man

The effect of interstimulus interval on nerve responses and subjective sensory ratings evoked by thermal stimulation of the teeth were studied in man. A total of 30 unitary discharges during heat stimulation of the lower incisor teeth were recorded from the inferior alveolar nerves using microneurographic technique. Fifteen of them had threshold sensory ratings above 3 (pain related-units) and 15 had ratings of less than 2 (non-pain-related units). Repetitive heat stimulation was applied to the teeth with interstimulus intervals of 180 s (ISI 180) and 30 s (ISI 30). Repetitive (ISI 180 and ISI 30) non-painful heat stimulation of the teeth did not alter either the intensity ratings or unitary discharge activities of non-pain-related units (P > 0.05). Repetitive painful heat stimulation of the teeth with ISI 180 did not alter the intensity ratings of pain-related units (P > 0.05), whereas that with ISI 30 significantly reduced the intensity ratings of pain-related units during a second session of heat trials (P < 0.05). On the other hand, repetitive heat stimulation of the teeth with ISI 180 caused a slight reduction in the firing frequency of pain-related units (P > 0.05). Repetitive painful heat stimulation with ISI 30 significantly reduced the firing frequency of pain-related units (P < 0.05).

The neurophysiological basis and the role of inflammatory reactions in dentine hypersensitivity

Recent studies indicate that intradental A-type nerve fibres are responsible for the sensitivity of dentine and are activated by fluid movements in dentinal tubules (hydrodynamic mechanism). The patency of the tubules affects dentine sensitivity to a great extent. Both A delta- and A beta-type nerve fibres respond to dentinal (hydrodynamic) stimulation in a similar way. Only a few studies have been made on the regional sensitivity of dentine or the receptive areas of intradental nerve fibres. The results indicate that the fibres innervating different parts of coronal dentine are equally sensitive to dentinal stimulation but those in the cervical area may be less responsive. Inflammation in the pulp can considerably alter dentine sensitivity. In dog teeth with chronically exposed dentine, nerve responses to hydrodynamic stimulation were reduced although other functional changes indicated nerve sensitization. This may be due to spontaneously occurring changes in the exposed dentine that block the tubules. In acute experiments on cat and dog teeth with open dentinal tubules, certain inflammatory mediators increase the sensitivity of the responding nerve fibres. It seems that intradental C-fibres do not respond to hydrodynamic stimulation of dentine. They are polymodal and activated when external stimuli reach the pulp proper. They could perhaps mediate the dull pain connected with pulpitis. However, they might also have an important modifying effect on dentine sensitivity because they can release neuropeptides, which function in the inflammatory reactions.

Projection of the inferior dental nerve to the primary somatosensory cortex in rats

We observed perioral representations in the primary somatosensory cortex in rats to identify the location of the tooth region. Field potentials evoked by stimulation of an inferior dental nerve were mapped on a surface of the cerebral cortex. Stimulation of the nerve bilaterally evoked biphasic (positive-negative) or triphasic (positive-negative-positive) field potentials with contralateral predominance. The focus of the field potentials was located in the rostral region of the lower jaw zone of the somatosensory map, as visualized in a flattened cerebral hemisphere, using cytochrome oxidase histochemistry.

The incidence and distribution of branched pulpal axons in the adult ferret

Previous laboratory studies have revealed that some axons branch to supply the pulps of two teeth, but the incidence of such fibres in different regions of the jaws has not been investigated. The present study has used electrophysiological techniques to determine the incidence and distribution of branched pulpal axons in ferret maxillary and mandibular teeth. Under anaesthesia, pairs of Ag/AgCl electrodes were inserted into cavities in the left mandibular (10 animals) or maxillary (seven animals) teeth. Using these electrodes, electrical stimuli were applied to each tooth in turn, and averaged responses were recorded individually from the other teeth. The responses revealed 14 axons that branched to supply two mandibular teeth and for 13 of these the teeth were adjacent. The responses had latencies of 1-9.8 ms (mean 3.8 ms) and amplitudes of 4-320 microV (mean 49 microV). These axons most commonly branched to supply the second and third premolars, and the canine and third incisor, and the branching point was always within the mandibular canal. Thirty-four branched axons supplying maxillary teeth were found (latency, 1.4-18.8 ms, mean 5.9 ms; amplitude; 5-210 microV, mean 36 microV); 14 of these supplied adjacent teeth and they most commonly innervated the canine and incisors.

Cat dental pulp after denervation and subsequent re-innervation: changes in blood-flow regulation and distribution of neuropeptide-, GAP-43- and low-affinity neurotrophin receptor-like immunoreactivity

The effects of unilateral extramandibular inferior alveolar nerve injury on pulpal blood-flow responses to electrical stimulation and i.v. injections of substance P (SP) in cat mandibular canine teeth with a dentinal lesion were investigated with laser Doppler flowmetry. After blood-flow recordings, the teeth were fixed and the pulps were examined with light and electron microscopy. The distribution of pulpal SP, neurokinin A (NKA), calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP), neuropeptide Y (NPY), growth-associated protein (GAP-43) and low-affinity neurotrophin receptor (LANR)-like immunoreactivity was examined with immunohistochemical fluorescence microscopy. Blood-flow recordings, performed at 10 days and 1 month postoperatively, showed that vasodilation, occurring in control teeth after bipolar electrical stimulation of the tooth crown, was absent in the denervated pulps, whereas at 3 months, five of six teeth had regained responsiveness, although at a low level. There was enhanced vasodilation (by 370%) to SP injections (400 fmol i.v.) at 10 days in denervated pulps. Such supersensitivity was reduced at 1 month despite the apparent lack of nerve fibers, and the response fell further towards the level in control teeth at 3 months when pulpal axons reappeared. At 10 days and 1 month postoperatively, light and electron microscopy demonstrated that surgery had resulted in total pulpal denervation. At 3 and 6 months, a large number of regenerated pulpal axons reappeared, in accordance with previous findings. At 10 days and 1 month after nerve transection immunohistochemistry showed a complete loss of pulpal immunoreactivity to all the neuropeptides that were studied. At 3 and 6 months, neuropeptide immunoreactivity reappeared but far fewer number of pulpal nerve fibers were SP-, NKA- and CGRP-immunoreactive than under normal conditions, as demonstrated by double-labeling experiments with GAP-43- or LANR-antiserum. The results indicate that pulpal hemoregulatory functions, which are lost after denervation, do not return to normal levels after nerve regeneration. This malfunction may be caused by inadequate target re-innervation and/or a deficiency of neuropeptides in the re-innervated pulp.

Selectivity of lingual nerve fibers to chemical stimuli

The cell bodies of the lingual branch of the trigeminal nerve were localized in the trigeminal ganglion using extracellular recordings together with horseradish peroxidase labeling from the tongue. Individual lingual nerve fibers were characterized with regard to their conduction velocities, receptive fields, and response to thermal, mechanical, and chemical stimuli. Fibers were classified as C, A delta, A beta, cold, and warm. The chemical stimuli included NaCl, KCl, NH4Cl, CaCl2, menthol, nicotine, hexanol, and capsaicin. With increasing salt concentration the latency of the response decreased and the activity increased. The responses elicited by salts (to 2.5 M), but not nonpolar stimuli such as menthol, were reversibly inhibited by 3.5 mM of the tight junction blocker, LaCl3. These data suggest that salts diffuse into stratified squamous epithelia through tight junctions in the stratum corneum and stratum granulosum, whereupon they enter the extracellular space. 11 C fibers were identified and 5 were characterized as polymodal nociceptors. All of the C fibers were activated by one or more of the salts NaCl, KCl, or NH4Cl. Three C fibers were activated by nicotine (1 mM), but none were affected by CaCl2 (1 M), menthol (1 mM), or hexanol (50 mM). However, not all C fibers or even the subpopulation of polymodals were activated by the same salts or by nicotine. Thus, it appears that C fibers display differential responsiveness to chemical stimuli. A delta fibers also showed differential sensitivity to chemicals. Of the 35 characterized A delta mechanoreceptors, 8 responded to NaCl, 9 to KCl, 9 to NH4Cl, 0 to CaCl2, menthol, or hexanol, and 2 to nicotine. 8 of 9 of the cold fibers (characterized as A delta's) responded to menthol, none responded to nicotine, 8 of 16 were inhibited by hexanol, 9 of 19 responded to 2.5 M NH4Cl, 5 of 19 responded to 2.5 M KCl, and 1 of 19 responded to 2.5 M NaCl. In summary, lingual nerve fibers exhibit responsiveness to chemicals introduced onto the tongue. The differential responses of these fibers are potentially capable of transmitting information regarding the quality and quantity of chemical stimuli from the tongue to the central nervous system.

Effects of capsaicin on KCl-induced blood flow and sensory nerve activity changes in the tooth pulp

Potassium ion-containing solutions have been shown to initially excite then depress intradental nerve activity (INA) when applied into deep dentinal cavities. The INA reflects activity originating in intradental A fibers. Application of KCl to deep dentinal cavities also induces an increase in pulpal blood flow (PBF). Capsaicin is known to exert a highly selective desensitizing effect on polymodal C-fiber nerve endings. These C fibers are generally believed to release vasoactive substances in response to stimulation. In order to determine if KCl exerts its vascular effect via activation of capsaicin-sensitive nerve fibers, we examined blood flow and sensory nerve responses to KCl obtained before and after capsaicin desensitization. The A-fiber nerve activity was determined by using INA recording technique. Blood flow was measured simultaneously from the same tooth using laser Doppler flowmetry. Local application of 0.25 M KCl to a deep dentinal cavity induced a brief spike burst and an increase in PBF of 76.0 +/- 14.6% (n = 8). Repeated applications of 0.25 M KCl caused a consistent increase in the peak PBF amplitude (n = 8). Local application of 100 microM capsaicin to a deep dentinal cavity caused an increase in PBF of 116.8 +/- 26.3% (n = 8) lasting 12-18 min, but capsaicin application did not appear to evoke any INA response. The amplitude of PBF in response to capsaicin application declined during repeated applications. Following repeated applications of capsaicin the PBF response to KCl was significantly reduced (9.9 +/- 4.3%, n = 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Tooth pulp primary neurons: cell size analysis, central connection, and carbonic anhydrase activity

Cell bodies and central terminals of trigeminal primary afferent neurons innervating the mandibular molar and incisor tooth pulps were labeled by injecting various neuroanatomical tracers into these tooth pulps. The cell bodies of major constituents of primary neurons innervating the tooth pulp, cornea, and cutaneous branch of the mylohyoid nerve were large (> or = 500 microns2, 65%), medium (300-400 microns2, 35%), and small (100-200 microns2, 34%), respectively. Those innervating the tooth pulp (tooth pulp cells) had the Nissl pattern characteristic of large light cells of the A type, while those innervating the cornea were small dark cells of the B type. Thirty percent of the tooth pulp cells exhibited histochemically demonstrable carbonic anhydrase activity. The transganglionic transport of HRP-WGA indicated marked concentration of central terminals of the tooth pulp primaries in the rostral subdivisions of the brain stem sensory trigeminal nuclear complex. In contrast, central terminals of the corneal primaries were concentrated in the medullary dorsal horn.

Number and size-spectra of myelinated nerve fibers of human premolars

The primary objective of this study was to determine the number and size of myelinated nerve fibers at the subcervical, midroot and juxta-apical levels of human premolars. Sixty-seven healthy premolars extracted from adolescents were utilized. Root-discs were prepared from the three sites and processed for light and electron microscopy. The myelinated nerve fibers were counted from semithin sections using a sampling microscope. The measurements were taken from composite electron micrographs using an electronic image processing unit. A total of 1883 myelinated axons from seven mandibular second premolars was gauged. The 67 teeth had an average of 312 +/- 149 myelinated nerve fibers at the juxta-apical level (range 18 to 728). The contra- and ipsilateral differences in means among the four groups of premolars were not significant (P > 0.05). The number of nerves increased significantly (P < 0.05) toward midroot and subcervical (P < 0.001) levels in all groups. The average neural diameter was 3.5 + 1.0 microns at the juxta-apical level, and the between-teeth difference in mean was found to be significant (P < 0.01). There was no decline (P > 0.05) in the diameter of myelinated nerve fibers toward midroot and subcervical levels.

The origin of short- and long-latency mylohyoid nerve responses elicited by high-intensity electrical stimulation of intradental nerve in cats

A double reflex response of the mylohyoid nerve to the jaw depressor muscles after electrical stimulation of the intradental nerves was recorded in cats anaesthetized with alpha-chloralose. The threshold value of the long-latency (16-19 ms) response was almost 20 times greater than that of the short-latency (5-8 ms) response. At the threshold intensity of the long-latency response, the short-latency response with shorter latency appeared. After extirpation of the stimulated tooth pulp, the short-latency response with a lower threshold disappeared, whereas the short-latency response with a higher threshold and the long-latency response both persisted and showed no change in threshold or latency. These findings indicate that the low-threshold, short-latency response was due to excitation of pulpal nerve fibres, while the high-threshold, short-latency response and the long-latency response were both due to excitation of extrapulpal afferent fibres as a result of the spread of current outside the tooth.

Methods for recording the jaw-opening reflex to tooth-pulp stimulation in awake cats

Techniques are described for use in awake, unrestrained cats which enable recordings to be made from the digastric muscle, electrical stimuli to be applied to the teeth, and intravenous injections to be made via an indwelling cannula. A headpiece was fixed to the skull of the animal and leads were passed subcutaneously from it to electrodes in the muscle and the teeth. A silicone rubber cannula was inserted into the external jugular vein and connected to an injection port in the headpiece. The headpiece incorporated a miniature 9-way connector which was connected to the electrode leads.

The effects of medetomidine, an alpha-2-adrenoceptor agonist, and cocaine on the tooth pulp-evoked jaw-opening reflex in cat

In the pentobarbitone-anesthetized cat, the threshold of the tooth pulp-elicited jaw-opening reflex was elevated in a dose-dependent way (30-100 micrograms/kg, IP) following the administration of medetomidine, an alpha-2-adrenoceptor agonist. This elevation was significantly reduced by atipamezole (1 mg/kg, IP), an alpha-2-adrenoceptor antagonist. The inhibitory interaction between two successive dental stimuli applied to the same tooth (in-field inhibition) was suppressed by a lower dose of medetomidine (30 micrograms/kg) than the threshold elevation to single electrical pulses (55 micrograms/kg). Only the highest dose of medetomidine used (100 micrograms/kg) significantly influenced the temporally facilitated (in-field facilitation) response. In comparison, cocaine, a nonspecific monoaminergic agent, did not produce a significant threshold elevation of the tooth pulp-elicited jaw-opening reflex (1-25 mg/kg, IP). It is concluded that medetomidine, through an action on alpha-2-adrenoceptors, can suppress a predominantly nociceptive trigeminal reflex in anesthetized cats. The threshold evoked by single electric pulses, in-field inhibition, and in-field facilitation display differential sensitivities to medetomidine effects.

Decreasing intradental nerve activity in the cat with potassium and divalent cations

Nerve activity was recorded from deep dentinal cavities in the canine teeth to assess the possible influence of potassium and divalent cations in decreasing this activity in hypersensitive teeth. The decreased activity after the topical application of 0.756 mol/l KCl to the cavity was primarily due to the cation. KCl elicited a biphasic response from intradental nerves, an initial transient excitatory response followed by a prolonged inhibitory period. During the inhibitory period 3 mol/l NaCl, an effective excitatory stimulus, failed to evoke intradental nerve activity. However, with time the response to 3 mol/l NaCl eventually recovered to its previous control level. Close, intra-arterial injection of KCl showed the same biphasic response and time-course of intradental nerve activity as with topical application. Therefore, whether KCl was applied topically or injected its effectiveness in altering the nerve activity was similar. Pretreatment of the dentinal cavity with CaCl2, MgCl2 or SrCl2 greatly reduced the response of intradental nerves to KCl. Therefore these divalent cations seem to have a depressant action on pulpal nerve fibres. The mechanism of action of KCl seems to be an alteration of K+ concentration immediately surrounding the intradental nerves which presumably depolarizes the nerve fibre membrane and elicits an initial firing of action potentials. Because of the persisting high levels of extracellular potassium a sustained depolarized state occurs that results in an inactivation of the action potential. Divalent cations appear to depress the excitability of the nerve cell membrane without altering membrane potential. Such ionic agents could be used in conjunction with KCl as a possible treatment for hypersensitive teeth.

Tooth pulp-evoked potentials in the trigeminal brainstem nuclear complex

The surface and depth distributions of mandibular canine, tooth pulp-evoked potentials (TPEPs) in the trigeminal brainstem nuclear complex were studied in anesthetized cats. Three pairs of positive-negative waves or components were elicited from each trigeminal brainstem nucleus (main sensory, MSN; oralis, NO; interpolaris, NI; caudalis or medullary dorsal horn, NC). The location and dipole orientation of the current generator source for each pair of components in each nucleus were determined by using the topographic amplitude distribution of TPEPs in both their normal-reference and inverted polarities and the isoelectric contour line. The current sources for all components were the following: MSN--dorsomedial subnucleus; NO--dorsolateral portion; NI--dorsomedial portion; NC--medial part of superficial and intermediate laminae. These loci are consistent with the central terminal zones of mandibular tooth pulp afferents reported in previous neuroanatomical studies. Measurements of mean peak latencies suggest that tooth pulp A beta afferents contribute to the putatively presynaptic (P1-N1) and monosynaptic (P2-N2) components found in all trigeminal brainstem nuclei and that A delta afferents contribute to the later and possibly polysynaptic components (P3-N3) in the same nuclei. The pertinence of these findings to the theory that both non-nociceptive and nociceptive intradental inputs project to rostral and caudal nuclei are discussed.

Histochemical demonstration of neural carbonic anhydrase activity within the mandibular molar and incisor tooth pulps of the rat

Carbonic anhydrase (CA) activity was enzyme histochemically assessed in: (1) neuronal cell bodies in the rat trigeminal ganglion that were retrogradely labeled with FITC-WGA from the mandibular molar and incisor tooth pulps; (2) cell bodies retrogradely labeled with HRP-WGA from the mandibular molar tooth pulp; and (3) nerve fibers within the decalcified mandibular molar and incisor tooth pulps. The cell size spectrum of the FITC-WGA-labeled neurons was similar for both molar and incisor tooth pulps with about 90% being medium or large (greater than or equal to 300 microns2 in cross-sectional area). About 30% of the FITC-WGA-labeled cell bodies exhibited CA activity for both tooth pulps. The HRP-WGA-labeled cells also showed CA activity. In the molar root pulp, finely myelinated nerve fibers exhibited CA activity. Histochemical reaction products were distributed in the axoplasm and the cytoplasmic pocket of Schwann cell inside the compact myelin. In the incisor pulp, CA-reactive unmyelinated axons coexisted with non-reactive axons within the same Schwann units. The Schwann cell cytoplasm directly surrounding reactive axons also exhibited histochemical stainability. In the light of known distribution of CA in the peripheral nervous system, the present data suggest that the rat molar and incisor tooth pulps receive substantial innervation of large myelinated primary afferent fibers. The finely myelinated and unmyelinated axons, that have been repeatedly shown to predominate the intrapulpal nerve fibers, are considered to represent intrapulpal, terminal and preterminal specialization of otherwise large myelinated nerve fibers.

The thresholds of the jaw-opening reflex and trigeminal brainstem neurons to tooth-pulp stimulation in acutely and chronically prepared cats

Electrical stimuli were applied to tooth-pulp in cats and the thresholds of the jaw-opening reflex and of neurons in the trigeminal sensory nuclei were determined. The effects of the method of preparation of the animal for stereotaxic recording were determined by making observations on animals set up in one of three ways: acutely in the usual manner; chronically, three to five days before recording; and acutely with precautions to minimize nociceptive input to the central nervous system. The threshold of the jaw-opening reflex increased progressively during the setting up of the normal, acute preparations and at the time brainstem recording began was significantly higher in these than in either the chronic or low-trauma acute preparations. Previous studies have shown that the increase in threshold is maintained for several hours and is not due to the effects of the anaesthetic. In normal acute preparations, few units (27/154) were found that had thresholds below 50 microA, 0.1 ms, whereas many units were encountered that responded to such a stimulus in chronic (147/152) and low-trauma acute (99/127) animals. In the chronic and in low-trauma acute preparations, there was no significant difference between the thresholds of the units in the main sensory trigeminal nucleus and spinal subnucleus oralis compared with those in subnucleus caudalis. Thus the preparation of an animal for stereotaxic recording can cause a severe and long-lasting depression in the excitability of neurons in the trigeminal sensory nuclei and an increase in the threshold of the jaw-opening reflex. This effect will have influenced the results of previous studies on the responses evoked in central neurons by stimulation of tooth-pulp, and may have similarly affected recordings from other regions.

A comparison of pulpal and tactile detection threshold levels in young adults

Pulpal and tactile sensory detection threshold (SDT) values of the maxillary and mandibular incisor and canine teeth were determined and recorded for young adult subjects at three test sessions. A commercially available monopolar pulp-testing device was used to determine pulpal SDT values, and von Frey hairs were used to determine the tactile SDT values. Statistical analysis of the data indicated that the pulpal and tactile test procedures were sufficiently reliable in identifying what is defined as the true SDT value for both parameters. The study confirmed the constancy of these SDT values over days and the independence of the values for jaw, side, and sex. SDT values were influenced, however, by tooth type, with canine teeth displaying higher tactile and pulpal values than the central and lateral incisor teeth. These data should provide a suitable baseline for a longitudinal study to identify the SDT fluctuations known to occur in tooth pulp and dental supporting tissues in a growing human population.

Afferent C fibre innervation of cat tooth pulp: confirmation by electrophysiological methods

1. The presence of afferent C fibres innervating the lower canine tooth was investigated in Nembutal-anaesthetized cats. 2. Twenty-five single fibres with conduction velocities (CVp) of less than 2.5 m/s, as calculated from the shortest response latency using monopolar electrical stimulation of the tooth, were recorded from the inferior alveolar nerve. In addition, the extradental conduction velocity (CVn) of the fibres was determined by using bipolar electrical stimulation of the trunk of the inferior alveolar nerve. 3. The mean CVp was 1.4 +/- 0.4 m/s (n = 25; range, 0.6-2.4 m/s); the mean CVn was higher, 1.7 +/- 0.9 m/s (n = 25; range, 0.6-4.0 m/s). For 20% of the fibres CVn exceeded 2.5 m/s; these were slowly conducting A delta fibres. For 80% of the fibres, however, the extradental conduction velocity was in the C fibre range. 4. The relationship between CVp (y) and CVn (x) was y = 0.66 + 0.40x, the correlation coefficient being r = 0.85. According to the present results this implies that for a reliable classification of pulpal C fibres (CVn less than or equal to 2.5 m/s) by monopolar tooth stimulation alone, CVp should be less than 1.7 m/s. 5. For twenty-three of the twenty-five fibres, one to three discrete shortenings of the response latency occurred when the intensity of the tooth stimulation was increased. When the nerve trunk itself was stimulated, a constant response latency was measured at all stimulus intensities applied. 6. For twelve fibres tested, the mean rate of electrical stimulation of the tooth, which the response followed with a constant latency, was 4.1 +/- 2.3 Hz (range, 1.5-10.0 Hz). With higher rates of stimulation the response latency increased until the fibres failed to follow each stimulus pulse. 7. Fifteen of the nineteen fibres tested responded to radiant heat stimulation of the tooth they were innervating. The mean temperature threshold was 41.4 +/- 2.7 degrees C (n = 11; range, 37.4 +/- 46.4 degrees C). 8. For eight heat-sensitive pulpal C fibres the receptive field was determined by mechanical stimulation of the exposed pulp tissue. Four C fibres developed a long-lasting on-going discharge after intense mechanical stimulation of the receptive field. 9. The discharge evoked by heat and mechanical stimulation of the tooth occluded the response evoked by simultaneously applied electrical current pulses to the nerve trunk, indicating that the same fibres were activated by both tooth and nerve stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparison of monopolar and bipolar electrical stimuli and thermal stimuli in determining the vitality of human teeth

The sensory threshold was determined for 50 teeth in 31 patients using constant-current stimuli of 0.1, 1.0 and 10 ms duration at 10 Hz through both monopolar and bipolar electrodes. The teeth were also tested with a cold stimulus (ethyl chloride on cotton wool), then extracted, processed and examined by light microscopy. Histologically, 38 teeth were vital and 7 non-vital. The best prediction of vitality was from ethyl chloride (80% correct) or bipolar stimuli of 10 ms duration and up to 200 microA (73% correct). The remaining 5 teeth had vital radicular pulps and necrotic tissue coronally, but a comparison between the results of monopolar and bipolar stimulation did not permit the detection of this group. There was no correlation between the electrical threshold and presence of caries, restorations, pulp stones or diffuse pulpal mineralization.

Combined retrograde tracing and enzyme/immunohistochemistry of trigeminal ganglion cell bodies innervating tooth pulps in the rat

Rat trigeminal neurons innervating tooth pulps were retrogradely labelled with fluorogold and analysed enzyme- and immunohistochemically for their content of substance P, calcitonin gene-related peptide, fluoride-resistant acid phosphatase, GM 1 ganglioside, carbonic anhydrase and neurofilament protein. The data showed that both small, medium-sized and large trigeminal neurons were labelled after fluorogold deposition in maxillary molar pulps, with a majority of the cells being medium-sized and large. Less than 2% of the pulpal neurons showed substance P-like immunoreactivity. Fifty-six per cent of the pulpal nerve cells were calcitonin gene-related peptide-positive. These cells were small, medium-sized and large. Only 1% of the fluorogold-labelled cells contained fluoride-resistant acid phosphatase enzyme activity. This paralleled the finding that the pulpal neurons were unstained by Griffonia simplicifolia isolectin I-B4, a plant lectin which preferentially binds to fluoride-resistant acid phosphatase-positive cells. Choleragenoid-like immunoreactivity, which identifies cells with the GM 1 ganglioside receptor, was found in 70% of the fluorogold-labelled pulpal neurons. Approximately 80% of the fluorogold-labelled cells showed RT 97-immunoreactivity. RT 97 labels neurofilament protein and is present in large light primary sensory neurons. No pulpal neurons appeared to contain carbonic anhydrase, as judged from both enzyme- and immunocytochemical observations. The findings suggest that, in the rat, trigeminal tooth pulp neurons, which according to the classical view are nociceptive, form a heterogeneous group of neurons with a minority of small cells which may contain calcitonin gene-related peptide but rarely either substance P or fluoride-resistant acid phosphatase. However, the vast majority of pulpal nerve cells appear to have sizes and cytochemical characteristics which are not generally associated with nociceptive primary sensory neurons.

The role of periodontal receptors in the jaw-opening reflex in the cat

1. In anaesthetized cats, graded electrical stimulation of the inferior alveolar nerve at just above threshold for the largest afferent fibres caused inhibition of jaw-closer motoneurones. Stimulus strength had to be increased to 1.5 times threshold with double shocks to cause reflex contraction of the digastric muscle. 2. Inhibition of jaw-closer muscles and excitation of digastric muscle resulted from transients of force applied to the upper canine tooth. However, the threshold for the digastric response was approximately 11 times higher than that of the periodontal afferent units recorded in the mesencephalic nucleus of the fifth nerve (MesV). Vibration of the upper canine at 50 Hz, with amplitude adequate to excite periodontal afferents, caused no digastric contraction. 3. Stimulation in the caudal part of the MesV so as to excite periodontal afferents caused no digastric reflex, provided that the stimulus did not spread to other parts of the fifth nerve nuclei. 4. It is concluded that under these conditions the low-threshold periodontal mechanoreceptors cause inhibition of jaw-closer muscles, but no significant excitation of jaw-opener muscles. 5. These findings are discussed from the point of view of the control which periodontal mechanoreceptors may exert over the biting force during mastication.

Intradental nerve activity and jaw-opening reflex in response to mechanical deformation of cat teeth

Mechanical stress was applied to canine teeth in anaesthetized cats to excite intradental A-fibres and to produce digastric muscle EMG responses. Activity in the intradental sensory units was recorded by two electrodes, one inserted in a dentinal cavity, the other in contact with the gingival sulcus. A pneumatically driven piston was used to cause a mechanical stress (10-150 N) on the stabilized tooth crown for 30 s, with instantaneous onset and release. Application of a load of 30 N produced a momentary burst of impulses in 2 of 12 teeth; 8 out of 10 teeth responded when 150 N was used. Digastric EMG responses were obtained at and above 60 N. Removal of the coronal pulp or cooling of the tooth crown with ethyl chloride abolished this reflex, whereas percussion of the tooth still produced a digastric response. Our results suggest that load-induced deformation of teeth activates intradental sensory mechanisms and a reflex withdrawal reaction unrelated to periodontal stimulation.

Cell size analysis of primary neurons innervating the cornea and tooth pulp of the rat

Primary neuronal cell bodies, whose peripheral axons comprised the cutaneous branch of the mylohyoid nerve or innervated the mandibular molar tooth pulp or the cornea, were labeled with HRP and their cross-sectional area was analyzed. Most of their cell bodies were smaller than 1000 microns2 in cross-sectional area and the histogram of each showed a unimodal pattern. The modes of percentage distribution were 100-200 microns2 (34.4%), 500-600 microns2 (17.4%) and 300-400 microns2 (35.1%) for the mylohyoid nerve, the tooth pulp and the cornea, respectively. A comparison of the 3 histograms indicated that there were at least 3 subpopulations of trigeminal primary neurons, i.e., small, medium, and large cells. Electron microscopically, the large primary neurons innervating the tooth pulp had endoplasmic reticulum throughout the cytoplasm. The small primary neurons innervating the cornea showed a clear zonation of organelles and the endoplasmic reticulum was located in the periphery of the cytoplasm. The light microscopically identified small, medium and large cell groups may correspond to C-, A delta- and A beta-fibers. The tooth pulp and the cornea appear to receive mainly A beta-fibers and A delta-fibers, respectively. The cutaneous branch of the mylohyoid nerve appears to contain numerous C-fibers and progressively smaller proportions of A delta- and A beta-fibers.

Response characteristics of tooth pulp-driven postsynaptic neurons in the spinal trigeminal subnucleus interpolaris of the cat: comparison with primary afferent fiber, subnucleus caudalis, reflex, and sensory responses

Tooth pulp-evoked single neuron responses were recorded in the spinal trigeminal subnucleus interpolaris of the cat. The thresholds to monopolar electric pulses of varying duration (0.2-20 ms) were determined using a constant current stimulator. The thresholds were comparable with those of primary afferent A-fibers, although the most sensitive primary afferent fibers have lower thresholds. The thresholds and latencies showed that none of the interpolaris neurons received their input solely from intradental C-fibers. The most sensitive subnucleus interpolaris neurons had lower thresholds than the respective subnucleus caudalis neurons studied in our previous work. The thresholds and strength-duration curves of the most sensitive interpolaris neurons and of the tooth pulp-elicited jaw-opening reflex are nearly similar, although the jaw reflex can be elicited at an intensity which is slightly lower than that needed to activate the most sensitive interpolaris neurons of the present sample. The most sensitive interpolaris neurons were activated at current intensities that were below the intensity needed to produce liminal dental pain in man, and the strength-duration curves of these neurons were flatter than the curve depicting liminal dental pain sensation in man. The relationship between stimulus intensity and response magnitude could be well described by power functions, the median exponent of which was 1.251. A conditioning stimulation of the tooth pulp at low intensity produced a short (less than 25 ms) enhancement of the response to the following test stimulus, whereas a high intensity conditioning stimulus produced a longer (greater than 40 ms) suppression of the response to the following stimulus. The threshold of 33% of the neurons was elevated during a noxious tail pinch, and this elevation was not reversed by naloxone, an opioid antagonist. The results indicate that in the trigeminal subnucleus interpolaris there are tooth pulp-driven neurons with an input from intradental A-fibers and that a considerable temporal summation of impulses from primary afferent fibers is needed to activate most of them. Human dental pain thresholds cannot be explained by the liminal response properties of the most sensitive interpolaris neurons, but they may be important in the mediation of near-threshold reflex events. It is possible, however, that the high-threshold interpolaris neurons may have a role in the mediation of sensory responses.

The effect of temporal parameters on subjective sensations evoked by electrical tooth stimulation

The effect of stimulus duration and frequency on subjective sensations evoked by electrical tooth stimulation was studied in 12 subjects. The sensory responses were classified using 5 equi-sensation categories (perception threshold, prepain, pain threshold, moderate pain, intense pain). Both continuously increasing and randomised stimuli were applied. A comparison was made with the activation thresholds of intradental A- and C-fibres in the cat. The mean threshold of intradental A-fibres was lower than the perception threshold at all pulse durations. Perception threshold decreased with increasing stimulus frequency. Current intensities which evoked prepain at a stimulus frequency of 1 Hz were rated as pain at 20 Hz. At supraliminal pain levels the effects of summation were more marked. High-frequency stimulation produced intense pain sensations at intensities well below the activation thresholds of pulpal C-fibres in the cat. We conclude that both perception and pain thresholds and supraliminal pain are modified by temporal summation, and that activation of different pulpal fibre populations is not responsible for production of prepain and pain sensations.

Medialis dorsalis thalamic unitary response to tooth pulp stimulation and its conditioning by brainstem and limbic activation

In nembutalized cats tooth pulp stimulation (TPS) was effective in exciting 18% of medialis dorsalis (MD) thalamic units. Facilitation of spontaneous MD unitary discharge followed high frequency stimulation of the lateral amygdala (25%), dorsal hippocampus (22%), mesencephalic reticular formation (20%) and septal nuclei (17%). Conditioning high-frequency stimulation of limbic and reticular structures, strongly facilitated the MD unitary responses to TPS. None of the thalamic neurons involved in nociception seems to project to the cerebral cortex. The conditioning effect on MD response of limbic and reticular stimulation suggests that these central structures may be involved in the modulation of the nociceptive input.

The neurobiology of facial and dental pain: present knowledge, future directions

This review outlines recent research which has identified critical neural elements and mechanisms concerned with the transmission of sensory information related to oral-facial pain, and which has also revealed some of the pathways and processes by which pain transmission can be modulated. The review highlights recent advances in neurobiological research that have contributed to our understanding of pain, how acute and chronic pain conditions can develop, and how pain can be controlled therapeutically. Each section of the review also identifies gaps in knowledge that still exist as well as research approaches that might be taken to clarify even further the mechanisms underlying acute and chronic oral-facial pain. The properties of the sense organs responding to a noxious oral-facial stimulus are first considered. This section is followed by a review of the sensory pathways and mechanisms by which the sensory information is relayed in nociceptive neurones in the brainstem and then transmitted to local reflex centers and to higher brain centers involved in the various aspects of the pain experience--namely, the sensory-discriminative, affective (emotional), cognitive, and motivational dimensions of pain. Reflex and behavioral responses to noxious oral-facial stimuli are also considered. The next section provides an extensive review of how these responses and the activity of the nociceptive neurones are modulated by higher brain center influences and by stimulation of, or alterations (e.g., by trauma) to, other sensory inputs to the brain. The neurochemical processes, involved in these modulatory mechanisms are also considered, with special emphasis on the role of neuropeptides and other neurochemicals recently shown to be involved in pain transmission and its control. The final section deals with recent findings of peripheral and central neural mechanisms underlying pain from the dental pulp.

An electrophysiological and morphological study of the innervation and reinnervation of cat dentine

1. Experiments were carried out to determine which, if any, of the cellular processes in cat dentine are nerves. This was done by examining in the electron microscope the contents of the dentinal tubules in control teeth and in teeth that had been denervated 56 h previously. The extent of any reinnervation, and associated return of neural responses to dentine stimulation were investigated 12 weeks after denervation. 2. In five cats, the inferior alveolar nerve was sectioned on one side and the cut ends reapposed. 3. Each of the tubules in the predentine of control teeth contained one process with a cross-sectional area of 0.21-1.14 micron2 and up to eight other, secondary processes which were generally smaller. The proportion which contained secondary processes was highest (83%) near the tip of the pulp and decreased further down the side of the crown of the tooth. 4. 56 h after denervation, almost all the secondary processes had disappeared, leaving just one of the larger processes in each tubule. It is concluded that these larger processes are odontoblast processes and that all the secondary processes are nerve terminals. 5. 12 weeks after denervation, small processes were again present in some tubules. Recordings in three cats showed that inferior alveolar nerve fibres had regenerated into the canine pulp and that some of these had re-established receptor properties similar to those in normal teeth.

The nociceptive jaw-opening reflex: evidence for alpha 2 adrenoceptor involvement

The ability of alpha adrenoceptor agonists to modulate the tooth pulp stimulation evoked (TPS) jaw-opening reflex (JOR) was investigated in rats and rabbits. Low doses of clonidine (6.25-50 micrograms/kg, IV) significantly increased dEMG thresholds. These effects were antagonized by alpha 2 adrenoceptor antagonists (e.g., yohimbine), but not by alpha 1 adrenoceptor antagonists (e.g., prazosin) or mu receptor antagonists (e.g., naloxone). Polar alpha 2 adrenoceptor agonists (e.g., ST-91 and 4-hydroxyclonidine) that cross the blood brain barrier (BBB) poorly and lipophilic alpha 1 adrenoceptor agonists (e.g., ST-587) that cross the BBB easily were without affect on the TPS-JOR. Structures of the peripheral efferent neurocircuitry of the JOR (e.g., the digastric muscle and the neuromuscular junction of the digastric muscle and its motor nerve, the mylohyoid) were shown not to be active sites of clonidine's effect on the TPS-JOR. Treatment with phentolamine (an alpha adrenoceptor antagonist that poorly crosses the BBB) completely poorly crosses the BBB) completely antagonized clonidine's initial transient cardiovascular (pressor) effect without altering its TPS-JOR effects. Pretreatment with reserpine (a catecholamine depleting agent) failed to alter clonidine's affects on the TPS-JOR. Our studies suggest that alpha 2 adrenoceptors potently modulate the TPS-JOR and such modulation may be important in understanding trigeminal neuronal circuitries that partake in pain processing.

Modulation during sleep of the cat trigeminal neurons responding to tooth pulp stimulation

Sleep-induced changes in the trigeminal neuron responses to electrical stimulation of the cat tooth pulp were studied. Two parameters were adopted: One was the evoked spike number at two times the threshold intensity (2 X T response magnitude), which would reveal the level shifting of the neuronal response by the sleep-regulatory system. Another was the rate of change in the response intensity when the stimulus was raised to a level of 0.7 time the arousal threshold during light slow wave sleep (sensitivity gradient), which would reflect the influences of the pain-modulatory system driven by strong noxious inputs. It was found that during sleep the two indexes tended to show a correlated change; the neurons which came to have a greater 2 X T response magnitude tended to have a smaller sensitivity gradient than during wakefulness, and vice versa. It was suggested that two contrasting populations of tooth pulp neurons might be differentiated, and that the sleep-regulatory system and the pain-modulatory system would have differential but correlated controls over these two kinds of neurons.

Tooth pulp-evoked activity in the spinal trigeminal nucleus caudalis of cat: comparison to primary afferent fiber, reflex, and sensory responses

Tooth pulp-evoked single-neuron responses were recorded in the spinal trigeminal nucleus caudalis of the cat. The thresholds to monopolar electric pulses of various durations (0.2 to 20 ms) were determined using a constant current stimulator. With stimulus pulse durations of 10 to 20 ms, the thresholds were comparable with those of primary afferent A-fibers, although the most sensitive primary afferent fibers had lower thresholds. Primary afferent C-fibers had higher thresholds than the postsynaptic neurons studied. The threshold for the tooth pulp-elicited jaw-opening response was obtained at a lower stimulus intensity than the liminal response in most postsynaptic neurons of this study. The threshold rise of the postsynaptic trigeminal neurons with decreasing stimulus pulse duration (from 5 to 0.2 ms) was much steeper than that of primary afferent A-fibers or jaw-opening response. The strength-duration curves for tooth pulp-elicited pain sensations in man resemble those of spinal trigeminal neurons. Sixty-two percent of the units had a threshold elevation during a noxious pinch of the tail. The results indicate that the activation of postsynaptic trigeminal neurons requires a considerable temporal summation of primary afferent impulses. The jaw reflex thresholds cannot be explained by the properties of the neurons in the subnucleus caudalis of the trigeminal tract. The results support the concept that dental pain is based on the activation of spinal trigeminal nucleus caudalis neurons receiving their input from intradental A-fibers.

Cortical nociceptive responses and behavioral correlates in the monkey

Experiments were performed to characterize cerebral cortical activity and pain behavior elicited by electrical stimulation of the tooth pulp in unanesthetized monkeys. Four monkeys were trained on two different operant paradigms: two on a simple escape task and two on an appetitive tolerance-escape task. All monkeys were implanted with bipolar stimulating electrodes in the right maxillary canine tooth and subdural recording electrodes over the left primary (SI) and/or secondary (SII) somatosensory cortices. Subdural tooth pulp-evoked potentials (TPEPs) recorded over the SII consisted of components P1 (27.5 ms), N1 (40.3 ms), P2 (84.0 ms), N2 (163.5 ms), P3 (295.3 ms), and N3 (468.0 ms). The long latency component (P3-N3) was found exclusively over the SII and was elicited by high intensity stimulation. The appearance of component P3-N3 required the recruitment of A delta nerve fibers into the maxillary nerve compound action potential and was correlated with high frequencies of escape. Administration of morphine sulfate (4 mg/kg, i.m.) caused a contemporaneous reduction in escape frequency and in the amplitude of P3-N3 recorded over the SII. The relationships between TPEP amplitude, escape behavior and A delta nerve fiber activity strongly suggest that the SII is involved with nociception and pain behavior.

Neuronal responses in rostral trigeminal brain-stem nuclei of macaque monkeys after chronic trigeminal tractotomy

Unilateral trigeminal tractotomy was carried out at the level of the obex, just rostral to the subnucleus caudalis, in five young adult Macaca fascicularis monkeys. The animals had been trained previously to perform a behavioral shock avoidance task in response to electrical stimulation of dental pulp and facial skin. Tractotomy produced an elevation in the stimulus strength which elicited escape behavior when facial skin was stimulated but not when the tooth pulp was stimulated. Unit activity, evoked by electrical stimulation of the tooth pulp and facial skin as well as innocuous and noxious mechanical stimulation of orofacial regions, was recorded from neurons in the trigeminal main sensory nucleus and the subnuclei oralis and interpolaris of the spinal nucleus 8 to 12 weeks after tractotomy. Primary afferent input to these nuclei is unaffected by the tractotomy which is located more caudally. The tractotomy interrupts primary afferent input into the trigeminal nucleus caudalis and also intranuclear connections between caudalis and the more rostral nuclei. Forty-one units contralateral and 47 ipsilateral to the tractotomy were studied. Thirty-six of the units responded only to low-threshold mechanical or electrical stimulation of orofacial zones, 46 were responsive to innocuous mechanical and electrical stimulation of orofacial zones and also to electrical stimulation of the dental pulp. Six units responded only to dental pulp stimulation. No statistically significant differences between the populations of neurons ipsilateral and contralateral to the tractotomies were found relating to the size or location of the peripheral receptive fields, latencies, thresholds, mean firing densities, or responsiveness to the various forms of stimulation. The behavioral results suggest that trigeminal relay neurons rostral to the obex are able to signal dental pain sensation, and the physiological studies confirm that the firing of such neurons is unaffected by tractotomy. The physiological studies demonstrate that the firing patterns of relay neurons activated by natural and electrical cutaneous facial stimuli and which are located in trigeminal brain-stem nuclei rostral to the obex are also not affected by tractotomy. The cutaneous facial analgesia observed after tractotomy thus appears to be due to deafferentation of relay neurons in trigeminal nucleus caudalis rather than to alterations in coding patterns in rostrally located trigeminal neurons due to interruption of the intratrigeminal pathway between the caudal and rostral nuclear groups.

Innervation of the dental pulp during tooth succession in the cat

The possibility that axons branch to supply the pulps of both the upper deciduous canine tooth and its permanent successor has been investigated by stimulating the pulp of one tooth and recording from the pulp of the other. In cats less than about 14 weeks of age, the permanent canine was too poorly developed to allow electrodes to be applied to it satisfactorily. In 5 of 14 preparations in cats aged 14-23 weeks, compound action potentials were recorded in one canine during stimulation of the other. These responses were not abolished by sectioning the infraorbital nerve or its canine branch in the floor of the orbit or by paralysing the animal, but they were abolished by sectioning the pulp of the permanent canine, indicating that they were due to branched axons. In preparations in which there was no tooth-to-tooth response, there was usually evidence that the pulp of one or other of the teeth did not have a functional innervation. The results indicate that at least some of the nerves which supply the pulp of a deciduous tooth are retained to supply its permanent successor.

Tooth pulp-evoked jaw-opening reflex in the cat: evidence for central facilitation induced by noxious discharge in the intradental nerve fibers

The tooth pulp-evoked jaw-opening reflex was studied in the barbiturate-anesthetized cat. At liminal intensity of the stimulus, a stable short-latency response was obtained in the digastricus and in the tongue. At a higher stimulus intensity, there occasionally appeared to be a prolonged discharge of variable duration in the digastricus, and a second period of activity in the tongue after a silent period. The threshold intensity for these late discharges was supraliminal for the intradental A-fibers and subliminal for intradental C-fibers. Noxious conditioning stimulation of a tooth led to a temporary decrease of the threshold for the jaw-opening reflex elicited from a contralateral or adjacent tooth; only conditioning stimulation at an intensity producing a marked arousal reaction was effective in this respect. Infiltration of the tooth apex with epinephrine produced a local elevation of the threshold for the tooth pulp-evoked jaw-opening reflex. Distant noxious conditioning stimulation (tail pinch) did not influence the jaw-opening threshold. The results indicated that based on some central mechanisms, conditioning noxious stimulation of a tooth can produce a facilitation of the jaw-opening reflex.

Is the jaw-opening reflex a valid model of pain?

Tooth pulp shock does not produce only pain; low intensity stimulation results in a non-painful sensation that is termed pre-pain. In animals low intensity tooth pulp shock does not evoke escape behavior; the similarity of the animal escape/detection threshold ratio with the human pain/pre-pain threshold ratio is evidence that pre-pain and pain may be present in animals as in humans. Both pre-pain and pain may arise from the activation of a common afferent modality. The TP-JOR does not correlate with the degree of pain experienced under all conditions. The TP-JOR threshold is at or near the sensory detection threshold, at stimulation intensities which evoke pre-pain. Under normal conditions both the magnitude of the TP-JOR response and the degree of pain experienced increase with increasing stimulation intensity. The TP-JOR and the tooth pulp-evoked pain are affected in parallel by sensory habituation and both appear to relay in the rostral trigeminal complex. There are no cases where the TP-JOR is suppressed and pain is still experienced from tooth pulp shock; the suppression of the TP-JOR may therefore be an accurate index of analgesia. However, in humans treatments that produce analgesia have not been shown to produce suppression of the TP-JOR. Thus, the TP-JOR that persists following analgesic treatments is not a reliable index of either analgesia or pain.

Tooth pulp-evoked potentials in the monkey: cortical surface and intracortical distribution

The distribution of tooth pulp-evoked potentials (TPEPs) was characterized in the primary motor (MI), primary somatosensory (SI) and secondary somatosensory (SII) cortices of the monkey. Bipolar electrical tooth pulp stimulation elicited TPEP components P23 and N44 over SI, P26 and N72 over MI, and P72, N161, P280, N420, P561 and N662 over SII. Muscular artifacts and extradental input did not affect the TPEP as demonstrated by experiments using a neuromuscular blocking agent and removal of the pulp, respectively. The short latency TPEPs recorded over SI and MI were evoked by low stimulus intensities and activation of A beta nerve fibers, whereas the long latency TPEPs recorded over SII required higher stimulus intensities and the additional recruitment of A delta nerve fibers. Intracortical recordings revealed polarity reversals of components P23 and N44 in area 3b, P26 and N72 in area 4, and P72, N161, P280, N420, P561 and N662 in the upper bank of the lateral sulcus (SII). Evidence presented in this study suggests that TPEPs recorded from SI and MI relate to non-nociceptive mechanisms while TPEPs recorded from SII relate to nociceptive mechanisms.

The digastric reflex evoked by tooth-pulp stimulation in the cat and its modulation by stimuli applied to the limbs

The digastric reflex evoked by electrical stimulation of tooth pulp in anaesthetized cats was studied together with the effects on this reflex of stimulating other parts of the body. The threshold for the digastric reflex generally lay in the range of stimulus intensities which would excite a large proportion of the pulpal afferent fibres which suggested that a large amount of central summation was required to evoke the reflex. During the course of 25/27 experiments, the threshold for the reflex increased. It was also found that repeated application of suprathreshold stimuli produced first an increase and then a decrease in the reflex response. The application of noxious but not of non-noxious mechanical conditioning stimuli to the limbs produced strong, long-lasting depressions of the digastric reflex. Electrical conditioning stimuli applied to the limbs also depressed the reflex; this depression had a latency of onset of 20-50 ms and lasted for up to 500 ms. When conditioning stimuli were applied to the saphenous nerve, the depression of the reflex occurred only when the stimuli were of an intensity sufficient to excite fibres conducting at less than 40 m X s-1; it may be assumed that some of these fibres would have been high threshold mechanoreceptors or nociceptors. These results show that noxious stimulation of anatomically remote structures can depress the activity of a population of trigeminal brainstem neurones. The opiate antagonist, naloxone, had no detectable effect on either the digastric reflex or the depression of the reflex produced by stimulating other parts of the body. The serotonin antagonists, methysergide and cinanserin, strongly depressed the digastric reflex but it was not clear whether these drugs also affected the depression of the reflex by the conditioning stimuli.

Physiological properties of intradental mechanoreceptors

A major role of tooth receptors in signaling overt or impending tissue damage (nociception) has been previously established by substantial evidence from mechanical, thermal and chemical stimulation of exposed dentin. We report evidence showing that some intradental receptors in canine teeth of the cat detect mechanical transients applied to intact enamel. This new finding suggests that dental innervation may play an important non-nociceptive role in oral function such as detecting tooth contact during mastication and swallowing.

The effects of decerebration and destruction of nucleus raphe magnus, periaqueductal grey matter and brainstem lateral reticular formation on the depression due to surgical trauma of the jaw-opening reflex evoked by tooth-pulp stimulation in the cat

The effects on the jaw-opening reflex evoked by tooth-pulp stimulation of surgical trauma, decerebration and the destruction of a number of nuclei associated with descending inhibition of trigeminal or spinal neurones have been investigated in the cat. Surgical preparation caused a progressive elevation of the digastric reflex threshold. After decerebration, reflex thresholds remained elevated for 8-11 h before returning to close to pre-surgical control values. Destruction of the nucleus raphe magnus and of the periaqueductal grey matter did not affect the depressed reflex in decerebrate or anaesthetized cats. Variable effects were produced by bilateral ablation of the juxta-raphe reticular formation and destruction of the rostral ipsilateral lateral reticular formation of the brainstem.

Peripheral and central aspects of trigeminal nociceptive systems

Three aspects of trigeminal pain are considered: the peripheral mechanisms of pain from teeth and from the cornea, and the role of the trigeminal brainstem nuclei in pain. Pain is probably the only sensation that can be evoked by stimulation of dentin or dental pulp in man. Five nerve-endings enter dentinal tubules from the pulp but do not extend into the outer dentine, which is nevertheless sensitive. In teeth of limited growth in experimental animals, the dental pulp is supplied by A beta, A delta and C fibres and these are associated with two categories of receptor: one responds to cooling and to other stimuli that cause displacement of the contents of the dentinal tubules such as probing and drying the dentine, and the other group responds most vigorously to heating. Some cold sensitive units have A beta fibres and the evidence suggests that stimulation of these is capable of evoking both muscle reflexes and pain and, near threshold, 'pre-pain' sensations. Thermal stimulation of the cornea produces sensations of pain and, with less intense stimuli, irritation, Mechanical stimulation also produces pain but it is not clear whether, below the pain threshold, such stimuli produce touch sensation or some other sensation related to pain. Histologically, the nerve-endings in the corneal epithelium consist of fine, bare processes closely associated with the surface of the epithelial cells. Recordings in experimental animals have shown that many of the receptors respond to several different forms of stimulus and their properties correlate well with those predicted from psychophysical experiments in man. The results of trigeminal tractotomy in man and recordings from the trigeminal brainstem nuclei in anaesthetized animals, have generally indicated that nucleus caudalis is the main relay in the pain pathway from the face and associated structures. Recent observations have, however, shown that tractotomy does not produce complete analgesia of this region and responses to thermal stimulation of teeth and noxious stimulation of other oro-facial tissues have been recorded from the more rostral parts of the brainstem nuclear complex. The surgical procedures employed to set up an animal for stereotaxic recording may induce long-lasting depression in the excitability of neurons in these nuclei, which masks some of their properties. The mechanism of this depression has not been established.

The effects of anaesthetics and remote noxious stimuli on the jaw-opening reflex evoked by tooth-pulp stimulation in the cat

Previous studies indicate that the threshold of the jaw opening reflex (JOR) evoked by tooth-pulp stimulation is much lower in cats subjected to minimal surgical trauma and a short period of anaesthesia than in animals prepared for stereotaxic recording from the brainstem. Experiments have been carried out to determine whether the higher JOR thresholds observed in the latter group of cats could be attributed to the duration of the anaesthesia or the greater surgical trauma to which they were subjected. The effects on the JOR evoked by tooth-pulp stimulation of brief episodes of noxious and high intensity electrical stimulation of other tissues have been studied in anaesthetized cats. In lightly anaesthetized, control animals, the reflex threshold was usually below 100 microA, 0.1 ms and maintained anaesthesia did not affect this. Alphaxalone/alphadolone, methohexitone and alpha-chloralose produced similar results. Noxious or high intensity electrical stimuli applied to a paw, a pinna or the scalp caused either no change or a decrease in the JOR threshold of cats lightly anaesthetized with alphaxalone/alphadolone. With deeper anaesthesia, these same conditioning stimuli caused a maintained increase in JOR threshold which could be reversed by decreasing the anaesthetic dose. The results suggest that the high threshold of the JOR observed in earlier experiments was not due to anaesthesia but may have been caused by trauma.